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Rectal biopsy in patients presenting to an infectious disease unit with diarrhoeal disease
lournal of Infection (1979) 1, 291-294
Abstracts of literature R E C T A L BIOPSY I N PATIENTS P R E S E N T I N G TO A N I N F E C T I O U S D I S E A S E U N I T W I T H DIARRHOEAL DISEASE
Dickinson, R. J., Gilmour, H. M. and McClelland, D. B. L. (1979). Gut, 20, 141. The role of sigmoidoscopy and rectal biopsy in the differentiation between infective and non-infection diarrhoeal diseases was investigated. Such differentiation is often problematical, but important as management for the two forms of diarrhoea may differ. Seventy-four patients, each of whom had three or more loose stools per day for at least 24 hours, were investigated and stools were cultured for salmonellae and shigellae; no attempt was made to identify enteropathogenic Esch. coli or viruses. Of the 74 patients nine had 'idiopathic' inflammatory bowel disease (seven had ulcerative colitis macro and microscopically, and two had Crohn's disease). Thirty-six patients had illnesses wholly consistent with an infective cause, in 13 a single pathogen was identified and in one mixed infection was found. The remaining 29 had a wide variety of conditions. Overall sigmoidoscopy appearances were abnormal in 35 and rectal biopsy histology was abnormal in 56 patients. Histological appearances were classified into six groups: A. Normal appearance or minimal oedema and/or congestion (18 patients). B. Mild to moderate excess of chronic inflammatory cells in the lamina propria but without distortion of crypt architecture, marked epithelial changes, crypt abscesses or granulomas (20 patients). C. A mixed infiltrate of acute and chronic inflammatory cells in the superficial lamina propria associated with oedema and congestion, degenerative or reactive changes in the epithelium of the superficial part of the crypts and the mucosal surface, with or without focal erosions. Migration of the neurophil polymorphs through the crypt epithelium or production of small numbers of superficial poorly formed crypt abscesses with a mucoid content rather than the plug of polymorphs seen in ulcerative colitis (15 patients). E. Biopsies with some features common to the preceding two groups but which could not be placed confidently in either category (six patients). F. Unclassifiable. Of the 36 patients with infective diarrhoea, four had grade A changes, 13 grade B, 11 grade C, four grade E and four grade F. Some patients with infective diarrhoea may have microscopic changes sufficiently unusual and characteristic to have diagnostic value (group C). Microscopical changes which showed striking improvement in the convalescent period were also suggestive of infective diarrhoea--eight patients with infective diarrhoea initially had changes suggesting inflammatory bowel disease but these changes did not persist into convalescence in contradistinction to all those patients with inflammatory bowel disease in whom microscopic changes persisted. Thus grade C changes emerged as being sufficiently unusual and characteristic of infective diarrhoea to be of diagnostic value. Reassuringly for clinicians where the microscopic findings were in conflict with a clear clinical history of infective disease, the clinical diagnosis was shown to have been correct. I M M U N O S U P P R E S S I O N BY MYCOBACTERIAL A R A B I N O M A N N A N
ElMer, J. J. and Daniel, T. M. (1979). Clinical Experimental Immunology, 35, 250. The means by which intracellular mycobacteria resist host defensive mechanisms is at present unclear.
Abstracts of literature R E C T A L BIOPSY I N PATIENTS P R E S E N T I N G TO A N I N F E C T I O U S D I S E A S E U N I T W I T H DIARRHOEAL DISEASE
Dickinson, R. J., Gilmour, H. M. and McClelland, D. B. L. (1979). Gut, 20, 141. The role of sigmoidoscopy and rectal biopsy in the differentiation between infective and non-infection diarrhoeal diseases was investigated. Such differentiation is often problematical, but important as management for the two forms of diarrhoea may differ. Seventy-four patients, each of whom had three or more loose stools per day for at least 24 hours, were investigated and stools were cultured for salmonellae and shigellae; no attempt was made to identify enteropathogenic Esch. coli or viruses. Of the 74 patients nine had 'idiopathic' inflammatory bowel disease (seven had ulcerative colitis macro and microscopically, and two had Crohn's disease). Thirty-six patients had illnesses wholly consistent with an infective cause, in 13 a single pathogen was identified and in one mixed infection was found. The remaining 29 had a wide variety of conditions. Overall sigmoidoscopy appearances were abnormal in 35 and rectal biopsy histology was abnormal in 56 patients. Histological appearances were classified into six groups: A. Normal appearance or minimal oedema and/or congestion (18 patients). B. Mild to moderate excess of chronic inflammatory cells in the lamina propria but without distortion of crypt architecture, marked epithelial changes, crypt abscesses or granulomas (20 patients). C. A mixed infiltrate of acute and chronic inflammatory cells in the superficial lamina propria associated with oedema and congestion, degenerative or reactive changes in the epithelium of the superficial part of the crypts and the mucosal surface, with or without focal erosions. Migration of the neurophil polymorphs through the crypt epithelium or production of small numbers of superficial poorly formed crypt abscesses with a mucoid content rather than the plug of polymorphs seen in ulcerative colitis (15 patients). E. Biopsies with some features common to the preceding two groups but which could not be placed confidently in either category (six patients). F. Unclassifiable. Of the 36 patients with infective diarrhoea, four had grade A changes, 13 grade B, 11 grade C, four grade E and four grade F. Some patients with infective diarrhoea may have microscopic changes sufficiently unusual and characteristic to have diagnostic value (group C). Microscopical changes which showed striking improvement in the convalescent period were also suggestive of infective diarrhoea--eight patients with infective diarrhoea initially had changes suggesting inflammatory bowel disease but these changes did not persist into convalescence in contradistinction to all those patients with inflammatory bowel disease in whom microscopic changes persisted. Thus grade C changes emerged as being sufficiently unusual and characteristic of infective diarrhoea to be of diagnostic value. Reassuringly for clinicians where the microscopic findings were in conflict with a clear clinical history of infective disease, the clinical diagnosis was shown to have been correct. I M M U N O S U P P R E S S I O N BY MYCOBACTERIAL A R A B I N O M A N N A N
ElMer, J. J. and Daniel, T. M. (1979). Clinical Experimental Immunology, 35, 250. The means by which intracellular mycobacteria resist host defensive mechanisms is at present unclear.