SHIGELLA

• Domain: Bacteria
• Phylum: Proteobacteria
• Class: Gammaproteobacteria
• Order: Enterobacterales
• Family: Enterobacteriaceae
• Genus: Shigella
 FAMILY CHARACTERS
(GENERAL PROPERTIES)
• They are gram-negative bacilli

• Aerobes and facultative anaerobes

• Nonfastidious, can grow in basal media like nutrient

agar
• Ferment glucose to produce acid with or without gas

• Reduce nitrate to nitrite

• They produce catalase (except Shigella
dysenteriae type-1)
• They do not produce oxidase

• They are generally motile with peritrichous

flagella, except for some members which are
nonmotile, such as Shigella and Klebsiella.
 Classification

• The oldest method of classification of the

family Enterobacteriaceae was based on
fermentation of lactose on MacConkey agar.
• Ewing’s classification: Most popular. It classifies
the family Enterobacteriaceae into eight tribes;
each tribe further comprises of several genera.
• Newer method of classification: After the availability of
molecular methods, the taxonomy is further changed.
• In 2016, the order ‘Enterobacterales’ was given the
priority and several new families within the
Enterobacterales were proposed, consisting of species
that were formerly members of the family
Enterobacteriaceae.
 Classification of family Enterobacteriaceae based on
lactose fermentation

Groups Colonies on MacConkey Examples

agar
Lactose fermenters (LF) Ferment lactose, produce Escherichia Klebsiella
pink colonies
Non-lactose Do not ferment lactose, Salmonella, Shigella,
fermenters (NLF) produce pale or colorless Proteus and Yersinia
colonies
Late lactose Ferment lactose late, Shigella sonnei
fermenters (LLF) produce pink colonies only
after 2 days of incubation

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Ewing’s classification of family Enterobacteriaceae
Tribe Genus

Tribe I: Escherichieae Escherichia, Shigella

Tribe II: Edwardsiella

Edwardsielleae
Tribe III: Salmonella
Salmonelleae
Tribe IV: Citrobacter
Citrobactereae
Tribe V: Klebsielleae Klebsiella, Enterobacter, Hafnia,
Serratia, Pantoea
Tribe VI: Proteeae Proteus, Morganella, Providencia
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Tribe VII: Yersinieae Yersinia
 SHIGELLA INFECTIONS
(SHIGELLOSIS)
▰ Shigella, the most important agent of bacillary dysentery - named after
Japanese microbiologist Kiyoshi Shiga who isolated the first member, S.
dysenteriae serotype-1 (the Shiga bacillus) in 1896 from epidemic
dysentery.

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 Classification

▰ Based on a combination of biochemical and serological characteristics (O

antigen), shigellae are classified into four species:
 S. dysenteriae
 S. flexneri
 S. boydii
 S. sonnei

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 Classification (Cont..)

▰ Based on O antigen, each species is further typed into several serotypes.

 S. dysenteriae has 15 serotypes

 S. flexneri and S. boydii have 8 and 19 serotypes respectively

 S. sonnei - antigenically homogeneous and has only one serotype - it

can be typed by colicin typing into 26 colicin types.

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 Pathogenesis

▰ Shigella - important cause of bacillary dysentery.

▰ Mode of transmission: Ingestion through contaminated fingers (most

common), food, and water or rarely flies - also be transmitted sexually
(homosexuals)

▰ Minimum infective dose: As low as 10 -100 bacilli - probably because of

their ability to survive in gastric acidity

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 Pathogenesis (Cont..)
▰ Entry via M cell
▰ Invasion is determined by a large virulence plasmid - which codes for
important virulence factors - ipa proteins and type III secretion system
▰ Direct cell-to-cell spread - mediated by IcsA proteins
▰ Exotoxins
 Shigella enterotoxin (ShET)
 Shiga toxin
▰ Endotoxin

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 Clinical Manifestations

Evolves through five phases:

▰ 1. Incubation period: It usually lasts for 1 - 4 days

▰ 2. Initial phase - watery diarrhea with fever, malaise, anorexia and

vomiting

▰ 3. Phase of dysentery – frequent passage of bloody mucopurulent stools

with increased tenesmus and abdominal cramps.

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 Clinical Manifestations (Cont..)

▰ 4. Phase of complication - seen with children less than 5 years age

 Intestinal complications
 Metabolic complications
 Ekiri syndrome or toxic encephalopathy

▰ 5. Postinfectious phase: Patients expressing HLA-B27, develop an

autoimmune reaction months after shigellosis.

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 Epidemiology

▰ Risk factors for shigellosis - overcrowding, poor hygiene and children less
than 5 years.

▰ It tends to occur as epidemics in developing countries - Indian

subcontinent and sub-Saharan Africa.

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 Epidemiology (Cont..)

▰ S. flexneri - maximum number of cases (60%) in the developing areas

including India.
▰ S. sonnei - more prevalent in developed and industrialized world,
accounting for 77% of cases.
▰ Cases caused by S. dysenteriae type-1 - associated with high mortality.
▰ Usually causes epidemics of dysentery, particularly in refugee camps

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 Epidemiology (Cont..)

▰ Humans - natural host and cases are the only source of infection.

▰ World: Shigellosis is the most communicable disease among bacterial

causes of diarrhea.

▰ Worldwide, 163.2 million cases of bacillary dysentery with 5–11 lakh

deaths occur annually, of which majority are from developing countries.

▰ Children (<5 years) accounts for nearly 69% of the cases

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 Laboratory Diagnosis

▰ Fresh stool is the ideal specimen.

▰ Rectal swabs are not satisfactory.

▰ Specimens should be transported immediately or sent in transport media -

Sach’s buffered glycerol saline.

▰ Wet mount preparation of feces shows large number of pus cells,

erythrocytes and macrophages

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 Laboratory Diagnosis (Cont..)
▰ Culture: To inhibit the commensals, fecal specimen is inoculated
simultaneously into enrichment broth and selective media.
▰ Enrichment broth - Selenite F broth, tetrathionate broth and gram-
negative broth .
▰ Selective media such as:
 Mildly selective media: MacConkey agar
 Highly selective medium - DCA and XLD agar

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 Laboratory Diagnosis (Cont..)
▰ Culture smear and motility testing: Gram stained smear of colonies reveal
short, gram-negative bacilli. They are nonmotile, noncapsulated and
nonsporing

▰ Identification: Made either by automated identification systems such as

VITEK; or by conventional biochemical tests

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 Laboratory Diagnosis (Cont..)
▰ Shigella - catalase positive (except S.dysenteriae serotype-1) and oxidase
negative

▰ ICUT tests: Indole test (negative), citrate test (negative), urease test
(negative) and TSI (triple sugar iron agar) test shows alkaline/acid, gas
absent, H2S absent

▰ All Shigella species are mannitol fermenters; except S. dysenteriae

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 Laboratory Diagnosis (Cont..)
▰ Automated method - MALDI-TOF poorly differentiates Shigella from E.coli
as they share the same ribosomal proteins.

▰ Serotyping

▰ Colicin typing can be done for S. sonnei

▰ Antimicrobial susceptibility testing

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 Treatment of Shigellosis

▰ Because of the prompt transmissibility, current recommendation is that

every case of shigellosis should be treated with antibiotics.

▰ Ciprofloxacin is the drug of choice

▰ Alternative drugs - ceftriaxone, azithromycin, pivmecillinam and some

fifth-generation quinolones

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 Treatment of Shigellosis (Cont..)
▰ Duration of treatment is about 3 days except for:

 S. dysenteriae type 1 infection - 5 days

 Infections in immunocompromised patients - 7–10 days

▰ Oral rehydration solution (ORS) - started for correction of dehydration and

nutrition should be started as soon as possible after the completion of
initial rehydration.

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 Prevention

▰ Handwashing after handling of children’s feces and before handling of food

is highly recommended.

▰ Stool decontamination (e.g. with sodium hypochlorite) has proven useful

▰ No vaccine against shigellosis is currently available, though several clinical

trials are being conducted.

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