Clinical Presentation and Diagnosis of Shigellosis

• Biphasic illness

• Early—high fever, watery diarrhea without blood

• Later—after approximately 48 hours, colitis develops with urgency, tenesmus, and dysentery.

• More frequent small-volume stools ("fractional stools")

• Abdominal cramping

• Major complications of shigellosis include

• Proctitis or rectal prolapse (infants and young children)

• Toxic megacolon (primarily in the setting of S. dysenteriae 1 infection)

• Intestinal obstruction

• Colonic perforation

• Bacteremia (more common in children)

• Metabolic disturbances

• Leukemoid reaction

• Neurologic disease

• Reactive arthritis or Reiter's syndrome

• Hemolytic-uremic syndrome (HUS)

• Microscopic examination of stool is extremely useful and reveals multiple polymorphonuclear leukocytes and red blood cells (RBCs). Diagnosis is usually confirmed by stool culture

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