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Shigella infection: Epidemiology, microbiology, and pathogenesis

Marcia B Goldberg, MD
Section Editors
Stephen B Calderwood, MD
Morven S Edwards, MD
Deputy Editor
Allyson Bloom, MD


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 [1]. 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 direct person-to-person spread, as well as via contaminated food and water. Humans are the only natural reservoir for disease.

The epidemiology, microbiology and pathogenesis of Shigella infections will be reviewed here. The clinical manifestations, diagnosis, and treatment are discussed separately. (See "Shigella infection: Clinical manifestations and diagnosis" and "Shigella infection: Treatment and prevention in adults".)


Bacterial dysentery due to Shigella species is a major cause of morbidity and mortality; 165 million cases occur annually worldwide, with 1 million associated deaths [2,3]. Shigella transmission can occur through direct person-to-person spread or from contaminated food and water. The minimal infectious dose can be transmitted directly from contaminated fingers, since intermediate bacterial replication is not required to achieve the low infectious dose.

In developed countries, most cases are transmitted by fecal-oral spread from people with symptomatic infection. Outbreaks in the United States occur predominantly in institutions such as day care centers, and less commonly by common source contamination of food or drinking water. Outbreaks among men who have sex with men, particularly with drug-resistant isolates are also increasingly reported.

In developing countries, both fecal-oral spread and contamination of common food and water supplies are important mechanisms of transmission.

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Literature review current through: Nov 2017. | This topic last updated: Sep 09, 2016.
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