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 sACigns and symptoms of Shigellosis?
How is the treatment of Shigellosis?
References
Wells BG, DiPiro J, Schwinghammer T (2013),
Pharmacotherapy Handbook
(6
th
Ed). New York, NY: McGraw-Hill.
DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):
Pharmacotherapy: A Pathophysiologic Approach
(7
th
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
(7
th
ed): New York, NY: McGraw-Hill.
END
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