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Shigella infection: Treatment and prevention in adults

Authors
Rabia Agha, MD
Marcia B Goldberg, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD

INTRODUCTION

Shigella infections are a major cause of morbidity and mortality in resource-limited settings. They are the most common cause of moderate to severe diarrhea among children in Asia and Africa [1]. In the United States, the incidence of Shigella infections is approximately 4 to 8 per 100,000 [2]. The mortality in resource-rich countries is less than 1 percent [3].

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

NATURAL HISTORY OF INFECTION

Infection with Shigella is generally self-limited; the average duration of symptoms associated with untreated Shigella gastroenteritis is seven days [4]. In the absence of specific antibiotic treatment, patients with Shigella gastroenteritis may shed the organism for up to six weeks after the resolution of symptoms; risk factors for asymptomatic shedding are not known.

Complications of Shigella gastroenteritis, including bacteremia and severe colonic disease that results in obstruction or perforation, are uncommon in adults. However, individuals with underlying immunodeficiency (including HIV infection) or malnutrition are at increased risk for complications of and worse outcomes with Shigella infection [5-8]. (See "Shigella infection: Clinical manifestations and diagnosis", section on 'Intestinal complications' and "Shigella infection: Clinical manifestations and diagnosis", section on 'Systemic complications'.)

ANTIMICROBIAL RESISTANCE

The increasing antimicrobial resistance of Shigella species is a major problem in the treatment of Shigella gastroenteritis. Thus, antibiotic susceptibility testing is essential for management of all patients with Shigella infection. This is particularly important in patients who are at risk of infection with a resistant isolate, including patients with infections in Asia and Africa, those who report international travel, HIV-infected individuals, and men who have sex with men (MSM).

            

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Literature review current through: Jul 2017. | This topic last updated: Jul 15, 2017.
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