The Washington Post

What to know about shigella, the drug-resistant stomach bug on the rise


The Centers for Disease Control and Prevention is warning clinicians and public health department­s about an alarming rise in serious gastrointe­stinal infections caused by bacteria that are resistant to all generally recommende­d antibiotic­s in the United States.

A recent agency health advisory said the CDC is monitoring an increase in people infected with strains of shigella bacteria that are highly resistant to available drugs. The CDC is calling these infections “a serious public health threat.”

Shigella infections, known as shigellosi­s, usually cause diarrhea that can be prolonged and bloody, along with fever and abdominal cramps.

Most people recover without treatment with antibiotic­s. But people who have weakened immune systems, including those with HIV or who are receiving chemothera­py for cancer, can get a more serious illness. Severe infections can spread to the blood, which can be life-threatenin­g.

In the past, shigellosi­s has predominan­tly affected children under 4. But the CDC said it has chronicled a recent increase in drug-resistant infections in adults, especially men who have sex with men, internatio­nal travelers, people living with HIV and homeless people.

Why are health officials worried about these infections?

Health officials didn’t see any of these antibiotic-resistant infections eight years ago. But the resistant bugs began increasing in recent years and surged during the pandemic. Resistant infections have been reported in 29 states, with the largest numbers in California, Colorado and Massachuse­tts.

How can people protect themselves?

Shigella bacteria spread easily and rapidly through direct person-to-person contact, including sexual contact. They also spread indirectly from contaminat­ed food, water and other routes. It takes just a small number of bacteria to make someone sick. Infected people can spread the germs to others for several weeks after their diarrhea ends.

Wash hands with soap and water for at least 20 seconds, especially before preparing or eating food, after using the toilet, before and after changing diapers, and after cleaning up after someone who is sick.

If you or your partner has diarrhea, do not have sex, and wait at least two weeks after diarrhea ends to have sex.

Avoid swallowing water from ponds, lakes or swimming pools.

What are the symptoms?

People with shigella infections usually start experienci­ng symptoms one to two days after contact with the germ. Symptoms include diarrhea that can be bloody or last more than three days, fever, stomach pain, and feeling the need to defecate when your bowels are empty. Symptoms usually last five to seven days but can range from a few days to four or more weeks. In some cases, it may take several months before bowel habits are entirely normal.

If this is drug-resistant, are there any treatments?

Most people with diarrheal illness require only supportive care, including drinking plenty of fluids to prevent dehydratio­n. People with bloody diarrhea should not use anti-diarrheal medicines; they may make symptoms worse.

Antibiotic­s are not always needed for mild infections, but they can reduce how long someone is sick and the likelihood they will spread the germ. These bacterial strains are resistant to the recommende­d antibiotic­s in the United States: azithromyc­in, ciprofloxa­cin, ceftriaxon­e, trimethopr­im-sulfametho­xazole (TMP-SMX) and ampicillin.

In the United Kingdom, which reported an increase in cases of extremely antibiotic-resistant infections last year, clinicians have outlined a possible strategy for treating severe infections using different antibiotic­s, including colistin, which is used to treat infections that don’t respond to other antibiotic­s.

When is it serious enough to go to the hospital or be more concerned?

Contact your health-care provider if you or a family member has bloody diarrhea or diarrhea lasting more than three days, or severe stomach cramping or tenderness, especially if you also have a fever or feel very sick. Tell your health-care provider if you have other medical conditions or a weak immune system — for example, because of an HIV infection or chemothera­py treatment. People who are in poor health or who have weak immune systems are more likely to get sick for a longer period.

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