shigellosis presentation , communicable diseases lecture, community medicine master , university of Khartoum contains basic information about the disease, its clinical features and treatment

1. bacillary dysentry
Shigelosis
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2. Table of content :
Introduction
Epidmiology
Causative agent
Clinical feature
Diagnosis
Treatment
Prevention and control

3. Introduction
 Bacillary dysentery is an acute bacterial disease
involving the large and small intestine
 It is caused by bacteria of the genus Shigella, of which
S. dysenteriae type 1 causes the most severe disease
and the largest outbreaks (other species
include S. flexneri, S. sonnei and S. boydii).
 It is the most important cause of acute bloody diarrhoea.

4. epidmiology
 Shigellosis causes an estimated 150 million illnesses
and 14,000 deathes worldwide
 Its endemic in both tropical & temprate climate
 S. dysenteriae type 1 is of particular concern in
developing countries and complex emergency situations
where huge outbreaks can occur.
 S. sonnei is most common in industrialized countries,
where the disease is generally less severe

5. Causative agent
 Shigella strains are gram negative , faculatively
anaerobic,non motile rods classified in the family
enterobacteriacae.
 Shigella strains cause dysentry by invading and
destroying the cells that line the large intestine
 There are 4 subgroups of shigella
• Group A: S.dysenteriae (most severe infection due to shig toxin
type 1)
• Group B: S.flexneri
• Group C: S.bodyii
• Group D: s.sonni
 Group A<B<C are further subdivided into 15,8,19
serotype respectively. While group D consist of a single
serotype

6. Mood of transmission
 The only significant reservoir is human
 Mainly by direct or indirect fecal-oral transmission from a
symptomatic patient or a short-term asymptomatic carrier
 Infection may occur after the ingestion of contaminated food or
water as well as from person to person.
 The infective dose can be as low as 10–100 organisms.
 Water and milk transmission may occur as the result of direct fecal
contamination;
 flies can transfer organisms from latrines to uncovered food items.

7. Incubation period
 Usually 1–3 days,
 but may range from 12 to 96
hours; up to 1 week for S. dysenteriae 1

8. Clinical feature
 acute
 loose stools of small volume accompanied by fever,
nausea and sometimes toxaemia, vomiting, cramps and
tenesmus
 In typical cases, the stools contain blood and mucus
(dysentery)resulting from mucosal ulcerations and
confluent colonic crypt micro abscesses caused by the
invasive organisms; many cases present with a watery
diarrhea.

9.  Mild and asymptomatic infections occur.
 illness is usually self-limited, lasting on average 4–7
days.
 Case fatality rate can be up to 20% even with
hospitalization

10. Differential diagnosis
 Other causes of dysentry include ::
• Campylobacter jejuni,
• entero-invasive Escherichia coli,
• Salmonella
• , Entamoeba histolytica (less frequently )

11. Complications
 High risk pateints include
• Children under 5 years
• Severly malnourished patiens
• Eldelrly over 50 years
 Complications include :
• Sepsis
• Rectal prolapse
• Haemolytic uremic syndrome
• Convulsions (especially among young children)
 Shiga bacillus is associated with
• Toxic megacolon
• Intestinal peroration
• HUS

12. Period of communicability
 During acute infection and until the infectious agent is no
longer present in feces, usually within 4 weeks after
illness.
 Asymptomatic carriers may transmit infection; rarely,
the carrier state may persist for months or longer.
 Appropriate antimicrobial treatment usually reduces
duration of carriage to a few days.

13. Diagnosis
 Isolation of shigella from feces or rectal swabs provide
bacteriological diagnosi
 Blood is observed in a fresh stool specimen
 Stool speciment should be processed rapidly because
Shigella remains viable only for a short
period outside human body
 Infection is usually associated with large numbers of
fecal leukocytes detected through microscopical
examination of stool mucus stained with methylene blue
or Gram.

14.  Isolated specimen should be tested for antimicrobial
suseptiablity
 No rapid diagnostic test or antigen assays are avaliable
yet

15. Case mangment
 Refer seriously ill or severely malnourished patients to
hospital immediately.
 Check the results of antimicrobial sensitivity tests with
the laboratory.
 Give an antimicrobial effective against local S.
dysenteriae type 1 (Sd1)strains promptly to all patients,
preferably as inpatients
 Treat dehydration with oral rehydration salts or
intravenous fluids if severe.
 If the antimicrobials used are effective, clinical
improvement should be noted within 48 hours.

16. Children < 6 mo. Less likely to get
infected as breast feeding is protective

17.  Azithromycin and ceftrixone may also be considered for
treatment of shigellosis especially in children
 The use of antimotility agents is discourged as they
prolong the duration of illness

18. Mangment of contacts
 Whenever feasible ill contacts should be discouraged
from handling food ,caring of children and patients ..
Until diareah stop and stool culutre is negative in one or
more succesive test taken 24 hours apart and 48 hours
after discontinuation of antibiotics
 Thourogh hand washing after defecation, before food
handling and caring of children patients is essential
 Investigate water and food sources and recreational
water sources using general sanitation measures

19. Prevention and control
 Health education regarding hand washing and sanitary
measures
 No prophylaxis
 No vaccination

20. Specail considerations
 Reporting : case report to health authoraties is obligatory
 Common source water and foood borne outbreak
require prompt investigaiton & intervention whaterever
the infecting species
 Shiga bacillus is a potential problem is disaster situation
where personal hygeine and enviromental sanitaion is
defiecient

22. Refences
 Who manual
 Control of communicable diseases manual 18th edition
 Control of communicable diseases manual 20th edition
 Communicable disease control manula 2012 ,ministry of
health,newzeland