Last updated
SynonymsBacillary dysentery, Marlow syndrome
Shigella stool.jpg
Shigella seen in a stool sample
Specialty Infectious disease
SymptomsDiarrhea, fever, abdominal pain [1]
Complications Reactive arthritis, sepsis, seizures, hemolytic uremic syndrome [1]
Usual onset1-2 days post exposure [1]
Duration5-7 days [1]
Causes Shigella [1]
Diagnostic method Stool culture [1]
Prevention Handwashing [1]
TreatmentDrinking fluids and rest [1]
Medication Antibiotics (severe cases) [1]
Frequency>80 million [2]
Deaths700,000 [2]

Shigellosis is an infection of the intestines caused by Shigella bacteria. [3] [1] Symptoms generally start one to two days after exposure and include diarrhea, fever, abdominal pain, and feeling the need to pass stools even when the bowels are empty. [1] The diarrhea may be bloody. [1] Symptoms typically last five to seven days. [1] Complications can include reactive arthritis, sepsis, seizures, and hemolytic uremic syndrome. [1]

Gastrointestinal tract organ system within humans and other animals pertaining the stomach and intestines

The gastrointestinal tract is an organ system within humans and other animals which takes in food, digests it to extract and absorb energy and nutrients, and expels the remaining waste as feces. The mouth, esophagus, stomach and intestines are part of the gastrointestinal tract. Gastrointestinal is an adjective meaning of or pertaining to the stomach and intestines. A tract is a collection of related anatomic structures or a series of connected body organs.

<i>Shigella</i> genus of bacteria

Shigella is a genus of Gram-negative, facultative aerobic, non-spore-forming, nonmotile, rod-shaped bacteria genetically closely related to E. coli. The genus is named after Kiyoshi Shiga, who first discovered it in 1897.

Bacteria A domain of prokaryotes – single celled organisms without a nucleus

Bacteria are a type of biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a number of shapes, ranging from spheres to rods and spirals. Bacteria were among the first life forms to appear on Earth, and are present in most of its habitats. Bacteria inhabit soil, water, acidic hot springs, radioactive waste, and the deep portions of Earth's crust. Bacteria also live in symbiotic and parasitic relationships with plants and animals. Most bacteria have not been characterised, and only about half of the bacterial phyla have species that can be grown in the laboratory. The study of bacteria is known as bacteriology, a branch of microbiology.


Shigellosis is caused by four specific types of Shigella. [2] These are typically spread by exposure to infected feces. [1] This can occur via contaminated food, water, or hands. [1] Contamination may be spread by flies or when changing diapers (nappies). [1] Diagnosis is by stool culture. [1]

Feces solid or semisolid remains of the food that could not be digested in the small intestine

Feces are the solid or semisolid remains of the food that could not be digested in the small intestine. Bacteria in the large intestine further break down the material. Feces contain a relatively small amount of metabolic waste products such as bacterially altered bilirubin, and the dead epithelial cells from the lining of the gut.

The risk of infection can be reduced by properly washing the hands. [1] There is no vaccine. [1] Shigellosis usually resolves without specific treatment. [1] Sufficient fluids by mouth and rest is recommended. [1] Bismuth subsalicylate may help with the symptoms; however, medications that slow the bowels such as loperamide are not recommended. [1] In severe cases antibiotics may be used but resistance is common. [1] [4] Commonly used antibiotics include ciprofloxacin and azithromycin. [1]

Vaccine biological preparatory medicine that improves immunity to a particular disease

A vaccine is a biological preparation that provides active acquired immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future. Vaccines can be prophylactic, or therapeutic.

Bismuth subsalicylate pharmaceutical drug

Bismuth subsalicylate, sold under the brand name Pepto-Bismol, is an antacid medication used to treat temporary discomforts of the stomach and gastrointestinal tract, such as diarrhea, indigestion, heartburn and nausea. It is also commonly known as pink bismuth.

Loperamide chemical compound

Loperamide, sold under the brand name Imodium, among others, is a medication used to decrease the frequency of diarrhea. It is often used for this purpose in gastroenteritis, inflammatory bowel disease, and short bowel syndrome. It is not recommended for those with blood in the stool. The medication is taken by mouth.

Globally shigellosis occurs in at least 80 million people and results in about 700,000 deaths a year. [2] Most cases occur in the developing world. [2] Young children are most commonly affected. [1] Outbreaks of disease may occur in childcare settings and schools. [1] It is also relatively common among travelers. [1] In the United States about half a million cases occur a year. [1]

Signs and symptoms

Signs and symptoms may range from mild abdominal discomfort to full-blown dysentery characterized by cramps, diarrhea, with slimy-consistent stools, fever, blood, pus, or mucus in stools or tenesmus. [5] [6] Onset time is 12 to 96 hours, and recovery takes 5 to 7 days. [7] Infections are associated with mucosal ulceration, rectal bleeding, and drastic dehydration. Reactive arthritis and hemolytic uremic syndrome are possible sequelae that have been reported in the aftermath of shigellosis.

Abdomen frontal part of the body between the thorax (chest) and pelvis

The abdomen constitutes the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the frontal part of the abdominal segment of the trunk, the dorsal part of this segment being the back of the abdomen. The region occupied by the abdomen is termed the abdominal cavity. In arthropods it is the posterior tagma of the body; it follows the thorax or cephalothorax. The abdomen stretches from the thorax at the thoracic diaphragm to the pelvis at the pelvic brim. The pelvic brim stretches from the lumbosacral joint to the pubic symphysis and is the edge of the pelvic inlet. The space above this inlet and under the thoracic diaphragm is termed the abdominal cavity. The boundary of the abdominal cavity is the abdominal wall in the front and the peritoneal surface at the rear.

Dysentery inflammation of the intestine causing diarrhea with blood

Dysentery is an inflammatory disease of the intestine, especially of the colon, which always results in severe diarrhea and abdominal pains. Other symptoms may include fever and a feeling of incomplete defecation. The disease is caused by several types of infectious pathogens such as bacteria, viruses and parasites.

Diarrhea Loose or liquid bowel movements

Diarrhea is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.

The most common neurological symptom includes seizures. [8]



Shigellosis is caused by a bacterial infection with Shigella , [1] a bacterium that is genetically similar to and was once classified as E. coli . [9] There are three serogroups and one serotype of Shigella:

The probability of being infected by any given strain of Shigella varies around the world. For instance, S. sonnei is the most common in the United States, while S. dysenteriae and S. boydii are rare in the U.S. [1]


Shigella is transmitted through the fecal-oral route of individuals infected with the disease, whether or not they are exhibiting symptoms. [1] [10] Long-term carriers of the bacteria are rare. [10] Apart from humans, the bacteria can also infect primates. [11]


Upon ingestion, the bacteria pass through the gastrointestinal tract until they reach the small intestine. There they begin to multiply until they reach the large intestine. [12] In the large intestine, the bacteria cause cell injury and the beginning stages of Shigellosis via two main mechanisms: direct invasion of epithelial cells in the large intestine and production of enterotoxin 1 and enterotoxin 2. [12]

Unlike other bacteria, Shigella is not destroyed by the gastric acid in the stomach. As a result, it takes only 10 to 200 cells to cause an infection. [12] This infectious dose is several order of magnitudes smaller than that of other species of bacteria (e.g. Cholera, caused by the bacterium Vibrio cholerae , has an infectious dose between 108 and 1011 cells). [13]


The diagnosis of shigellosis is made by isolating the organism from diarrheal fecal sample cultures. Shigella species are negative for motility and are generally not lactose fermenters, but S. sonnei can ferment lactose. [14] They typically do not produce gas from carbohydrates (with the exception of certain strains of S. flexneri) and tend to be overall biochemically inert. Shigella should also be urea hydrolysis negative. When inoculated to a triple sugar iron slant, they react as follows: K/A, gas -, and H2S -. Indole reactions are mixed, positive and negative, with the exception of S. sonnei, which is always indole negative. Growth on Hektoen enteric agar produces bluish-green colonies for Shigella and bluish-green colonies with black centers for Salmonella.


Simple precautions can be taken to prevent getting shigellosis: wash hands before handling food and thoroughly cook all food before eating. The primary prevention methods are improved sanitation and personal and food hygiene, but a low-cost and efficacious vaccine would complement these methods. [15]

Since shigellosis is spread very quickly among children, keeping infected children out of daycare for 24 hours after their symptoms have disappeared, will decrease the occurrence of shigellosis in daycares. [16]


Currently, no licensed vaccine targeting Shigella exists. Several vaccine candidates for Shigella are in various stages of development including live attenuated, conjugate, ribosomal, and proteosome vaccines. [15] [17] [18] Shigella has been a longstanding World Health Organization target for vaccine development, and sharp declines in age-specific diarrhea/dysentery attack rates for this pathogen indicate that natural immunity does develop following exposure; thus, vaccination to prevent the disease should be feasible. Shigellosis is resistant to many antibiotics used to treat the disease, [19] so vaccination is an important part of the strategy to reduce morbidity and mortality. [15]


Treatment consists mainly of replacing fluids and salts lost because of diarrhea. Replacement by mouth is satisfactory for most people, but some may need to receive fluids intravenously. Antidiarrheal drugs (such as diphenoxylate or loperamide) may prolong the infection and should not be used. [20]


Antibiotics should only be used in severe cases or for certain populations with mild symptoms (elderly, immunocompromised, food service industry workers, child care workers). For Shigella-associated diarrhea, antibiotics shorten the length of infection, [21] but they are usually avoided in mild cases because many Shigella strains are becoming resistant to common antibiotics. [22] Furthermore, effective medications are often in short supply in developing countries, which carry the majority of the disease burden from Shigella. Antidiarrheal agents may worsen the sickness, and should be avoided. [23]

In most cases, the disease resolves within four to eight days without antibiotics. Severe infections may last three to six weeks. Antibiotics, such as trimethoprim-sulfamethoxazole, ciprofloxacin may be given when the person is very young or very old, when the disease is severe, or when the risk of the infection spreading to other people is high. Additionally, ampicillin (but not amoxicillin) was effective in treating this disease previously, but now the first choice of drug is pivmecillinam. [24]


Insufficient data exist, [25] but it is estimated to have caused the death of 34,000 children under the age of five in 2013, and 40,000 deaths in people over five years of age. [15] Shigella also causes about 580,000 cases annually among travelers and military personnel from industrialized countries. [26]

An estimated 500,000 cases of shigellosis occur annually in the United States. [19] Infants, the elderly, and the critically ill are susceptible to the most severe symptoms of disease, but all humans are susceptible to some degree. Individuals with acquired immune deficiency syndrome (AIDS) are more frequently infected with Shigella. [27] Shigellosis is a more common and serious condition in the developing world; fatality rates of shigellosis epidemics in developing countries can be 5–15%. [28]

Orthodox Jewish communities (OJCs) are a known risk group for shigellosis; Shigella sonnei is cyclically epidemic in these communities in Israel, with sporadic outbreaks occurring elsewhere in among these communities. "Through phylogenetic and genomic analysis, we showed that strains from outbreaks in OJCs outside of Israel are distinct from strains in the general population and relate to a single multidrug-resistant sublineage of S. sonnei that prevails in Israel. Further Bayesian phylogenetic analysis showed that this strain emerged approximately 30 years ago, demonstrating the speed at which antimicrobial drug–resistant pathogens can spread widely through geographically dispersed, but internationally connected, communities." [29]

See also

Related Research Articles

Cholera Bacterial infection of the small intestine

Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and muscle cramps may also occur. Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance. This may result in sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet. Dehydration can cause the skin to turn bluish. Symptoms start two hours to five days after exposure.

Typhoid fever A bacterial infectious disorder contracted by consumption of food or drink contaminated with Salmonella typhi. This disorder is common in developing countries and can be treated with antibiotics.

Typhoid fever, also known simply as typhoid, is a bacterial infection due to Salmonella typhi that causes symptoms. Symptoms may vary from mild to severe and usually begin six to thirty days after exposure. Often there is a gradual onset of a high fever over several days; weakness, abdominal pain, constipation, headaches, and mild vomiting also commonly occur. Some people develop a skin rash with rose colored spots. In severe cases there may be confusion. Without treatment, symptoms may last weeks or months. Diarrhea is uncommon. Other people may carry the bacterium without being affected; however, they are still able to spread the disease to others. Typhoid fever is a type of enteric fever, along with paratyphoid fever.

<i>Clostridioides difficile</i> infection

Clostridioides difficile infection, also known as Clostridium difficile infection, is a symptomatic infection due to the spore-forming bacterium, Clostridioides difficile. Symptoms include watery diarrhea, fever, nausea, and abdominal pain. It makes up about 20% of cases of antibiotic-associated diarrhea. Complications may include pseudomembranous colitis, toxic megacolon, perforation of the colon, and sepsis.

Gastroenteritis Inflammation of the stomach and small intestine

Gastroenteritis, also known as infectious diarrhea, is inflammation of the gastrointestinal tract—the stomach and small intestine. Symptoms may include diarrhea, vomiting and abdominal pain. Fever, lack of energy and dehydration may also occur. This typically lasts less than two weeks. It is not related to influenza, though it has been called the "stomach flu".

Campylobacteriosis genus of Gram-negative bacteria

Campylobacteriosis is an infection by the Campylobacter bacterium, most commonly C. jejuni. It is among the most common bacterial infections of humans, often a foodborne illness. It produces an inflammatory, sometimes bloody, diarrhea or dysentery syndrome, mostly including cramps, fever and pain.

Travelers diarrhea disease

Traveler's diarrhea (TD) is a stomach and intestinal infection. TD is defined as the passage of unformed stool while traveling. It may be accompanied by abdominal cramps, nausea, fever, and bloating. Occasionally bloody diarrhea may occur. Most travelers recover within four days with little or no treatment. About 10% of people may have symptoms for a week.

<i>Shigella dysenteriae</i> species of bacterium

Shigella dysenteriae is a species of the rod-shaped bacterial genus Shigella. Shigella species can cause shigellosis. Shigellae are Gram-negative, non-spore-forming, facultatively anaerobic, nonmotile bacteria.

Bacillary dysentery is a type of dysentery, and is a severe form of shigellosis.

Childhood immunizations in the United States

The schedule of childhood immunizations in the United States is given by the Centers for Disease Control and Prevention (CDC). The vaccination schedule is broken down by age: birth to six years of age, seven to eighteen, and adults nineteen and older. Childhood Immunizations are key in preventing children for diseases that were once epidemics.

Meningococcal disease Human disease

Meningococcal disease describes infections caused by the bacterium Neisseria meningitidis. It has a high mortality rate if untreated but is vaccine-preventable While best known as a cause of meningitis, it can also result in sepsis, which is an even more damaging and dangerous condition. Meningitis and meningococcemia are major causes of illness, death, and disability in both developed and under-developed countries.

Paratyphoid fever bacterial infection caused by one of the three types of Salmonella enterica

Paratyphoid fever, also known simply as paratyphoid, is a bacterial infection caused by one of the three types of Salmonella enterica. Symptoms usually begin 6–30 days after exposure and are the same as those of typhoid fever. Often, a gradual onset of a high fever occurs over several days. Weakness, loss of appetite, and headaches also commonly occur. Some people develop a skin rash with rose-colored spots. Without treatment, symptoms may last weeks or months. Other people may carry the bacteria without being affected; however, they are still able to spread the disease to others. Both typhoid and paratyphoid are of similar severity. Paratyphoid and typhoid fever are types of enteric fever.

Gonorrhea sexually transmitted infection

Gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. Many of those infected have no symptoms. Men may have burning with urination, discharge from the penis, or testicular pain. Women may have burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain. Complications in women include pelvic inflammatory disease and in men include inflammation of the epididymis. If untreated, gonorrhea can spread to joints or heart valves.

<i>Shigella sonnei</i> species of bacterium

Shigella sonnei is a species of Shigella. Together with Shigella flexneri, it is responsible for 90% of shigellosis cases. Shigella sonnei is named for the Danish bacteriologist Carl Olaf Sonne. It is a Gram-negative, rod-shaped, nonmotile, non-spore-forming bacterium.

Amoebiasis human protozoa disease

Amoebiasis, also known amoebic dysentery, is an infection caused by any of the amobae of the Entamoeba group. Symptoms are most common during infection by Entamoeba histolytica. Amoebiasis can be present with no, mild, or severe symptoms. Symptoms may include abdominal pain, diarrhea, or bloody diarrhea. Complications can include inflammation and ulceration of the colon with tissue death or perforation, which may result in peritonitis. People affected may develop anemia due to loss of blood.

Enteroinvasive Escherichia coli (EIEC) is a type of pathogenic bacteria whose infection causes a syndrome that is identical to shigellosis, with profuse diarrhea and high fever. EIEC are highly invasive, and they use adhesin proteins to bind to and enter intestinal cells. They produce no toxins, but severely damage the intestinal wall through mechanical cell destruction.

Pathogenic <i>Escherichia coli</i>

Escherichia coli ( Anglicized to ; commonly abbreviated E. coli) is a gram-negative, rod-shaped bacterium that is commonly found in the lower intestine of warm-blooded organisms (endotherms). Most E. coli strains are harmless, but some serotypes are pathogenic and can cause serious food poisoning in humans, and are occasionally responsible for product recalls. E. coli are also responsible for a majority of cases of urinary tract infections. The harmless strains are part of the normal flora of the gut, and can benefit their hosts by producing vitamin K2, and by preventing the establishment of pathogenic bacteria within the intestine.


  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 "General Information| Shigella – Shigellosis | CDC". 3 August 2016. Archived from the original on 16 April 2017. Retrieved 20 April 2017.
  2. 1 2 3 4 5 Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae type 1 (PDF). WHO. 2005. p. 2. ISBN   978-9241593304. Archived (PDF) from the original on 21 August 2017. Retrieved 20 April 2017.
  3. "Factsheet about shigellosis". European Centre for Disease Prevention and Control.
  4. "Update – CDC Recommendations for Managing and Reporting Shigella Infections with Possible Reduced Susceptibility to Ciprofloxacin". 7 June 2018. Retrieved 16 June 2018.
  5. "Shigellosis". The Merck Manual Home Health Handbook. Archived from the original on 4 January 2012. Retrieved 10 February 2012.
  6. Niyogi, SK (April 2005). "Shigellosis". Journal of Microbiology (Seoul, Korea). 43 (2): 133–43. PMID   15880088.
  7. "Symptoms Of Shigella Infection". About Shigella. Marler Clark. Archived from the original on 8 January 2012. Retrieved 10 February 2012.
  8. "Diarrhoeal Diseases: Shigellosis". Initiative for Vaccine Research. World Health Organization. Archived from the original on 15 December 2008. Retrieved 11 May 2012.
  9. Devanga Ragupathi, NK; Muthuirulandi Sethuvel, DP; Inbanathan, FY; Veeraraghavan, B (21 January 2018). "Accurate differentiation of Escherichia coli and Shigella serogroups: challenges and strategies". New Microbes New Infect. 21: 58–62. doi:10.1016/j.nmni.2017.09.003. PMC   5711669 . PMID   29204286.
  10. 1 2 "Shigellosis (Bacillary Dysentery)". Merck Manual Professional Version. Retrieved 16 March 2018.
  11. Bowen, Anna (31 May 2017). "Travelers' Health, Chapter 3, Shigellosis (CDC)" . Retrieved 17 March 2018.
  12. 1 2 3 Aslam, A; Gossman, WG (14 February 2018). Shigella (Shigellosis). Treasure Island, FL: StatPearls. PMID   29493962.
  13. Nelson, EJ; Harris, JB; Glenn Morris, Jr., J; Calderwood, SB; Camilli, A (October 2009). "Cholera transmission: the host, pathogen and bacteriophage dynamic". Nat Rev Microbiol. 7 (10): 693–702. doi:10.1038/nrmicro2204. PMC   3842031 . PMID   19756008.
  14. Ito, Hideo; Kido, Nobuo; Arakawa, Yoshichika; Ohta, Michio; Sugiyama, Tsuyoshi; Kato, Nobuo (1991). "Possible mechanisms underlying the slow lactose fermentation phenotype in Shigella spp". Applied and Environmental Microbiology. 57 (10): 2912–7. PMC   183896 . PMID   1746953.
  15. 1 2 3 4 Mani, Sachin; Wierzba, Thomas; Walker, Richard I. (2016). "Status of vaccine research and development for Shigella". Vaccine. 34 (26): 2887–2894. doi:10.1016/j.vaccine.2016.02.075. PMID   26979135.
  16. mayo clinic "Archived copy". Archived from the original on 6 September 2015. Retrieved 14 September 2015.CS1 maint: Archived copy as title (link)
  17. "WHO vaccine pipeline tracker". World Health Organization. Archived from the original on 25 July 2016. Retrieved 29 July 2016.
  18. "Vaccine Research And Development: New strategies for accelerating Shigella vaccine development" (PDF). Weekly Epidemiological Record. 72 (11): 73–80. 14 March 1997. Archived (PDF) from the original on 19 May 2009. Retrieved 10 February 2012.
  19. 1 2 US Centers for Disease Control and Prevention. "Shigella – Shigellosis". Archived from the original on 24 July 2016. Retrieved 29 July 2016.
  20. "How can Shigella infections be treated?". Shigellosis: General Information. Centers for Disease Control and Prevention. Archived from the original on 8 February 2016.
  21. Christopher, Prince RH; David, Kirubah V; John, Sushil M; Sankarapandian, Venkatesan; Christopher, Prince RH (2010). "Antibiotic therapy for Shigella dysentery". The Cochrane Database of Systematic Reviews (8): CD006784. doi:10.1002/14651858.CD006784.pub4. PMID   20687081.
  22. Kahsay, AG; Muthupandian, S (30 August 2016). "A review on Sero diversity and antimicrobial resistance patterns of Shigella species in Africa, Asia and South America, 2001-2014". BMC Research Notes. 9 (1): 422. doi:10.1186/s13104-016-2236-7. PMC   5004314 . PMID   27576729.
  23. "How can Shigella infections be treated?". Shigellosis: General Information. Centers for Disease Control and Prevention. Archived from the original on 11 February 2012. Retrieved 11 February 2012.
  24. Katzung, Bertram G. (2007). Basic and Clinical Pharmacology. New York, NY: McGraw Hill Medical. p. 733. ISBN   978-0-07-145153-6.
  25. Ram, PK; Crump JA; Gupta SK; Miller MA; Mintz ED (2008). "Analysis of Data Gaps Pertaining to Shigella Infections in Low and Medium Human Development Index Countries, 1984–2005". Epidemiology and Infection. 136 (5): 577–603. doi:10.1017/S0950268807009351. PMC   2870860 . PMID   17686195.
  26. World Health Organization (2006). State of the art of new vaccine research and development (PDF). Archived (PDF) from the original on 4 March 2016.
  27. Angulo, Frederick J.; Swerdlow, David L. (1995). "Bacterial Enteric Infections in Persons Infected with Human Immunodeficiency Virus". Clinical Infectious Diseases. 21 (Supplement 1): S84–S93. doi:10.1093/clinids/21.supplement_1.s84.
  28. Todar, Kenneth. "Shigella and Shigellosis". Todar's Online Textbook of Bacteriology. Archived from the original on 9 February 2012. Retrieved 10 February 2012.
  29. Baker, K et. al (September 2016). "Travel- and Community-Based Transmission of Multidrug-Resistant Shigella sonnei Lineage among International Orthodox Jewish Communities". Emerg Infect Dis. 22 (9): 1545–1553. doi:10.3201/eid2209.151953. PMC   4994374 . PMID   27532625.
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