Shigellosis natural history, complications and prognosis: Difference between revisions

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Latest revision as of 19:04, 18 September 2017

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.

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.^[1]
Bronchopneumonia

Disseminated intravascular coaguloapathy (DIC)

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

↑ ^1.0 ^1.1 ^1.2 http://www.cdc.gov/ncidod/dbmd/diseaseinfo/shigellosis_t.htm

Template:WikiDoc Sources

[CDC-1] 1.0 ^1.1 ^1.2 http://www.cdc.gov/ncidod/dbmd/diseaseinfo/shigellosis_t.htm

[1]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Shigellosis}}
-{{CMG}}
+{{CMG}} '''Associate Editor(s)-In-Chief:''' [[User:YazanDaaboul|Yazan Daaboul]]; [[User:Sergekorjian|Serge Korjian]]
 ==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==
 ===Ingestion of ''Shigella''===
@@ Line 9: / Line 10: @@
 ===Development of Clinical Manifestations===
-*Clinical manifestations of shigellosis typically appear approximately 12 hours to 3 days following ingestion of ''Shigella".
+*Clinical manifestations of shigellosis typically appear approximately 12 hours to 3 days following ingestion of ''Shigella''.
-*Patients generally first develop colicky diffuse abdominal pains associated with nausea and fever.
+*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 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.
+*[[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.
+*In immunocompromised individuals and young children, shigellosis may be more severe and prolonged, necessitating hospitalization to reduce the risk of ''Shigella''-associated 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==
-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==
 {{Reflist|2}}
 [[Category:Disease]]
-[[Category:Infectious disease]]
 [[Category:Gastroenterology]]
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