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shigella

shigella

introduction

  • Shigellosis is an infectious gastroenteritis usually causing dysentery-type pattern
  • transmission of Shigella is by the faecal-oral route
  • ingestion of a very low number of bacteria can cause infection
  • incubation period is usually one to three days
  • cases remain infectious while bacteria are continuing to be shed in the faeces, which can last for up to four weeks after symptoms resolve, although rarely, the carrier state may persist for months or longer
  • appropriate antibiotic treatment usually reduces the duration of carriage to a few days and is an appropriate public health measure

high risk patients for Shigella in Australia

  • men who have sex with men
  • travelers from overseas

clinical features

  • acute onset of diarrhoea, fever, nausea, vomiting and abdominal cramps
  • typically, stools contain blood, mucus and pus
  • some people will present with watery diarrhoea without these features

Dx

  • stool culture - ensure stool samples are sent for culture and antibiotic sensitivity testing in order to guide appropriate antibiotic treatment as antibiotic resistance is increasing

Rx

  • supportive care
  • gastro precautions
  • prevent transmission to others
    • it is a notifiable disease in Victoria!
      • medical practitioners must notify the department of all cases of suspected and confirmed shigellosis, and should advise confirmed cases who are food handlers, child care workers and health care workers not to work pending further advice from the department.
    • because of the small infectious dose, food handlers, child care workers and health care workers should be excluded from work until two faecal specimens (collected 24 hours apart but not sooner than 48 hours following the discontinuance of antibiotics) are found to be free of Shigella
    • thoroughly wash hands after going to the toilet and before eating or preparing food
    • not prepare food for others until 48 hours after symptoms completely resolve
    • avoid having sex for seven days after symptoms completely resolve
    • antibiotics to reduce stool shedding:
      • antibiotic resistance is increasing
      • in Victoria, 2016, resistance levels were: 64% resistant to ampicillin, 87% to trimethoprim, 49% to azithromycin and 20% to ciprofloxacin 1)
      • check sensitivities BEFORE starting Rx
shigella.txt · Last modified: 2017/06/02 15:25 (external edit)