When should I consider referring a patient with Shigella infection to secondary care?

Consider referring a patient with Shigella infection to secondary care if any of the following apply:

• The patient shows signs of severe dehydration requiring intravenous fluid therapy, especially if oral rehydration is not tolerated or effective.
• There is evidence of systemic infection such as suspected septicaemia or extra-intestinal spread of infection.
• The patient is very young (e.g., under 6 months) or immunocompromised, increasing risk of complications.
• There is blood and/or mucus in the stool, which may indicate dysenteric shigellosis requiring antibiotic treatment and specialist input.
• The patient has red flag symptoms such as shock, altered conscious state, severe abdominal pain, or other signs suggesting serious illness.
• The diarrhoea has not improved by day 7 or diagnosis is uncertain, warranting further investigation and specialist assessment.
• There is a need for specialist advice on antibiotic therapy, especially if the patient has recently travelled abroad.

Referral should be urgent if the patient shows symptoms suggesting shock or other serious complications.

These criteria align with NICE guidance on managing gastroenteritis and infections like Shigella, which recommend referral for intravenous fluids, systemic infection, red flag symptoms, and complicated cases requiring specialist care ¹.