Fact-sheet: Infectious ileitis


Updated on 04/19/2018 at 4:47 PM

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Definition

Bacterial infections are the most common causes of acute ileitis:

  • Yersiniosis: the most common bacterial ileitis, accounting for nearly 40% of infectious causes (36 to 83% depending on the series). Infection with Yersinia enterocolitica (the most common) or Yersinia pseudotuberculosis occurs through ingestion of contaminated food (raw vegetables, cold cuts, dairy products).
  • Salmonellosis (6.5% to 25.6%): Infections with Salmonella enteritidis and Campylobacter jejuni are also contracted through ingestion of contaminated food (undercooked chicken, unpasteurized dairy products).
  • Campylobacter jejuni infections (24.5% to 35%)
  • Intestinal tuberculosis: rare in Western countries and ileocecal in location in more than 80% of cases. It should be considered in patients from high-endemic areas, immunocompromised patients, or those living in precarious sanitary conditions. Mycobacterium tuberculosis is the most commonly implicated mycobacterium, but in certain populations, particularly immunocompromised patients, Mycobacterium bovis infections from ingestion of unpasteurized dairy products may be encountered.
  • Numerous other pathogens can cause ileitis (Clostridium difficile, Cytomegalovirus, Histoplasma capsulatum, Cryptococcosis, Actinomycosis). Anisakiasis is a cause of intestinal inflammation in consumers of raw fish. Involvement is more often localized to the upper digestive tract, and the course is generally favorable with spontaneous resolution of the infection. Diagnosis is established by visualization of the parasite on endoscopy, performed if symptoms fail to resolve.

Clinical features

Abdominal pain: most often in the right iliac fossa.

+/- Fever.

Cholera-like or dysenteric diarrhea.

Laboratory findings

Nonspecific:

Biological inflammatory syndrome

Infectious workup: Negative blood culture

Stool culture: positive in only 20 to 30% of cases.

Serology of limited specificity.

Ultrasound

On ultrasound:

Indication:

-For differential diagnosis: appendicitis.

-Fasting patient, children, and pregnant women.

Findings:

  • Thickening of the terminal ileal loop, most often stratified.
  • Hyperemia on Doppler.
  • Submucosal edema.
  • Satellite mesenteric lymphadenopathy.
  • +/-Hyperechogenicity of the mesenteric fat.

If invasive enteropathy:

  • Loss of stratification with thickening of the terminal ileal loop: hypoechoic thickening of the mucosa +/- nodular with valvulae conniventes hypertrophy. Thin, non-visible submucosa.

CT

Contrast-enhanced abdominopelvic CT:

  • Mucosal hyperemia
  • Submucosal hypodensity: edema
  • Wall thickening
  • Fat stranding
  • Lymphadenopathy

Differential diagnosis

Inflammatory ileitis

Vascular ileitis

Drug-induced ileitis