Shigellosis: Causes, Symptoms, Treatment and Cost

Shigella is a genus of bacteria that causes the contagious illness shigellosis. It is transferred from person to person by contaminated food, drink, or contact with an infected person and mostly affects the intestines.

• Classical Shigellosis: This is the most common form of shigellosis, which is characterised by a watery or bloody diarrhoea, vomiting, and fever.
• Asymptomatic Shigellosis: This form of shigellosis is relatively milder and may be asymptomatic or have only minor symptoms such as mild abdominal cramps and/or bloating.
• Infantile Shigellosis: Infants with this type of shigellosis are more likely to become severely dehydrated due to frequent vomiting and low urine output. Severe diarrhoea that is bloody or watery, fever, stomach discomfort, and appetite loss are possible symptoms.
• Increased Reactive Shigelloides (ERS) Syndrome: This disorder can cause inflammation in multiple organs resulting in abdominal discomfort, nausea, headache and joint pain. Additionally, it can lead to kidney failure or anaemia if left untreated for long periods of time.

• The four primary Shigella bacterial species that cause shigellosis are Shigella flexneri, Shigella sonnei, Shigella boydii, and Shigella dysenteriae.
• The bacteria are transmitted by coming into touch with an infected person, contaminated water or food, or both. The risk of infection might rise as a result of poor hygiene habits.
• Unvaccinated individuals or those with weakened immune systems are more likely to develop shigellosis if exposed to the bacteria, as well as children in daycare centres, people who travel to endemic countries, those without access to safe drinking water and wastewater treatment services, male homosexual couples and intravenous drug users.

• Cramping and soreness in the abdomen.
• Fever
• Diarrhoea (frequently with blood, pus, or mucous) (often with blood, pus, or mucus).
• Nausea, vomiting, and appetite loss
• Skin rashes might happen in extreme circumstances.

Before, during, and after handling food, after using the restroom or changing a baby's diaper, as well as before and after providing care for someone who is ill, wash your hands thoroughly and frequently.

• Cook all food properly: Make sure meat, fish and eggs are cooked until they are steaming hot all the way through.
• Drink only boiled or bottled water: Boil tap or well water for at least one minute before drinking it.
• Practise safe sex: Always use condoms when having sex in order to prevent infections that are passed on through bodily fluid contact like Shigellosis.
• Practise good hygiene: After bathroom visits, change diapers frequently and properly dispose of contaminated materials such as wipes, napkins and diapers to help reduce the spread of illness associated with Shigellosis infection.

• Physical examination:During a physical exam, the doctor will observe the patient's general health and check for any signs of dehydration. They may also check the patient's abdomen for tenderness or distention and do a rectal examination to look for inflamed or bloody stool.
• Stool test:A stool sample will be collected and tested to detect the bacteria that cause shigellosis.
• Blood test:Blood tests may be taken to look for white blood cells which indicate infection
• Sigmoidoscopy or Colonoscopy:These are special tests used to look in the rectum and colon which provide better diagnosis and help rule out other conditions such as inflammatory bowel disease.
• Urine test:Urine samples are also taken in order to detect any signs of infection in the bladder or kidneys, which can occur from Shigellosis.

• The most common complication of shigellosis is dehydration, caused by persistent diarrhoea.
• Fever, stomach ache, convulsions, renal failure, and death are unusual but possible side effects as well.
• Shigellosis may also cause inflammation of the colon (colitis), reactive arthritis, liver damage, endotoxic shock from bacteria toxin in the blood and bacteremia or sepsis.
• Shigellosis can result in serious consequences more frequently in those with compromised immune systems than in those with otherwise robust immune systems.

• Consume buttermilk or Achari Pudina Lassi (mint flavoured yoghurts shake) to soothe stomach inflammation and aid in digestion.
• Have roasted coriander powder mixed with 2-3 tablespoons of buttermilk to relieve abdominal discomfort and support the digestive system.
• Make a paste using garlic, cumin, rock salt, jaggery and lemon juice and consume it regularly for symptomatic cure.
• Boil 30 grams methi seeds in half a litre of water, add some honey and drink it twice daily to reduce severity of diarrhoea symptoms.
• Drink herbal teas prepared from cumin, ajwain and pepper to detoxify the gut and improve digestion process naturally.

• In cases of shigellosis, it is important to follow a diet that includes nutritious foods that are easy to digest and are not likely to aggravate the condition.
• Maintain adequate hydration by drinking plenty of fluids throughout the day to avoid getting dehydrated and other complications of shigellosis.
• Consume warm, cooked foods such as soups or porridges with mild spices like lightly salted rice and lentils.
• Opt for well-cooked vegetables instead of raw ones like boiled potatoes, carrots, beets, sweet potatoes and squash which may have therapeutic benefits in case of gastrointestinal infection relief during shigellosis treatment phase.

• Undercooked or raw meat and fish.
• Produce that hasn't been washed.
• Foods manufactured from unpasteurized milk, such as soft cheeses, or unpasteurized milk.
• Leftover food that has been stored without proper refrigeration or reheated improperly.
• Contaminated foods not cooked to proper temperature.
• Any food prepared or handled by someone with shigellosis.

• Rest:Rest is important to facilitate the body to heal and prevent dehydration.
• Fluid Replacement:Fluids are essential for maintaining electrolyte balance and should be replaced as needed with oral rehydration solutions.

  Surgical options for Shigellosis are generally not preferred, as the condition can be effectively managed with medications. However, in certain cases, a surgery may be recommended. These may include:

• Performing a bowel resection to remove infected parts of the intestine:If the infection extends beyond the bowel wall, a portion of the intestine may need to be removed to prevent any further spread of infection.
• Intestinal perforation repair:In cases where an individual experiences a life-threatening complication such as an intestinal perforation—a hole in the intestine—surgery will be required to close it up.
• Appendectomy or Gallbladder removal:There are some instances where shigella bacteria can cause appendicitis or cholecystitis (inflammation of the gallbladder). In such cases, an appendectomy or gallbladder removal may also be required to treat these conditions.

For treatment of Shigellosis, it is recommended to consult a doctor specialised in infectious diseases such as an infectious disease specialist. They will be able to diagnose the condition and prescribe the necessary medications.

• Antibiotics:Commonly used antibiotics for shigellosis include ciprofloxacin, ampicillin, and trimethoprim-sulfamethoxazole.
• Fluoroquinolones:Moxifloxacin and levofloxacin are sometimes used to treat shigellosis in adults, but should not be used in children due to the risk of serious adverse events.
• Loperamide (Imodium):This is an antidiarrheal drug that can help reduce the frequency of stools and relieve cramping but should be used with caution due to the potential for serious adverse effects in children or those at higher risk for complications from shigellosis such as pregnant women, people with HIV/AIDS, or people taking immunosuppressant drugs.
• Probiotics:Studies have found that probiotic supplements may help reduce the duration and severity of diarrhoea associated with shigellosis by restoring normal gut flora balance, however further research is needed before they can be recommended as a standard treatment option.

Recovery from Shigellosis depends on the severity of the illness and the promptness of treatment. Generally, mild cases can recover in 5-7 days with antibiotics. In more severe cases, symptoms may take up to a few weeks to resolve with antibiotics, hydration and rest.

The cure for Shigellosis typically has long-lasting effects. While there is no cure for the infection, successful completion of antibiotic therapy can eradicate the bacteria responsible for causing the infection. This prevents a relapse of symptoms associated with Shigellosis such as fever, abdominal pain and bloody diarrhoea.

• After treatment, it's important to take all medications as prescribed by the doctor. This should include antibiotics, fluids and electrolytes, and probiotics.
• It's important to drink plenty of fluids (water or other clear liquids) to replenish lost fluids due to vomiting and diarrhoea.
• Getting rest, increasing dietary fibre intake, avoiding caffeine and alcohol for a few days are also recommended for post-treatment guidelines for shigellosis.
• Post-treatment guidelines also suggest washing hands thoroughly with soap and water before meals and after using the bathroom and avoid sharing eating utensils or drinking from other people's glasses or dishes until fully recovered from the infection.
• Avoid contact with those who have shigellosis until they have completed their full course of treatment as well as sexual contact with partners if in a sexually-active relationship; both should be completely treated first before engaging in any kind of sexual activity again as shigellosis is highly contagious through sexual contact.

Shigellosis treatment costs in India vary depending on the severity of the condition and the necessary therapies.Generally, a mild shigellosis case may require only supportive care and cost approximately 300-500 INR (4-7 USD).

A more severe case may call for antibiotics, and hospitalisation, making the total expense go up to 5000-10,000 INR (68 - 140 USD). Additionally, lab tests such as complete blood count and stool culture may also need to be conducted, adding to the overall costs.

• Common side effects of treatment of Shigellosis include nausea, vomiting, diarrhoea, cramping and abdominal pain.
• Fever, chills, a rash, and joint discomfort are some uncommon but more severe adverse effects.
• In some cases, the complications can be more severe and require hospitalisation which may include dehydration or sepsis.

Shigellosis complications can lead to problems including 'dehydration, colitis, liver damage,' for which treatment regimens might last from a few months to years depending on the severity of the condition. If you are experiencing any of these problems, you should see a doctor in your area right once.