Last week, the Allegheny County Health Department issued a health advisory for the Pittsburgh region regarding an outbreak of shigellosis, a common, bacterial infection that can cause severe diarrhea. The focus of this outbreak centers on daycare facilities:
The Allegheny County Health Department (ACHD) is currently investigating an outbreak of shigellosis (Shigella infection) linked to daycare facilities in Allegheny County. An unusually high number of cases have been reported to ACHD since October of 2014. Cases range in age from 6 months to 68 years with a median age of 5 years. About half of the cases are associated with day care facilities in Allegheny County. Increases in shigellosis have also been observed in surrounding counties in southwestern Pennsylvania.
Shigella sonnei causes the most cases of shigellosis worldwide. Symptoms begin a day or two after acquiring the bacteria (via the fecal-oral route — touching and then ingesting the bacteria) and include abdominal pain and cramping, diarrhea (often bloody), fever, and dehydration. For most people, treatment is simply supportive (oral rehydration and rest) and most people recover uneventfully within a week, without the need for medications or hospitalization.
Shigella is extremely contagious — exposure to as few as 10 bacteria can lead to this dreadful infection — and so it’s easy to see why daycare centers would be an obvious source of spread within a community. But shigella also causes “traveler’s diarrhea” worldwide and experts are concerned this particular species is becoming increasingly resistant to antibiotics. With penicillins and sulfas already ineffective due to resistance, Maggie Fox says that the rate of resistance to the antibiotic ciprofloxacin has gone up from 2% to 90% in just one year:
The medical name is Shigella sonnei, but it’s one of the germs that causes shigellosis — otherwise known as “Delhi belly” or “Montezuma’s revenge.” Many international travelers are sadly familiar with the stomach cramps, diarrhea and nausea that can ruin a vacation or business trip.
If the infection is caused by Shigella bacteria, it was once easy to treat with antibiotics. What has the Centers for Disease Control and Prevention worried is evidence that a mutant form is now not only being carried into the U.S. by travelers, but it’s spreading once it’s here.
“Shigella sonnei bacteria resistant to the antibiotic ciprofloxacin sickened 243 people in 32 states and Puerto Rico between May 2014 and February 2015,” the CDC said in a statement.
While most people recover from shigellosis without antibiotics, some really need them to be effective, including people with especially severe diarrhea (dysentery), blood infections (septicemia), and those who have immature (newborns), suppressed, or otherwise compromised immune systems (by medications and diseases). Increased resistance to antibiotics occurs as a community uses more antibiotics, which is why (as we’ve seen before on The PediaBlog) physicians and patients should demand prudence in using antibiotics for any illness only when they are justified clinically. Kent Sepkowitz understands resistance but says the problem is “overblown.” He thinks we all need to chill:
The crossing over of Shigella to even more resistance—despite the fact that we don’t treat it very often—changes up the usual rules. OK, some people with Shigella do take antibiotics—they have some old medicine in the house left over from an intrepid youthful backpacking adventure or else call a doctor with a tale of woe and get a prescription. But usually those with Shigella don’t see a doctor—the time from illness to realizing you are more ill than usual to getting to a doctor is so compressed that by the time you decide to make an appointment, you already are better.
Rather, the standard see-bug-treat-bug-see-resistance trope is now a much more ominous tale of collateral damage. The Shigella resistance is a story not about one bacterium but about the collective ecosystem of the 300 million human large intestines in the U.S., all of which are seeing antibiotics for good reasons and bad reasons, as well as passed on to us from animal feed and maybe even the water we drink.
It means we have passed a tipping point of sorts, a moment when the trillion or so bacteria per large intestine, multiplied by 300 million citizens have moved on from a class of antibiotics. We—or our oddly called intestinal “flora” (nothing floral about it, really)—have just said no to drugs. Drug resistance ‘R’ Us.
Which is calamitous surely but not in the way that you fear. It is simply another area that needs attention and thought but represents little immediate threat. Part of the strategy is the stink bomb of news and doomsday forecasts that already has altered prescribing behavior.
You don’t need an antibiotic until, of course, you do. That makes antibiotic resistance a big problem for all of us. All we may have left are steps to prevent the need for them by doing some simple things, like washing hands after using the bathroom, changing diapers, and before preparing and eating food.
It’s the little things, like soap and water, that can go a long way in fighting antibiotic resistance.