CDC Health Advisory
The CDC issued a concern with an uptick in extensive drug resistance (XDR) Shigella in the United States. Although anyone can get the XDR infection such as children, those with weakened immune systems (HIV or chemotherapy) , or travelers to areas with poor sanitation and hygiene systems, the majority of cases are males in the GBMSM category (gay or bisexual or men having sex with men). Children account for 0.4% of cases. Women 14.7% and men 84.9%.
Prevention is the key:
- Avoid any sex including anal or oral with anyone who has had diarrhea in the last 2 weeks.
- Reduce fecal-oral exposure with the use of barriers and washing hands and genitals.
Most infections of Shigella will resolve with rest and oral or IV fluids. Children under 5 years of age are rarely drug resistant. There are oral drugs used in the United Kingdom/ Japan such as chloramphenicol, pivmecillinam, and fosfomycin. In ill hospitalized patients, ertapenem and meropenem are useful for 3-5 days.
F. James McGouran, MD
DRH Health, Chief of Staff