SHIGELLOSIS Acute diarrhea associated with blood mucus and

SHIGELLOSIS

� Acute diarrhea associated with blood, mucus and pus cells in stool is called dysentery � The term bacillary dysentery is used to describe dysentery caused by shigella

� Shigellae � 4 are non motile, gram negative rods types � S. Dysenteriae(group A) � S. Flexneri(group B) � S. boydii(group C) � S. Sonnei (group D)

� It is a common disease occurring primarily in children between 1 -10 years of age � Feco-oral transmission is more common inthis age group � Infection in the 1 st 6 months of age s rare especially in breast-fed babies � Humans are major reservior of infection � Contaminated food and water supply are most common source of spread � IP= 1 -7 days (av 2 -4 days) � Infected patient not receiving antibiotics therapy may shed organism upto 1 month

� Shigellae are invasive pathogens that destroy the superficial epithelial cells, producing inflammation, oedema, microabcesses, ulceration with bleeding � Colon is selectively affected

� Onset may be abrupt � Child may have abdominal pain. Urgency, tenesmus, malaise and non-localized lower abdominal tenderness � Temperature is usually upto 104 lasting 1 -3 days � Due to vomiting and diarrhea, there is dehydration � Watery and mucoid stool contained blood

� Shigellosis may present as CNS disease such as meningitis especially when high grade fever is associated with seizures, lethargy and neck rigidity � Seizures occur in 30% of children especially when fever is rises upto 104 � Symptoms generally last 3 -7 days

� Stool examination should reveal leukocytes and red blood cells � CBC shows leukocytosis � Children who are toxic blood culture may be positive � Diagnosis is confirmed by isolating the shigellae by stool culture

� Dehydration � Acidosis � Shock � Renal failure � Bacteraemia � Febrile seizures � Rectal prolapse � HUS

Other organism causing dysentry � E. coli � E. histolytica � Campylobacter jejuni � Yerinia entercolitica � Salmonallae Other condition mimicking shigellosis � IBD � intussesception

� Fluid and electrolyte replacement by using ORS � Antibiotic not only cure the disease but also decreases further intestinal shedding of the organism and further transmission of infection to others � Choice of antibiotic depends upon recent local stool culture report � All antibiotics are given for 5 days � DOC is ciprofloxacin � Ampicillin and nalidixic acid can be used

� Encourage prolonged breast feeding � Hand washing after defecation and before food preparation and consumption � Proper water and sewage treatment

� Prognosis is excellent if dehydration is treated adequately with fluid therapy � The mortality rate is high in very young, malnourished infant who don’t receive fluid and electrolyte therapy � Antibiotic treatment produces a bacteriological cure in 80% of cases after 48 hours of treatment