Shigellosis

Shigellosis is a form of foodborne intestinal infection that arises during the summer months among kids aging 2-4 years old. Get detailed information about the disease, including its causes, symptoms, complications, diagnosis, and treatment options.

What is Shigellosis?

As aforesaid, it is an acute infection of the intestinal tract which can be transmitted via direct contact with the bacteria, present in the stool. The bacteria generate toxins that affect the lining of the large intestine, giving rise to a number of problems such as ulcers and diarrhea. This gastrointestinal disorder can be passed through contaminated water or food and can even lead to hospitalization in severe cases.

This bacterial disorder is also known by various other names, such as:

• Bacillary dysentery
• Marlow Syndrome

Shigellosis ICD9 Code

The ICD9 code for this medical condition is 004.

Shigellosis Incidence

Shigellosis outbreak is related to contaminated water and food along with poor hygiene. It gives rise to 90 million medicinal conditions of dysentery, generally among children. Although all humans are susceptible to the syndrome, infants aging between 2-3 years old are generally affected by the bacteria since they hardly maintain hygiene inside the toilet and lack basic sanitation rules. In the US, almost 25,000 to 40,000 cases of Shigella infection are reported annually. People affected with AIDS (Acquired Immune Deficiency Syndrome) are more prone to Shigella.

Shigellosis Types

The disorder is classified into three main types:

Shigella flexneri

It is also known as the Group B Shigella form of bacteria, responsible for almost all other causes of Bacillary dysentery.

Shigella Sonnei

It is also referred to as Group D Shigella, accountable for most of the shigellosis cases in the US.

Shigella dysenteriae

It is a type 1 form of disorder. It is prevalent in the US and causes fatal shigellosis outbreaks in developing nations such as the US.

Shigellosis Causes

This disorder is caused by a group of bacteria known as Shigella. The bacterium gets transmitted from one person to another and is generally found in the diarrheal stools of the affected individual. The infection arises when an individual accidentally swallows the shigella bacteria. Such form of dysentery can also arise due to a number of other reasons including:

Eating contaminated food

People who are affected with the syndrome can often transmit the infection to other individuals by contaminating the food while handling it. Foods can also get contaminated when grown in a crop field which includes sewage.

Touching the mouth

If hands are not properly washed after changing the diaper of an infant affected with shigella infection, the person becomes more susceptible to the disorder. Direct contact with an infected individual is one of the most prevalent ways in which the disease is propagated.

Consuming contaminated water

Water generally gets contaminated with Shigella infection due to sewage. Individuals affected with the infection can also contaminate the water by swimming in it. Bacillary dysentery occurs when such water is accidentally consumed by any person.

Shigellosis Symptoms

The warning signs of this gastrointestinal disorder, after coming in contact with the infection, develop within 1-7 days and may include:

• Sudden fever
• Crampy rectal pain
• Watery diarrhea
• Sudden abdominal pain
• Stool accompanied with mucus, blood or pus
• Nausea and vomiting
• Seizures

In a few severe cases, patients often display signs of:

• Convulsions
• Headache
• Confusion
• Stiff neck
• Extreme fatigue

Dehydration, along with kidney failure, is also common among shigellosis patients.

Shigellosis Diagnosis

The diagnosis of the disorder begins when patients complain about severe diarrhea or bleeding from the anus. Doctors usually begin the diagnosis with:

Medical history

The disorder usually begins with the onset of certain warning signs such as frequent episodes of watery diarrhea or abdominal cramps. Such symptoms may be accompanied with fever, loss of appetite, vomiting etc. Within a short span, the diarrhea may be accompanied with blood and pus making an affected individual weaker with each passing day. The persistent diarrhea may lead to sudden weight loss and dehydration in sufferers.

Physical examination

Physical exam may yield vague results. However, it helps detect hyperactive bowel actions along with abdominal tenderness. A proper physical exam may detect the primary signs of the disorder which include:

• Sunken eyes
• Reduced skin tension
• Dry mucous membrane

Clinical Tests

Direct microscopic evaluation of the stained smudge displays the presence of red cells and leukocytes in the stool. The diagnosis is generally confirmed by locating the infectious bacteria in the stool. If doctors suspect toxins in blood, CBC (Complete Blood Count) may be recommended to determine the increase of white blood cell count.

Shigellosis Differential Diagnosis

The differential diagnosis of this disease involves distinguishing it from conditions that give rise to similar symptoms, such as:

• Crohn’s Disease
• Salmonella Infection
• Campylobacter Infections
• Shigatoxin-producing Escherichia coli
• Ulcerative Colitis
• Yersinia Enterocolitica Infection

Shigellosis Treatment

Shigella bacteria generally persist for 5-7 days. The treatment of Bacillary dysentery focuses on refilling the fluids in the body lost due to diarrhea, depending on the health condition of the affected patient and the intensity of the infection. A few drugs, which are recommended by doctors to treat diarrhea, such as diphenoxylate with atropine and loperamide (Imodium) should be strictly avoided in order to prevent the disorder from getting worse. A few other options to treat the syndrome may include:

Fluid and salt replacement

The dehydrating affects of the disorder, caused due to diarrhea, can be compensated by drinking lots of water on a regular basis. Doctors often recommend Pedialyte, a type of oral rehydration solution for infants affected with the disorder. Such medicinal solutions are available in drug stores in various brands.  In a few cases, patients are severely dehydrated due to diarrhea. Such individuals require immediate medical treatment in a hospital and should be injected with fluids and salts intravenously, instead of oral hydration. Injecting fluids via veins works much faster in supplying water and mandatory nutrients to the body, rather than by mouth.

Antibiotics

Antibiotics are recommended to individuals affected with shigella infection, so as to cure the syndrome more quickly. It is always advisable that patients take antibiotics after consulting a doctor or a qualified health care provider. Such medications are mandatory for older adults, infants and individuals affected with HIV infection, in order to stop the disease from spreading.

Shigellosis Prognosis

Generally, the infection occurring among individuals is mild and goes away after completing its due course. This disorder, except in malnourished children and individuals with poor immune system, is considered to have an excellent outcome among other patients.

Shigellosis Prevention

To prevent the spread of Shigella infection, health care providers recommend a number of measures including:

• Administering infants when they wash their hands
• Sterilizing the diaper changing areas once it is done
• Keeping infants away from children affected with such disorders
• Washing hands frequently
• Arranging and disposing the soiled diapers in a systematic manner
• Restricting Shigella-infected patients to cook food for others
• Avoiding drinking water from contaminated places such as lakes, ponds and untreated pools

Shigellosis Complications

This type of infection can give rise to a number of complications including:

• Severe dehydration
• Shock
• Renal failure

Patients of this condition often experience Septicemia, a fatal disorder which occurs when the shigella bacteria multiplies inside the bloodstream and affects other organs of the body. The chronic form of Bacillary dysentery, caused due to Shigella flexneri bacteria often gives rise to Reiter’s syndrome (chronic arthritis) among patients.

Shigellosis Risk Factors

The risk factors of the disorder are:

Taking part in group actions

Any form of close encounter of an infected individual with other people spreads the bacteria very rapidly. The outbreaks of shigella infection are more prevalent in nursing homes, child care centers, military barracks and jails.

Being an infant

Such infections are common in children aging between 2- 4.

Dwelling in areas lacking sanitation

People who live in less developed countries or places which lack basic hygiene are more susceptible to the syndrome.

Shigellosis being a contagious infection of the intestinal tract, proper hygiene should be maintained in order to prevent the occurrence of the disorder. If you experience diarrhea or blood along with stool, consult your health care provider immediately. Proper diagnosis and treatment can cure the syndrome completely.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001340/

http://en.wikipedia.org/wiki/Shigellosis

http://www.medicinenet.com/shigella_infection/page4.htm#what_can_a_person_do_to_prevent_this_illness

http://kidshealth.org/teen/infections/bacterial_viral/shigellosis.html#a_Can_I_Prevent_Shigellosis_