As of February 8, 2023, 32 people reported becoming ill with Shigellosis after eating food from the Tamarind Tree Restaurant in Seattle, Washington. Public health officials are investigating this Shigellosis outbreak. Of those interviewed, all 32 people ate at the same restaurant January 14 – 17, 2023, and started having symptoms January 17 – 20, 2023. Symptoms reported include diarrhea, cramps, nausea, fever, chills, and vomiting.
Ten of the 32 people who became ill tested positive for Shigella. Six cases have confirmatory testing indicating Shigella sonnei, a species of Shigella. Symptoms among those who did not get tested are suggestive of a Shigella infection.
Upon a routine inspection, on January 18, 2023, Environmental Health investigators observed several risk factors that could contribute to foodborne outbreaks, including bare hand contact with ready-to-eat foods.
On January 24, 2023, Environmental Health investigators visited the Tamarind Tree restaurant to assess the food safety practices. They observed improper food handling, including blocked access to handwashing facilities, improper storage of wiping cloths, risk of cross contamination, and lack of maintenance, cleaning, and sanitizing of food equipment and physical facilities. The restaurant was closed on January 24,2023 to address these issues and was required to complete a thorough cleaning and disinfection
Often those infected with Shigella do not have obvious symptoms. Therefore, the Public Health Department worked with the restaurant to complete testing for all of their employees. At this time, no employees have tested positive for Shigella.
Investigators provided education about preventing the spread of gastrointestinal illness — including proper handwashing and preventing bare hand contact with ready-to-eat foods. Investigators have also reviewed with restaurant management the requirement that people with a gastrointestinal illness who work in food handling should not work while ill, and those with diagnosed Shigella infections who work in food handling must be cleared by Public Health before returning to work to make sure they are no longer contagious.
Shigella
Shigella is the bacterium that causes the disease shigellosis, also known as bacillary dysentery. Shigella is one of the most easily transmitted bacterial diarrheas, since it can occur after fewer than 100 bacteria are ingested. While reported cases of Shigella range between 14,000 and 20,000 annually, with the majority of these cases occurring between July and October. Shigella Sonnei is the most common type of Shigella. It accounts for over two-thirds of cases of shigellosis in the United States.
Shigella bacteria are generally transmitted through a fecal-oral route. Foods that come into contact with human or animal waste can transmit Shigella. Thus, handling toddlers’ diapers, eating vegetables from a field contaminated with sewage, or drinking pool water are all activities that can lead to shigellosis.
Symptoms of Shigella Food Poisoning
Symptoms of Shigella poisoning most commonly develop one to three days after exposure to Shigella bacteria, and usually go away within five to seven days. It is also possible to get Shigella but experience no symptoms, and still be contagious to others, a condition known as being asymptomatic.
Common Shigella Food Poisoning Symptoms
- Diarrhea: Diarrhea ranges from mild to severe. It is bloody in 25 to 50 percent of cases and usually contains mucus
- Fever
- Stomach cramps
- Rectal spasms
Complications from Shigella
Complications from shigellosis can include severe dehydration, seizures in small children, rectal bleeding, and invasion of the blood stream by the bacteria. Young children and the elderly are at the highest risk of death. The following is a list of specific complications caused by Shigella.
Proctitis and Rectal Prolapse: The bacteria that causes shingellosis can also cause inflammation of the lining of the rectum or rectal prolapse.
Reactive Arthritis: Approximately 3 percent of patients with Shigella infection, most often those with Shigella flexneri, develop Reactive Arthritis. It occurs when the immune system attempts to combat Shigella but instead attacks the body. Symptoms of Reactive Arthritis include inflammation of the joints, eyes, or reproductive or urinary organs. On average, symptoms appear 18 days after infection.
Toxic Megacolon: In this rare complication, the colon is paralyzed and unable to pass bowel movements or gas. Symptoms of Toxic Megacolon include abdominal pain and swelling, fever, weakness, and disorientation. If this complication goes untreated and the colon ruptures, the patient’s condition can be life-threatening.
Hemolytic Uremic Syndrome, or HUS: Shigella rarely results in HUS, which is more commonly a complication of Shiga toxin-producing E. coli infections. HUS can lead to kidney failure.
Diagnosis of Shigella
A Shigella infection is diagnosed through laboratory testing of a stool sample.
Shigella Food Poisoning Treatment
A Shigella infection usually goes away on its own in five to seven days, although bowel movements may continue to be abnormal for up to a month following infection. Antibiotics, however, can shorten the course of the illness. A doctor can prescribe antibiotics after testing a stool sample for the presence of Shigella bacteria.
Some strains of shigellosis are resistant to antibiotics, meaning that antibiotics might not always be an effective treatment. Antidiarrheal medication should be avoided, as it can actually make the illness worse.
Preventing a Shigella Infection
Frequent hand washing is key to preventing Shigella, since individuals can carry Shigella without noticing symptoms, and Shigella bacteria can remain active for weeks after illness.
Steps for Preventing the Spread of Shigella Infection
- If a child in diapers has shigellosis, wash your hands after changing their diaper and wipe down the changing area with disinfectant
- People with Shigella should not prepare food for others for at least two days after diarrhea has stopped
- Drink only treated or boiled water while traveling and only eat fruits you peel yourself.
- Only swim in pools maintaining a chlorine level of 0.5 parts per million and stay clear of pools where children not yet toilet trained are swimming
Marler Clark, Inc., P.S., The Food Safety Law Firm, is the nation’s leading law firm representing victims of Shigella outbreaks. The Shigella lawyers of Marler Clark have represented thousands of victims of Shigella and other foodborne illness outbreaks and have recovered over $850 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our attorneys have litigated Shigella cases stemming from outbreaks traced to a variety of sources, such as tomatoes, airplane and restaurant food.
If you or a family member became ill with Shigella infection after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Shigella attorneys for a free case evaluation.