Fact-sheet: Infectious colitis
Updated on 04/19/2018 at 3:56 PM
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Definition
Colonic infection of bacterial, viral, parasitic, or fungal origin.
Bacteria: Shigella, Salmonella, Yersinia, Campylobacter, E. coli, Klebsiella; often foodborne.
In immunocompromised patients:
- Virus: CMV, herpes
- Parasite: Schistosoma, Entamoeba, Cryptosporidium.
- Fungus: Histoplasma, Candida, Actinomyces, rhinocerebral mucormycosis.
Sometimes occurs in the setting of recent antibiotic therapy.
Clinical features
Diarrhea, which may be profuse or bloody.
Fever often marked.
Shock if significant fluid and electrolyte disturbance.
Laboratory findings
Neutrophilic leukocytosis if bacterial infection.
Neutropenia and immunosuppression in other cases.
Marked inflammatory syndrome.
Radiography
Plain abdominal radiograph.
Diffuse bowel dilatation.
Rare pneumoperitoneum if perforation.
Ultrasound
Bowel wall thickening.
Adjacent fat infiltration.
Intraperitoneal effusion.
CT
CT performed after contrast injection, at the portal venous phase.
- Pancolitis or segmental involvement.
- Wall thickening > 4 mm, with a target appearance and marked mucosal enhancement after contrast injection, along with circumferential submucosal edema.
- Accordion sign if severe: irregular, polypoid wall thickening.
- Frequent luminal emptiness.
- Possible intraperitoneal lymphadenopathy.
- Generally moderate intra-abdominal effusion.
Diagnostic orientation:
Right colon and ileum: salmonella, amebiasis, yersinia.
Left colon: schistosomiasis, shigella, herpes.
Pancolic: CMV, E. coli
Management
Diagnosis by serology and stool culture.
Differential diagnosis
Pseudomembranous colitis due to Clostridium difficile.
Ischemic colitis.
Ulcerative colitis