According to the United States Centers for Disease Control (CDC), a new multidrug-resistant intestinal illness has travelled internationally and landed on U.S. soil. Repeat outbreaks occur when sick travelers bring the disease back and forth from their origin and destination.
The CDC has recently investigated some clusters of shigellosis in Massachusetts, California and Pennsylvania. Nearly 90 percent of the cases tested were resistant to the antibiotic ciprofloxacin (Cipro), which is the first choice of treatment. "Shigellosis can spread very quickly in groups like children in childcare facilities, homeless people and gay and bisexual men, as occurred in these outbreaks," the CDC reported.
"These outbreaks show a troubling trend in Shigella infections in the United States," said CDC Director Dr. Tom Frieden. "Drug-resistant infections are harder to treat and because Shigella spreads so easily between people, the potential for more - and larger - outbreaks is a real concern. We're moving quickly to implement a national strategy to curb antibiotic resistance because we can't take for granted that we'll always have the drugs we need to fight common infections."
Most Shigella in the United States is resistant to the antibiotics ampicillin and trimethoprim/sulfamethoxazole. Resistance to Cipro is increasing globally.
"The increase in drug-resistant Shigella makes it even more critical to prevent shigellosis from spreading," said lead author of the study Dr. Anna Bowen, a medical officer in CDC's Waterborne Diseases Prevention Branch. "Washing your hands with soap and water is important for everyone. Also, international travelers can protect themselves by choosing hot foods and drinking only from sealed containers."
From the CDC:
"Shigella causes an estimated 500,000 cases of diarrhea in the United States every year. It spreads easily and rapidly from person to person and through contaminated food and recreational water. It can cause watery or bloody diarrhea, abdominal pain, fever, and malaise. Although diarrhea caused by Shigella typically goes away without treatment, people with mild illnesses are often treated with antibiotics to stop the diarrhea faster. Until recently, Cipro resistance has occurred in just 2 percent of Shigella infections tested in the United States, but was found in 90 percent of samples tested in the recent clusters.
"Because Cipro-resistant Shigella is spreading, CDC recommends doctors use lab tests to determine which antibiotics will effectively treat shigellosis. Doctors and patients should consider carefully whether an infection requires antibiotics at all.
"To prevent the spread of shigellosis, CDC recommends that people wash their hands often with soap and water, especially after using the toilet and before preparing food or eating; keep children home from childcare and other group activities while they are sick with diarrhea; avoid preparing food for others while ill with diarrhea; and avoid swimming for a few weeks after recovering. Improving access to toilets and soap and water for washing hands may help prevent Shigella transmission among the homeless."
