Shigellosis / Bacillary Dysentery / Marlow Syndrome

Shigellosis also known as bacillary dysentery or Marlow syndrome, in its most severe manifestation, is a food borne illness caused by infection by bacteria of the genus shigella.

 Shigella species such as shigella dysenteriae, shigella flexeri, shigella sonnei, shigella boydii are aerobic, non motile, glucose-fermenting, gram-negative rods that are highly contagious, causing diarrhea after ingestion of a few as 180 organsims.

Shigella species causes damage to human body by 2 mechansims, as follows: 

Invasion of the colonic epithelium which is dependent on a plasmid-mediated virulence factor

>Production of enterotoxin which is not essential for colitis but enhances virulence.

The organism is spread by fecal-oral contact via infected food and water, during travel or in long-term care facilities, day care centers or nursing homes.

[/expand]Age/sex prevalence of Shigellosis /Bacillary dysentery/Marlow syndrome

Shigella can affect individuals at any age. Shigellosis is most common in children aged 6 months to 5 years.
No sexual predilections exist in shigella infections.

Races affected by Shigellosis /Bacillary dysentery/Marlow syndrome

Shigellosis can occur in individuals of any race.
Causes of Shigellosis /Bacillary dysentery/Marlow syndrome
The major causative organisms for shigellosis are as follows
• S. sonnei and S flexneri are cause of shigellosis in 90% of cases.
• S dysenteriae has produced epidemic shigellosis.

Shigellosis /Bacillary dysentery/Marlow syndrome sign and symptoms

Symptoms presented by patients of shigellosis are as follows
• Mild abdominal discomfort.
• Full blown dysentery characterized by
Cramps
Diarrhea
Fever
Vomiting
Blood
Pus
Mucus in stools
Tenesmus
• Dehydration
• Lower abdominal tenderness
• Lower abdominal bowel sounds
• Infection of shigellosis is usually associated with
Mucosal ulceration
Rectal bleeding
Hemolytic uremic syndrome

Investigations of Shigellosis /Bacillary dysentery/Marlow syndrome

Laboratory tests to be done are as follows
• Fecal leukocytes and erythrocytes
• Mildly elevated hematocrit
• Serum sodium
• Urea nitrogen
• Positive findings on stool culture of fresh fecal specimen
• Blood cultures
Histologic findings are as follows
• Hemorrhage
• Ulcers
• Mucous depletion
• Occasional crypt abscesses

Treatment of Shigellosis /Bacillary dysentery/Marlow syndrome

Treatment can be done on following basis
• Replacing fluids and salt lost because of diarrhea
• Oral replacement
• Antibiotics
• Antimotility agents should be avoided

Complications of Shigellosis /Bacillary dysentery/Marlow syndrome

Chronic carriers of shigellosis are unusual
Prognosis of Shigellosis /Bacillary dysentery/Marlow syndrome
Postinfection carriage is generally less than 3-4 weeks.
Mild cramps and diarrhea may continue for many days to weeks after treatment of shigellosis.

Differential diagnosis of Shigellosis /Bacillary
dysentery/Marlow syndrome

• Viral gastroenteritis
• Bacterial gastroenteritis
• Salmonellosis
• Ulcerative colitis
• Yersinia enterocolitica
• Cholera
• Clostridium difficile colitis
• Colon cancer
• Crohn disease
• Cryptosporidiosis
• Pseudomembranous colitis
• Amebiasis
• Campylobacter infections
• Escherichia coli infections

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