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Campylobacter Colitis
Campylobacter Colitis J Pohl, Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany r 2013 Elsevier GmbH. All rights reserved. Received 13 March 2012; Revision submitted 13 March 2012; Accepted 1 April 2012
Abstract When a patient presents with acute bloody diarrhea, it is important to differentiate an infectious disease from a first attack of inflammatory bowel disease. In cases with prolonged or acute illness when steroids are being considered, colorectal mucosal visualization and biopsy might be helpful. The author presents a case with Campylobacter colitis and the endoscopic appearance of infectious colitis with inflammation of the mucosa. This article is part of an expert video encyclopedia.
Keywords Diarrhea; Infectious colitis; Standard endoscopy; Ulceration; Video.
Video Related to this Article
Key Learning Points/Tips and Tricks
Video available to view or download at doi:10.1016/S22120971(13)70132-8
• •
C. jejuni commonly presents with a nonspecific endoscopic appearance of erythema and shallow ulcerations. The clinical presentation and the macroscopic appearance of Campylobacter colitis can mimic the acute colitis of inflammatory bowel disease.
Technique Colonoscopy.
Scripted Voiceover
Material Colonoscope: 3870 UTK; Pentax, Tokyo, Japan.
Background and Endoscopic Procedure Campylobacter jejuni and Campylobacter coli are gram-negative rods or spirals that produce an inflammatory, sometimes bloody, diarrhea and abdominal pain. Campylobacter account for up to 20% of acute bacillary diarrhea, but are often not detected at routine stool culture.1 The main site of attack is the colon. The correct diagnosis is based on clinical symptoms, medical history, and stool culture. At endoscopy, C. jejuni commonly presents with a nonspecific endoscopic appearance of erythema and shallow ulcerations that may be difficult to distinguish from Crohn’s disease or ulcerative colitis in some cases. It is important to note that in most cases, it is not possible to distinguish different pathogens based on endoscopic findings, as colitis caused by Shigella, Salmonella, Campylobacter, and Escherichia coli might cause the same type of mucosal damage.
This is a colonoscopy in a 20-year-old man with a 2 week history of bloody diarrhea. A previous stool culture did not reveal enteric pathogens. The ascending colon appears normal. As we withdraw the colonoscope to the transverse colon we see this segmental inflammation of the colon with erythema and scattered shallow ulcerations. These superficial ulcerations are surrounded by normal appearing mucosa. Although these endoscopic findings are non-specific the appearance is rather suggestive of an infectious colitis. The erythema in our case might remind you of the typical snail tracks in Crohn’s disease. However, we do not identify characteristic hallmarks of Crohn’s disease, like aphtoid lesions, or cobblestoning. The spread of the lesions and the lack of friability and granularity also argue against an ulcerative colitis. Indeed in our case repeated stool culture confirmed Campylobacter and the patient was started on amoxicillin 250 mg by mouth three times daily and recovered quickly.
Reference 1. Navaneethan, U.; Giannella, R. A. Infectious Colitis. Curr. Opin. Gastroenterol. 2011, 27, 66–71.
This article is part of an expert video encyclopedia. Click here for the full Table of Contents.
Video Journal and Encyclopedia of GI Endoscopy
http://dx.doi.org/10.1016/S2212-0971(13)70132-8
306
Abstract When a patient presents with acute bloody diarrhea, it is important to differentiate an infectious disease from a first attack of inflammatory bowel disease. In cases with prolonged or acute illness when steroids are being considered, colorectal mucosal visualization and biopsy might be helpful. The author presents a case with Campylobacter colitis and the endoscopic appearance of infectious colitis with inflammation of the mucosa. This article is part of an expert video encyclopedia.
Keywords Diarrhea; Infectious colitis; Standard endoscopy; Ulceration; Video.
Video Related to this Article
Key Learning Points/Tips and Tricks
Video available to view or download at doi:10.1016/S22120971(13)70132-8
• •
C. jejuni commonly presents with a nonspecific endoscopic appearance of erythema and shallow ulcerations. The clinical presentation and the macroscopic appearance of Campylobacter colitis can mimic the acute colitis of inflammatory bowel disease.
Technique Colonoscopy.
Scripted Voiceover
Material Colonoscope: 3870 UTK; Pentax, Tokyo, Japan.
Background and Endoscopic Procedure Campylobacter jejuni and Campylobacter coli are gram-negative rods or spirals that produce an inflammatory, sometimes bloody, diarrhea and abdominal pain. Campylobacter account for up to 20% of acute bacillary diarrhea, but are often not detected at routine stool culture.1 The main site of attack is the colon. The correct diagnosis is based on clinical symptoms, medical history, and stool culture. At endoscopy, C. jejuni commonly presents with a nonspecific endoscopic appearance of erythema and shallow ulcerations that may be difficult to distinguish from Crohn’s disease or ulcerative colitis in some cases. It is important to note that in most cases, it is not possible to distinguish different pathogens based on endoscopic findings, as colitis caused by Shigella, Salmonella, Campylobacter, and Escherichia coli might cause the same type of mucosal damage.
This is a colonoscopy in a 20-year-old man with a 2 week history of bloody diarrhea. A previous stool culture did not reveal enteric pathogens. The ascending colon appears normal. As we withdraw the colonoscope to the transverse colon we see this segmental inflammation of the colon with erythema and scattered shallow ulcerations. These superficial ulcerations are surrounded by normal appearing mucosa. Although these endoscopic findings are non-specific the appearance is rather suggestive of an infectious colitis. The erythema in our case might remind you of the typical snail tracks in Crohn’s disease. However, we do not identify characteristic hallmarks of Crohn’s disease, like aphtoid lesions, or cobblestoning. The spread of the lesions and the lack of friability and granularity also argue against an ulcerative colitis. Indeed in our case repeated stool culture confirmed Campylobacter and the patient was started on amoxicillin 250 mg by mouth three times daily and recovered quickly.
Reference 1. Navaneethan, U.; Giannella, R. A. Infectious Colitis. Curr. Opin. Gastroenterol. 2011, 27, 66–71.
This article is part of an expert video encyclopedia. Click here for the full Table of Contents.
Video Journal and Encyclopedia of GI Endoscopy
http://dx.doi.org/10.1016/S2212-0971(13)70132-8
306