It has been another busy week at Marler Clark due to the ever-increasing number of victims looking for assistance in the Lombard, Illinois Subway Shigella outbreak. As DuPage County’s health department continues its investigation, the number of confirmed victims, currently at 78, will surely continue to rise. It is likely that this outbreak has left hundreds of people ill, over 50 of whom have contacted us thus far seeking representation in this horrible outbreak.
For those who are unfamiliar with a Shigella infection, and who wrongly believe it is nothing more than a mere "stomach bug," please allow me to speak for the victims and provide you with just a taste of what an infection from this nasty bug entails. The symptoms are often downright brutal, with many proclaiming it to be the most agonizing experience they can recall.
Most people who are infected with Shigella develop diarrhea, fever, and stomach cramps after they are exposed to the bacteria. Symptoms may start within 12 to 96 hours after exposure, usually 1 to 3 days (APHA, 2000). Diarrhea is bloody 25 to 50 percent of the time and most often contains mucus. Rectal spasms, medically termed “tenesmus,” are common. The diarrhea may range from mild to very severe diarrhea. Shigellosis usually resolves in 5 to 7 days.
A severe infection with high fever may be associated with seizures in children less than two years old. Some persons who are infected may have no symptoms at all, but may still pass the Shigella bacteria to others. Persons with shigellosis in the U.S. rarely require hospitalization, although the hospitalization rate has been estimated to be in excess of 50,000 per year (Mead, et al., 1999). The hospitalization rate tends to be highest among older individuals (MMWR April 10, 2009).
What are the serious and long-term risks of Shigella infection?
Persons with diarrhea caused by S. sonnei in particular usually recover completely, although it may be several months before their bowel habits are entirely normal. About 2% of persons who are infected with S. flexneri later develop pains in their joints, irritation of the eyes, and painful urination. This is called post-infectious arthritis (see Reiter’s Syndrome below) (CDC, 2009a). Once someone has had shigellosis, they are not likely to get infected with that specific type again for at least several years. However, they can still get infected with other types of Shigella.
Shigellosis is more severe, though, than other forms of gastroenteritis. Shigella bacteria multiply in the human intestinal tract and invade the cells, which results in much tissue destruction (Philpott, Edgeworth & Sansonetti, 2000). Also, many strains produce a toxin called shiga toxin, which is very potent and destructive. Shiga toxin is very similar to the verotoxin of E. coli O157:H7. Complications of shigellosis include severe dehydration, seizures in small children, rectal bleeding, and invasion of the blood stream by the bacteria (bacteremia or sepsis). Other complications include:
Proctitis and rectal prolapse. The bacteria that cause shigellosis may also cause inflammation of the lining of the rectum (proctitis) or rectal prolapse. In the latter condition, straining during bowel movements may cause the rectal mucous membrane, or lining, to move down or through the anus (Mayo website, 2009).
Toxic megacolon. This rare complication occurs when the colon becomes paralyzed, preventing bowel movements or passing gas. Signs and symptoms include abdominal pain and swelling, fever, weakness, and disorientation. Untreated, the colon may rupture and cause peritonitis, a life-threatening condition requiring emergency surgery (Mayo clinic, 2009). It is more common in S. dysenteriae infections (APHA, 2000).
Reiter’s Syndrome (Reactive Arthritis). Recent data suggest that the more severe the initial gastrointestinal infection, the more likely Reiter’s Syndrome or reactive arthritis will develop (Carter & Hudson, 2009), although it is usually associated with S. flexneri (APHA, 2000). Up to 3% of persons who are infected with Shigella may later develop a syndrome that includes joint pain and swelling, irritation of the eyes, and sometimes painful urination. It occurs because the immune system, intending to fight Shigella, attacks the body instead (Ringrose, 2001). Reiter’s Syndrome is most common in persons with the HLA-B27 genetic makeup (testing for this is readily available), and is more common in adults than children. Reiter’s Syndrome can last for months or years and may be difficult to treat.
Hemolytic uremic syndrome (HUS). This rare complication of shigellosis, more commonly caused by E. coli O157:H7, can lead to a low red blood cell count (hemolytic anemia), low platelet count (thrombocytopenia), and acute kidney failure (Mayo Clinic, 2009). It is more common in S. dysenteriae infections (APHA, 2000).
In the U.S., it is estimated that about 700 persons die yearly from shigellosis (Mead, 1999). Young children and the elderly are at greatest risk of death from a Shigella infection. More than one million deaths occur in the developing world yearly due to infections with Shigella; the victims are mostly children (Philpott, Edgeworth & Sansonetti, 2000).