Health Department reports 148 shigellosis cases this year

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Kendyl Sebesta/Staff Writer

Issue date: 4/17/09 Section: News

The City of Lubbock Health Department will continue its investigation and monitoring of the bacterial group shigella this month as it continues to affect Lubbock County residents following an outbreak in September 2008.

Beckie Brawley, Lubbock Health Department public health coordinator, said 148 cases of shigella have been reported in Lubbock County so far this year compared to 714 in 2008 among a total of 864 cases of enteric diseases, under which the bacterial group falls.

"So far this year we've seen 174 cases of enteric diseases in Lubbock," Brawley said. "Enteric diseases can be caused by a number of factors like contaminated water, contaminated food or coming into contact with infected animals and usually causes diarrhea or vomiting."

According to the Centers for Disease Control and Prevention Web site, shigellosis is an infectious disease contained under the enteric diseases category and typically causes diarrhea, fever, and stomach cramps beginning a day or two after the person has been exposed to the bacteria, but does not typically require hospitalization in the United States.

Brawley said although the number of shigella cases have remained relatively low this year compared to 2008, it is important to realize the year is not over, and Lubbock residents still should practice healthy habits to prevent contracting the bacteria.

"One of the best ways to prevent this is to wash your hands regularly," she said. "That's probably one of the most important things you can do, and it's probably the thing people neglect the most."

People with mild infections of shigella typically recover quickly without the use of antibiotics, according to the Centers for Disease Control and Prevention Web site, but for those who are prescribed antibiotics, Bactrim or Septra are most commonly used to decrease the duration of the illness.

Shigella passes from one infected person to the next through inadequate basic hygiene and hand-washing habits, the CDC Web site reported, and can be prevented by frequent and careful hand washing.

Ronald Warner, associate professor in the Tech Health Sciences Center Department of Family Medicine, said shigella is commonly referred to as a gram bacteria that affects the small and large intestines with outbreaks typically occurring in young children through person-to-person contact in day care centers and elementary schools.

"Lubbock always seems to have typically low levels of shigella cases," Warner said. "One of several ways it can be contracted is through fecal origin, meaning dirty hands in the bathroom that don't end up getting washed and then spread to toys or other things that people come into contact with frequently."

Warner said Lubbock also appears to experience shigella outbreaks every four to six years as new populations enter child care facilities and become exposed to the bacterial strain.

"This happens everywhere, not just Lubbock," he said. "The major way it's spread here is through person-to-person contact. In fact, only a very small percentage may be spread through contaminated food where a food handler may not wash their hands and then prepare the food for example."

Dr. Kelly Bennett, Texas Tech Student Health Services medical director, said Student Health Services has not seen any cases of shigella recently, but does encounter a very small number of students who become sick from contaminated foods.

"I saw a young man yesterday who was very sick from food poisoning because he didn't know that when he purchases fish at the store that it has to be cooked in a timely manner ­- two or three days - or put in the freezer," Bennett said. "He went ahead and cooked it after being in the fridge for a week, and although it tasted funny and had a mushy consistency, he ate it anyway. It took less than 12 hours before he became violently ill."

Bennett said people typically do not realize storing food in the refrigerator only delays the food's decay by a few days and does not necessarily mean that it is cryogenically frozen or safe, and they should recognize the importance of labeling all meats, fish and milk products by date when stored in a refrigerator to prevent contamination.


Warner said food handling and safety tips include cleaning food and food preparation surfaces properly, avoiding cross-contamination of raw and ready-to-eat foods, cooking foods at proper temperatures, and chilling foods that require refrigeration.

Salmonella, a bacterial infection listed under the enteric diseases category along with shigellosis and linked to the recent peanut butter contamination outbreak resulting in 529 infections as of Jan. 28, according to the CDC Web site, also has not been seen in patients at Student Health Services, Bennett said.

"So far we have not had patients with illness from any of the spinach, jalapeņo, peanut butter, etc. recalls of the past two to three years," she said. "Our patients by and large have very healthy immune systems so aren't affected much even if they do eat some of these things."

Warner said salmonella also is similar to shigella in that they are both gram-rod bacteria that infect the intestinal tracts.

"Salmonella is typically found in food places more than shigella," he said. "But the general consensus with shigella seems to be that unless the symptoms are really severe - dehydration and affected stool - people seem to treat it at home with rest and Pepto."

Warner said death is uncommon among people affected by shigella and the illness typically passes with time, but exact numbers become difficult to determine due to the tendency of patients to avoid visiting their doctors.

"Most food born illnesses are not diagnosed, and the shigella we are talking about here is usually person to person, not through food," he said. "But food-born illnesses usually cause things like nausea, diarrhea and vomiting, too, that people tend to avoid going to the doctor for and just treat themselves with rest or things like Imodium. It usually isn't until they see blood in their stool or become severely dehydrated that they go to their physician."

Warner said physicians also may prescribe an antibiotic if they suspect a food-born illness and may not take cultures to determine the exact cause, which also makes determining the true number of affected cases difficult.

"If they suspect something like this, they will usually prescribe a wide-range antibiotic," he said. "It usually isn't until they see a widespread illness that they begin to take cultures, though, to figure out what exactly it is and what's causing it."

According to the CDC Web site, about 14,000 cases of shigellosis are reported each year in the United States, but because many are milder cases and are not diagnosed or reported, the actual number of infections may be 20 times greater.


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