More than two dozen people who ate at Mariscos San Juan restaurant (205 N. 4th Street) in downtown San Jose on Friday October 16 or Saturday October 17 have been stricken with gastroenteritis caused by Shigella sonnei, according to the Santa Clara County Public Health Department Monday.
The restaurant was closed on Sunday morning and remains closed. Of the ill persons, over a dozen have tested positive for Shigella by PCR, and one has a blood culture growing Shigella sonnei; almost all of the reported cases have required hospital admission, and 11 are in intensive care.
There are other individuals who were seen and not admitted or who were ill but did not seek medical attention. To date, antimicrobial susceptibilities on the isolate are not been completed. The cases represent only a small proportion of actual cases. Case finding is ongoing, health officials note.
The health alert advises clinicians to suspect Shigella gastroenteritis in persons presenting with fever and diarrhea who ate at Mariscos San Juan at the 4th Street location, or who had contact with an ill person; test with stool culture and order antimicrobial susceptibility testing. If patient is ill enough to require hospitalization, obtain blood culture and tailor therapy based on results of susceptibility testing, recognizing that routine antimicrobial susceptibility tests for Shigella may not include some commonly available oral antibiotics.
Shigellosis is an acute bacterial disease of the intestines caused by several species of the bacterium, Shigella. It is typified by loose stools, frequently containing blood and mucus (dysentery), accompanied by fever, vomiting, fever, vomiting, cramps and occasionally toxemia.
It can cause bacillary dysentery because of the invasive ability of the organism that may result ulcerations and abscesses of the intestines.
It rarely spreads to the bloodstream.
More severe complications may include convulsions in children, Reiter’s syndrome and hemolytic uremic syndrome depending on the species of Shigella implicated.
This diarrheal disease is found worldwide with the vast majority of cases and deaths being in children. Outbreaks usually occur where there are crowded conditions and where personal hygiene is poor: prisons, day care centers and refugee camps are three examples.
It is transmitted primarily by fecal-oral person to person means. It can also occur through contaminated food or water. Those primarily responsible for transmission are people that fail to wash their hands thoroughly after defecation.
Because shigella is resistant to gastric acid, a person can be infected with as little as 10 organisms.
After being infected, symptoms usually appear 1-3 days later. It can be transmitted during the acute phase of infection until approximately four weeks after illness when the organism is no longer present in the feces. Asymptomatic carriers can also infect others.
Diagnosis is confirmed through bacteriological culture of feces. Treatment of shigellosis may include fluid and electrolyte replacement if there are signs of dehydration.
Antibiotics can shorten the course of infection, the severity of illness and the period of time a person may excrete the pathogen. Because of some antibiotic resistance, an antibiotic susceptibility test should be performed to determine which antibiotic would be effective.