This is a 17yearoldman who is part of a strict religious community in Brooklyn, NY, with no significant past medical history who presents to the emergency room with the complaint of diarrhea for 1 day. The patient’s symptoms began the night prior to presentation, when he noted some suprapubic abdominal pain, and then began to have nonbloody, watery bowel movements. He estimates 10 to 15 similar episodes since then. He notes some diaphoresis, and an episode of lightheadedness while on the commode. The patient’s social history is notable for eating some reheated food the day prior to presentation and he reports that he saw a cousin several days ago who had diarrhea. He denies recent travel. Vital signs on admission were notable for a temperature of 100.8 Fahrenheit, and a heart rate of 109 beats per minute. He was notably diaphoretic, with dry oral mucosa. His abdominal exam was notable for present bowel sounds and tenderness to deep palpation throughout the abdomen. Lab data was notable for a serum sodium of 130 millimoles/Liter, with a positive fecal lactoferrin and occult blood. A computed tomography scan of the abdomen and pelvis with intravenous contrast showed diffuse thickening of the colon with wall thickening of the terminal ileum. The patient was treated with aggressive intravenous fluids. Due to the imaging findings, the patient was started on piperacillin/tazobactam for infectious colitis, and finally changed to azithromycin for discharge. Three days after discharge, the stool culture revealed many shigella sonnei (Subgroup D) resistant only to ampicillin and fluoroquinolones.
Between August and November of 2011, the New York City Department of Health and Hygiene reported an outbreak of 45 cases of shigella within a religious community in Brooklyn; this patient was diagnosed in September. Shigella is a reportable infectious disease, and hospitalists remain an important part of the public health system by reporting confirmed cases. In the United States, 450,000 cases are reported annually, most commonly in patients under the age of 5. Characteristic findings include watery diarrhea with blood and mucous, as well as the presence of greater than 10 fecal leukocytes per high powered field. Confirmation is made by stool culture. Shigella, a gram negative rod, survives well in an acidic environment and has a long incubation period. Consequently, handwashing, and antibiotics for severely affected patients, are essential tools for stopping outbreaks.
Shigella is the third most common cause of infectious diarrhea in the United States. Positive cases should be reported to the health department, so that affected communities can be alerted and given access to resources to help prevent the spread of the infection.
Figure 1Computed tomagraphy of the abdomen and pelvis with intravenous contrast showing diffuse thickening of the colon with wall thickening of the terminal ileum.
To cite this abstract:Cohen A. One Patient at a Time: Identifying a Community Outbreak of Shigella Infection. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97770. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/one-patient-at-a-time-identifying-a-community-outbreak-of-shigella-infection/. Accessed March 28, 2020.