Increased transmission of a hard-to-treat stomach illness called shigellosis now poses a serious public health concern in the United States, according to the Centers for Disease Control and Prevention (CDC) . Infections caused by an extensively drug-resistant (XDR) strain of the genus Shigella have climbed from 0 to 5 percent of all shigellosis cases between 2015 and 2022, according to national surveillance. Is Drug-Resistant Shigella a Threat? The CDC estimates that shigella bacteria cause about 450,000 infections in the United States every year. Worldwide, shigellosis causes 160 million cases of diarrhea and 1.1 million deaths annually, according to estimates from the World Health Organization (WHO) . Although most of these diarrhea-producing infections are not long-lasting or fatal, XDR shigellosis poses a public threat because treatment options are very limited for moderate to severe cases, and the illness is highly contagious. “It just takes a very few bacteria to initiate an infection,” says William Schaffner, MD , an infectious-disease specialist and professor of preventive medicine and health policy at the Vanderbilt University School of Medicine in Nashville, Tennessee. “It can spread very readily on hands and through person-to-person contact. On occasion, the bacteria can contaminate water systems or food, but that’s less usual.” Dr. Schaffner adds that the bacteria may cause outbreaks in semi-enclosed populations, such as nursing homes or day-care centers. Historically, the illness has mostly affected young children between ages 1 and 4 years, according to the CDC . Individuals with weakened immune systems also face a higher infection risk. The bacteria, which originate in the stool of an infected person, can survive on toys, bathroom fixtures, and diapers, and then spread to the hand, then from hand to mouth. The CDC notes that this increase in treatment-resistant shigella infections is unusual because many recent cases are among men who have sex with men, people living with HIV, adults experiencing homelessness, and travelers to countries with unsafe water and inadequate sanitation. “This is a new wrinkle, in that it clearly is able to be transmitted through the kind of intimacy that frequently occurs among men who have sex with men,” says Schaffner. “If people get together with sexual intimacy, the genitalia are very close to the backside, and that means they can easily get contaminated with microscopic amounts of fecal material, and that's enough to initiate an infection.” What Are the Symptoms of Shigella Infection? Diarrhea is the primary sign of shigella infection. Diarrhea can often be bloody and last more than three days. Diarrhea can also cause dehydration, which if severe can lead to hospitalization. Infection can also cause fever, abdominal cramping, and tenesmus , or the feeling that you need to pass stool even when your bowels are empty. Symptoms can last anywhere from a few days to four or more weeks, but it may take several months before bowel habits return to normal. Most shigella infections resolve on their own without treatment. While antibiotics such as azithromycin and ciprofloxacin are often used to treat patients with severe infection or weakened immune systems, increasing bacterial resistance to these drugs threatens available treatment options. Schaffner blames overuse of antibiotics for this growth in resistance. “The more antibiotics we use, the more resistance we will generate,” he says. “We just need to be much more careful and restrained in how we use antibiotics.” What Is the Difference Between Shigella and Norovirus Infections? Shigellosis is often confused with stomach flu caused by a norovirus because the two infections have similar symptoms, adds Schaffner. A definite diagnosis can be determined through testing of a stool sample, per Mayo Clinic . Schaffner notes that there is no specific treatment for a norovirus issue, and because viruses have a different structure from bacteria, antibiotics are ineffective against these infections. The CDC emphasizes that one of the key ways to prevent infection with either shigella or norovirus is to wash your hands carefully with soap and water after engaging in activities that may spread germs, including after going to the bathroom, changing a diaper, or cleaning up after someone who used the bathroom. You should also wash your hands before and after any sexual activity, and before preparing food or eating. “People may undervalue the power of washing their hands,” says Schaffner. “Soap and water really work wonderfully.”
Everyday Health
2/28/2023
Increased transmission of a hard-to-treat stomach illness called shigellosis now poses a serious public health concern in the United States, according to the Centers for Disease Control and Prevention (CDC) . Infections caused by an extensively drug-resistant (XDR) strain of the genus Shigella have climbed from 0 to 5 percent of all shigellosis cases between 2015 and 2022, according to national surveillance. Is Drug-Resistant Shigella a Threat? The CDC estimates that shigella bacteria cause about 450,000 infections in the United States every year. Worldwide, shigellosis causes 160 million cases of diarrhea and 1.1 million deaths annually, according to estimates from the World Health Organization (WHO) . Although most of these diarrhea-producing infections are not long-lasting or fatal, XDR shigellosis poses a public threat because treatment options are very limited for moderate to severe cases, and the illness is highly contagious. “It just takes a very few bacteria to initiate an infection,” says William Schaffner, MD , an infectious-disease specialist and professor of preventive medicine and health policy at the Vanderbilt University School of Medicine in Nashville, Tennessee. “It can spread very readily on hands and through person-to-person contact. On occasion, the bacteria can contaminate water systems or food, but that’s less usual.” Dr. Schaffner adds that the bacteria may cause outbreaks in semi-enclosed populations, such as nursing homes or day-care centers. Historically, the illness has mostly affected young children between ages 1 and 4 years, according to the CDC . Individuals with weakened immune systems also face a higher infection risk. The bacteria, which originate in the stool of an infected person, can survive on toys, bathroom fixtures, and diapers, and then spread to the hand, then from hand to mouth. The CDC notes that this increase in treatment-resistant shigella infections is unusual because many recent cases are among men who have sex with men, people living with HIV, adults experiencing homelessness, and travelers to countries with unsafe water and inadequate sanitation. “This is a new wrinkle, in that it clearly is able to be transmitted through the kind of intimacy that frequently occurs among men who have sex with men,” says Schaffner. “If people get together with sexual intimacy, the genitalia are very close to the backside, and that means they can easily get contaminated with microscopic amounts of fecal material, and that's enough to initiate an infection.” What Are the Symptoms of Shigella Infection? Diarrhea is the primary sign of shigella infection. Diarrhea can often be bloody and last more than three days. Diarrhea can also cause dehydration, which if severe can lead to hospitalization. Infection can also cause fever, abdominal cramping, and tenesmus , or the feeling that you need to pass stool even when your bowels are empty. Symptoms can last anywhere from a few days to four or more weeks, but it may take several months before bowel habits return to normal. Most shigella infections resolve on their own without treatment. While antibiotics such as azithromycin and ciprofloxacin are often used to treat patients with severe infection or weakened immune systems, increasing bacterial resistance to these drugs threatens available treatment options. Schaffner blames overuse of antibiotics for this growth in resistance. “The more antibiotics we use, the more resistance we will generate,” he says. “We just need to be much more careful and restrained in how we use antibiotics.” What Is the Difference Between Shigella and Norovirus Infections? Shigellosis is often confused with stomach flu caused by a norovirus because the two infections have similar symptoms, adds Schaffner. A definite diagnosis can be determined through testing of a stool sample, per Mayo Clinic . Schaffner notes that there is no specific treatment for a norovirus issue, and because viruses have a different structure from bacteria, antibiotics are ineffective against these infections. The CDC emphasizes that one of the key ways to prevent infection with either shigella or norovirus is to wash your hands carefully with soap and water after engaging in activities that may spread germs, including after going to the bathroom, changing a diaper, or cleaning up after someone who used the bathroom. You should also wash your hands before and after any sexual activity, and before preparing food or eating. “People may undervalue the power of washing their hands,” says Schaffner. “Soap and water really work wonderfully.”
Everyday Health
