Shigellosis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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.
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: 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.
- 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.
Resolution of Clinical Manifestations: 5 to 7 days following onset 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
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 [1]
- Intestinal Complications (Rare)
- Systemic Complications
- Bacteremia (gram-negative rod's (GNR’s), not just Shigella)
- Hyponatremia (syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Leukemoid Reactions
- Seizure
- Reactive Arthritis
- Hemolytic Uremic Syndrome
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.
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.