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Key Features

Essentials of Diagnosis

  • Diarrhea, often with blood and mucus

  • Crampy abdominal pain, high fevers, and systemic toxicity

  • White blood cells in stools; organism isolated on stool culture

General Considerations

  • Shigella dysentery is a common disease, often self-limited and mild but occasionally serious

  • Food-borne illness

  • Shigella sonnei is the leading cause in the United States, followed by Shigella flexneri

  • Shigella dysenteriae causes the most severe form of the illness

  • There has been a rise in strains resistant to multiple antibiotics

Demographics

  • Residence in or travel to a foreign country

  • Men who have sex with men at higher risk

  • Exposure to contaminated food, especially in outbreak setting

  • Approximately 450,000 cases (mostly due to S sonnei) occur in the United States each year

Clinical Findings

Symptoms and Signs

  • Table 30–3

  • Abrupt onset of illness, with diarrhea, lower abdominal cramps, and tenesmus

  • The diarrheal stool often is mixed with blood and mucus

  • Systemic symptoms are fever, chills, anorexia and malaise, and headache

  • The abdomen is tender

  • Temporary disaccharidase deficiency may follow the diarrhea

Table 30–3.Acute bacterial diarrheas and “food poisoning” (listed in alphabetical order).

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