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Shigella

Shigella

Shigellosis is an important intestinal illness. In terms of bacterial gastroenteritis, it ranks fourth in B.C. behind campylobacteriosis, salmonellosis and yersiniosis in numbers of reports (195 reports in 2009). On a worldwide scale, it is a very significant cause of illness and deaths. As with many enteric illnesses, sanitation, overcrowding and hygiene are important factors. Prevention is by practicing frequent hand washing, following good food safety practices, providing safe drinking water and by following other practices that break the fecal-oral links of illness.

Information for Health Professionals

Shigellosis is an acute diarrheal infection in the bowels caused by the Shigella group of bacteria. 

 

Symptoms include:

  • diarrhea, sometimes with blood and/or mucus
  • fever
  • nausea, and may also include
  • cramps
  • vomiting
  • toxins (or "poisons") in the blood (toxemia)
  • an urge to void, with no passage of stool (also called "tenesmus")

Symptoms usually start 1 to 3 days after exposure. Usually, symptoms go away in 4 to 7 days. A person with shigellosis may experience mild or severe symptoms, or no symptoms at all.

If you have serious symptoms, you should see your doctor. In most cases it takes no more than 7 days to get better, but sometimes it takes longer. 

 

Shigellosis is very infectious and spreads easily. Shigella are present in the diarrheal stools of infected persons while they are sick and for up to a week or two afterwards. In that time, they may infect healthy people.

Most shigella infections are the result of the bacteria passing from stools or soiled fingers of one person to the mouth of another person, when sanitation and hygiene are poor. For example, the transmission may happen after:

  • being exposed directly to infected stool or indirectly with objects contaminated with stool; for example: in day care centres, if hands are not washed each time you touch children and change diapers
  • putting objects that have tiny bits of stool on them - like food, pens, cigarettes etc. - into your mouth
  • having oral-anal (mouth to anus) sexual contact
  • being exposed to contaminated water or food:

1) if food is contaminated by infected food handlers, or by flies picking up contamination from latrines

2) if drinking water is contaminated by the feces of infected animals or people (e.g. water improperly treated in developing countries)  

3) if swimming at beaches with contaminated water

 

People with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal.


Shigella flexneri
 can cause a form of arthritis that can last months or years in a few people.

 

Shigellosis is confirmed by microscopic testing of stool samples.

 

If you have serious symptoms, you should see your doctor. Persons with mild infection usually recover quickly without antibiotic treatment. However, an appropriate antibiotic treatment kills the shigella and may shorten the illness by a few days.

If you have diarrhea, drink lots of fluids to avoid dehydration. See your family doctor or local health authority. Call a doctor if you experience:

  • fever
  • abdominal pains or cramps, and
  • diarrhea or loose stools, especially if blood is present
 

If you have shigellosis (or if you have any symptoms of gastrointestinal illness like diarrhea or vomiting) and you work in a high-risk occupation (e.g. you are a food handler, caregiver or work in a day care), you should stop working and contact a professional at your local public health office to discuss staying away from work until you have recovered.


Children attending child care will need to be removed from the day care until they recovered.

Workers and children in high risk settings can return after two negative stool samples have been provided.

 

Avoid exposure to infected stool:

  • Frequent and careful hand washing is important for everybody. Make sure children wash their hands properly in day care centres and at home (they may need help). This is especially important for children who are not completely toilet-trained (including children in diapers)
  • When possible, young children with shigella infection who are still in diapers should not be around or play with uninfected children

Contaminated food or water:

  • Basic food safety precautions and drinking water treatment help prevent shigellosis
  • At swimming beaches, having enough bathrooms near the swimming area helps keep the water from becoming contaminated

Simple precautions to take while travelling to the developing world:

  • Drink only treated or boiled water
  • Eat only cooked hot foods or fruits you peel yourself
  • Learn more about Travelers’ Diarrhea

In the home:

Be aware of ways that tiny bits of stool can get into your mouth. These include:

  • Biting your nails
  • Eating unwrapped candy, nuts, chips, fruit or other food 
  • Sharing cups, bottles, utensils, plates or other household equipment
  • Lighting up a cigarette with soiled hands

Ways to avoid giving Shigella to others:

  • Washing your hands well and often, with soap and water, is important for all age groups, especially after having a bowel movement, changing diapers and before preparing food or drinks
  • Watch and help children when they wash their hands. This is really important for children who are not completely toilet-trained (including children in diapers)
  • Get rid of dirty diapers properly
  • Disinfect diaper changing areas with diluted household bleach (one teaspoon [five ml] bleach per litre of water), or an effective, purchased  "off the shelf" disinfectant spray or wipes. The container should show a drug identification number (DIN) 
  • Children with shigellosis must be kept out of day care centres until it is shown that they are no longer infected
  • People who handle food, or who care for children, the sick, the elderly or other dependents, cannot go to work until it is shown that they have cleared the infection

Proper hand washing:

  • Use warm running water and liquid soap
  • Lather well, paying attention to your fingertips, in between fingers and under your fingernails
  • Wash for about 30 seconds 
  • Rinse thoroughly 
  • Dry with a paper towel
 

Last Updated: August 29, 2012

SOURCE: Shigella ( )
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