Materiały źródłowe

• #1 Shigella infection – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/shigella/diagnosis-treatment/drc-20377533

  Diagnosis of shigella infection involves a physical exam and testing to find out if you have the illness. Many other health conditions can cause diarrhea or bloody diarrhea. […] You or your healthcare professional collects a sample of your stool. Then a lab checks the sample for shigella germs or for harmful substances called toxins that the germs make. […] During the physical exam, your healthcare professional may press on parts of your stomach area. This is done to check for pain or tenderness. Your healthcare professional also may use a cotton swab to get a stool sample. Or you may be given instructions on how to collect and send a sample of your stool to a lab for testing.

• #2 Shigella Infection (Shigellosis): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17826-shigellosis

  Shigella infection, a type of food poisoning, may also be called bacillary dysentery. Dysentery is a word for diarrhea that contains blood or mucus. […] Your provider may diagnose you with Shigella infection on the basis of your symptoms. However, testing a stool sample for the presence of the bacteria will let you know for sure. […] In more severe cases of shigellosis, and for people with weak immune systems, doctors may prescribe an antibiotic to treat the infection. Your provider may prescribe ciprofloxacin or azithromycin. […] Researchers are working on vaccines against Shigella bacteria but haven’t developed one yet.

• #3 Shigella – Medical Microbiology – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK8038/

  Shigellosis can be correctly diagnosed in most patients on the basis of fresh blood in the stool. Neutrophils in fecal smears is also a strongly suggestive sign. Nonetheless, watery, mucoid diarrhea may be the only symptom of many S sonnei infections, and any clinical diagnosis should be confirmed by cultivation of the etiologic agent from stools. […] Patients presenting with watery diarrhea and fever should be suspected of having shigellosis. The diarrheal stage of the infection cannot be distinguished clinically from other bacterial, viral, and protozoan infections. […] Although clinical signs may evoke the suspicion of shigellosis, diagnosis is dependent upon the isolation and identification of Shigella from the feces. Positive cultures are most often obtained from blood-tinged plugs of mucus in freshly passed stool specimens obtained during the acute phase of disease. Rectal swabs may also be used to culture shigellae if the specimen is processed rapidly or is deposited in a buffered glycerol saline holding solution. Isolation of shigellae in the clinical laboratory typically involves an initial streaking for isolation on differential/selective media with aerobic incubation to inhibit the growth of the anaerobic normal flora. Commonly used primary isolation media include MacConkey, Hektoen Enteric Agar, and Salmonella-Shigella (SS) Agar. These media contain bile salts to inhibit the growth of other Gram-negative bacteria and pH indicators to differentiate lactose fermenters (Coliforms) from non-lactose fermenters such as shigellae. A liquid enrichment medium (Hajna Gram-negative broth) may also be inoculated with the stool specimen and subcultured onto the selective/differential agarose media after a short growth period. Following overnight incubation of primary isolation media at 37 C, colorless, non-lactose-fermenting colonies are streaked and stabbed into tubed slants of Kligler’s Iron Agar or Triple Sugar Iron Agar. In these differential media, Shigella species produce an alkaline slant and an acid butt with no bubbles of gas in the agar. This reaction gives a presumptive identification, and slide agglutination tests with antisera for serogroup and serotype confirm the identification.

• #4 For health professionals: Shigellosis (Shigella) – Canada.ca

  https://www.canada.ca/en/public-health/services/diseases/shigella/health-professionals.html

  Shigellosis can be clinically diagnosed in most patients based on fresh blood in the stool. Patients presenting with watery diarrhea and fever should be suspected of having shigellosis. […] Bloody, mucoid stools are highly indicative of shigellosis, however, the differential diagnosis should include: Enteroinvasive E. coli (EIEC), Salmonella Enteritidis, Yersinia enterocolitica, Campylobacter species, Entamoeba histolytica. […] Laboratories can confirm diagnosis by the isolation of Shigella sp. from an appropriate clinical specimen (e.g. sterile site, deep tissue wounds, stool, vomit or urine).

• #5 Clinical Overview of Shigellosis | Shigella – Shigellosis | CDC

  https://www.cdc.gov/shigella/hcp/clinical-overview/index.html

  Healthcare providers can order laboratory tests to identify Shigella germs in the stool of an infected person. […] Testing the stool of patients with shigellosis-like symptoms is recommended. Characterizing isolates can lead to more accurate diagnoses, targeted treatment (when needed), improved patient outcomes, and earlier detection of outbreaks. […] When shigellosis is suspected, request a stool specimen for testing by culture or by a culture-independent diagnostic test (CIDT). […] If a CIDT is positive for shigellosis, confirm the diagnosis with a stool culture. […] Given the increasing rate of antimicrobial-resistant shigellosis, perform antimicrobial susceptibility testing if you plan to treat with an antibiotic. […] Shigellosis can be a mild, self-limited illness. When treatment is indicated, select an antimicrobial agent based on the susceptibility profile of the individual isolate or, during a local outbreak, on that of the outbreak strain.

• #6 Shigellosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482337/

  Shigellosis is an acute enteric infection caused by shigellae, a facultative gram-negative, anaerobic bacillus. […] This activity for healthcare professionals reviews the etiology, epidemiology, clinical presentation, diagnosis, treatment, and sequelae of shigellosis and highlights the importance of an interprofessional approach to the managements of this infectious disease. […] The diagnosis of shigellosis is confirmed when the bacteria is identified in the feculent material of a symptomatic person. A stool sample should be obtained from patients with shigellosis-type symptoms or signs for analysis and culture; stool samples are superior to rectal swabs. […] Stool alpha-1 antitrypsin assays, enzyme-linked immunosorbent assays (ELISAs), and polymerase chain reaction (PCR) testing are not required to diagnose shigellosis.

• #7 Shigella Infection Workup: Laboratory Studies, Other Tests

  https://emedicine.medscape.com/article/968773-workup

  Isolation of Shigella from feces or rectal swab specimen is diagnostic but lacks specificity. Routine microscopy may reveal sheets of leukocytes on methylene-blue stained stool smear, which is a sensitive test for colitis but not specific for Shigella species. […] A sample for stool culture should be obtained in all suspected cases of shigellosis. […] Antimicrobial susceptibility tests of all confirmed isolates should be performed by using the agar diffusion technique. […] An enzyme immunoassay for Stx is used to detect S dysenteriae type 1 in the stool. […] Additional diagnostic tools, such as gene probes and PCR analysis of stool for specific genes such as ipaH, virF, or virA can detect cases not diagnosed by culture but are usually available in research laboratories.

• #8 Shigella: Disease, Properties, Pathogenesis, Lab Diagnosis • Microbe Online

  https://microbeonline.com/shigella-disease-properties-pathogenesis-and-laboratory-diagnosis/

  Freshly passed stool is the preferred sample. The sample must reach the laboratory within 2 hours of collection. If a delay is anticipated transport media should be used to retain the viability of the organism. […] The sample can be plated directly in either MacConkey agar or deoxycholate citrate agar (DCA) or xylose lysine desoxycholate (XLD) agar, Salmonella-Shigella agar, or after enrichment in selenite F broth (incubated at 37o C). […] Confirmation of the organism as Shigella and determination of its group is done by slide agglutination test.

• #9 Laboratory Diagnosis, Treatment and Prevention of Shigella dysenteriae

  https://microbenotes.com/laboratory-diagnosis-treatment-and-prevention-of-shigella-dysenteriae/

  Specimens: stool, mucus flecks, and rectal swabs for culture. Large numbers of fecal leukocytes and some red blood cells often are seen microscopically. […] Microscopic examination of stool smears reveals higher number of PMN cells. […] The materials are streaked on differential media (eg, MacConkey or EMB agar or SS agar) and on selective media (Hektoen enteric agar or xylose-lysine-deoxycholate agar), which suppress other Enterobacteriaceae and gram-positive organisms. […] After overnight incubation, pale non-lactose-fermenting colonies are tested by standard biochemical and sugar utilization tests to differentiate them from other enterobacteria. […] On MacConkey, Hektoen, BCP and SS agar, typical colonies have a small diameter of 0.51 mm; they are convex and translucent with a smooth surface. Colorless (lactose-negative) colonies are inoculated into TSI agar.

• #10 Laboratory Diagnosis, Treatment and Prevention of Shigella dysenteriae

  https://microbenotes.com/laboratory-diagnosis-treatment-and-prevention-of-shigella-dysenteriae/

  On Hektoen agar blue green, convex colonies are observed. […] Organisms that fail to produce H2S, that produce acid but not gas in the butt and an alkaline slant in TSI agar medium, and that are nonmotile, should be subjected to slide agglutination by specific Shigella. […] Strains of S. dysenteriae are characteristically negative for mannitol fermentation and production of catalase, and they are occasionally o-nitrophenyl-b-D-galactopyranoside (ONPG) positive. […] Expression of Shiga toxin can be detected by Vero and HeLa cell tests and immunoassays designed for the Verocytotoxin produced by certain E. coli strains. […] Patients infected with S. dysenteriae 1 produce serum and salivary antibodies to the lipopolysaccharide antigens, but tests for the antibodies are not available routinely.

• #11 Shigellosis – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/bacterial-infections-gram-negative-bacteria/shigellosis

  Identifying the bacteria in a sample of stool can confirm the diagnosis. […] To confirm the diagnosis of shigellosis, doctors take a sample of stool and send it to a laboratory to grow (culture) and identify the bacteria. […] Doctors may use the PCR technique to increase the amount of the bacteria’s DNA, so that the bacteria can be detected more quickly.

• #12 Laboratory Diagnosis, Treatment and Prevention of Shigella dysenteriae

  https://microbenotes.com/laboratory-diagnosis-treatment-and-prevention-of-shigella-dysenteriae/

  Strains of Shigella can be detected with polymerase chain reaction (PCR) tests targeting the genes encoding the invasion plasmid antigen H (ipaH). […] The genes for Shigella enterotoxin 2 can be detected with the ShET-2 PCR and strains with the genes encoding an aerobactin-mediated iron uptake system can be identified with a PCR using primers targeting the iuc gene complex. […] There are several commercial NAATs that directly detect shigellae in fecal samples along with some of the other major enteric pathogens.

• #13 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536

  Culture-independent diagnostics have revealed a larger burden of Shigella among children in low-resource settings than previously recognized. […] The sensitivity of culture compared to qPCR was 6.6% and increased to 27.8% in Shigella-attributable dysentery. […] Culture missed most clinically relevant cases of severe diarrhea and dysentery. […] The recent use of quantitative PCR for Shigella detection revealed a more than five times higher burden of Shigella-attributable diarrhea among children in low-resource settings than previously recognized using culture-based diagnostics. […] An 11-fold higher detection of Shigella was observed with qPCR compared to culture, including a 3-fold increase for Shigella-attributable dysentery. […] These results highlight the need for more sensitive diagnostic tools.

• #14 Shigellosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482337/

  However, stool alpha-1 antitrypsin levels can be elevated in the acute phases of shigellosis and will remain high in patients who fail medical therapy. […] In rare circumstances, culture-independent diagnostic tests like ELISA or PCR may be required to detect bacterial genetic material or toxins in order to make a diagnosis. […] Blood cultures may be recommended in patients with severe cases of shigellosis. […] Laboratory studies are not required to diagnose shigellosis. However, patients with evidence of dehydration, severe disease, or clinical complications will benefit from diagnostic laboratory evaluations. […] Antimicrobial susceptibility testing is critical to ensure appropriate therapeutic selection.

• #15 Post-Travel Diarrhea | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/shigellosis

  Most cases of TD are the result of bacterial or viral infection and are short-lived and self-limited. […] Given emergence of extensively drug-resistant strains, for patients with Shigella infection who have severe disease (e.g., bacteremia, hospitalized) or who are immunocompromised, empiric treatment with a carbapenem is recommended while awaiting results of drug susceptibility testing. […] The initial workup of persistent TD should always include C. difficile testing. […] Diagnosis can be made by stool PCR, microscopy, enzyme immunoassay, or immunofluorescence. […] Diagnosis can be made by stool PCR, microscopy, or enzyme immunoassay. […] Diagnostic tests to determine specific microbial etiologies in cases of post-travel diarrhea have advanced in the past number of years. […] For persistent diarrhea, specific treatment of identified enteropathogens is usually indicated and appropriate management of underlying GI disease is warranted.

• #16 Shigellosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/shigellosis

  Diagnosis is clinical and confirmed by stool culture. […] Diagnosis of shigellosis is facilitated by a high index of suspicion during outbreaks and in endemic areas and by the presence of fecal leukocytes on smears stained with methylene blue or Wright stain. Stool cultures are diagnostic and should be obtained; for severely ill or at-risk patients, antimicrobial sensitivity testing is done. PCR testing using highly sensitive and specific multiplex NAATs is also available. […] In patients with symptoms of dysentery (bloody and mucoid stools), the differential diagnosis should include enterohemorrhagic E. coli, Salmonella, Yersinia, and Campylobacter infections; amebiasis; and Clostridioides difficile infection.

• #17 IDSA 2017 Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea

  https://www.idsociety.org/practice-guideline/infectious-diarrhea/

  People with fever or bloody diarrhea should be evaluated for enteropathogens for which antimicrobial agents may confer clinical benefit, including Salmonella enterica subspecies, Shigella, and Campylobacter (strong, low). […] When the clinical or epidemic history suggests a possible Shiga toxin-producing organism, diagnostic approaches should be applied that detect Shiga toxin (or the genes that encode them) and distinguish Escherichia coli O157:H7 from other Shiga toxin-producing E. coli (STEC) in stool (strong, moderate). […] Stool testing should be performed for Salmonella, Shigella, Campylobacter, Yersinia, C. difficile, and STEC in people with diarrhea accompanied by fever, bloody or mucoid stools, severe abdominal cramping or tenderness, or signs of sepsis (strong, moderate). […] Diagnostic testing is not recommended in most cases of uncomplicated travelers diarrhea unless treatment is indicated.

• #18 Infectious Diarrhea: IDSA Updates Guidelines for Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0515/p676.html

  Diagnostic testing is not routinely recommended in patients with uncomplicated traveler’s diarrhea. […] If diarrhea is accompanied by fever, bloody stools, abdominal cramping, or signs of sepsis, stool should be tested for Salmonella, Shigella, Campylobacter, Yersinia, Clostridium difficile, and STEC. […] Patients with fever or bloody diarrhea should be evaluated for enteropathogens for which antimicrobial agents may be beneficial, including Shigella. […] Early detection of Shiga toxinproducing Escherichia coli (STEC) infection, especially virulent strains, is important to reduce complications and transmission. […] If the clinical or epidemic history suggests a Shiga toxinproducing organism, diagnostic testing should be initiated to identify a Shiga toxin, distinguish STEC O157:H7 from other STEC infections, and, if possible, distinguish Shiga toxin 1 from Shiga toxin 2, which is usually more potent.

• #19 Clinical Overview of Shigellosis | Shigella – Shigellosis | CDC

  https://www.cdc.gov/shigella/hcp/clinical-overview/index.html

  If antibiotics are needed before susceptibility results are available, select treatment based on local resistance data when available. […] Fluoroquinolones (such as ciprofloxacin), azithromycin, and third-generation cephalosporins (such as ceftriaxone) are recommended antibiotics. […] If a patient has prolonged diarrhea (diarrhea lasting more than 3 days), follow-up stool cultures may be needed.

• #20 Shigellosis | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/shigellosis-16689596.html

  Shigellosis in an epidemic context: […] Confirm the causal agent (stool culture) and perform antibiotic sensitivity tests. […] Perform monthly culture and sensitivity tests (antibiotic resistance can develop rapidly, sometimes during the course of an outbreak).

• #21 Infectious Diarrhea: IDSA Updates Guidelines for Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0515/p676.html

  Stool testing is indicated in patients at high risk of severe illness and when identification of a pathogen is important for the patient or public health. […] In patients with diarrhea accompanied by fever, bloody or mucoid stools, severe abdominal cramping or tenderness, or signs of sepsis, stool should be tested for Shigella. […] Diagnostic testing is not routinely recommended in patients with uncomplicated traveler’s diarrhea unless treatment is needed. […] However, those with diarrhea lasting 14 days or more should be tested for intestinal parasitic infection, and those who were treated with an antimicrobial within the preceding eight to 12 weeks should be tested for C. difficile infection. […] Testing may be considered for C. difficile infection in patients older than two years who have a history of diarrhea following antimicrobial use and in those with health-careassociated diarrhea.

• #22 Department of Health | Communicable Disease Service | Shigellosis

  https://www.nj.gov/health/cd/topics/shigellosis.shtml

  Shigellosis is an intestinal illness caused by infection with Shigella bacteria. […] Report within 24 hours of Diagnosis to the Local Health Department. […] Symptoms may include watery diarrhea (which may contain blood or mucus), fever, nausea, vomiting, and abdominal cramps.

• #23 Shigellosis

  https://www.health.vic.gov.au/infectious-diseases/shigellosis

  Shigellosis must be notified by medical practitioners and pathology services in writing within 5 days of diagnosis. […] Diagnosis is made by isolation of Shigella spp. from a clinical specimen. Polymerase chain reaction (PCR) is a very sensitive testing method for Shigella, although some positives are due to the closely related enteroinvasive Escherichia coli. Consequently diagnoses by PCR alone are categorised as probable for national data collection purposes. Culture and antibiotic susceptibility testing is important to guide antibiotic therapy when it is required. […] Two or more related cases should be considered indicative of an outbreak and require investigation.

• #24 Rapid Diagnosis of Diarrhea Caused by Shigella sonnei Using Dipsticks; Comparison of Rectal Swabs, Direct Stool and Stool Culture | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0080267

  We evaluated a dipstick test for rapid detection of Shigella sonnei on bacterial colonies, directly on stools and from rectal swabs because in actual field situations, most pathologic specimens for diagnosis correspond to stool samples or rectal swabs. […] The traditional identification by culture lacks sensitivity due to the low number of causative micro-organisms excreted, competition with commensal organisms, and deleterious changes in ambient temperature and pH during specimen transport. […] The present work describes the second evaluation of this new test that addressed the issue of rapid diagnosis of S. sonnei diarrhoea and dysentery testing from bacterial cultures, stools and rectal swabs which is usually how the specimen is often collected or received from the field or from remote settings.

• #25 Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008536

  The overall sensitivity of culture was 6.6%. […] Sensitivity was even higher in dysentery episodes (27.8%). […] The majority of Shigella burden was associated with watery diarrhea, not dysentery. […] Shigella was detected at quantities high enough to attribute the episode to Shigella in 11.2% of diarrheal stools. […] The overall incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years.

• #26 Rapid Diagnosis of Diarrhea Caused by Shigella sonnei Using Dipsticks; Comparison of Rectal Swabs, Direct Stool and Stool Culture | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0080267

  The dipstick was developed essentially as previously described. […] The RDSs test was found to be highly specific when tested on bacterial cultures, with a better detection threshold (4 x 106 CFU/ml of S. sonnei and 5 ng/ml of LPS) than dipstick tests developed to diagnose cholera, S. dysenteriae 1 infection and S. flexneri 2a infection. […] The RDSs test evaluation on stools and rectal swabs of patients living in four different endemic and non-endemic areas verified its excellent sensitivity and a good specificity. […] The RDSs test was evaluated on rectal swabs obtained from clinical setting, an area of dysentery endemicity, from December 2008 to April 2009 during the period of high incidence of the disease. […] The RDSs tests were shipped by air mail from France to India, Chile and Vietnam at ambient temperature in grip seal bags. […] The dipstick tests were performed with no delay on freshly collected rectal swabs and stools. […] The public health implications of this specific and sensitive assay are high in areas where this serotype is rare and in countries where the disease is endemic.

• #27 How is Shigellosis Diagnosed? | Marler Clark

  https://marlerclark.com/foodborne-illnesses/shigella/shigella-diagnosis

  So-called genetic fingerprinting of the bacterial isolate, using pulsed-field gel electrophoresis (PFGE), is a molecular technique that can help to characterize Shigella isolates, whether obtained from human or food samples. […] Taken together, all of these tests can assist public health officials in determining whether cases (confirmed infections) are isolated or associated with common-source outbreaks. […] There is potential for future creation and use of a rapid stool test for shigellosis diagnosis, but this method is still in testing phases.

• #28 BTNX | Shigella Test Cassette – BTNX Inc.

  https://www.btnx.com/Product/shigella-test-cassette

  The Rapid Response Shigella Test Cassette is an in vitro immunoassay for the direct and qualitative detection of Shigella antigens from human feces. It is intended to aid in the rapid differential diagnosis of shigellosis. […] Negative results do not rule out Shigella infection and should be confirmed via bacterial culture or molecular assay. The test is for professional use only.

• #29 How is Shigellosis Diagnosed? | Marler Clark

  https://marlerclark.com/foodborne-illnesses/shigella/shigella-diagnosis

  Shigella infection is diagnosed through testing of a stool sample. […] Because the symptoms of a Shigella infection are consistent with a fairly large number of potential illnesses, including most foodborne infections, a diagnosis must be confirmed by a laboratory test. […] First, a stool sample must be obtained from the potentially infected person and then placed on a medium to encourage the growth of bacteria. […] The laboratory can also do special tests to tell which species of Shigella the person has and which antibiotics would be best to treat the infection. […] Antibiotic-sensitivity tests are important because Shigella is often resistant to multiple antibiotics. […] More advanced testing and surveillance methods, such as plasmid profiling and chromosomal fingerprinting, can also be used.

• #30 Shigellosis: symptoms, treatment, prevention – Institut Pasteur

  https://www.pasteur.fr/en/medical-center/disease-sheets/shigellosis

  Shigellosis diagnosis is confirmed by the detection of Shigella bacteria in a patient stool sample, whether by stool culture or molecular tests (polymerase chain reaction (PCR)) in a medical test laboratory. […] Conventional microbiological techniques are still the best way of confirming the serogroup and determining antibiotic sensitivity. […] All strains received at the CNR are now sequenced, enabling more precise typing that goes beyond the serogroup and also determines all the antibiotic-resistant genes in the bacterial strain.

• #31

  https://hip.phila.gov/disease-control/diseasesconditions/shigella/

  An increase in shigella cases has been observed in Philadelphia over the last month. Shigellosis is a reportable condition in Philadelphia. Providers who use culture-independent diagnostic test (CIDT) instead of culture for diagnosis should request reflex culture when CIDT is positive. […] The primary way shigellosis is diagnosed is through a stool culture. Providers using culture-independent diagnostic test (CIDT) instead of culture for diagnosis of enteric infections should request that the clinical laboratory perform reflex culture when CIDT is positive for Shigella species. If a culture is positive for Shigella, order antimicrobial susceptibility testing to inform antimicrobial selection. […] Infection with Shigella bacteria can be treated with antibiotics, but these bacteria are frequently resistant to many antibiotic drugs. Providers should order antimicrobial susceptibility testing to determine the appropriate drug for treatment.

• #32

  https://hip.phila.gov/disease-control/diseasesconditions/shigella/

  The Philadelphia Department of Public Health regulations require the exclusion of persons with Shigella infection who participate or work in high-risk settings (e.g., childcare, foodservice, healthcare). They must have two negative stool cultures collected 24 hours apart and at least 48 hours after the completion of antibiotic therapy before they can return.

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