Drug-resistant Shigella cases on the rise in Colorado

COLORADO SPRINGS, Colo. (KRDO) -- Colorado is seeing a sharp increase in a gastrointestinal infection called Shigella. Now, the Centers for Disease Control and Prevention (CDC) is issuing a warning, saying this increase is specifically for a difficult-to-treat form of Shigella.

The CDC reports Colorado has the second-largest number of drug-resistant Shigella cases.

According to health officials, the concerning aspect of this recent rise in cases is its resistance to the five commonly used antibiotics used to treat shigella in the United States. Also, the fact that it's affecting adults more when previously it most commonly affected children under four.

In 2022, about 5% of Shigella infections reported to the CDC were caused by drug-resistant strains, compared to none in 2015.

"We tend to see cases of Shigella every year," El Paso County Public Health Communicable Disease Specialist Haley Zachary said. "But we're starting to see more and more cases resistant to frontline antibiotics that providers prescribe. So that tells us that we as a provider community need to start looking at pulling susceptibilities which can allow us to understand which bacteria is resistant to which antibiotic, and from there we're able to treat the disease effectively."

The CDC said the most vulnerable to drug-resistant Shigella are international travelers, people living with HIV, men who have sex with men, and people experiencing homelessness.

"We tend to be most concerned with people who live or work in congregate care or housing," Zachary explained. "So we pay a lot of attention to long-term care facilities, daycare facilities, and homeless shelters because that bacteria, you only need a small amount to make people sick."

According to the Colorado Department of Public Health and Environment, Shigella bacteria spreads through direct person-to-person contact, and indirectly through contaminated food and water. Preventative measures include frequent hand washing, cleaning your fruits and vegetables, and being careful when traveling or eating out.

"Risk factors for shigella include international travel to places where it's common, eating food that's been contaminated through an ill-food handler, and contact with someone who has shigella," Colorado State Epidemiologist Rachel Jervis said. "That could be household contact preparing food for you or sexual transmission."

Most infections go away on their own. However, people who have weakened immune systems can get a more serious illness, possibly spreading into the blood. Those individuals are advised to look into treatment if the symptoms persist.

"Shigella causes an intense diarrheal infection," Zachary said. "So people will have fever, nausea, vomiting, diarrhea, and sometimes it will be bloody."

According to the European Centre for Disease Control and Prevention, as of mid-February, 12 countries - including the United States - have reported over 250 shigella infections since Sep. 2022 in people who went to Cape Verde in West Africa.

The CDC believes the high levels of antibiotic use during the pandemic may have contributed, allowing drug resistance to develop and spread.

Symptoms usually start 1-2 days after infection and can last 7 days. But infected people can spread the disease to others for 2 weeks after their symptoms end.

Tuesday from noon to 1 p.m., the CDC will brief clinicians through a webinar about the rise in cases and how to manage them. Including how the infection presents, approaches to clinical management, how clinicians should test and report shigella, and the importance of having a detailed sexual and travel history.