Locally acquired extended‐spectrum β‐lactamase Shigella infection

Hui‐Ling Yeoh, Victoria Hall, Deborah A Williamson and Bradley J Gardiner
Med J Aust 2019; 211 (4): . || doi: 10.5694/mja2.50245
Published online: 19 August 2019

A 32‐year‐old Australian‐born, human immunodeficiency virus (HIV) negative man presented to hospital with 3 days of cramping abdominal pain, diarrhoea and fevers, 5 days after having unprotected receptive anal intercourse. Regular medications were tenofovir disoproxil fumarate and emtricitabine for pre‐exposure prophylaxis (PrEP), with complete adherence. On examination, he had left lower quadrant abdominal tenderness. White cell count was 7.3 × 109/L (reference range [RR], 3.9–12.7 × 109 cells/L) and C‐reactive protein (CRP) 164 mg/L (RR, 0–5 mg/L). A presumptive diagnosis of infective colitis was made, and he was empirically commenced on intravenous ceftriaxone 2 g daily. He initially improved with resolution of fever and abdominal pain. A sexually transmissible infection screen was performed, which was negative, including HIV serology. Faecal cultures returned positive for Shigella flexneri serotype 3a. The patient completed 5 days of ceftriaxone therapy and was discharged home improved, with a CRP of 28 mg/L.

  • 1  Alfred Health, Melbourne, VIC
  • 2  Doherty Institute, University of Melbourne, Melbourne, VIC
  • 3 Monash University, Melbourne, VIC


Competing interests:

No relevant disclosures.

  • 1. Ingle DJ, Easton M, Valcanis M, et al. Co‐circulation of multidrug‐resistant Shigella among men who have sex with men, Australia. Clin Infect Dis 2019. [Epub ahead of print]
  • 2. Lane CR, Sutton B, Valcanis M, et al. Travel destinations and sexual behavior as indicators of antibiotic resistant Shigella strains — Victoria, Australia. Clin Infect Dis 2016; 62: 722–729.
  • 3. Chang Z, Zhang J, Ran L, et al. The changing epidemiology of bacillary dysentery and characteristics of antimicrobial resistance of Shigella isolated in China from 2004–2014. BMC Infect Dis 2016; 16: 685.
  • 4. Baker KS, Dallman TJ, Ashton PM, et al. Intercontinental dissemination of azithromycin‐resistant shigellosis through sexual transmission: a cross‐sectional study. Lancet Infect Dis 2015; 15: 913–921.
  • 5. Borg ML, Modi A, Tostmann A, et al. Ongoing outbreak of Shigella flexneri serotype 3a in men who have sex with men in England and Wales, data from 2009–2011. Euro Surveill 2012; 17. pii: 20137.


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