Prevention and Treatment

The spread of Shigella sp. is controlled by sanitary measures and surveillance of food handlers and water supplies. There is no vaccine. Antimicrobial medications such as ampicillin and cotrimox-azole are useful against susceptible strains because they shorten the duration of symptoms and the time during which shigellas are discharged in the feces. Almost 20% of Shigella strains, however, are resistant to these two commonly employed medications. R factors conveying resistance to several antibacterial medications are often present. Two specimens of feces, collected at least 48 hours after stopping antimicrobial medicines, must be negative for Shigella sp. before a person is allowed to return to a day care center or food-handling job. ■ R plasmids, p. 210

Table 24.6 describes the main features of shigellosis.

Escherichia coii Gastroenteritis

Escherichia coli generally ferments lactose, in contrast to most shigellas and salmonellas. It is an almost universal member of the normal intestinal flora of humans and a number of other animals. Long ignored as a possible cause of gastrointestinal disease, certain strains were shown in 1945 to cause life-threatening epidemic gastroenteritis in hospitalized infants. Later, E. coli strains were shown to cause gastroenteritis in adults, notably as agents responsible for traveler's diarrhea (also called "Delhi belly," "Montezuma's revenge," "Turkey trots," etc.). Still later, E. coli strains were identified as causative agents in dysentery, cholera-like illnesses, and diarrheas associated with the hemolytic uremic syndrome.

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