– 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.
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
• 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.