CDC Warns That ‘Extensively Drug-Resistant Shigella’ Is on the Rise
The CDC is warning about a rise in extensively drug resistant Shigella.
The bacteria causes bloody diarrhea that can last for days.
The CDC did not specify a treatment that can help.
The Centers for Disease Control and Prevention has issued a health advisory to warn about an increase of a drug-resistant bacteria. According to the CDC, about 5% of Shigella infections reported to the agency were “extensively drug resistant,” compared to 0% in 2015.
The CDC warned that there are limited treatments for these strains of Shigella—and that it spreads easily. The CDC also noted that the extensively drug resistant strains of Shigella can even spread antimicrobial resistance genes to other bacteria that infect the intestines.
“Given these potentially serious public health concerns, CDC asks healthcare professionals to be vigilant about suspecting and reporting cases of extensively drug resistant Shigella infection to their local or state health department,” the warning reads.
While drug-resistant bacteria is on the rise in the U.S. (and the world), these strains of Shigella are particularly concerning because they’re resistant to a lot of treatments, says Thomas Russo, M.D., a professor and chief of infectious diseases at the University at Buffalo in New York. “These resistant strains of Shigella have been around for a while, but their prevalence is increasing,” Dr. Russo says. “All the usual antibiotics to treat Shigella just don’t work anymore.”
But what is Shigella, how does it spread, and who is the most at risk? Here’s what you need to know about this infectious bacteria.
What is Shigella?
Shigella is a bacteria that can cause an infection called shigellosis, according to the CDC. There are four species of Shigella: Shigella sonnei (the most common species in the United States), Shigella flexneri, Shigella boydii, and Shigella dysenteriae. According to the CDC’s warning, most of the extensively drug resistant forms of Shigella in the U.S. are Shigella sonnei (66%), followed by Shigella flexneri (34%).
How is Shigella spread?
Shigella is a fecal-oral disease, meaning you get it when bacteria from feces (aka poop) winds up in your mouth, says infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security. “It’s very infectious,” Dr. Russo says. “Just a very small dose can result in infection.
You can get infected with Shigella a slew of different ways. According to the CDC, those include:
Getting Shigella on your hands and then touching your mouth
Eating food prepared by someone with a Shigella infection
Swallowing water you swim or play in, like lake water or improperly treated swimming pool water
Swallowing contaminated drinking water, like water from a well that’s been contaminated with sewage or flood water
Exposure to poop during sexual contact with someone with a Shigella infection or who has recently recovered from a Shigella infection
The CDC notes that you can pick Shigella up from touching surfaces like toys, bathroom fixtures, diapers, and cleaning up after someone with Shigella uses the toilet.
Shigella symptoms
Shigella isn’t a fun illness to have. According to the CDC, most people will have the following symptoms:
Diarrhea that can be bloody
Diarrhea that lasts more than three days
Fever
Stomach pain
Feeling the need to poop even when you don’t have to
Symptoms of Shigella usually start one to two days after someone is infected and can last a week, the CDC says. It can even change how often you poop and the consistency of your poop for several months.
Ways to prevent Shigella
Anyone can get shigellosis, but there are certain groups of people who are more likely to get a Shigella infection, according to the CDC. Those include children under the age of five, along with their caregivers; travelers to places where food and water sanitation is poor; men who have sex with men; and people with weakened immune systems.
To lower the risk of getting infected, it’s important to follow good hand hygiene. “Particularly for parents of younger children, let’s emphasize the hand washing,” says William Schaffner, M.D., an infectious disease specialist and professor of medicine at the Vanderbilt University School of Medicine. That means washing your hands before preparing food and eating and after changing diapers.
It’s also important to try to avoid swallowing water from ponds, lakes, or untreated swimming pools, the CDC says. And, if you’re traveling internationally where sanitation may not be as good as it is in the U.S., Dr. Russo urges caution around drinking the tap water, eating raw fruits and vegetables without a peel, and ensuring any bottled water you drink was sealed before you opened it.
It’s also crucial to avoid having vaginal, anal, and oral sex with your partner for at least a week after they recover from diarrhea, the CDC says.
Is there a vaccine or treatment for Shigella?
There is no vaccine for Shigella, Dr. Adalja points out, and treatment is very limited. The extensively drug resistant strains of Shigella are resistant to a slew of antibiotics, including:
Azithromycin
Ciprofloxacin
Ceftriaxone
Trimethoprimsulfamethoxazole (TMP-SMX)
Ampicillin
The CDC even clearly says in the warning that it doesn’t have recommendations for “optimal antimicrobial treatment” for people who are infected with these Shigella strains. “The treatments are very minimal and poor,” says Alfred Tallia, M.D., M.P.H., professor and chair of the Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical Center. Instead, he says, treatment is usually supportive, which means someone may be hospitalized and given IV fluids to try to help prevent them from getting dehydrated. “It’s a real dilemma,” he says.
Dr. Adalja agrees. “This strain, because of its resistance profile, is extremely challenging to craft an antibiotic regimen for,” he says.
William Schaffner, M.D., an infectious disease specialist and professor of medicine at the Vanderbilt University School of Medicine, warns that these extensively drug resistant strains of Shigella are “creeping up in cases” in the U.S. “It reinforces, among other things, that in every circumstance—whether shigella or not—we should all be careful of how we use antibiotics,” he says. Overusing antibiotics for illnesses where they aren’t needed allows these resistant bacteria to surface, spread, and thrive, he points out.
If you’re an otherwise healthy person, Dr. Russo says you shouldn’t stress about contracting an extensively drug resistant strain of Shigella. “In those cases, hydration can usually get most people through,” he says. But if you’re immunocompromised or have young or elderly people in your household, it’s a good idea to practice careful hand hygiene to minimize the odds someone in your family will get sick, Dr. Russo says.
Overall, experts warn that these cases of extensively drug resistant strain Shigella are on the rise. “Shigella, from time to time in the past, has developed some resistance and then it’s gotten more susceptible again,” Dr. Schaffner says. “But, once again, we’ve gotten a more resistant strain out there.”
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