Hemolytic-uremic syndrome enterohemorrhagic E coli , Campylobacter jejuni , Shigella. Reactive arthritis Shigella , Campylobacter jejuni , Yersinia enterocolitica colitis. Patients with CMV colitis complicating inflammatory bowel disease may develop severe hemorrhage, megacolon, fulminant colitis, or colon perforation; these complications contribute to the high risk of mortality. Deterrence and Patient Education Patients need to receive counsel regarding the importance of antibiotic adherence, as well as any signs of relapse or worsening condition.
Pearls and Other Issues In managing patients presenting with colitis, computed tomography scans, colonoscopy, and biopsies could help differentiate between infectious and noninfectious colitis. Enhancing Healthcare Team Outcomes Infectious colitis is complex and requires an interprofessional team for the diagnosis, management, and early detection of complications.
Review Questions Access free multiple choice questions on this topic. Comment on this article. Figure Radiograph of an infant with necrotizing enterocolitis. Figure Gross Pathology of neonatal necrotizing enterocolitis, Autopsy, infant, abdominal distention, necrosis, hemorrhage, peritonitis due to perforation. References 1. Characterization of Shiga toxin-producing Escherichia coli isolates associated with two multistate food-borne outbreaks that occurred in Appl Environ Microbiol.
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Eur Respir J. Hook EW. N Engl J Med. Clin Infect Dis. Salmonella colitis as an unusual cause of elevated serum lipase. Am J Emerg Med. Bacterial colitis. Clin Colon Rectal Surg. Toxic megacolon. Inflamm Bowel Dis. Endoscopic findings and lesion distribution in amebic colitis. J Infect Chemother. Gastrointestinal symptoms after infectious diarrhea: a five-year follow-up in a Swedish cohort of adults.
Clin Gastroenterol Hepatol. Infectious Colitis. In: StatPearls [Internet]. In this Page. Related information. Similar articles in PubMed. Rev Gastroenterol Peru. Evaluation of Luminex xTAG gastrointestinal pathogen analyte-specific reagents for high-throughput, simultaneous detection of bacteria, viruses, and parasites of clinical and public health importance.
J Clin Microbiol. Epub Jul Therefore, an approach is needed to evaluate and diagnose the cause of colitis and exclude non-infectious causes. This activity discusses current strategies to diagnose and manage infectious colitis and how to make a high index of suspicion based on clinical presentation and use investigation methods to reach a final diagnosis.
This activity discusses the etiology, epidemiology, pathophysiology, clinical presentation, evaluation, differential diagnosis, complications, and management of patients with infectious colitis. Learn More.
Bacterial colitis results in an inflammatory-type diarrhea that is characterized by bloody, purulent, and mucoid stool. These diseases have been designated as bacterial hemorrhagic enterocolitis. Associated symptoms include fever, tenesmus, and severe abdominal pain. The pathologic changes range from superficial exudative enterocolitis to a transmural enterocolitis with ulceration.
Common pathologic bacteria causing bacterial colitis include Campylobacter , Salmonella , Shigella , Escherichia , and Yersinia species. The primary source of transmission is fecal-oral spread and ingestion of contaminated food and water. Although detailed history and identification of specific risk factors assist in the diagnosis, definitive diagnosis requires bacterial identification.
Therefore, the physician must be familiar with the disease pathophysiology, epidemiology, and specific diagnostic modalities for clinical diagnosis and management. Specific tests are used to detect enteric pathogens and include stool and rectal swab culture, histology, and identification of specific bacterial toxins. Although many of these bacterial colitis infections are self-limiting, antibiotics should be used for high-risk patients and patients with complicated disease.
Acute infectious bacterial diarrhea is a common presenting problem in general practice and is a significant health problem in both developing and developed regions of the world. Children, elderly persons, and immunocompromised individuals are especially susceptible to these infections. Common modes of transmission include the fecal-oral route, animal hosts, ingestion of contaminated food and water, and close human-to-human contact.
Infection through direct contact is common in areas where people are housed together with potential exposure to compromised hygiene i. Bacterial diarrhea can be classified into noninflammatory diarrhea and inflammatory diarrhea. Noninflammatory diarrhea is caused by pathogenic bacteria i. Inflammatory diarrhea is characterized by bloody and mucopurulent stool that is often associated with fever, tenesmus, and severe abdominal pain.
Common pathogenic bacteria causing inflammatory diarrhea include Campylobacter , Salmonella , Shigella , enteroinvasive and enterohemorrhagic Escherichia coli , Yersinia , Chlamydia , Neisseria , and tuberculosis. These organisms cause a bacterial hemorrhagic enterocolitis and are the focus of this article. Campylobacter , a curved, highly motile microaerophilic gram-positive rod, has become one of the major causes of infectious diarrhea today.
Transmission occurs most commonly through contaminated poultry and is acquired by eating undercooked chicken. The reservoir for this organism is enormous because many animals can be infected and includes cattle, sheep, swine, birds, and dogs. After ingestion, the incubation period is 24 to 72 hours. Clinical illness manifests as frank dysentery, with few patients exhibiting watery diarrhea or asymptomatic excretion. Localized infections of the terminal ileum and cecum can suggest a clinical picture of acute appendicitis.
Campylobacter species possess oxidase and catalase activity that facilitates invasion and ulceration in the colonic mucosa, resulting in bloody stools. Recurrent and chronic infection is generally reported in immunocompromised patients. Complications of Campylobacter infections are rare and include gastrointestinal hemorrhage, toxic megacolon, pancreatitis, cholecystitis, hemolytic-uremic syndrome HUS , meningitis, and purulent arthritis.
Reiter syndrome is a reactive arthritis that is observed more frequently in patients who carry the HLA-B27 phenotype. Cross-reactivity of antibodies to C. Stool examination reveals the presence of fecal leukocytes and erythrocytes supporting the diagnosis of colitis, and laboratory tests frequently indicate volume depletion and leukocytosis.
Colonoscopic findings show segmental edema, loss of normal vascular pattern with ulceration, and patchy involvement of the colonic mucosa. Diagnosis can be established only by culture of organisms. The yield of C. Most patients with mild to moderate C. Quinolone antibiotics should be used empirically because isolation and identification of the pathogen takes time and quinolone antibiotics are active against Campylobacter , Shigella , and other common enteric pathogens.
Resistance to fluoroquinolones is a major problem in parts of the developing world and has been identified in certain parts of the United States. In a large study from Minnesota, human isolates of Campylobacter species exhibited a rise in quinolone resistance from 1. In areas where fluoroquinolone resistance is common, azithromycin has proved effective and should be used.
Although C. Salmonella species are gram-negative, rod-shaped bacilli that are members of the Enterobacteriaceae family. Salmonella typhi and Salmonella paratyphi cause typhoid fever, and other Salmonella species are associated with gastroenteritis, enterocolitis, and focal infections including meningitis, septic arthritis, cholangitis, and pneumonia.
Salmonella is considered primarily a food-borne infection. Large outbreaks of Salmonella species—induced enterocolitis are frequently derived from institutional dinners and contaminated food and water supply. In the United States, the two most common serotypes that result in enterocolitis are Salmonella enteritidis and Salmonella typhimurium. Household pets, especially turtles and lizards, have also been implicated in outbreaks of Salmonella. Infectivity of a specific strain is related to its serotype and inoculum quantity.
Identification of an infection could indicate the presence of a carrier state; therefore, public health authorities should be notified so that chronic carriers can be registered and the microorganism typed so that outbreaks can be traced. Nontyphoidal Salmonella infections arise with nausea, vomiting, abdominal cramps, and diarrhea.
The diarrhea can vary from loose stools to dysentery with grossly bloody and purulent feces. Symptoms arise 8 to 48 hours after ingestion of contaminated food. The illness lasts for 3 to 5 days in patients manifesting with gastroenteritis and 2 to 3 weeks in patients who develop enterocolitis. Toxic megacolon is a known complication of Salmonella colitis. Clinical symptoms of S.
Typhoidal disease is not truly an intestinal disease and has more systemic than intestinal symptoms. Ingested organisms penetrate the small bowel mucosa and rapidly enter the lymphatics, mesenteric lymph nodes, and then the bloodstream. After this initial bacteremic event, the organism is sequestered in macrophages and monocytic cells of the reticuloendothelial system.
These sequestered cells multiply and reemerge several days later in recurrent waves of bacteremia spreading throughout the host and infecting many organ sites. The liver, spleen, and lymph nodes including Peyer's patches become involved and may result in focal areas of liver and spleen necrosis, acute cholecystitis, and microperforations in the terminal ileum.
Erosion into blood vessels may produce severe intestinal hemorrhage. Patients who are high risk for the carrier state are older patients, women, and patients with biliary disease. Diagnosis of salmonellosis and typhoid fever is established by isolating the organism. Cultures from stool, rectal swab, and endoscopic biopsy specimens are effective. Endoscopic evaluation of the colon in patients with nontyphoidal salmonellosis reveals hyperemia, friability of the mucosa, ulcerations, aphthous erosions, and deep fissures with segmental involvement of the colon.
Most cases of nontyphoidal Salmonella enterocolitis are self-limiting and do not require antibiotic therapy. Antibiotic therapy has no effect on duration of illness, diarrhea, or fever, and some studies have shown prolonged fecal excretion in antibiotic-treated patients.
Exceptions include patients with lymphoproliferative disorders, malignancy, AIDS, transplantation, prosthetic implants, valvular heart disease, hemolytic anemias, extreme ages of life, and symptoms of severe sepsis. Amoxicillin, quinolones, or trimethoprim-sulfamethoxazole TMP-SMX are first-line antibiotics for uncomplicated disease; parenteral third-generation cephalosporin or quinolones are reserved for more severe infections.
However, worldwide emergence of organisms that are resistant to these antibiotics has caused concern. A to day course of a quinolone is highly effective for the treatment of typhoid fever, and quinolone antibiotics have become the treatment of choice in eradicating the carrier state. Shigellae are a group of gram-negative enteric organisms that are included in the Enterobacteriaceae family and cause a broad spectrum of gastrointestinal illness ranging from mild diarrhea to life-threatening dysentery.
There are four major subgroups: Shigella dysenteriae group A , S. Shigella is highly contagious and requires only a small number of ingested inocula to yield clinical symptoms in infected volunteers.
In developed countries, Shigella infection is most commonly seen in day care centers, nursery schools, and male homosexuals. After ingestion, incubation periods range between 6 hours and 9 days.
The classic presentation of bacillary dysentery is with crampy abdominal pain, rectal burning, and fever, associated with multiple small-volume bloody mucoid stools. All Shigella species are capable of elaborating Shiga toxin, a potent toxin that is enterotoxic, cytotoxic, and neurotoxic.
The second phase is associated with tenesmus and small-volume bloody stools that occur 3 to 5 days after onset and corresponds to invasion of the colonic epithelium and acute colitis. Toxic, highly febrile illness is associated with severe colitis; however, bacteremia is distinctly uncommon. Severe complications are relatively common and include intestinal perforation, megacolon, septic shock, HUS, profound dehydration, hypoglycemia, hyponatremia, seizures, and encephalopathy.
This clinical picture is a result of cross-reacting antigens with Shigella proteins resulting in circulating antibody-antigen complexes. The clinical course of shigellosis is variable with children exhibiting mild infections lasting no more than 1 to 3 days. Untreated disease with a prolonged course may be confused with ulcerative colitis. Chronic carriers are uncommon and are susceptible to intermittent attacks of the disease.
The diagnosis of shigellosis is suspected by the triad of lower abdominal pain, rectal burning, and diarrhea. Bacterial colitis results in an inflammatory-type diarrhea that is characterized by bloody, purulent, and mucoid stool. These diseases have been designated as bacterial hemorrhagic enterocolitis. Associated symptoms include fever, tenesmus, and severe abdominal pain.
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