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Abdominal pain; cramps[?]; diarrhea; fever; vomiting; blood, pus, or mucus in stools; tenesmus. Onset time: 12 to 50 hours.
Infections are associated with mucosal ulceration[?], rectal bleeding[?], drastic dehydration; fatality may be as high as 10-15% with some strains. Reiter's disease[?], reactive arthritis, and hemolytic uremic syndrome[?] are possible sequelae that have been reported in the aftermath of shigellosis.
The disease is caused when virulent Shigella organisms attach to, and penetrate, epithelial cells of the intestinal mucosa. After invasion, they multiply intracellularly, and spread to contiguous epitheleal cells resulting in tissue destruction. Some strains produce enterotoxin[?] and Shiga toxin (very much like the verotoxin of E. coli O157:H7).
Shigella can be transmitted through food; food known to do so includes salads (potato, tuna, shrimp, macaroni, and chicken), raw vegetables, milk and dairy products, and poultry. Contamination of these foods is usually through the fecal-oral route. Fecally contaminated water and unsanitary handling by food handlers are the most common causes of contamination.
An estimated 300,000 cases of shigellosis occur annually in the U.S. Infants, the elderly, and the infirm are susceptible to the severest symptoms of disease, but all humans are susceptible to some degree. Shigellosis is a very common malady suffered by individuals with acquired immune deficiency syndrome (AIDS) and AIDS-related complex[?], as well as non-AIDS homosexual men.