When asked about the wildest topics I encountered during my NCLEX exam, Shigellosis comes to mind first. I am well aware of its existence but that’s it. The NCLEX question asked for the drug of choice and I thought, “Well, maybe I could just use some test-taking strategies on this one.” I at least know Shigellosis is caused by bacteria, so naturally it would require an antibiotic.
Then lo and behold, all options were antibiotics.
So here are some notes that I wanted to share just in case you haven’t brushed up on this topic. Then later on in the practice test, I’ll reveal my answer on that question.
Shigellosis is an acute intestinal infection caused by Shigella bacteria, which are gram-negative, non-motile bacilli. It is transmitted primarily through the fecal–oral route and is highly contagious, requiring only a small number of organisms to cause infection. The disease is a major cause of bloody diarrhea (dysentery) worldwide and occurs most often in children, individuals living in crowded environments, and those with poor sanitation. Outbreaks are common in daycare centers, nursing homes, prisons, and refugee camps.
It’s a foodborne and waterborne illness transmitted via the fecal–oral route.
More common in children under 5 years.
Globally, Shigella causes ~80–165 million cases annually, especially in developing countries.
It commonly causes bloody diarrhea and abdominal cramping.
Watch Out For: dehydration, seizures (in children), hemolytic uremic syndrome
Safety Precaution: Contact precaution—gloves, gown, and strict hand hygiene
After ingestion, Shigella invades the colonic mucosa and causes mucosal ulceration and inflammation. This results in impaired fluid absorption and secretion of mucus and blood into the stool. The inflammatory response can also lead to fever and systemic symptoms. In some children, neurotoxic effects from high fever or electrolyte disturbances may cause seizures. Because the infectious dose is very low, person-to-person transmission occurs easily in crowded or unsanitary conditions.
Caused by Shigella dysenteriae, S. flexneri, S. boydii, or S. sonnei.
As few as 10 organisms can cause illness.
Risk factors include:
Poor hand hygiene and contaminated food or water
Immunocompromised status
Crowded living condition
Clinical presentation: Bloody, mucoid diarrhea, abdominal cramping, fever, tenesmus (painful straining with stool), and sometimes vomiting.
Physical exam: Signs of dehydration such as dry mucous membranes, tachycardia, sunken eyes, hypotension, and poor skin turgor may be present.
Laboratory findings:
Stool culture is the gold standard for confirming Shigella.
CBC may reveal leukocytosis.
Electrolyte imbalances (hyponatremia, hypokalemia) may be found in severe cases.
Blood cultures may be indicated if systemic infection is suspected.
NCLEX Tip: Always consider fluid and electrolyte balance as the nursing priority.
Rehydration is the cornerstone of therapy, with oral rehydration solutions for mild cases and IV fluids for moderate to severe dehydration.
Ceftriaxone (for resistant cases or children)
Antipyretics such as acetaminophen may be used to manage fever and discomfort.
AVOID: Antidiarrheal medications such as loperamide. These prolong bacterial carriage and can worsen the illness.
Nursing care focuses on hydration, infection control, comfort, and education.
stool frequency, consistency, and presence of blood/mucus.
hydration status: skin turgor, mucous membranes, urine output.
temperature and signs of systemic infection.
Hydration support: Monitor intake/output, daily weight, and vital signs. Administer oral rehydration or IV fluids as needed.
Infection control: Implement contact precautions for all patients with diarrhea. Emphasize strict hand hygiene with soap and water after toileting and before meals. Note that alcohol-based sanitizers are less effective against Shigella.
Medication administration: Administer antibiotics as ordered. Avoid giving antidiarrheals. Provide antipyretics for fever control.
Nutrition: Encourage a bland diet as tolerated. Avoid foods that may irritate the gut.
Patient and family education: Teach about safe hygiene practices, handwashing after bathroom use or diaper changes, cleaning contaminated surfaces, and keeping children home from daycare until cleared by a provider. Also emphasize to not share towels, utensils, or food during illness. Completing the full course of antibiotics is very important.
Fluid volume deficit is the highest priority in shigellosis due to severe diarrhea.
Contact precautions are required because of fecal–oral transmission.
Antibiotics shorten illness duration and reduce transmission, but the choice depends on resistance patterns.
Do not give antidiarrheals—they increase risk of complications.
Complication in pediatrics: seizures may occur due to high fever and electrolyte imbalance.
Mnemonic for Shigella (SHIGELLA):
Small infectious dose spreads easily
Hygiene is the best prevention
Infection control = contact precautions
Give fluids first
Educate on handwashing
Loperamide is contraindicated
Leukocytosis may be present
Antibiotics shorten illness