Shigellosis

 

– There are four subgroups of Shigella S. flexneri, S. boydii, S. sonnei and S. dysenteriae.

S. dysenteriae type 1 (Sd1) is the only strain that causes large scale epidemics. It is that which has the highest fatality (up 10%).

– Ciprofloxacin is currently the only effective treatment. It is therefore essential to avoid the emergence of resistance.

Clinical signs:

Bloody diarrhea with or without fever, abdominal pain and rectal often violent.

Patients responding to at least one of the following criteria are at high risk of death:

– Signs of severity:

• fever higher than 38.5 ° C

• malnutrition (<80% of the median)

• severe dehydration

• confusion, seizures or coma

– Age groups at risk: • Children under 5 years

• adult over 50 years

Treatment:

– Antibiotic:

• First-line, ciprofloxacin PO

Children: 30 mg / kg / day in 2 divided doses for 3 days

Adult: 1 g / day in 2 divided doses for 3 days

• pregnant women, ciprofloxacin is in principle against-indicated, prefer ceftriaxone IM: 1 g / once daily for 3 to 5 days

Amoxicillin is ineffective in vivo. The use of nalidixic acid favors the emergence of resistance to ciprofloxacin.

– In case of pain:

hyoscine butylbromide PO

Children 6 to 12 years: 10 mg to be repeated every 8 hours if necessary

Adult: 10 to 20 mg to be repeated every 8 hours if necessary

All opioid analgesics should be avoided because they slow transit.

– Support Treatment:

• nutrition: all patients should receive supplemental nutrition: 2500 kcal / day for inpatients 1000 kcal / day for outpatients

Children already in nutritional centers should be isolated.

• rehydration: systematic administration of ORS.

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