Shigella infection: Clinical manifestations and diagnosis
- Rabia Agha, MD
Rabia Agha, MD
- Assistant Professor of Pediatrics
- Albert Einstein College of Medicine
- Marcia B Goldberg, MD
Marcia B Goldberg, MD
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Section Editors
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
Shigella species are a common cause of bacterial diarrhea worldwide, especially in developing countries. Shigella organisms can survive transit through the stomach since they are less susceptible to acid than other bacteria; for this reason as few as 10 to 100 organisms can cause disease . Ingested bacteria pass into the small intestine where they multiply; large numbers of bacteria then pass into the colon, where they enter the colonic cells. Given its relatively low infectious dose, Shigella transmission can occur via contaminated food and water and via direct person-to-person spread. (See "Shigella infection: Epidemiology, microbiology, and pathogenesis".)
The clinical manifestations, complications, and diagnosis of Shigella infection will be reviewed here. The treatment of this infection is discussed separately. (See "Shigella infection: Treatment and prevention in adults" and "Shigella infection: Treatment and prevention in children".)
General features — Shigella is an infection of the lower gastrointestinal tract. Patients with Shigella gastroenteritis typically present with high fever, abdominal cramps, and bloody, mucoid diarrhea [2-6]:
●Fever – 30 to 40 percent
●Abdominal pain – 70 to 93 percent
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- CLINICAL MANIFESTATIONS
- General features
- Intestinal complications
- - Proctitis or rectal prolapse
- - Toxic megacolon
- - Intestinal obstruction
- - Colonic perforation
- Systemic complications
- - Bacteremia
- - Metabolic disturbances
- - Leukemoid reaction
- - Neurologic disease
- - Reactive arthritis
- - Hemolytic-uremic syndrome
- Other manifestations
- Clinical suspicion
- Organism identification
- - Stool culture
- - Molecular testing