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Shigellosis

For further information, see CMDT Part 33-18: Shigellosis

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 or water 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

  • Common cause of "traveler's" diarrhea

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

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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Table 30–3. Acute bacterial diarrheas and “food poisoning” (listed in alphabetical order).
Organism Incubation Period Vomiting Diarrhea Fever Associated Foods Diagnosis Clinical Features and Treatment
Bacillus cereus (diarrheal toxin) 10–16 hours ± +++ – Toxin in meats, stews, and gravy. Clinical. Food and stool can be tested for toxin. Abdominal cramps, watery diarrhea, and nausea lasting 24–48 hours. Supportive care.
Bacillus cereus (preformed toxin) 1–8 hours +++ ± – Reheated fried rice causes vomiting or diarrhea. Clinical. Food and stool can be tested for toxin. Acute onset, severe nausea and vomiting lasting 24 hours. Supportive care.
Campylobacter jejuni 2–5 days ± +++ + Raw or undercooked poultry, unpasteurized milk, water. Stool culture on special medium. Fever, diarrhea that can be bloody, cramps. Usually self-limited in 2–10 days. Treat with azithromycin and secondarily fluoroquinolones for severe disease. May be associated with Guillain-Barré syndrome.
Clostridium botulinum 12–72 hours ± – – Clostridia grow in anaerobic acidic environment eg, canned foods, fermented fish, foods held warm for extended periods. Stool, serum, and food can be tested for toxin. Stool and food can be cultured. Diplopia, dysphagia, dysphonia, respiratory embarrassment. Treatment requires clear airway, ventilation, and intravenous polyvalent antitoxin (see text). Symptoms can last for days to months.
Clostridioides difficile Usually occurs after 7–10 days of antibiotics. Can occur after a single dose or several weeks after completion of antibiotics. – +++ ++ Associated with antibacterial drugs; clindamycin and beta-lactams most commonly implicated. Fluoroquinolones associated with hypervirulent strains. Stool tested for toxin. Abrupt onset of diarrhea that may be bloody; fever. Vancomycin 125 mg orally four times per day or fidaxomicin 200 mg twice daily for 10 days recommended over metronidazole.
Clostridium perfringens 8–16 hours ± +++ – Clostridia grow in rewarmed meat and poultry ...

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