Sharq Elneil College School of Medical Laboratory Sciences Department of Microbiology Medical Bacteriology course

shigella
U.Mahadi Hassan Mahmoud
mahadi2010sd@yahoo.com Bsc, Msc, MIBMS Microbiology

Kiyoshi Shiga

7 February 1871

Historical information
Discovered over 100 years ago by a Japanese scientist named Kiyoshi Shiga, Since its discovery, there have been several epidemics of shigellosis (caused by the S. dysenteriae bacterium Outbreak in the Mexican-Guatemalan border caused the deaths of 20,000 people

Reservoirs:

Human intestines are the natural habitat and reservoir for Shigella , thus the bacteria are present in the stools of an infected person up to a week or two after the alleviation of symptoms

Morphology
Shigellae are Gram negative, rods. Unlike salmonellae and many other enterobacteria, shigellae are non-motile. Non-sporing
Noncapsulate

Medically Important spp

Subgroup A: Shigella dysenteriae Contains 12 distinct serotypes Serotype 1 was formerly called S. shiga Serotype 2 was formerly called S. schmitzii Subgroup B: Shigella flexneri Contains 6 related serotypes and 4 serotypes divided into subserotypes. Subgroup C: Shigella boydii Contains 18 distinct serotypes Subgroup D: Shigella sonnei Contains one serotype

Culture &chaacteristics:
Shigellae are aerobes and facultative anaerobes. They grow between 1045 C with an optimum temperature of 37 C. Specimens must be cultured with the minimum of delay. A selective medium is required to isolate Shigella species from faeces.

XLD agar: Shigellae produce redpink colonies, 24 mm in diameter, without black centres
DCA and MacConkey agar: Shigellae produce non-lactose fermenting pale coloured 12 mm diameter colonies. On prolonged incubation, S. sonnei forms pink colonies

Salmonella-Shigella (SS) agar: Despite its name, this medium is not suitable for isolating shigellae as it is inhibitory to most strains

Routes of transmission
Faecal-oral route with poor sanitation, unhygienic conditions, overcrowding, facilitating the rapid spread of infection. Only a few organisms are required to cause disease. Houseflies help to transfer shigellae from faeces to food. The

Reactions of shigellae
Lactose negative (S. sonnei is a late lactose and sucrose fermenter) H2S negative Urease negative Oxidase negative Citrate negative Lysine decarboxylase (LDC) negative Ornithine decarboxylase (ODC) negative except S. sonnei which is ODC positive Beta-galactosidase (ONPG) negative. S. sonnei and up to 15% of Sd 1 strains and minority of S. boydii strains are ONPG positive

Colicins typing
Colicins are bactericidal macromolecules which have narrow spectrum activity and they are produced by Sh.sonneii (16) colicins kill sensitive bacteria in 3 defined steps : 1. Adsorption onto a specific receptor at the surface of the bacterium. 2. Translocation across the outer membrane. 3. Killing activity.

Virulence factors
several toxins (endotoxin, enterotoxin, and cytotoxin) its ability to induce endocytosis into host cells, and intracellular growth. Each variation of the bacteria is able to penetrate large intestine epithelial cells and multiply within. S. dysenteriae, however, causes more severe symptoms due to the production of the Shiga toxin. This enables it to kill host cells by inhibiting protein synthesis

Pathology: Shigellosis
Developing countries: Sh. flexneri is endemic (always present) in most communities Sh. dysenteriae type 1 often occurs in an epidemic pattern These two species of Shigella generally produce the most severe illness.

Developed countries: Sh. sonnei is the most common and is the least virulent Sh. boydii causes disease of intermediate severity is least common, except in the Indian sub-continent.

Fecal-oral transmission person-to-person, fomites, food, water, Waterborne and water-washed Infectious dose: low; as few as 10 cells to infect Incubation period: 1 to 7 days; typically, 1-3 days Duration of illness: untreated: severe symptoms for about two weeks Antibiotic treatment shortens illness and prevent spread to others

severe anorexia (loss of appetite) hypoproteinaemia (a low concentration of blood protein) hyponatraemia (a low concentration of blood sodium) dilation of the large intestine seizures anaemia kidney damage persistent diarrhoea

Shigellosis - Complications

Laboratory diagnosis
Specimens: Collection of Spacimen Culture Identificaion Serology Molecular characterization
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Antimicrobial suseptibility testing Ampicillin, Septra, Nalidixic acid Ciprofloxacin. Since many
Shigella are becoming resistant to antibiotics, they should be avoided as a means of treatment for mild cases , as most will recover without help.

Prevention and Control:

Handwashing, especially after defacation Improved sanitation and hygiene Improve water, waste treatment/disposal and food sanitation Reduce overcrowding, etc.

No effective vaccine

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