Increase in Drug-Resistant Shigella is a Concern

Health News -- March 9, 2023In recent years, the United States has faced a growing threat from a non-virus,

drug-resistant bug called Shigella.

This bacterial infection, which is transmitted through contaminated food and water, has become increasingly resistant to antibiotics, making it difficult to treat. In fact, according to recent data, 0.5% of Shigella cases last year were deemed "untreatable."

One of the most concerning aspects of this growing problem is that hand sanitizers, which have become ubiquitous during the COVID-19 pandemic, are not effective against Shigella. This is because Shigella is a bacteria, not a virus, and hand sanitizers are designed to kill viruses, not bacteria.

According to the Centers for Disease Control and Prevention (CDC), the best way to prevent the spread of Shigella is to wash your hands with soap and water for at least 20 seconds, especially before eating or preparing food, after using the bathroom, and after changing diapers. Additionally, it is important to avoid sharing food or drinks with others, and to disinfect surfaces that may have come into contact with contaminated food or water.

While Shigella infections are typically not life-threatening, they can cause severe diarrhea, fever, and stomach cramps, and can lead to dehydration if left untreated. In rare cases, the infection can spread to the bloodstream and cause serious complications.

The increasing prevalence of drug-resistant Shigella is a reminder of the ongoing threat posed by infectious diseases, and the importance of taking steps to prevent their spread. As we continue to grapple with the COVID-19 pandemic, it is important not to overlook other infectious diseases that pose a threat to public health.

From the CDC:

Shigella bacteria cause an infection called shigellosis. Shigella cause an estimated 450,000 infections in the United States each year and an estimated $93 million in direct medical costs.

The four species of Shigella are:

Shigella sonnei (the most common species in the United States)
Shigella flexneri
Shigella boydii
Shigella dysenteriae
S. dysenteriae and S. boydii are rare in the United States, though they continue to be important causes of disease in areas with less access to resources. Shigella dysenteriae type 1 can be deadly.
How do Shigella bacteria spread?
Shigella spread easily; it takes just a small number of bacteria to make someone ill. People with a Shigella infection can spread the infection to others for several weeks after their diarrhea ends.

You can get infected by swallowing Shigella. Some ways Shigella can get into your mouth are:

Getting Shigella on your hands and touching your mouth. Shigella can get on your hands by:Touching surfaces, such as toys, bathroom fixtures, changing tables, and diaper pails, contaminated with Shigella bacteria from someone with an infection.
Changing the diaper of a child with a Shigella infection.
Taking care of a person with an infection, including cleaning up after the person uses the toilet.
Eating food prepared by someone with a Shigella infection.
Swallowing water you swim or play in, such as lake water or improperly treated swimming pool water.
Swallowing contaminated drinking water, such as water from a well that’s been contaminated with sewage or flood water.
Exposure to poop during sexual contact with someone with a Shigella infection or who has recently recovered from a Shigella infection.
What are the symptoms of Shigella infection and how long do they last?
Most people with Shigella infection (shigellosis) experience:

Diarrhea that can be bloody or prolonged (lasting more than 3 days)
Fever
Stomach pain
Feeling the need to pass stool (poop) even when the bowels are empty
Symptoms usually start 1–2 days after infection and last 7 days. In some cases, bowel habits (frequency and consistency of stool) do not return to normal for several months.
Who is most likely to get Shigella infection?
Children younger than 5 years old are the most likely to get shigellosis, but people of all ages can get the disease.
Many outbreaks occur in early care and education settings and schools. Infection commonly spreads from young children to their family members and other people in their communities because these bacteria spread easily.
Travelers to places where water and food may be unsafe and sanitation is poor are more likely to get a Shigella infection. They are also more likely to become sick with types of Shigella that are more difficult to treat. Travelers may be exposed to the bacteria through contaminated food, water (both drinking and recreational water), surfaces, and even other people. Travelers can protect themselves by choosing safe food and drink options and washing hands with soap often.
Gay, bisexual, and other men who have sex with men* are among groups at high risk for Shigella infection. Shigella can pass from stool or soiled fingers of one person to the mouth of another person, including during sexual activity.
People who are experiencing homelessness are at high risk for Shigella infection when there is shigellosis spread in the community. They may face challenges in their living situations that increase the risk for disease transmission, which can result in outbreaks.
People who have weakened immune systems because of illnesses or conditions (such as HIV) or medical treatment (such as chemotherapy) can get a more serious illness. A severe Shigella infection can spread into the blood, which can be life-threatening.
*The term “men who have sex with men” is used in CDC surveillance systems to indicate men who engage in sexual behavior that may spread Shigella; it does not indicate how people identify their sexuality.

Symptoms
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People with Shigella infection (shigellosis) usually start experiencing symptoms 1 to 2 days after contact with the germ. These symptoms include:

Diarrhea that can be bloody or prolonged (lasting more than 3 days)
Fever
Stomach pain
Feeling the need to pass stool (poop) even when the bowels are empty
Some people will not have any symptoms.

Symptoms usually last 5 to 7 days, but some people may experience symptoms anywhere from a few days to 4 or more weeks. In some cases, it may take several months before bowel habits (for example, how often someone passes stool and the consistency of their stool) are entirely normal.
When to Contact Your Doctor
People with diarrhea should contact their doctor if they have any of these symptoms:

Fever
Bloody or prolonged diarrhea
Severe stomach cramping or tenderness
Dehydration
People who are in poor health or whose immune systems are weakened from diseases (such as HIV) or medical treatments (such as chemotherapy for cancer) are more likely to get sick for a longer period of time. Contact your doctor if you are in one of these groups and have symptoms of Shigella infection (shigellosis).

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WNCtimes by Marjorie Farrington