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Colitis pp 91-106 | Cite as

Infectious Colitis

  • Helene Dano
  • Olivier Dewit
  • Anne Jouret-Mourin
Chapter

Abstract

Infections are a major cause of diarrhea and colitis. Usually, the disease is short-lived and biopsies are not necessary. When the diarrhea is prolonged, biopsies can be taken for solving the differential diagnosis with IBD and microscopic colitis. Most cases of infectious colitis do not present a specific histological pattern. Acute self-limited colitis (ASLC) is the most common pattern in enteric infections. Pathology is not the appropriate tool to identify this problem. The differential diagnosis relies mainly on the absence of features suggestive for IBD such as architectural distortion and basal plasmacytosis. In rare cases, specific infections can be diagnosed such as CMV colitis, spirochetosis, and cryptococcosis. This is also possible for chronic infections such as intestinal tuberculosis. In many developing countries, it is important to recognize this diagnosis and to distinguish tuberculosis from Crohn’s disease. Patients with IBD may also present with bacterial or other superinfections. The goals of pathologists are twofold: first, acute self-limited colitis should be distinguished from chronic IBD, ischemia, or other chronic atypical colitides, and second, pathologists have to identify the specific organisms when present.

Keywords

Infectious diarrhea Bacterial colitis Acute self-limited colitis Acute infectious-type colitis Acute self-limited colitis differential diagnosis with IBD Yersinia Campylobacter Salmonella Shigella EHEC Clostridium difficile Mycobacteria Infections and IBD 

References

  1. 1.
    Meuwissen SGM, Vandenbroucke-Grauls CMJ, Geboes K. Spectrum of acute self-limiting colitis: role of the clinician and pathologist. Ital J Gastroenterol Hepatol. 1999;31:807–16.PubMedGoogle Scholar
  2. 2.
    Siproudhis L, Mahmoud H, Briand N, et al. Responsabilité des médicaments dans la survenue des colites aiguës. Gastroenterol Clin Biol. 1998;22:778–84.PubMedGoogle Scholar
  3. 3.
    Schumacher G, Kollberg B, Sandstedt B, Jorup C, Grillner L, Ljungh A, Möllby R. A prospective study of first attacks of inflammatory bowel disease and non-relapsing colitis. Microbiologic findings. Scand J Gastroenterol. 1993;28:1077–85.CrossRefPubMedGoogle Scholar
  4. 4.
    Nostrant T, Kumar NB, Appelman HD. Histopathology differentiates acute self-limited colitis from ulcerative colitis. Gastroenterology. 1987;92:318–3285.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Dundas SAC, Dutton J, Skipworth P. Reliability of rectal biopsy in distinguishing between chronic inflammatory bowel disease and acute self-limiting colitis. Histopathology. 1997;31:60–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Jouret-Mourin A, Geboes K. Infectious colitis. Acta Endosc. 2002;32:167–84.CrossRefGoogle Scholar
  7. 7.
    Lamps LW. Infective disorders of the gastrointestinal tract. Histopathology. 2007;50:55–63.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Katakura S, Reinholt FP, Karnell A, et al. The pathology of Shigella flexneri infection in rhesus monkeys: an endoscopic and histopathological study of colonic lesions. APMIS. 1990;98:313–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Van Spreeuwel JP, Duursma GC, Meijer CJLM, et al. Campylobacter colitis: histological, immunohistochemical and ultrastructural findings. Gut. 1985;26:945–51.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Spiller RC, Jenkins D, Thornley JP, et al. Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acute Campylobacter enteritis and in post-dysenteric irritable bowel syndrome. Gut. 2000;47:804–11.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Schneider EN, Havens JR. Molecular detection of Campylobacter infection in cases of focal active colitis. Am J Surg Pathol. 2006;30:782–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Xin W, Brown PI, Greenson JK. The clinical significance of focal active colitis in pediatric patients. Am J Surg Pathol. 2003;27:1134–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Greenson JK, Stern RA, Carpenter SL, Barnett JL. The clinical significance of focal active colitis. Hum Pathol. 1997;28:729–33.CrossRefPubMedGoogle Scholar
  14. 14.
    Griffin PM, Olmstead LC, Petras RE. Escherichia coli 0157: H7-associated colitis: a clinical and histological study. Gastroenterology. 1990;99:142–9.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kelly JK, Pai CH, Jadusingh IH, et al. The histopathology of rectosigmoid biopsies from adults with bloody diarrhea due to verotoxin-producing Escherichia coli. Am J Clin Pathol. 1987;88:78–82.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Price AB, et al. Pseudomembranous colitis. J Clin Pathol. 1977;30:1–12.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Arnold CA, Lemketkai BN, Illei PB, et al. Syphilitic and lymphogranuloma venereum (LGV) proctocolitis: clues to a frequently missed diagnosis. Am J Surg Pathol. 2013;37:38–46.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Pulimood AB, Ramakrishna BS, Kurion G, et al. Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn’s disease from tuberculosis. Gut. 1999;45:537–41.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Vantrappen G, Ponette E, Geboes K, et al. Yersinia enteritis and enterocolitis: gastroenterological aspects. Gastroenterology. 1977;72:220–7.PubMedGoogle Scholar
  20. 20.
    Surawicz CM, Hagitt RC, Husseman M, et al. Mucosal biopsy diagnosis of colitis: acute self-limited colitis and idiopathic inflammatory bowel disease. Gastroenterology. 1994;107:755–63.CrossRefPubMedGoogle Scholar
  21. 21.
    Theodossis A, Spiegelhalter DJ, Jass J, et al. Observer variation and discriminatory value of biopsy features in IBD. Gut. 1994;35:961–8.CrossRefGoogle Scholar
  22. 22.
    Goldman H. Acute vs chronic colitis: how and when to distinguish by biopsy. Gastroenterology. 1984;86:199–201.PubMedGoogle Scholar
  23. 23.
    Schumacher G, Kolberg B, Sandstedt B. A prospective study of first attacks of IBD and infectious colitis. Scand J Gastroenterol. 1994;29:318–32.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Weber P, Koch M, Heizmann WR, et al. Microbic superinfection in relapse of inflammatory bowel disease. J Clin Gastroenterol. 1992;14:302–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Wang T, Matukas L, Streutker CJ. Histologic findings and clinical characteristics in acutely symptomatic ulcerative colitis patients with superimposed Clostridium difficile infection. Am J Surg Pathol. 2013;140:831–7.Google Scholar
  26. 26.
    Nomura K, Fujimoto Y, Yamashita M, et al. Absence of pseudomembranes in Clostridium difficile-associated diarrhea in patients using immunosuppression agents. Scand J Gastroenterol. 2009;44:74–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Korelitz BI. When should we look for amebae in patients with inflammatory bowel disease. J Clin Gastroenterol. 1989;11:373–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Moonka D, Furth EE, MacDermott RP, et al. Pouchitis associated with primary cytomegalovirus infection. Am J Gastroenterol. 1998;93:264–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Geboes K, Riddell R, Jain D. Inflammatory bowel disease. In: Riddell R, Jain D, editors. Lewin, Weinstein and Riddel’s gastrointestinal pathology and its clinical implications. 2nd ed. Philadelphia: Wolters Kluwer; 2014. p. 983–1206.Google Scholar
  30. 30.
    Cottone M, Pietrosi G, Martorana G, et al. Prevalence of Cytomegalovirus infection in severe refractory ulcerative colitis and Crohn’s colitis. Am J Gastroenterol. 2001;96:773–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Mills AM, Guo FP, Copland AP, et al. A comparison of CMV detection in gastrointestinal mucosal biopsies using immunohistochemistry and PCR performed on formalin-fixed, paraffin-embedded tissue. Am J Surg Pathol. 2013;37:995–1000.CrossRefPubMedGoogle Scholar
  32. 32.
    Schumacher G, Sandstedt R, Molby R, Kolberg B. Clinical and histological features differentiating non relapsing colitis from first attacks of IBD. Scand J Gastroenterol. 1991;26:151–61.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Helene Dano
    • 1
  • Olivier Dewit
    • 2
  • Anne Jouret-Mourin
    • 1
  1. 1.Department of PathologyCliniques Universitaires St Luc, UCLBrusselsBelgium
  2. 2.Department of GastroenterologyCliniques Universitaires St Luc, UCLBrusselsBelgium

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