Shigellosis laboratory findings

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

Overview

The majority of patients with shigellosis have no significant derangements in either blood or stool work-up. Common findings include leukocytosis with left shift on blood examination, and blood and/or mucus in stools on stool examination. Multiple blood and stool cultures are needed to rule out bacteremia and to obtain antibiotic susceptibility testing, but the majority of cases yield negative cultures. Hematology, renal, and liver function testing may be required in some cases to rule out the development of any complications associated with shigellosis, such as severe dehydration, cholestatic liver disease, or hemolytic uremic syndrome (HUS).

Shigellosis Laboratory Findings

Blood Examination

Hematology

• Leukocytosis with left shift is common, but leukopenia has also been reported.
• Anemia
• Thrombocytopenia

Electolytes

• Hyponatremia

Blood Glucose

• Hypoglycemia

Inflammatory Markers

• Elevated C-reactive protein (CRP)
• Elevated erythrocyte sedimentation rate (ESR)

Renal Function

• Azotemia (elevated blood urea nitrogen)
• Elevated concentration of serum creatinine

Liver Function

• Mild elevation in bilirubin

Blood Culture

• Positive blood culture may be positive for Shigella in the minority of cases with bacteremia.

Stool Examination

Stool Analysis

• Fecal blood
• Fecal leukocytes

Microscopic Evaluation

• Microscopic evidence of leukocytosis on stool smear with methylene-blue stain

Stool culture

• Stool cultures may be positive for Shigella in the minority of cases, especially early during the disease.
• Stool samples typically cultured using agars such as: MacConkey, Hektoen enteric, Salmonella-Shigella, Eosin-methylene blue, or xylose-lysine-deoxycholate. Stool cultures typically demonstrate colorless colonies that do not ferment lactose.

References

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