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
Persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal. About 2% of persons who are infected with one type of Shigella, Shigella flexneri, later develop pains in their joints, irritation of the eyes, and painful urination. This is called post-infectious arthritis. It can last for months or years, and can lead to chronic arthritis. Post-infectious arthritis is caused by a reaction to Shigella infection that happens only in people who are genetically predisposed to it.
Once someone has had shigellosis, they are not likely to get infected with that specific type again for at least several years. However, they can still get infected with other types of Shigella.
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.