Shigellosis natural history, complications and prognosis: Difference between revisions

Jump to navigation Jump to search
m (Changes made per Mahshid's request)
 
(26 intermediate revisions by one other user not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Shigellosis}}
{{Shigellosis}}
{{CMG}}
{{CMG}} '''Associate Editor(s)-In-Chief:''' [[User:YazanDaaboul|Yazan Daaboul]]; [[User:Sergekorjian|Serge Korjian]]
==Overview==
==Overview==
Infections are associated  mucosal ulceration, [[rectal bleeding]], drastic [[dehydration]]; fatality may be as high as 10-15% with some strains. [[Reiter's disease]], reactive [[arthritis]], and [[hemolytic uremic syndrome]] are possible sequelae that have been reported in the aftermath of shigellosis.
Clinical manifestations of shigellosis typically develop 12 hours to 3 days following ingestion of ''Shigella''. Patients often first develop colicky diffuse abdominal pain and fever, followed by diarrhea and tenesmus. If left untreated, shigellosis self-resolves within 5 to 7 days of onset of clinical manifestations in the majority of patients. High risk patient populations (young children, elderly, and immunocompromised patients) are at increased risk of developing complications, which may be intestinal or extra-intestinal. Classical complications include post-infectious arthritis and hemolytic uremic syndrome (HUS). Prognosis is generally excellent for immunocompetent individuals. Factors that are associated with poorer prognosis include prolonged duration of disease, development of complications, and infection of high risk patients.
 
==Natural History==
==Natural History==
*Not all individuals develop clinical manifestations of shigellosis. Individuals may remain asymptomatic but transmit the organism to other individuals.  
===Ingestion of ''Shigella''===
*Clinical manifestations of shigellosis typically appear approximately 12 hours to 3 days following ingestion of ''Shigella".
*Not all individuals develop clinical manifestations of shigellosis. Individuals may remain asymptomatic but transmit the organism to other individuals.
*Patients generally first develop colicky diffuse abdominal pains associated with nausea and fever.
 
*Diarrhea and tenesmus (rectal spasms) typically follow. Diarrhea is often reported to be small in volume and may range from mild to severe. The majority of patients report mucus in stools, and up to half of infected patients report bloody stools. Children younger than 2 years of age may develop high-grade fevers and febrile seizures  
===Development of Clinical Manifestations===
*If left untreated, clinical manifestations of shigellosis typically self-resolve within 5 to 7 days. However, in immunocompromised individuals and young children, shigellosis may be more severe and prolonged, necessitating hospitalization to reduce the risk of shigella-associated complications.
*Clinical manifestations of shigellosis typically appear approximately 12 hours to 3 days following ingestion of ''Shigella''.
*Patients typically first develop colicky, diffuse [[abdominal pain]]s associated with [[nausea]] and [[fever]].
*[[Diarrhea]] and [[tenesmus]] (rectal spasms) typically follow. Diarrhea is often reported to be small in volume and may range from mild to severe.  
*The diarrhea is usually watery at first, but patients may also develop [[dysentery]].
*Children younger than 2 years of age may develop high-grade fevers and [[febrile seizures]].
 
===Resolution of Clinical Manifestations===
*If left untreated, clinical manifestations of shigellosis typically self-resolve within 5 to 7 days of development of clinical manifestations.
*In immunocompromised individuals and young children, shigellosis may be more severe and prolonged, necessitating hospitalization to reduce the risk of ''Shigella''-associated complications.


==Complications==
==Complications==
[[Reiter's syndrome]] is a late complication of ''S. flexneri'' infection, especially in persons with the genetic marker HLA-B27. [[Hemolytic-uremic syndrome]] can occur after ''S. dysenteriae'' type 1 infection. [[Convulsions]] may occur in children; the mechanism may be related to a rapid rate of temperature elevation or metabolic alterations
<ref>http://www.cdc.gov/ncidod/dbmd/diseaseinfo/shigellosis_t.htm </ref>


* Intestinal Complications (Rare)
===Intestinal Complications<ref name="CDC">http://www.cdc.gov/ncidod/dbmd/diseaseinfo/shigellosis_t.htm </ref>===
*:* [[Rectal prolapse]], [[proctitis]]
*[[Rectal prolapse]]
*:* [[Toxic Megacolon]]
*[[Proctitis]]
*:* [[Colonic Perforation]]
*[[Toxic megacolon]]
* Systemic Complications
*[[Intestinal obstruction]]
*:* [[Bacteremia]] ([[gram-negative]] rod's (GNR’s), not just [[Shigella]])
*[[Colonic perforation]]
*:* [[Hyponatremia]] ([[syndrome of inappropriate antidiuretic hormone]] secretion ([[SIADH]])
 
*:* [[Leukemoid Reactions]]
===Systemic Complications<ref name="CDC">http://www.cdc.gov/ncidod/dbmd/diseaseinfo/shigellosis_t.htm </ref>===
*:* [[Seizure]]
*[[Post-infectious arthritis]] (Reiter's syndrome)
*:* [[Reactive Arthritis]]
**Approximately 2% of individuals infected with ''S. flexneri'' develop [[Reiter's syndrome]] (triad of [[arthritis]], [[uveitis]], and [[urethritis]]).
* [[Hemolytic Uremic Syndrome]]
**Post-infectious arthritis may persist for several weeks to months and may become chronic.
*:* MAHA ([[microangiopathic hemolytic anemia]])
**Individuals with [[HLA-B27]] subtype are predisposed to development of Reiter's syndrome following shigellosis.
*:* [[Thrombocytopenia]]
*Concomitant infections
*:* [[Acute Renal Failure]]<ref>http://www.cdc.gov/ncidod/dbmd/diseaseinfo/shigellosis_t.htm </ref><ref>http://www.cdc.gov/ncidod/dbmd/diseaseinfo/shigellosis_g.htm </ref>
**Patients with dysentery lose proteins, including immune factors, in stools and are predisposed to concomitant infections that are not related to shigellosis.
 
*[[Bacteremia]]
**Bacteremia is common among immunocompromised individuals, such as HIV-positive individuals and individuals with cancer and malnutrition.
*[[SIADH]] and SIADH-associated [[hyponatremia]]
*[[Seizure]]
**Among children less than 2 years of age.
*[[Encephalopathy]]
**Among children less than 2 years of age.
*[[Reactive arthritis]]
*[[Hemolytic uremic syndrome]] (HUS)
**HUS is mediated by Shiga toxin that is typically present in ''S. dysenteriae''.
**HUS is characterized by the triad [[microangiopathic hemolytic anemia]] (MAHA), [[thrombocytopenia]], and [[acute kidney injury]].<ref name="CDC">http://www.cdc.gov/ncidod/dbmd/diseaseinfo/shigellosis_t.htm </ref>
*[[Bronchopneumonia]]
 
*[[Disseminated intravascular coaguloapathy]] (DIC)


About 1 in 10 children with severe shigella enteritis develop neurological problems including [[febrile seizures]] or brain disease ([[encephalopathy]]) with [[headache]], [[lethargy]], [[confusion]], and stiff neck.
*[[Cholestatic hepatitis]]
*[[Myocarditis]]
*[[Coma]]
*[[Death]]


==Prognosis==
==Prognosis==
Often the infection is mild and goes away on its own. Most patients, except malnourished children and those with weakened immune systems, have an excellent outlook.
*Generally, prognosis of shigellosis is excellent, and the majority of patients recover without sequelae.
*Factors associated with poorer prognosis include:
**Prolonged duration of disease (> 7 days)
**Development of complications
**Patient risk factors (young children, elderly patients, or immunocompromised patients).
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
 
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]


{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}

Latest revision as of 19:04, 18 September 2017

Shigellosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Classification

Causes

Differentiating Shigellosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Shigellosis natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Shigellosis natural history, complications and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Shigellosis natural history, complications and prognosis

CDC on Shigellosis natural history, complications and prognosis

Shigellosis natural history, complications and prognosis in the news

Blogs on Shigellosis natural history, complications and prognosis

Directions to Hospitals Treating Shigellosis

Risk calculators and risk factors for Shigellosis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Yazan Daaboul; Serge Korjian

Overview

Clinical manifestations of shigellosis typically develop 12 hours to 3 days following ingestion of Shigella. Patients often first develop colicky diffuse abdominal pain and fever, followed by diarrhea and tenesmus. If left untreated, shigellosis self-resolves within 5 to 7 days of onset of clinical manifestations in the majority of patients. High risk patient populations (young children, elderly, and immunocompromised patients) are at increased risk of developing complications, which may be intestinal or extra-intestinal. Classical complications include post-infectious arthritis and hemolytic uremic syndrome (HUS). Prognosis is generally excellent for immunocompetent individuals. Factors that are associated with poorer prognosis include prolonged duration of disease, development of complications, and infection of high risk patients.

Natural History

Ingestion of Shigella

  • Not all individuals develop clinical manifestations of shigellosis. Individuals may remain asymptomatic but transmit the organism to other individuals.

Development of Clinical Manifestations

  • Clinical manifestations of shigellosis typically appear approximately 12 hours to 3 days following ingestion of Shigella.
  • Patients typically first develop colicky, diffuse abdominal pains associated with nausea and fever.
  • Diarrhea and tenesmus (rectal spasms) typically follow. Diarrhea is often reported to be small in volume and may range from mild to severe.
  • The diarrhea is usually watery at first, but patients may also develop dysentery.
  • Children younger than 2 years of age may develop high-grade fevers and febrile seizures.

Resolution of Clinical Manifestations

  • If left untreated, clinical manifestations of shigellosis typically self-resolve within 5 to 7 days of development of clinical manifestations.
  • In immunocompromised individuals and young children, shigellosis may be more severe and prolonged, necessitating hospitalization to reduce the risk of Shigella-associated complications.

Complications

Intestinal Complications[1]

Systemic Complications[1]

  • Post-infectious arthritis (Reiter's syndrome)
    • Approximately 2% of individuals infected with S. flexneri develop Reiter's syndrome (triad of arthritis, uveitis, and urethritis).
    • Post-infectious arthritis may persist for several weeks to months and may become chronic.
    • Individuals with HLA-B27 subtype are predisposed to development of Reiter's syndrome following shigellosis.
  • Concomitant infections
    • Patients with dysentery lose proteins, including immune factors, in stools and are predisposed to concomitant infections that are not related to shigellosis.

Prognosis

  • Generally, prognosis of shigellosis is excellent, and the majority of patients recover without sequelae.
  • Factors associated with poorer prognosis include:
    • Prolonged duration of disease (> 7 days)
    • Development of complications
    • Patient risk factors (young children, elderly patients, or immunocompromised patients).

References


Template:WikiDoc Sources