In the United Kingdom, the incidence of Shigella infections is usually related to foreign travel. However, according to a Health Protection Agency (HPA) study published Friday, researchers see an increase in dysentery cases from Shigella in men who have sex with men (MSM).
According to an HPA news release Friday, two outbreaks consisting of 20 cases of Shigella flexneri in MSM last year in Greater Manchester and London caused the HPA to performed “enhanced surveillance” to determine the magnitude of the problem in the country.
The enhanced surveillance, which ran from September to December 2011, picked up 145 cases of shigella infection, of which 31 were UK acquired. Of these 31 cases, they were predominantly male and just under half reported MSM activity within the previous week. The investigation showed that these men attended regular health checkups and all reported having a casual male partner in the preceding week.
These findings suggest that the UK acquired cases in men who have sex with men may be transmitted through sex or through secondary contact.
The enhanced surveillance was incorporated because it is unusual to see outbreaks of shigellosis absent of foreign travel.
Dr Isabel Oliver, head of the outbreak control team said, “Our investigation has revealed a strong association between UK acquired shigella and onward transmission in men who have sex with men.
“We also know that the cases are not part of one large outbreak, but are small clusters happening across the country, therefore it is important to be aware of simple precautions to stop the spread of the infection.
Health officials advise the following:
- See your doctor if you have diarrhea, particularly bloody diarrhea.
- Wash hands before preparing or eating food, after going to the toilet and before and after sex.
- Avoid having sex until treated for the infection and making a full recovery.
Shigellosis is an acute bacterial disease of the intestines caused by several species of the bacterium, Shigella. It is typified by loose stools, frequently containing blood and mucus (dysentery), accompanied by fever, vomiting, cramps and occasionally toxemia.
It can cause bacillary dysentery because of the invasive ability of the organism that may result ulcerations and abscesses of the intestines.
It rarely spreads to the bloodstream.
More severe complications may include convulsions in children, Reiter’s syndrome and hemolytic uremic syndrome depending on the species of Shigella implicated.
This diarrheal disease is found worldwide with the vast majority of cases and deaths being in children. Outbreaks usually occur where there are crowded conditions and where personal hygiene is poor: prisons, day care centers and refugee camps are three examples.
It is transmitted primarily by fecal-oral person to person means. It can also occur through contaminated food or water. Those that are primarily responsible for transmission are those that fail to wash their hands thoroughly after defecation.
Because Shigella is resistant to gastric acid, a person can get infected with as little as 10 organisms.
After getting infected symptoms usually appear 1-3 days later. It can be transmitted during the acute phase of infection till approximately four weeks after illness when the organism is no longer present in the feces. Asymptomatic carriers can also infect others.
Diagnosis is confirmed through bacteriological culture of feces. Treatment of shigellosis may include fluid and electrolyte replacement if there are signs of dehydration.
Antibiotics can shorten the course of infection, the severity of illness and the period of time a person may excrete the pathogen. Because of some antibiotic resistance, an antibiotic susceptibility test should be performed to determine which antibiotic will be effective.