Bellyache-causing bacteria makes local appearance

Published 10:25 pm Friday, September 5, 2008

Children complaining of stomach cramps and experiencing bowel irritability may be suffering from more than a simple bellyache.

Dr. Bhagwan D. Bang, a pediatrician who practices throughout Covington County, said he has encountered a strain of bacteria that began as an isolated case, but has since appeared numerous times in children complaining of stomach problems.

“Recently, we have seen several cases of children testing positive for Shigella Sonnei,” Bang said. “Shigellosis is an infectious disease caused by a group of bacteria called Shigella. Most people infected with Shigella develop diarrhea, fever and stomach cramps starting a day or two after they are exposed to the bacteria. The diarrhea is often bloody or blood tinged unlike viral gastroenteritis. Shigellosis usually resolves in five to seven days.”

Bang said he first heard of a case of Shigella approximately two weeks ago, but several children and even one adult have tested positive for the bacteria during the last several days.

“I have encountered four cases of the disease and I am investigating a few more that may also be Shigella,” he said. “I have one child who came into the office (Friday) and I feel it may be another case of Shigella.

“There are several types of Shigella bacteria,” he added. “Shigella Sonnei, also known as ‘Group D’ Shigella, accounts for over two-thirds of shigellosis in the United States. Determining that Shigella is the cause of the illness depends on the laboratory tests that identify Shigella in the stools of an infected person. The laboratory can also conduct a special test to determine which antibiotics, if any, would be best to treat the infection.”

According to Bang the detection of the disease may require testing, but simply methods can be used to reduce the chance of being infected by the bacteria.

“The Shigella bacteria passes from one infected person to the next,” he said. “Shigella is present in the diarrhea stools of infected persons while they are sick and for up to a week or two afterwards. Good hand washing and hygiene habits are strongly encouraged.”

Family members and playmates of such children are at high risk of becoming infected.

“Shigella infections may also be acquired from eating contaminated food,” he added. “The contaminated food may look and smell normal. Infected food handlers who forget to wash their hands with soap after using the restroom may contaminate food. Vegetables can become infected if they are harvested in a field with sewage in it. Water can become infected with Shigella if sewage runs into it or if someone with shigellosis swims in, or plays in the water. Examples of this could be splash tables, untreated wading pools or shallow play fountains used by daycares. Shigella infections can then be acquired by drinking, swimming in or playing with the contaminated water.”

According to Bang, persons with mild infections usually recover quickly without antibiotic treatment. However, appropriate antibiotics treatment kills the Shigella bacteria, and may shorten the illness by a few days.

“The cases of Shigella that have been reported in our office have been resistant to ampicillin, and trimethoprim/sulfamethoxazole (also known as Bactrim or Septra),” he said. “This means that these antibiotics might not be effective for treatment because it has become resistant to these medications. It is susceptible to other antibiotics like Rocephin. When many persons in a community are infected by shigellosis, antibiotics should only be used in the most severe cases. Anti-diarrhea agents such as Lomotil and Imodium can make the illness worse and should be avoided.”

Bang said that there is currently no vaccination for Shigella, but persons with diarrhea usually recover completely, although it may be several months before their bowel habits are entirely normal.

”People with shigellosis should not prepare food or drinks for others until they have been shown to no longer be carrying the Shigella bacterium, or if they have had no diarrhea for at least two days,” he said. “Children should not be permitted to re-enter daycare or school settings until diarrhea has ceased and repeat stool cultures are negative for Shigella.”

The Centers for Disease Control and Prevention (CDC) is currently assisting the local and state health departments in determining means of transmission and devising control measures. The CDC is also conducting research to better understand how to identify and treat shigellosis.

Bang said that every year, about 14,000 cases of shigellosis are reported in the United States. Because many milder cases are not diagnosed or reported, the actual number of infections may be twenty times greater. It is more common in summer than winter. Children, especially toddlers ages 2 to 4, are the most likely to get shigellosis. Many cases are related to the spread of illness in child care settings, and many are the result of the spread of the illness in families with small children.

According to Bang, individuals should utilize the following methods to reduce the risk of being exposed to or spreading Shigella:

Encourage everyone to wash their hands with soap carefully and frequently, especially after going to the bathroom, after changing diapers, and before preparing food and beverages.

Dispose of soiled diapers properly

Disinfect diaper changing areas after using them

Keep children with diarrhea out of child care settings

Supervise hand washing or toddlers and small children after they use the toilet

Do not prepare food for others while ill with diarrhea

Avoid swallowing water from ponds, lakes, or untreated pools.