SFDPH Health Advisory: Increased Shigella Cases; Ciprofloxacin-Resistance Common December 22, 2014 Public Health, SF Dept of Public Health Ciprofloxacin-Resistance, SFDPH Health Advisory, Shigella 0 SFDPH has noted an increase in Shigella reports this December (37 cases as of 12/18/2014). Many isolates have been resistant to ciprofloxacin. A number of the cases have been in homeless and HIV-infected individuals and have resulted in hospitalization, although there have been no deaths or severe complications reported. Shigella infection can be subclinical, but typically causes watery or bloody diarrhea with abdominal pain, fever, and malaise. A small inoculum (10-200 organisms) is sufficient to cause infection, and spread occurs easily via the fecal-oral route. Sexual transmission is known to occur. Young children, the elderly, and HIV-infected individuals with CD4 count <200 are more likely to have severe symptoms including dehydration, bacteremia, and seizures. Although Shigella gastroenteritis is generally self-limited, lasting 5-7 days in an immunocompetent host, untreated individuals may shed the organism in stool for up to 6 weeks. Shortening the duration of shedding with antibiotics can reduce the risk of person-to-person spread. Due to growing antimicrobial resistance in both developing and developed countries, antibiotic susceptibility testing is essential. Actions Requested of All Clinicians: Suspect Shigella gastroenteritis in cases with compatible symptoms. Test with stool culture and order antimicrobial susceptibility testing. Tailor therapy based on results of susceptibility testing, recognizing that routine antimicrobial susceptibility tests for Shigella may not include some commonly available oral antibiotics. For isolates that are resistant to ciprofloxacin, azithromycin may be a reasonable oral treatment option, and ceftriaxone may be a reasonable parenteral treatment option. Report cases to SFDPH Communicable Disease Control Unit (CDCU) at (415) 554-2830. Inform patients that meticulous hand washing and avoiding fecal-oral exposure during sexual contact can decrease risk for infection. Click here for SFDPH's Health Advisory on Shigella, dated December 22, 2014. Comments are closed.
