Alert: Drug Resistant Strain of Shigella

Posted in Our Blog,Outbreaks & Recalls,Shigella on February 24, 2023

Alert: Drug resistant strain of Shigella!

The CDC has put out a new alert on Shigella and its latest strains being linked to resistances to antibiotics. Here is what we know about this scary turn of events:

Before we can wrap our heads around what the CDC is warning us about, we have to start with what Shigella (Shigellosis) is and how easily it gets transmitted. Shigella bacteria cause an infection called shigellosis. It is a bacterium that invades the intestine. There are four species of Shigella bacteria, Shigella dysenteriae, Shigella boydii, Shigella flexneri, and shigella sonnei, which is the most common strain we see in the United States. According to the CDC, Shigella causes an estimated 450,000 infections in the US each year.

How Are People Infected With This Drug Resistant Strain of Shigella?

This bacterial infection can be transmitted directly through person to person contact with someone who is already infected. You can also become sick with Shigella by ingesting contaminated drinking water or eating food that was prepared by someone who is sick with Shigella. Another way to get infected is through exposure to feces by changing diapers or through sexual contact with someone who has the infection.

Symptoms of Drug Resistant Strain of Shigella

People who have been exposed to this infection will experience some if not all of the following symptoms:

• Diarrhea (can be bloody)
• Fever
• Stomach pain
• Nausea and/or vomiting

A person exposed to Shigella usually will show symptoms about one to two days after exposure. Shigella infections can last from a few days or, sometimes, many weeks. In some instances, the person can be asymptomatic (doesn’t show any symptoms but can carry the bacteria in their stool). Because of this, the bacteria are transferred with no trouble to others. There are a few groups who are more likely to get Shigella infection, including: children 5 years or younger, travelers who go to places where sanitation is poor, and people who have weakened immune systems.

Who Is More at Risk for This Drug Resistant Strain of Shigella?

Those with a compromised immune system may have long-term complications or develop severe illnesses. Reactive arthritis, bloodstream infections, and HUS (Hemolytic uremic syndrome) can be prolonged effects that can arise from Shigella infection. If you have any prolonged symptoms, consult your doctor, and get a stool test to confirm. It is important to follow up with your doctor if you have been diagnosed with Shigella to prevent further health issues.

Although Shigella has been around for decades, it has commonly affected younger kids in compromised environments, such as schools and daycares. The CDC has noted a shift, now seeing the drug resistant strain affecting men who have sex with men, people with HIV, international travelers, and those living in homelessness. People infected by Shigella should drink plenty of fluids to avoid dehydration and exclude themselves from sexual activities. Typically, two antibiotics are available for patients who require them: ciprofloxacin and azithromycin. These antibiotics help reduce fever and diarrhea. For many years, these two antibiotics have tremendously helped patients who suffer from severe cases of Shigella. Alert! There was a 5%  increase since 2015, and a recent XDR Shigella species is resistant to 5 recommended drugs. They are seeing this in communities where antibiotic usage is high (2).

Drug Resistant Strain of Shigella Poses Global Threat

According to the World Health Organization, S. sonnei has earned its place as a priority organism for which new antimicrobials are urgently needed. Again, Alert! This is a problem, especially for those who need antibiotics in order to reduce other health issues. If no antibiotic is available to reduce severe diarrhea, it could unfortunately result in Hemolytic Uremic Syndrome (HUS). This is a rare but extremely serious disease that has an effect on the kidneys and blood clotting functions resulting in kidney failure.

It is important to note this alert because of how easily Shigellosis infection spreads. According to the article, “Currently, there are no data from clinical studies of treatment of XDR Shigella to inform recommendations for the optimal antimicrobial treatment of these infections. As such, CDC does not have recommendations for optimal antimicrobial treatment of XDR Shigella infection”. So, how are these people supposed to get better?

How to Reduce Your Risk

The following are some precautions that the CDC recommends people take in order to avoid getting infected:

• Wash your hands often. Most importantly before preparing or eating food and after using the restroom.
• Carefully change diapers. Be sure to clean up after any accidental leaks or spills from the diaper, immediately throw away the diaper in a lined garbage can and wash your and your child’s hands.
• Avoid swallowing water from ponds, lakes, or swimming pools.
• When traveling internationally, follow safe food and water habits.
• If you have been diagnosed, be mindful of spreading germs until you are cleared by your doctor.

To learn more, you can visit the agency’s website to inform yourself more about this infection. The CDC agency also wants healthcare professionals to report any cases of XDR variant of Shigella to the local and state health departments. Most importantly, if you are diagnosed with Shigella, avoid going to public places, especially healthcare, food services, or childcare facilities until you are no longer sick. The more alert we stay, the better our health can be.