In a follow-up to a report concerning a cluster of Shigella flexneri infections in men who have sex with men (MSM) in Los Angeles County and other Southern California counties, LA County health officials have reported two fatalities due to the bacterial infection.

Los Angeles County map/Thadius856
Los Angeles County map/Thadius856

The Los Angeles County Department of Public Health (LAC DPH) has seen 48 cases of S. flexneri through August 2016. Eighty-eight percent of the cases were in men.

The Los Angeles County Department of Public Health recommends:

  • MSM should be aware of the outbreak and that Shigella can be a severe illness, particularly in those with reduced immunity
  • Changing sexual practices to avoid oral-anal contact will help prevent disease
  •  Any MSM with fever and diarrhea should see their healthcare provider and a stool culture should be done to identify whether the cause isShigella
  • Antibiotic treatment will shorten duration of illness and reduce the risk of transmission
  • 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)
  • Those with Shigella infection should not prepare food for others while sick
  • People who work in healthcare, food service, or childcare, might be kept from work until they recover

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.