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Symptoms

People who are sick from Shigella infection usually start experiencing symptoms 1 to 2 days after contact with the germ. Symptoms of shigellosis include:

  • Diarrhea (sometimes bloody)
  • Fever
  • Stomach pain
  • Feeling the need to pass stool [poop] even when the bowels are empty

Some people with shigellosis 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 healthcare provider if they have any of these symptoms:

  • Fever
  • Bloody diarrhea
  • Severe stomach cramping or tenderness
  • Dehydrated
  • Feel very sick.

People who are in poor health or who have immune systems weakened from diseases such as HIV/AIDS, or chemoterhapy for cancer, are more likely to get sick for a longer period of time if they have shigellosis. They should contact their healthcare provider if they think they have shigellosis to determine the best course of treatment.

Rare Symptoms from Shigella Infections

Post-infectious arthritis

About 2% 1-4 of people who are infected with the type of Shigella called Shigella flexneri will experience post-infectious arthritis, which causes joint pains, eye irritation, and painful urination. The syndrome only occurs in people who have specific genetic makeup that puts them at risk 1,5-7. It can last for months or years, and can lead to chronic arthritis. Post-infectious arthritis usually does not occur in people who get sick from the other types of Shigella, called S. sonnei 8,9S. boydii, or S. dystenteriae 10.

References
  1. Simon DG, Kaslow RA, Rosenbaum J, Kaye RL, Calin A. Reiter’s syndrome following epidemic shigellosis. J Rheumatol. 1981;8(6):969-73.
  2. Noer HR. An “experimental” epidemic of Reiter’s Syndrome. 1966;198(7):693-8.
  3. Finch M, Rodey G, Lawrence D, Blake P. Epidemic Reiter’s syndrome following an outbreak of shigellosis. Eur J Epidemiol. 1986;2(1):26-30.
  4. Van Bohemen CG, Lionarons RJ, van Bodegom P, Dinant HJ, Landheer JE, Nabbe AJ, Grumet FC, Zanen HC. Susceptibility and HLA-B27 in post-dysenteric arthropathies. 1985;56(2):377-9.
  5. American Academy of Pediatrics. Red Book: Report of the Committee on Infectious Diseases. 2012. 645-647.
  6. Morse HG, Rate RG, Bonnell MD, Kuberski TT. Reiter’s syndrome in a five-year-old girl. Arthritis Rheum. 1980;23(8):960-1.
  7. Hannu T, Mattila L, Siitonen A, Leirisalo-Repo M. Reactive arthritis attributable to Shigella infection: a clinical and epidemiological nationwide study. Ann Rheum Dis. 2005;64(4):594-8.
  8. Lauhio A, Lahdevirta J, Janes R, Kontiainen S, Repo H. Reactive arthritis associated with Shigella sonnei Arthritis. Rheum. 1988;31(9):1190-3.
  9. Chen M, Delpech V, O’Sullivan B, Donovan B. Reactive arthritis associated with Shigella sonnei. Int J STD AIDS. 2002;13(2):135-6.
  10. Mazumder RN, Salam MA, Ali M, Bhattacharya MK. Reactive arthritis associated with Shigella dysenteriae type 1 infection. J Diarrhoeal Dis Res. 1997;15(1):21-4.

Bloodstream infections-Rare

People with shigellosis can get bloodstream infections caused by Shigella germs or by other germs in the gut that get into the bloodstream when shigellosis damages intestinal linings. Bloodstream infections are most common among patients with weakened immune systems, such as those with HIV, cancer, or severe malnutrition.1, 2, 3

References
  1. American Academy of Pediatrics. Red Book: Report of the Committee on Infectious Diseases. 2012. 645-647.
  2. Morduchowicz G, Huminer D, Siegman-Igra Y, Drucker M, Block CS, Pitlik SD. Shigella bacteremia in adults. A report of five cases and review of the literature. Arch Intern Med. 1987;147(11):2034-7.
  3. Appannanavar SB, Goyal K, Garg R, Ray P, Rathi M, Taneja N. Shigellemia in a post renal transplant patient: a case report and literature review. J Infect Dev Ctries. 2014;8(2):237-9.

Seizures

A few young children with shigellosis have had generalized seizures, but the seizures usually go away without treatment. Children with shigellosis who experience seizures typically have a high fever or abnormal blood electrolytes (salts). However, healthcare professionals do not know why the seizures occur 1,2-6.

References
  1. American Academy of Pediatrics. Red Book: Report of the Committee on Infectious Diseases. 2012. 645-647.
  2. Goldberg EM, Balamuth F, Desrochers CR, Mittal MK. Seizure and altered mental status in a 12-year-old child with Shigella sonnei. Pediatr Emerg Care. 2011;27(2):135-7.
  3. Lahat E, Katz Y, Bistritzer T, Eshel G, Aladjem M. Recurrent seizures in children with Shigella-associated convulsions. Ann Neurol. 1990;28(3):393-5.
  4. Khan WA, Dhar U, Salam MA, Griffiths JK, Rand W, Bennish ML. Central nervous system manifestations of childhood shigellosis: prevalence, risk factors, and outcome. 1999;103(2):E18.
  5. Galanakis E, Tzoufi M, Charisi M, Levidiotou S, Papadopoulou ZL. Rate of seizures in children with shigellosis. Acta Paediatr. 2002;91(1):101-2.
  6. Shamsizadeh A, Nikfar R, Bavarsadian E. Neurological manifestations of shigellosis in children in southwestern Iran. Pediatr Int. 2012;54(1):127-30.

Hemolytic-uremic syndrome

Hemolytic-uremic syndrome (HUS) occurs when bacteria enter the digestive system and produce a toxin that destroys red blood cells. Patients with HUS often have bloody diarrhea. The syndrome can be deadly. In patients with shigellosis, HUS is associated with Shiga toxin-producing Shigella, most often Shigella dystenteriae 1,2-4.

References
  1. American Academy of Pediatrics. Red Book: Report of the Committee on Infectious Diseases. 2012. 645-647.
  2. Butler T. Haemolytic uraemic syndrome during shigellosis. Trans R Soc Trop Med Hyg. 2012;106(7):395-9.
  3. Rahaman MM, Greenough WB, 3rd. Shigellosis and haemolytic uraemic syndrome. Lancet. 1978;1(8072):1051.
  4. Bloom PD, MacPhail AP, Klugman K, Louw M, Raubenheimer C, Fischer C. Haemolytic-uraemic syndrome in adults with resistant Shigella dysenteriae type I. Lancet. 1994;344(8916):206.

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