Complications
Diarrhoea with Shigella is usually low volume, and therefore volume depletion is usually not problematic. In more severe disease, volume depletion and metabolic abnormalities (such as acidosis, electrolyte abnormalities, and hypoglycaemia) should be treated appropriately.[16]
Features include oligo-anuria, renal failure, fluid overload and hypertension, anaemia due to non-immune-mediated haemolysis, and thrombocytopenia. Neurological features include irritability, seizures, and confusion (due to cerebrovascular microthrombi, hypertension, electrolyte imbalance, or uraemia). Rarely, intestinal necrosis or pancreatic involvement occurs.
Most cases (70% to 90%) are caused by enterohaemorrhagic Escherichia coli O157.[27][29][30] Of the remaining cases, a few are caused by Shigella dysenteriae type 1. The syndrome is mediated by Shiga toxin (or Shiga-like toxin in the case of enterohaemorrhagic E coli).
Onset is more likely in the context of sepsis, so early treatment is useful to prevent progression to HUS.
Prognosis is best in younger children. Most recover spontaneously. Adults and older patients tend to do worse, and may have residual hypertension or chronic renal impairment.
Rare. Significant abdominal pain or signs of peritonitis should raise suspicion for toxic megacolon and perforation. Early detection and treatment are paramount.[16]
Rare, and usually occurs in younger children. The prolapse may usually be gently reduced.[16]
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