Acute Communicable
Disease Control

 

Contact Information
County of Los Angeles
Department of Public Health
Acute Communicable Disease Control
313 N. Figueroa Street, #212
Los Angeles, CA 90012
Phone: (213) 240-7941
Fax: (213) 482-4856
Email:acdc2@ph.lacounty.gov

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Acute Communicable Disease Control
Shigellosis (Shigella)

Multi-drug resistant SHIGELLA infections among men who have sex with men (MSM)

In the last two years, LA County has experienced an increase in cases of multi-drug resistant Shigella among MSM. MSM are at increased risk for this disease, and should be aware of the outbreak and that Shigella can be a severe illness, particularly in those with reduced immunity. CDC released a recent health alert regarding the increase in multi-drug resistant Shigella outlining clinical guidance available HERE.

  • To minimize risk of infection, strategies include avoiding oral-anal contact, not engaging in sexual activity with anyone with a fever, diarrhea or other symptoms, and ensuring hands and toys are all washed with soap and water between use. People with Shigella infection should not prepare food for others while sick.
  • MSM with fever and diarrhea should see their healthcare provider and a stool culture should be done to identify whether the cause is Shigella. Abstaining from sex for at least 2 weeks after infection is important to further reduce transmission (and then maintaining safe sex practices when one resumes sexual relations). People who work in healthcare, food service, or childcare, might be kept from work until they recover.

For Clinicians:
  • Obtain a stool culture from MSM who present with fever and diarrhea.
  • Order antimicrobial susceptibility testing (AST) when ordering stool culture for Shigella and request ciprofloxacin AST that includes lowest dilutions available (dilutions of 0.12 μg/mL or lower are ideal but not always available). Await AST results before treating.
  • If antimicrobial treatment is warranted based on severe or prolonged illness, hospitalization, underlying risk factors such as immune-compromising conditions including HIV/AIDS or treatment with immunosuppressive drugs, clinicians should prescribe treatment on best data available and upon receipt of the antimicrobial susceptibility results, and change therapy if necessary.
  • If you routinely order PCR tests, please ensure it is in addition to culture. PCR does not replace culture as an isolate or specimen is required to be sent to the public health lab per the 2016 update to the CA CCR Title 17 Reportable Disease Guidance:
  • If the method of AST used reports out minimum inhibitory concentration (MIC), avoid prescribing fluoroquinolones for ciprofloxacin MICs in the 0.121.0 μg/mL range.
  • Obtain follow-up stool cultures and AST in shigellosis patients who have continued or worsening symptoms despite antibiotic therapy.
  • Tailor risk reduction and prevention messaging to MSM.
  • Report all cases and AST results to the Los Angeles County Department of Pubic Health (LAC DPH).

Reporting for Clinically Suspect Cases:
Los Angeles County suspect cases are reportable within 1 working day from identification by electronic transmission (including FAX at 888-397-3778), telephone (888-397-3993) or mail by completing a confidential morbidity report (CMR).


For Clinicians:



What is Shigellosis?
Shigellosis is caused by a Gram-negative bacillus with 4 main serogroups: Shigella dysenteriae (group A), S. flexneri (group B), S. boydii (group C) and S. sonnei (group D). Incubation period is 1-3 days. Transmission occurs when individuals fail to thoroughly wash their hands after defecation and spread infective particles to others, either directly by physical contact, including sexual behaviors, or indirectly by contaminating food. Infection may occur with ingestion of as few as 10 organisms. Common symptoms include diarrhea, fever, nausea, vomiting, and tenesmus. Stool may contain blood or mucous. In general, the elderly, the immunocompromised, and the malnourished are more susceptible to severe disease outcomes. 


Additional Resources
 
Shigella Infections among Gay & Bisexual Men

Note: Content contains mature language

Gay, bisexual and other men who have sex with men (MSM) are at risk for Shigella infections.

CDC: General Information

Print-and-Go Fact Sheet



Shigellosis Palm Card for MSM
(English) (Spanish)
Shigellosis FAQ for Gay, Bisexual and MSM
(English) (Spanish)
Shigellosis
Frequently Asked Questions
(English) (Spanish)
 
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