Session 30-Pharmacotherapy of Shigellosis

PST 06106
Basic Pharmacotherapy
Session 30: Pharmacotherapy of Shigellosis
Learning objectives
By the end of this session students are expected to be able to:
• Define shigellosis
• Explain pathophysiology of shigellosis
• Explain the clinical presentation of shigellosis
• Outline diagnosis of shigellosis
• Describe pharmacological treatment of shigellosis
• Describe the monitoring of shigellosis therapy
Activity: Buzzing
 What is Shigellosis?
Definition of Shigellosis
Shigellosis
• Shigellosis is spread by means of fecal-oral, by ingestion of
contaminated food and water and it leads to bacillary dysentery.
Pathophysiology of shigellosis
• The source of infection is the feces of infected people or convalescent
carriers; humans are the only natural reservoir for Shigella.
• Direct spread is by the fecal-oral route. Indirect spread is by
contaminated food and fomites.
• Flies serve as vectors.
• Because Shigella is relatively resistant to gastric acid, ingestion of as
few as 10 to 100 organisms can cause disease.
Pathophysiology of shigellosis Cont….
• Shigella organisms penetrate the mucosa of the colon, causing mucus
secretion, hyperemia, leukocytic infiltration, edema, and often superficial
mucosal ulcerations.
• Shigella dysenteriae type 1 (commonly present in travelers returning
from endemic areas) produces Shiga toxin, which causes marked watery
diarrhea and sometimes hemolytic-uremic syndrome(HUS)
Clinical Presentation and Diagnosis of
Shigellosis
Signs and Symptoms
• Acute abdominal cramping, high-grade fever, emesis and large-
volume watery diarrhea,
• Tenesmus, urgency, fecal incontinence, mucoid bloody diarrhea,
• Severe headache, lethargy, meningismus, delirium and convulsions,
• Hemolytic uremic syndrome (HUS),
• microangiopathic hemolytic anemia, thrombocytopenia, and renal
failure,
• Profound dehydration and hypoglycemia
Clinical Presentation and Diagnosis of
Shigellosis Cont…
Diagnosis
• Laboratory evidence of microscopic isolation of the bacteria from
stool or rectal swabs specimens OR
• Stool culture for suspected cases in early course of infection OR
• An enzyme immunoassay (ELISA) for shiga toxin detection in stool
for S. dysenteriae type-1.
Activity: Small Group Discussion
• What is the treatment of Shigellosis?

Pharmacological treatment of Shigellosis
• Treatment
• Ciprofloxacin (PO) 500mg 12 hourly for 5 days OR
• Nalidixic acid (PO) 1000mg 6 hourly for 7 days OR
• Erythromycin (PO) 250mg 6 hourly for 5 days
Monitoring of Shigellosis Therapy
• It is important to monitor for resolution of the symtoms, adherence to

medicines and adverse drug reactions and severe side effects; in case
of any they should be reported and addressed accordingly
Key Points
• Shigella infection (shigellosis) is an intestinal disease caused by a

family of bacteria known as shigella.
• The main sign of shigella infection is diarrhea, which often is bloody.
• Shigella can be passed through direct contact with the bacteria in the
stool.
• Shigella infection usually clears up without complications, although
chemotherapy may be needed to some patients
• It may take weeks or months before the bowel habits return to normal.
Evaluation
• What is Shigellosis?
• What is the pathophysiology of Shigellosis?
• What are the signs and symptoms of Shigellosis?
• How is the treatment of Shigellosis?
References
• Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6th
Ed). New York, NY: McGraw-Hill.
• DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):
Pharmacotherapy: A Pathophysiologic Approach (7th ed): New York, NY: McGraw-
Hill.
• Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011) Principles
& Practice Study Guide: A Case-Based Care Plan Approach: New York, NY:
McGraw-Hill.
• Schwinghammer TL, Koehler JM (2009) Pharmacotherapy Casebook: A Patient-
Focused Approach (7th ed): New York, NY: McGraw-Hill.
END

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PST 06106

• What is the treatment of Shigellosis?

• It is important to monitor for resolution of the symtoms, adherence to

• Shigella infection (shigellosis) is an intestinal disease caused by a

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