Symptoms

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People with Shigella infection (shigellosis) usually start experiencing symptoms 1 to 2 days after contact with the germ. These symptoms include:

  • Diarrhea that can be bloody or prolonged (lasting more than 3 days)
  • Fever
  • Stomach pain
  • Feeling the need to pass stool (poop) even when the bowels are empty

Some people will not have any symptoms.

Symptoms usually last 5 to 7 days, but some people may experience symptoms anywhere from a few days to 4 or more weeks. In some cases, it may take several months before bowel habits (for example, how often someone passes stool and the consistency of their stool) are entirely normal.

When to Contact Your Doctor

People with diarrhea should contact their doctor if they have any of these symptoms:

  • Fever
  • Bloody or prolonged diarrhea
  • Severe stomach cramping or tenderness
  • Dehydration

People who are in poor health or whose immune systems are weakened from diseases (such as HIV) or medical treatments (such as chemotherapy for cancer) are more likely to get sick for a longer period of time. Contact your doctor if you are in one of these groups and have symptoms of Shigella infection (shigellosis).

Learn more about diagnosis and treatment.

Rare Risks from Shigella Infection (shigellosis)

Reactive arthritis

About 2%1-4 of people who are infected with certain types of Shigella, most commonly Shigella flexneri, will experience reactive arthritis after infection, which can cause joint pain, eye irritation, and painful urination. The syndrome typically occurs in people who have specific genetic makeup that puts them at risk.1,5-7 It usually lasts for 3 to 5 months, but occasionally it can last for years and lead to chronic arthritis.8-9 Reactive arthritis can also occur in people who get sick from Shigella sonnei,6-7, 9-10 but is less common in other types of Shigella called S. boydii and S. dystenteriae.11

  1. Simon DG, Kaslow RA, Rosenbaum J, Kaye RL, Calin A. Reiter’s syndrome following epidemic shigellosis. J Rheumatol. 1981;8(6):969-73.
  2. Noer HR. An “experimental” epidemic of Reiter’s Syndrome. JAMA 1966;198(7):693-8.
  3. Finch M, Rodey G, Lawrence D, Blake P. Epidemic Reiter’s syndrome following an outbreak of shigellosis. Eur J Epidemiol. 1986;2(1):26-30.
  4. American Academy of Pediatrics. “Shigella Infections” Red Book: 2021-2024. Report of the Committee on Infectious Diseases.
  5. Morse HG, Rate RG, Bonnell MD, Kuberski TT. Reiter’s syndrome in a five-year-old girl. Arthritis Rheum. 1980;23(8):960-1.
  6. Hannu T, Mattila L, Siitonen A, Leirisalo-Repo M. Reactive arthritis attributable to Shigella infection: a clinical and epidemiological nationwide study. Ann Rheum Dis. 2005;64(4):594-8.
  7. Leirisalo-Repo M. Prognosis, course of disease, and treatment of the spondyloarthropathies. Rheum Dis Clin North Am. 1998;24(1998):737-51.
  8. Hannu T, Inman R, Granfors K, Leirisalo-Repo M. Reactive arthritis or post-infectious arthritis? Best Pract Res Clin Rheumatol. 2006;20(3):419-33.
  9. Lauhio A, Lahdevirta J, Janes R, Kontiainen S, Repo H. Reactive arthritis associated with Shigella sonnei Arthritis. Rheum. 1988;31(9):1190-3.
  10. Chen M, Delpech V, O’Sullivan B, Donovan B. Shigella sonnei: another cause of sexually acquired reactive arthritis. Int J STD AIDS. 2002;13:135–6.
  11. Mazumder RN, Salam MA, Ali M, Bhattacharya MK. Reactive arthritis associated with Shigella dysenteriae type 1 infection.J Diarrhoeal Dis Res. 1997;15(1):21-4.

Bloodstream infections

Around 0.4% to 7.3% of people with Shigella infection (shigellosis) develop bloodstream infections caused by Shigella germs or by other germs in the gut that get into the bloodstream when Shigella damages intestinal linings.1, 4 Bloodstream infections are most common among patients with weakened immune systems, such as those with HIV, diabetes, cancer, or severe malnutrition, and are more commonly seen in children.1-4 Bloodstream infections are most commonly seen in infections caused by S. flexneri and S. dysenteriae.4 Shigellosis patients with bloodstream infections are at a higher risk of death compared to those with without bloodstream infections.4

  1. American Academy of Pediatrics. “Shigella Infections” Red Book: 2021-2024. Report of the Committee on Infectious Diseases.
  2. Morduchowicz G, Huminer D, Siegman-Igra Y, Drucker M, Block CS, Pitlik SD. Shigella bacteremia in adults: A report of five cases and review of the literature. Arch Intern Med. 1987;147(11):2034-7.
  3. Appannanavar SB, Goyal K, Garg R, Ray P, Rathi M, Taneja N. Shigellemia in a post renal transplant patient: a case report and literature review. J Infect Dev Ctries. 2014;8(2):237-9.
  4. Struelens MJ, Patte D, Kabir I, Salam A, Nath SK, Butler T. Shigella Septicemia: Prevalence, Presentation, Risk Factors, and Outcome. J Infect Dis. 1985;152(4):784-90.

Seizures

Generalized seizures have been reported among young children with Shigella infection (shigellosis), but usually go away without treatment. Children with Shigella infection who experience seizures typically have a high fever, low blood sugar, or abnormal blood electrolytes (salts). However, healthcare professionals have not been able to definitively explain why these seizures occur.1,2-6

  1. American Academy of Pediatrics. “Shigella Infections” Red Book: 2021-2024. Report of the Committee on Infectious Diseases.
  2. Goldberg EM, Balamuth F, Desrochers CR, Mittal MK. Seizure and altered mental status in a 12-year-old child with Shigella sonnei. Pediatr Emerg Care. 2011;27(2):135-7.
  3. Lahat E, Katz Y, Bistritzer T, Eshel G, Aladjem M. Recurrent seizures in children with Shigella-associated convulsions. Ann Neurol. 1990;28(3):393-5.
  4. Khan WA, Dhar U, Salam MA, Griffiths JK, Rand W, Bennish ML. Central nervous system manifestations of childhood shigellosis: prevalence, risk factors, and outcome. 1999;103(2):E18.
  5. Galanakis E, Tzoufi M, Charisi M, Levidiotou S, Papadopoulou ZL. Rate of seizures in children with shigellosis. Acta Paediatr. 2002;91(1):101-2.
  6. Shamsizadeh A, Nikfar R, Bavarsadian E. Neurological manifestations of shigellosis in children in southwestern Iran. Pediatr Int. 2012;54(1):127-30.

Hemolytic-uremic syndrome

Hemolytic-uremic syndrome (HUS) is a rare complication of Shigella infections (shigellosis) that also most commonly occurs in children.1-4 HUS occurs when bacteria enter the digestive system and produce a toxin that destroys red blood cells, which block kidneys’ filtering function and can lead to kidney failure. Patients with HUS often have bloody diarrhea, and it can be a deadly complication. In patients with shigellosis, HUS is associated with Shiga toxin-producing Shigella, most often occurring with Shigella dystenteriae.1,2-4 HUS can occur when antimicrobial resistant drugs are used to treat the infection or when treatment is started after 4 days of symptoms, and it is the leading cause of death in S. dysenteriae outbreaks.2

  1. American Academy of Pediatrics. “Shigella Infections” Red Book: 2021-2024. Report of the Committee on Infectious Diseases.
  2. Butler T. Haemolytic uraemic syndrome during shigellosis. Trans R Soc Trop Med Hyg. 2012;106(7):395-9.
  3. Rahaman MM, Greenough WB, 3rd. Shigellosis and haemolytic uraemic syndrome. Lancet. 1978;1(8072):1051.
  4. Bloom PD, MacPhail AP, Klugman K, Louw M, Raubenheimer C, Fischer C. Haemolytic-uraemic syndrome in adults with resistant Shigella dysenteriae type I. Lancet. 1994;344(8916):206.
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