Shigella infection and clinical symptoms

 Q: 34 years old male after returning from a trip abroad is admitted to ICU with severe hypovolemic shock, fever, severe diarrhea, and blood-stained stools. Patient is diagnosed with Shigella infection.  If the patient is responding to antibiotics, how quickly clinical symptoms should improve? (select one)

A) 1 -2 days

B) 5-7 days

Answer: A

The objective of this question is to highlight the massive worldwide problem of high resistance to antibiotics in Shigella infection. Shigella can be treated with a wide range of antibiotics including ciprofloxacin, ceftriaxone, azithromycin, trimethoprim-sulfamethoxazole, and ampicillin. Said that resistance to all the classes is high due to rampant and widespread use of antibiotics for any travelers' diarrhea. Many times resistance is reported simultaneously to more than 3 classes of antibiotics. 

One effective way to establish antibiotic efficiency is to gauge improvement in clinical symptoms. If sensitive to prescribed antibiotic, clinical symptoms improve very quickly in shigella infection. 

Aggressive hydration continues to be the most important aspect in such severe diarrhea.

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References:

1. Centers for Disease Control and Prevention. National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS). NARMS Now: Human data, Shigella, 2018. Available at: https://wwwn.cdc.gov/narmsnow/ (Accessed on November 1, 2021).

2. Ranjbar R, Farahani A. Shigella: Antibiotic-Resistance Mechanisms And New Horizons For Treatment. Infect Drug Resist. 2019;12:3137-3167. Published 2019 Oct 7. doi:10.2147/IDR.S219755 

3. Puzari M, Sharma M, Chetia P. Emergence of antibiotic resistant Shigella species: A matter of concern. J Infect Public Health. 2018 Jul-Aug;11(4):451-454. doi: 10.1016/j.jiph.2017.09.025. Epub 2017 Oct 20. PMID: 29066021.