Shigella Recovery

I am a 34 year old male. I was in Mexico and contracted shigella. Symptoms started on Feb 17th. They were relatively minor at first, but progressively got worse. I had severe cramping/intestional pain and diarrhea 4-6 times/day, but no blood. I finally went to the Dr. and they cultured out Shigella (I am not sure which strain) on March 7th. I was put on Bactrim for 3 days things got a little better but not completely and then after a couple of additional days was on Cipro for 3 days. Since this point, my symptoms improved to a point and now are at steady state - they are not intolerable but not great either. I was recultured a couple of weeks ago and came back negative for shigella and C. difficil.

I typically have diarrhea about 1-2 times per day and some mild/moderate cramping after meals. The diarrhea is typically semi-formed. I am eating a very bland diet (no dairy & almost no fat, no caffine, no alcohol, etc.). Fat or dairy seems to trigger significantly worse diarrhea (wattery) and bad cramping. If I go to bannas/rice/toast/etc. I will get formed stools. I have also been having some rectal pain over the past 3 weeks or so. I went to the doctor again yesterday and he examined me and noted that things looked red/raw, but he saw no tearing/hemeroids/etc. He gave me a perscription for a cortisone cream. The rawness seems to be aggrevated by each stool.  

Some additional information:
- Had prostatis symptoms in mid January - was on a course of bactrim and a course of cipro. Symptoms are somewhat improved, but not 100%. Have been taking Prosta-Q 2x day(herb mix - queceretin, saw pallmeto, etc.) and it seems to help.

-Had a vasectomy on Feb 21st. Was on Keflex (preventative for 5 days).

-Was put on 25mg/day of Paxil for anxiety/depression March 25h. I have been feeling mentally better for the last week or so.

-I have been taking a multivitamin each day and trying to get in a min of 15-20 minutes of excercise/day.

- I made an appointment with a gastro specialists in case I need it (about 3 weeks leadtime).

What is the typical recovery time for shigella? Is it typical that I would still be having these symptoms (cramping, diarrhea, rectal pain) after two months. I am very frustrated that I can not eat what I consider to be a normal diet. Are there any diet modifications that might help me (more fiber?), what about using imodium (immodium) or something similar? Would this help me have fewer bowel movements, letting my rectum heal? Is there anything else that I can do to feel better? Help! The doctor yesterday said that I give it a few more weeks - argggh! If I am not better in 3 weeks, what should I discuss with the gastroenterologist?
  
Karl

[Kevin Pho, MD]

Hello - thanks for asking your question.

To answer your questions:
1) In general, Shigella gastroenteritis is self-limited.  The duration of untreated Shigella infection averages 7 days.

2) It is not typical to continue having these symptoms for 2 months.  I would consider a colonoscopy or flexible sigmoidoscopy to make sure there are no other causes of your symptoms.  

3) Supportive treatment may help with the symptoms (i.e. fiver, immodium etc.), but without finding out the cause, they will likely continue.  

4) As I have mentioned before, I would suggest obtaining an endoscopy (either a colonoscopy or flexible sigmoidoscopy).  Other tests to consider include sending the stool off for malabsorption (i.e. fecal fat tests).  You may also want to test for a bacteria called Clostridium Difficile (it is associated with previous antibiotic use).  

5) Discuss the option of obtaining an endoscopy for further evaluation.  I would obtain a Clostridium Difficile test.  Ask your gastroenterologist other causes of chronic diarrhea and cramping, including chronic infections, malabsorption, irritable bowel disease or inflammatory bowel disease.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.