Shigellosis, which is also called bacillary dysentery, is an acute intestinal infection that causes a high fever (especially in children) and acute, self-limiting diarrhea with tenesmus; it also may cause electrolyte imbalance and dehydration. There are about 140 million cases of shigellosis worldwide, with almost 600,000 deaths, particularly in children under age 5, especially in underdeveloped countries.
Shigellosis commonly occurs in low-income, minority-group residents. Rates are especially high in children who attend day-care centers, retarded children in custodial care, and in people from poor, urban communities.
The prognosis for this infection is good. Mild infections normally subside within 10 days; severe infections may persist for 2 to 6 weeks.
Shigellosis is spread when the bacteria in feces or on soiled fingers are ingested. Poor hand-washing habits and eating contaminated food may cause the condition. Shigellosis is often found in day care centers, nursing homes, refugee camps, and other places where conditions are crowded and sanitation is poor.
Symptoms and Signs
Signs and symptoms of shigellosis usually begin a day or two after exposure to shigella. Diarrhea, often bloody, is the most common sign of shigellosis. Other signs and symptoms may include:
During acute illness, stool cultures usually are positive. Microscopic examination of a fresh stool specimen may reveal mucus, red blood cells, and polymorphonuclear leukocytes; direct immunofluorescence with specific antisera may reveal Shigella. Severe infection increases hemagglutinating antibody levels. Sigmoidoscopy may reveal typical superficial ulcerations.
Diagnosis must rule out other causes of diarrhea, such as enteropathogenic Escherichia coli infection, malabsorption diseases, and amoebic or viral diseases.
Shigellosis treatment involves contact precautions and includes nutritional support to reverse catabolism and, most important, replacement of fluids and electrolytes with I.V infusions in sufficient quantities to maintain a urine output of 40 to 50 ml/hour and correct imbalances.
Antibiotics are of questionable value but may be used in an attempt to eliminate the pathogen and thereby prevent further spread. Ampicillin or trimethoprim-sulfamethoxazole is generally recommended and may be useful in severe cases, especially in children with overwhelming fluid and electrolyte losses.
Antidiarrheals that slow intestinal motility are contraindicated in shigellosis because they delay fecal excretion of Shigella and prolong fever and diarrhea.
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