S. sonnei, flexneri, boydii: Fever, cramps, watery-then-bloody, mucoid diarrhea with pus; seizures (children).
S. flexneri: Reiter's syndrome possible in HLA-B27 genotypes.
S. dysenteriae: Shiga toxin, severe dysentery, tenesmus, rectal prolapse, hemolytic uremic syndrome (HUS) in children, thrombotic thrombocytopenic purpura (TTP) in adults.
Primary prevention: No vaccine; handwashing, hygienic food preparation, avoid contaminated drinking water and recreational water. Secondary prevention: Fecal pmns, fecal Gram stain, stool C&S, Shiga toxin ELISA, flexible sigmoidoscopy with colon biopsy. Tertiary prevention: Quinolones preferred; resistant to ampicillin, TMP/SMX, and TCN.
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