SHIGELOSIS

SHIGELOSIS/
BACILLARY
DYSENTRY
Learning objectives
•a) Define diarrhoea diseases
• b) Explain risk factors/aetiology of diarrhoea diseases
• c) Explain clinical features and complications of diarrhoea
diseases
• d) Perform clinical assessment for a patient with diarrhoea
diseases
• e) Establish provisional and differential diagnoses
• f)Determine appropriate investigations to be performed to
patients with diarrhoea diseases
• g) Treat, conduct follow up and refer patients with diarrhoea
diseases as appropriate
• h) Provide preventive measures to patients with diarrhoea
diseases
Definition
• Shigellosis
• is a diarrheal infection caused by Shigella species—
gram-negative, non-spore forming, facultative
anaerobes that infect the intestinal lining—and
spread by fecal-oral transmission.
• it is a diarrheal illness which is characterized by

frequent passage of blood stained mucopurulent
stools.
Etiology-shigella
• Short Gram Negative rods
• aerobic,
• 1-3 μm x 0.5 μm
• Nonmotile
• Noncapsulate & nonsporing
• Fimbriae – may be present
• highly contagious, causing diarrhea after ingestion
of as few as 180 organisms
Cont…
• The four important species of the genus Shigella
are:
• Shigella dysenteriae
• Shigella flexneri
• Shigella sonnei
• Shigella boydii.
Pathogenesis
• VIRULENCE FACTORS
• Shigella dysenteriae produces 3 types of toxins: –
• Endotoxin
• Exotoxin
• Verocytotoxin.
PATHOGENESIS
• Infective dose is low 10 - 100 bacilli
• Source of Infection – Patient or carriers
•Route of entry – faecal – oral route
• Site of infection – Large intestine
• Incubation Period – Less than 48 hours (1–7 days)
• Mode of transmission – Food, finger, faeces and

flies
Clinical presentation
• Manifestations of • Acute bloody diarrhea [40]
shigellosis generally • Occasional vomiting (35%
begin within 1-2 days prevalence)
of infection
• Crampy abdominal pain
• Tenesmus
• Urgency
• Fever (1-3 days after
exposure)
Cont…..
• Physical examination
• Clinical findings may include the following:
• Lower abdominal tenderness
• Normal or increased bowel sounds
• Dehydration (occasional)
Differential Diagnoses
• Amebiasis • Cryptosporidiosis
• Bacterial Gastroenteritis • Escherichia coli (E coli)
• Campylobacter Infections
Infections • Pseudomembranous
• Cholera Colitis
• Clostridioides • Salmonella Infection
(Clostridium) Difficile (Salmonellosis)
Colitis • Ulcerative Colitis
• Colon Cancer • Viral Gastroenteritis
• Crohn Disease
Investigation LAB DIAGNOSIS
• Stools examination.
• Stool appears dark red (bloody) with a lot of mucous.
• Microscopy shows
• Numerous white blood cells (leucocytes)
• Many red blood cells (erythrocytes)
• Macrophages which contain red blood cells (after
phagocytosis) are easily mistaken for trophozoites of
entamoeba histolytica.
• The diagnosis is confirmed by a positive stool
culture for Shigella but this is done in well equipped
hospitals.
Treatment
• General supportive care of patients with shigellosis includes
the following
• Treat high fever
• Avoid narcotic-related antidiarrheals.
• Antibiotic treatment is indicated in most patients..
• Clear liquids followed by a low-residue, lactose-free diet is

recommended until symptoms of shigellosis resolve.
• Pharmacological Treatment
• A: ciprofloxacin (PO) 500mg 12hourly for 5days

• OR
• A: erythromycin (PO) 500mg 6hourly for 5days.
Complications
• Hemolytic uremic syndrome (HUS),

Haemolytic uraemic syndrome is characterized by acute
haemolysis, renal failure, uraemia, and disseminated
intravascular coagulation. (HURD)
• Microangiopathic hemolytic anemia,
• Thrombocytopenia, and renal failure
• Reactive arthritis
cont
Gastrointestinal complications
• Toxic mega-colon
• Perforation of the intestines
• Rectal prolapse
PREVENTION
• Personnel hygiene.
• Environmental hygiene.
• Good sanitation / purification water supply.
• Food Handling care.
• Complete cooking.
Key points
• Is the diarrhoea disease caused by shigella species
• Transmitted by fecal oral rout
• Mainly affect the large colon
• Clinical feature abd pain tenesmus, fever and bloody

diarrhoes
• Treatment include cipro and erythromycin

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SHIGELOSIS

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SHIGELOSIS/

• it is a diarrheal illness which is characterized by

• Source of Infection – Patient or carriers

•Route of entry – faecal – oral route

• Site of infection – Large intestine

• Incubation Period – Less than 48 hours (1–7 days)

• Mode of transmission – Food, finger, faeces and

• Clinical findings may include the following:

• Lower abdominal tenderness

• Normal or increased bowel sounds

• Treat high fever

• Avoid narcotic-related antidiarrheals.

• Antibiotic treatment is indicated in most patients..

• Clear liquids followed by a low-residue, lactose-free diet is

• A: ciprofloxacin (PO) 500mg 12hourly for 5days

• Hemolytic uremic syndrome (HUS),

• Microangiopathic hemolytic anemia,

• Thrombocytopenia, and renal failure

• Good sanitation / purification water supply.

• Food Handling care.

• Transmitted by fecal oral rout

• Mainly affect the large colon

• Clinical feature abd pain tenesmus, fever and bloody

• Treatment include cipro and erythromycin

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