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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Infectious Disease

Complications: HUS, Seizures, and Reactive Arthritis

At a Glance

While most people recover from shigellosis, it can cause severe complications. Young children may experience seizures from high fever. Certain strains can trigger Hemolytic Uremic Syndrome (HUS), a dangerous kidney condition, and some patients may develop reactive arthritis weeks after infection.

While most people recover from shigellosis without long-term issues, it is important to be aware of certain complications that can arise. These conditions require prompt medical attention if they occur.

Seizures in Children

In young children under the age of 5, the high fever and systemic toxicity early in a Shigella infection can trigger severe generalized seizures [1]. These are often independent of other complications and are considered a medical emergency. If your child experiences a seizure, seek immediate medical care.

Hemolytic Uremic Syndrome (HUS)

HUS is a serious condition that primarily affects the kidneys and the blood’s ability to clot [2]. In the context of shigellosis, it is most commonly triggered by a specific strain called Shigella dysenteriae type 1, which produces a potent toxin known as the Shiga toxin [3][4].

How HUS Develops

The Shiga toxin enters the bloodstream and attacks the inner lining of small blood vessels, particularly in the kidneys [5][6]. This causes:

  1. Hemolytic Anemia: Red blood cells are shredded as they pass through damaged vessels [7].
  2. Thrombocytopenia: Platelets are used up, leading to low platelet counts [8].
  3. Acute Kidney Injury: The damaged vessels and shredded cells clog the kidney’s filtering units, potentially leading to kidney failure [9].

Warning Signs of HUS

Seek emergency care immediately if you notice:

  • Decreased Urination: A significant drop in urine output [10].
  • Pallor: Looking unusually pale or extreme fatigue [7].
  • Unexpected Bruising: Tiny red or purple spots on the skin (petechiae) [8].

Reactive Arthritis

Reactive arthritis is an inflammatory condition that occurs as a “reaction” to an infection elsewhere in the body [11]. It is not caused by the bacteria spreading to the joints, but by the immune system mistakenly attacking healthy tissue after the original infection has passed [12]. Unfortunately, there is no proven way to prevent it, as it is largely determined by individual immune responses and genetics.

The Timeline and “Triad”

Reactive arthritis typically appears days to weeks after the diarrhea has ended [13]. It is traditionally characterized by a triad of symptoms:

  1. The Joints (Arthritis): Pain and swelling in large joints like the knees or ankles [14].
  2. The Eyes (Conjunctivitis/Uveitis): Redness, itching, or pain in the eyes [15].
  3. The Urethra (Urethritis): Pain or burning during urination [15].

For many people, reactive arthritis is self-limiting and disappears within a few months [15]. However, some individuals with a specific genetic marker (HLA-B27) may experience a more chronic form [16][12].

Common questions in this guide

Can a shigella infection cause seizures in children?
Yes, the high fever and severe toxicity early in a shigella infection can trigger generalized seizures in children under five years old. This is considered a medical emergency that requires immediate medical attention.
What is Hemolytic Uremic Syndrome (HUS)?
HUS is a serious kidney complication most often caused by the Shigella dysenteriae type 1 strain. The bacteria produce a toxin that damages small blood vessels, leading to the destruction of red blood cells, low platelets, and acute kidney injury.
What are the warning signs of kidney failure or HUS after shigellosis?
You should seek emergency medical care if you notice a significant drop in urination, unusual paleness, extreme fatigue, or tiny red or purple spots on the skin known as petechiae.
Why do my joints hurt weeks after having a shigella infection?
Joint pain that appears days or weeks after your diarrhea has stopped could be reactive arthritis. This condition occurs when your immune system mistakenly attacks healthy joint tissue after fighting off the initial infection.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Was my infection caused by 'Shigella dysenteriae type 1,' and should we be monitoring my kidney function more closely because of that?
  2. 2.What specific blood markers (like platelet count or hemoglobin levels) are you watching to screen for HUS?
  3. 3.What signs of a seizure should I watch out for in my young child?
  4. 4.I am noticing joint pain several weeks after my infection; could this be Reactive Arthritis?
  5. 5.Are there long-term follow-up tests I need to ensure my kidneys have fully recovered?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (16)
  1. 1

    Hemolytic Uremic Syndrome With Severe Neurologic Complications in an Adult.

    Nasir A, Patel N, Prabakaran S, et al.

    Federal practitioner : for the health care professionals of the VA, DoD, and PHS 2019; (36(Suppl 4)):S36-S41.

    PMID: 31296982
  2. 2

    Atypical Hemolytic-Uremic Syndrome: Genetic Basis, Clinical Manifestations, and a Multidisciplinary Approach to Management.

    Yerigeri K, Kadatane S, Mongan K, et al.

    Journal of multidisciplinary healthcare 2023; (16()):2233-2249 doi:10.2147/JMDH.S245620.

    PMID: 37560408
  3. 3

    Disparities in Shigellosis Incidence by Census Tract Poverty, Crowding, and Race/Ethnicity in the United States, FoodNet, 2004-2014.

    Libby T, Clogher P, Wilson E, et al.

    Open forum infectious diseases 2020; (7(2)):ofaa030 doi:10.1093/ofid/ofaa030.

    PMID: 32099844
  4. 4

    Commentary: Campylobacter and Hemolytic Uremic Syndrome.

    Smith JL, Gunther NW

    Foodborne pathogens and disease 2019; (16(2)):90-93 doi:10.1089/fpd.2018.2513.

    PMID: 30307748
  5. 5

    AB Toxins as High-Affinity Ligands for Cell Targeting in Cancer Therapy.

    Márquez-López A, Fanarraga ML

    International journal of molecular sciences 2023; (24(13)) doi:10.3390/ijms241311227.

    PMID: 37446406
  6. 6

    Redefining Shiga toxin-induced human cell death as NLRP1- and gasdermin E-mediated pyroptosis.

    Ricci-Azevedo R, Sarkar B, Shivcharan S, et al.

    Proceedings of the National Academy of Sciences of the United States of America 2026; (123(3)):e2510274123 doi:10.1073/pnas.2510274123.

    PMID: 41533439
  7. 7

    Hemolytic uremic syndrome associated with Escherichia coli O157:H7 infection in older adults: a case report and review of the literature.

    Ko H, Maymani H, Rojas-Hernandez C

    Journal of medical case reports 2016; (10()):175 doi:10.1186/s13256-016-0970-z.

    PMID: 27301547
  8. 8

    Hemolytic Uremic Syndrome.

    Cody EM, Dixon BP

    Pediatric clinics of North America 2019; (66(1)):235-246 doi:10.1016/j.pcl.2018.09.011.

    PMID: 30454746
  9. 9

    Eculizumab in severe Shiga toxin-mediated haemolytic uraemic syndrome.

    Carroll M, Blake L, Sharma S

    BMJ case reports 2024; (17(1)) doi:10.1136/bcr-2023-256524.

    PMID: 38238162
  10. 10

    Escherichia coli Complications in Pediatric Critical Care.

    Puentes SS, Dunstan M

    Critical care nursing clinics of North America 2018; (30(1)):149-156 doi:10.1016/j.cnc.2017.10.013.

    PMID: 29413210
  11. 11

    Enteric Infection-Associated Reactive Arthritis: A Systematic Review and Meta-Analysis.

    Shafiee D, Salpynov Z, Gusmanov A, et al.

    Journal of clinical medicine 2024; (13(12)) doi:10.3390/jcm13123433.

    PMID: 38929962
  12. 12

    [Reactive arthritis - a disease almost forgotten?]

    Märker-Hermann E

    Deutsche medizinische Wochenschrift (1946) 2020; (145(24)):1786-1790 doi:10.1055/a-1036-9359.

    PMID: 33254255
  13. 13

    Reactive arthritis: a clinical review.

    Jubber A, Moorthy A

    The journal of the Royal College of Physicians of Edinburgh 2021; (51(3)):288-297 doi:10.4997/JRCPE.2021.319.

    PMID: 34528623
  14. 14

    Reactive arthritis: the convoluted history of Reiter's disease.

    Buchanan WW, Kean WF, Rainsford KD, Kean CA

    Inflammopharmacology 2024; (32(1)):93-99 doi:10.1007/s10787-023-01336-4.

    PMID: 37805646
  15. 15

    Evolving patterns of reactive arthritis.

    Hayes KM, Hayes RJP, Turk MA, Pope JE

    Clinical rheumatology 2019; (38(8)):2083-2088 doi:10.1007/s10067-019-04522-4.

    PMID: 30919146
  16. 16

    Reactive Arthritis.

    Schmitt SK

    Infectious disease clinics of North America 2017; (31(2)):265-277 doi:10.1016/j.idc.2017.01.002.

    PMID: 28292540

This page is for informational purposes only and does not replace professional medical advice. If you or your child experience signs of a seizure, reduced urination, or severe joint pain following a shigella infection, seek emergency medical care immediately.

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