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Drug-resistant Shigella found in Massachusetts

April 06, 2015

Superbugs and antibiotic resistance. It’s a story we’re hearing all too often in the news.

Now comes word from the Centers for Disease Control and Prevention (CDC) that international travelers are bringing a multidrug-resistant illness called Shigella to the United States and spreading it to others who have not traveled.

“Shigella is a bacterial illness known for causing severe gastroenteritis often accompanied by diarrhea, malaise, which we describe as ‘just not feeling right,’ and fever. It can be quite serious, particularly in the elderly,” said Dr. Niels Rathlev, chair of Emergency Medicine at Baystate Medical Center.

“Shigella is what we call a self-limiting illness, meaning one which usually resolves on its own with or without treatment. There are resistant strains of Shigella that can cause significant problems. So, patients who are not getting better despite being treated appropriately will need to be reevaluated by their physician,” he added.

Although diarrhea caused by Shigella typically goes away without treatment, people with mild illnesses are often treated with antibiotics to stop the diarrhea faster. What is concerning, noted Dr. Rathlev, is that CDC and public health partners investigated several recent clusters of shigellosis in Massachusetts, California and Pennsylvania and found that nearly 90 percent of the cases tested were resistant to ciprofloxacin (Cipro), the first choice to treat shigellosis among adults in the United States

He noted the “big problem” with the bacterial illness is that it can cause dehydration, where patients continue to lose bodily fluids through diarrhea and vomiting.

“They eventually find themselves in the emergency department where we treat them with intravenous replacement of fluids,” said Dr. Rathlev.

Shigella – spread through contaminated food and recreational water – can spread very quickly in groups like children in childcare facilities, homeless people and gay and bisexual men, as occurred in these recent outbreaks.

“To prevent the spread of Shigella, we recommend frequent hand-washing, not using the same toilet when someone in the house is ill with the bacteria, and not preparing food for others to eat when sick with the illness,” said Dr. Rathlev.

In the United States, most Shigella is already resistant to the antibiotics ampicillin and trimethoprim/sulfamethoxazole. Globally, Shigella resistance to Cipro is increasing. Cipro is often prescribed to people who travel internationally, in case they develop diarrhea while out of the United States.

According to the CDC, travelers to developing countries can take additional precautions to avoid diarrhea and minimize infection with resistant bacteria. Officials recommend choosing safe foods and beverages, such as food that is steaming hot and drinks from sealed containers (download CDC’s app “Can I Eat This?” to help you make safer food and beverage choices when you travel). The CDC recommends taking bismuth subsalicylate to prevent travelers’ diarrhea and treat it with over-the-counter drugs like bismuth subsalicylate or loperamide, but to try to reserve antibiotics for severe cases of travelers’ diarrhea.