The CDC is warning the public of an increase of drug-resistant strains of a bacteria called Shigella.
Shigella bacteria cause an infection called shigellosis. When severe, the infection can be life-threatening. Some symptoms include severe diarrhea, fever and stomach pain. Shigella can spread easily from one person to another and it only takes a small amount to make someone sick.
The CDC said extensively drug-resistant (XDR) strains of Shigella can spread antimicrobial resistance genes to other enteric bacteria.
“Given these potentially serious public health concerns, CDC asks healthcare professionals to be vigilant about suspecting and reporting cases of XDR Shigella infection to their local or state health department and educating patients and communities at increased risk about prevention and transmission. "
The percentage of infections from drug-resistant strains of Shigella increased from zero in 2015 to 5% in 2022, according to the CDC.
In general, there are nearly 3 million antimicrobial-resistant infections each year in the United States. The CDC estimates that more than 35,000 people die as a result.
The United Nations estimates that globally up to 10 million people could die each year by 2050 due to anti-microbial resistance.
What are the symptoms of shigellosis?
According to the CDC, symptoms usually start one to two days after infection and last seven days. In some cases, bowel habits do not return to normal for several months.
Most people with a Shigella infection experience the following symptoms:
- 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
How does Shigella spread?
Shigella spreads very easily and it just takes a small number of bacteria to make someone sick. People with a Shigella infection can continue to spread the infection to others several weeks after their diarrhea ends.
People become infected by swallowing Shigella. The CDC said Shigella can get into your mouth in some of the following ways; when you touch something with Shigella on it and then touch your mouth; by eating food prepared by someone with Shigella; swallowing contaminated drinking water or water people swim and play in; or being exposed to poop during sexual contact with someone who was infected or recently recovered.
How is a Shigella infection diagnosed?
Doctors can order laboratory tests to identify Shigella germs in the stool of an infected person.
There are many types of germs that cause diarrhea. The CDC said knowing which germ is causing the illness is important for healthcare providers to offer appropriate treatment.
How is a Shigella infection treated?
People who have shigellosis usually get better on their own within five to seven days.
People with a mild illness will likely only need fluids and rest. Bismuth subsalicylate (Pepto-Bismol) might help with symptoms.
People should not use medications that cause the gut to slow down and interfere with the way the body digests food. Those medications include loperamide (for example, Imodium) or diphenoxylate with atropine (for example, Lomotil).
Doctors might prescribe antibiotics for people with severe cases to help them get better faster. But some antibiotics are not effective against certain types of Shigella. Your doctor might want to order a lab test to determine which antibiotics are more likely to work.
You should call your doctor if you don’t get better within a couple of days after starting antibiotics. They might need to do more tests or try a different type of antibiotic.
What to know about drug-resistant Shigella
Antibiotics may not be effective for treating some Shigella infections because of antimicrobial resistance.
Antimicrobial resistance happens when germs develop the ability to defeat the drugs meant to kill them. Because of that, the germs are not killed and continue to grow.
If Shigella bacteria are resistant healthcare providers might need to prescribe alternative drugs. Those drugs might be less effective and may needed to be given through a vein (IV) instead of by mouth. The drugs also might be more toxic and more expensive.
Recommended antibiotics for severe infections include fluoroquinolones, azithromycin, and ceftriaxone. The CDC said any use of antibiotics can cause resistance. People should only use antibiotics when absolutely necessary.
How to protect yourself from Shigella
The CDC recommends following these tips to reduce your chances of getting sick from Shigella:
- Carefully washing your hands with soap and water during key times:
- Before preparing food and eating.
- After changing a diaper or helping to clean another person who has pooped.
- Do not prepare food for others if you have shigellosis and wash your hands carefully after you’ve recovered.
- If you care for a child in diapers who has shigellosis, promptly throw away the soiled diapers in a covered, lined garbage can. Wash your hands and the child’s hands carefully with soap and water right after changing the diapers. Clean up any leaks or spills of diaper contents immediately.
- Avoid swallowing water from ponds, lakes, or untreated swimming pools.
- When traveling internationally, stick to safe eating and drinking habits, and wash hands often with soap and water.
- Avoid having sex (vaginal, anal, and oral) for one week after your partner recovers from diarrhea. Because Shigella germs may be in stool for several weeks, follow safe sexual practices, or ideally avoid having sex, for several weeks after your partner has recovered.
Who is most likely to get shigellosis?
According to the CDC, children younger than five years old are most likely to get shigellosis, but people of all ages are at risk of getting the disease. Many shigellosis outbreaks occur in daycare settings and schools. Infection commonly spreads from young children to their family because the bacteria spreads so easily.
Travelers to places where water and food may be unsafe are also 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.
Gay, bisexual and other men who have sex with men are among the groups at high risk for Shigella infection, according to the CDC.
People with weakened immune systems because of illnesses, conditions or medical treatments are more at risk for serious illness. A severe Shigella infection can spread into the blood, which can be life-threatening.