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Shigella infection: Treatment and prevention in adults

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


Shigella infections are a major cause of morbidity and mortality in developing countries. Worldwide, about 165 million cases occur annually with 1 million associated deaths [1]. In the United States, the incidence of Shigella infections is 4 to 8 per 100,000, with nearly 14,000 reported cases in 2004 [2]. The mortality in developed countries is less than 1 percent [3]. (See "Shigella infection: Epidemiology, microbiology, and pathogenesis".)

Shigella gastroenteritis is typically characterized by high fever, abdominal cramps, and diarrhea. The stools are characteristically small in volume, bloody, and mucoid. Individuals with underlying immune deficiency (including HIV infection) or malnutrition are at increased risk for complications of shigellosis [4-7].

The diagnosis of Shigella infection should be considered in a toxic-appearing patient with the sudden onset of bloody diarrhea, cramping, and tenesmus. Although the assay is rarely performed, polymorphonuclear leukocytes are typically present on a methylene blue stain of the stool. Shigella is isolated by culture of a stool specimen or rectal swab using techniques that are routine in most microbiology laboratories. Isolation of the organism from blood is uncommon.

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


Infection with Shigella is generally self-limited; the average duration of untreated Shigella gastroenteritis is seven days [8]. Antibiotic therapy is not essential, since infection clears spontaneously in most individuals; however, because of the severity of the disease and for public health reasons, most favor antibiotic therapy for patients with positive stool culture [9]. Antibiotics have been shown to decrease the duration of fever and diarrhea by about two days [10,11]. Shortening the duration of shedding with the administration of antibiotics can also reduce the risk of person-to-person spread.


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Literature review current through: Sep 2016. | This topic last updated: Sep 9, 2016.
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