– 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.