Résumé
Le diagnostic différentiel entre processus infectieux et inflammatoire est souvent difficile à l’apparition d’une diarrhée. Outre le rôle étiopathogénique possible de certains agents infectieux dans les maladies inflammatoires chroniques du tube digestif, une surinfection peut conduire à des erreurs diagnostiques au cours d’une poussée inflammatoire. La clinique, la biologie et les techniques d’imagerie sont extrêmement utiles dans le diagnostic différentiel. Le contenu endoluminal et les lésions limitées à la muqueuse seront précisés par les méthodes de laboratoire, l’endoscopie et son support histologique et/ou l’étude radiologique barytée.
En cas de suspicion de fistule ou d’abcès, l’échographie représente la meilleure technique d’imagerie de première intention, bien que la tomodensitométrie reste la méthode la plus sensible (95 %).
Les signes cliniques autant que la biologie, la radiologie et la médecine nucléaire seront de grande utilité en cas de complication systémique, qu’elle soit d’origine infectieuse ou inflammatoire.
Summary
Differential diagnosis between inflammation and infectious processes is often difficult at the onset of a diarrheal syndrom. In addition of the possible etiopathogenic role of some infectious agents in IBD, superinfection may lead to misdiagnosis in case of active IBD. Several clinical, biological and morphological features are available and may be strongly helpful for the differential diagnosis. The intraluminal content and the lesions limited to the mucosa should be distinguished by laboratory methods, endoscopy with histological support and/or radiological barium study.
When fistulae or abscesses are suspected, sonography represents the best imaging modality for the initial investigation, although computed tomography remains the most accurate procedure with a 95 % sensitivity.
Clinical signs as well as biological, radiological or nuclear techniques should be of great interest in case of systemic infectious or inflammatory complications.
Resumen
En una diarrea, el diagnóstico diferencial entre un proceso infaccioso o inflamatorio es generalmente difícil. Además el posible papel etiopatogénico de ciertos agentes infecciosos en las enfermedades inflamatorias crónicas del tubo digestivo, una sobre-infección, puede inducir a errores diagnósticos en el curso de un acceso inflamatorio. La clínica, la biología y las téchnicas imagenológicas son extremadamente útiles en el diagnóstico diferencial. El contenido endoluminal y las lesiones limitadas a la mucosa serán precisadas por téchnicas de laboratorio, la endoscopio y su sporte histológico y/o el estudio bardado radiológico.
En caso de sospecha de fístula o de abceso, la ecografía representa la mejor téchnica imagenológica de primera instancia aunque la escanografía continúa siendo el método más sensible (95 %).
Los signos clínicos así como la biología, la radiología y la medicina nuclear serán de gran utilidad en caso de complicación sistémica, cualquiera que sea su origen infeccioso o inflamatorio.
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Reuck, M.D. Diagnostic différentiel entre infection et inflammation dans les maladies inflammatoires de l’intestin. Acta Endosc 21, 275–282 (1991). https://doi.org/10.1007/BF02968716
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DOI: https://doi.org/10.1007/BF02968716