Infectious Colitides
The colon is susceptible to many infectious pathogens including bacteria, fungi, viruses, and parasites. Although Clostridium difficile infection is the most common cause of infectious colitis in Western countries, other infections are an important cause
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Key Concepts • Common bacterial colitides are often the result of foodborne pathogens from undercooked meat or contaminated vegetables. • Parasites are an important pathogen in the differential diagnosis of diarrhea and colitis, especially in patients who have traveled abroad. • Cytomegalovirus can cause a life-threatening colitis usually in the setting of decreased immune status such as HIV or inflammatory bowel disease. • Travelers to low-income parts of the world frequently have the misfortune of developing acute diarrhea, caused by various forms of Escherichia coli in over 50 % of cases. • Diarrhea in the setting of HIV or immunosuppression for transplantation requires an extensive workup for bacteria, viruses, and protozoa. Infectious colitis is a worldwide cause of morbidity and mortality. Estimates suggest that 2–4 billion episodes of infectious diarrhea occur in developing countries annually [1], and around 48 million Americans were afflicted with food-borne illness in 2012 [2]. Bacteria, parasites, viruses, or fungi may cause infectious colitides. Pseudomembranous colitis, caused by the Clostridium difficile toxin, has become an increasingly more common cause of infectious colitis and should be included in the differential diagnosis for any patient presenting with an acute diarrheal illness. This entity is fully discussed in Chap. 53.
Bacterial Colitides Campylobacter Campylobacter typically produces diarrhea and fever. The stool may be bloody, and infection may be accompanied by abdominal pain. Campylobacter results in up to 14 %
of cases worldwide, with Campylobacter jejuni the usual culprit. Transmission is commonly through contaminated poultry, but many animals can be infected. A recent report described an outbreak of campylobacter enteritis following a mud bike race, thought to be from ingestion of contaminated mud [3]. Infection of the terminal ileum and cecum can mimic acute appendicitis. Most illnesses last less than 7 days, but up to 16 % of patients may harbor the organism for 2–10 weeks. Complications of infection can include hemorrhage, toxic megacolon, pancreatitis, Reiter syndrome, and Guillain–Barre’ syndrome [4]. Stool samples with fecal leucocytes and blood support the diagnosis of infectious colitis, but diagnosis of Campylobacter is made by culture of the bacteria. Colonoscopy may demonstrate segmental edema, loss of vascular pattern, and patchy erythema of the mucosa. These findings are nonspecific and may be difficult to differentiate from that of other colonic mucosal diseases [5]. The majority of patients do not require treatment, as the disease is self-limiting. Fluoroquinolone antibiotics, which are also active against Shigella and other common enteric organisms, can be used empirically. However, resistance to fluoroquinolones is becoming a major problem, with Smith et al. [6] showing an increase in resistance from 1.3 to 10.2 % between 1992 and 1998. In some countries, resistance has been found in up to 80 % of isolates [7]. Azithromycin has been shown to be effective when fluoroquinol
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