Shigella flexneri Outbreak at a Rehabilitation Center: First Report from Saudi Arabia

Area of Science:

• Infectious Diseases
• Public Health
• Microbiology

Background:

• Shigella flexneri causes shigellosis, particularly in developing regions and institutional settings.
• Transmission occurs via the fecal-oral route, leading to intestinal epithelial cell invasion.
• Complications include diarrhea, systemic symptoms, and hemolytic uremic syndrome.

Purpose of the Study:

• To characterize clinical presentation, treatment, outcomes, and infection control during a local Shigella flexneri outbreak.
• To investigate Shigella flexneri infections in a rehabilitation center setting.

Main Methods:

• A case series involving microbiological and molecular analysis of stool and blood samples.
• Investigation of four Shigella flexneri cases at King Saud University Medical City (Oct-Dec 2024).
• Genetic linkage and virulence gene analysis of S. flexneri isolates.

Main Results:

• Four patients with comorbidities in a rehabilitation center presented with fever and diarrhea.
• Laboratory findings included leukocytosis, electrolyte imbalances, and elevated inflammatory markers; two cases showed colitis on imaging.
• Molecular studies confirmed genetic relatedness and identified virulence genes linked to disease severity.

Conclusions:

• Shigella flexneri outbreaks in long-term care facilities are challenging, particularly for bedbound patients.
• Diaper use can facilitate transmission, and infections can lead to severe complications.
• Robust infection control, source identification, and prevention strategies are vital for vulnerable populations.