Shigella

Background

  • Anaerobic, gram-negative rod
  • Requires a very small inoculum to cause disease

Clinical Features

  • Symptoms usually start within 1-3 days of exposure[1]
    • Variation depends on serotype
    • Can be anywhere from 12 hours to 7 days for incubation period
  • Fever
  • Diarrhea (can be bloody)
  • Generalized abdominal pain
  • In severe cases in children, can lead to seizures[2]

Differential Diagnosis

Acute diarrhea

Infectious

Noninfectious

Watery Diarrhea

  • Enterotoxigenic E. coli (most common cause of watery diarrhea)[3]
  • Norovirus (often has prominent vomiting)
  • Campylobacter
  • Non-typhoidal Salmonella
  • Enteroaggregative E. coli (EAEC)
  • Enterotoxigenic Bacteroides fragilis

Traveler's Diarrhea

Management

Adult

  • Antibiotics
    • Not essential, since infection clears spontaneously in most individuals
    • However, most favor antibiotic therapy for patients with positive stool culture[4]
    • First line is fluroquinolone (e.g. Cipro 500mg PO BID x 7 days)

Antibiotic Sensitivities[5]

Category Antibiotic Sensitivity
PenicillinsPenicillin GR
Penicillin VR
Anti-Staphylocccal PenicillinsMethicillinR
Nafcillin/OxacillinR
Cloxacillin/Diclox.R
Amino-PenicillinsAMP/AmoxI
Amox-ClavS
AMP-SulbS
Anti-Pseudomonal PenicillinsTicarcillinS
Ticar-ClavS
Pip-TazoS
PiperacillinS
CarbapenemsDoripenemS
ErtapenemS
ImipenemS
MeropenemS
AztreonamS
FluroquinolonesCiprofloxacinS
OfloxacinS
PefloxacinS
LevofloxacinS
MoxifloxacinS
GemifloxacinX1
GatifloxacinS
1st G CephaloCefazolinX1
2nd G. CephaloCefotetanX1
CefoxitinX1
CefuroximeX1
3rd/4th G. CephaloCefotaximeS
CefizoximeS
CefTRIAXoneS
CeftarolineS
CefTAZidimeS
CefepimeS
Oral 1st G. CephaloCefadroxilR
CephalexinR
Oral 2nd G. CephaloCefaclor/LoracarbefX1
CefproxilX1
Cefuroxime axetilX1
Oral 3rd G. CephaloCefiximeS
CeftibutenS
Cefpodox/Cefdinir/CefditorenS
AminoglycosidesGentamicinS
TobramycinS
AmikacinS
ChloramphenicolS
ClindamycinR
MacrolidesErythromycinR
AzithromycinI
ClarithromycinR
KetolideTelithromycinR
TetracyclinesDoxycyclineI
MinocyclineI
GlycylcyclineTigecyclineS
DaptomycinX1
Glyco/LipoclycopeptidesVancomycinR
TeicoplaninR
TelavancinR
Fusidic AcidR
TrimethoprimI
TMP-SMXI
Urinary AgentsNitrofurantoinS
FosfomycinX1
OtherRifampinR
MetronidazoleR
Quinupristin dalfoppristinR
LinezolidR
ColistimethateX1

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

Table Overview

See Also

References

  1. Missouri Department of Health and Senior Services. Shigellosis. Last revised June 2017. https://health.mo.gov/living/healthcondiseases/communicable/communicabledisease/cdmanual/pdf/Shigella.pdf
  2. Lahat E, Katz Y, Bistritzer T, Eshel G, Aladjem M. Recurrent seizures in children with Shigella-associated convulsions.External Ann Neurol. 1990;28(3):393-5.
  3. Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
  4. Dupont HL. Shigella species (bacillary dysentery). In: Principles and Practice of Infectious Diseases, 6th Ed, Mandell GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, Philadelphia 2005. p.2655.
  5. Sanford Guide to Antimicrobial Therapy 2014
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