Snapshot A 20-year-old prison inmate was brought in from the detention clinic with a 3 day history of crampy abdominal pain and diarrhea. Patient reports the stools were small volume and bloody. On examination, temperature was found to be 101.5°F (38.6°C). Patient was admitted for rehydration and workup. Stool microscopy reveals numerous RBCs and WBCs and a stool culture was carried out. Introduction Classification bacteria gram-negative bacilli the enterics facultative anaerobes Enterobacteriaceae non-lactose fermenting Shigella S.dysenteriae Presentation Enterocolitis bloody diarrhea with mucus and pus fever (generally > 101°F) tenesmus (straining) lower abdominal cramps Extremely contagious oral-fecal transmission Especially affects children institutionalized patients Severe dehydration Febrile seizures Reactive arthritis may follow infection Hemolytic-uremic syndrome may be seen following infection in children Evaluation Fecal RBCs and WBCs Defintive diagnosis is by stool culture PCR has also been used Differential Other causes of infectious diarrhea S. typhi E. coli O157:H7 Campylobacter jejuni Treatment Fluoroquinolones TMP-SMX Azithromycin Do not use ampicillin many strains are resistant