MOULTRIE -- An Odom Elementary School fifth grader was hospitalized over the weekend due to contracting shigella from an unknown source.

Shigellosis, a fecal/oral infectious disease, is on the rise in Georgia. Colquitt County has had at least 15 reported cases of the bacterial infection in the past several months, and the boy's case is the worst so far, health officials said.

Thursday night an hour after his mother noticed a fever, he began complaining of severe stomach cramps. He vomited through the night, his mother said.

Friday, he was terribly weak and began passing blood in diarrhea. Bloody diarrhea is an indication of shigella infection.

"To me, every time he went to the restroom, it seemed like there was more and more blood," said Susan Martinez, the boy's mother.

The boy went to his family pediatrician in the morning before blood was evident and later was admitted to Colquitt Regional Medical Center. By Saturday afternoon, the worst of the infection had blown over, and by Sunday, he was home.

The rest of her family is fine, she said.

There is a marked increase of shigellosis in Georgia. As of October 2002, 1,729 reported shigella infections were reported compared to about 455 in October 2001, Georgia public health officials said. Outside of Atlanta, the Albany health district has the largest number of infections, according to the most recent public health figures.

Shigellosis results in 600,000 deaths in the world annually, particularly in tropical and temperate climates. But no one has died in Georgia in at least five years from the disease, health officials said.

A severe infection with high fever may also be associated with seizures in children less than two years old. Some persons who are infected may have no symptoms at all but may still pass the shigella bacteria to others, health officials said.

"We are investigating every case that comes to our attention," said Dan Staib, regional director of Acute, Chronic and Infectious Disease. "But it's hard to say where it's coming from. ... But we do know that hand washing and appropriate personal hygiene will prevent the transmission to other individuals."

In Colquitt County, the health department has investigated several daycares and the high school, Staib said.

"What's unusual is that we can't isolate the source," he said.

Shigella is a human fecal/oral infectious disease-- meaning somebody has to be sick with shigella to begin with, and then another person somehow comes in contact with it. The different ways to become infected are innumerable, Staib said.

Antibiotics can treat secondary infections, but shigella has to run its course. Its duration is generally from five to seven days, and, like food poisoning, infected persons are not immune after they contract the bacteria.

"Just in the past several years, the rates of shigella have probably increased threefold. Shigella is just one of those diseases that is around us all the time. There's probably more reporting now. I wonder how many are not reported," Staib said.

Shigellosis is cyclical, typically peaking every five to six years, he said.

About half of the reported cases are school-age children. School nurses are aware of shigella cases increasing and know what symptoms to look for in students and staff, School Nurse Coordinator Suzanne Sumner said. The nurses also are instructed to notify Sumner of any concentrations of suspected cases.

The janitorial staff at the schools are told to be especially thorough in cleaning the restrooms, she said.

Outside the lunchrooms, some of the schools in the Colquitt County district do not have hot water in restrooms for the children.

Thorough hand washing is the best defense from infection, but kids will be kids, health officials said. So they are urging parents to coach their child to wash hands thoroughly (including under the nails and the backs of the hand) with the antibacterial soap provided in the restrooms.

Sumner said there's no pattern in the number of suspected shigella infections seen by school nurses. There is no





one central location.

Students must not have experienced diarrhea for at least 24 hours before returning to school, she said.

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