Colon
Infectious colitis
Acute self limited colitis


Topic Completed: 1 January 2014

Minor changes: 30 September 2020

Copyright: 2003-2020, PathologyOutlines.com, Inc.

PubMed Search: Acute self limited[title]colitis

Lili Lee, M.D.
Page views in 2019: 3,611
Page views in 2020 to date: 3,518
Cite this page: Lee L. Acute self limited colitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/colonacuteselflimited.html. Accessed October 24th, 2020.
Definition / general
  • Due to infections, NSAID or other drugs, bowel preparation or procedure associated injury (eg. gluteraldehyde disinfection of endoscope, Endoscopy 1998;30:428)
  • Not always acute or self-limited
Etiology
  • Causes:
    • Ingestion of pre-formed toxins (Staphylococcus aureus, Vibrio cholera, Clostridium perfringens; cause symptoms within hours including explosive diarrhea)
    • Infection by toxigenic organisms (incubation of hours to days)
    • Infection by enteroinvasive organisms which invade and destroy mucosal epithelium cells
    • Infection by viral organisms (CMV, HSV, HIV, etc.)
  • Bacterial virulence factors include:
    • Adherence to epithelial cells
    • Enterotoxins
    • Invasion factors
    • Cytotoxicity
  • Adherence:
    • Via fimbriae or pili
    • The process of adherence destroys the microvilli brush border
  • Enterotoxins:
    • Toxin binds to cell membrane, enters cell, activates massive electrolyte secretion (cholera toxin, E. coli heat-labile and heat-stable toxins produce travelers diarrhea)
    • No white blood cells in stool
  • Invasion factors:
    • Enteroinvasive E. coli and Shigella invade via microbe-simulated endocytosis
    • Then intracellular proliferation, cell lysis, cell to cell spread
  • Cytotoxicity:
    • Shiga toxin, enterohemorrhagic E. coli
Clinical features
  • Abdominal pain, watery or bloody diarrhea
  • Sudden onset, early fever, often with numerous (greater than 6) bowel movements daily
  • Complications of dehydration, sepsis, perforation can occur secondary to potential massive fluid loss and loss of mucosal barrier
Diagnosis
  • Stool cultures
  • Colonoscopy with mucosal biopsy
Laboratory
  • High white blood cell count (leukemoid reaction) with left shift
Radiology description
  • Limited role since inflammatory abnormalities are nonspecific (eg. colonic wall thickening)
Case reports
Treatment
  • Supportive therapy with rehydration
  • Rarely may require antibiotics or steroids
Clinical images

Images hosted on other servers:
Missing Image

Gross description

Gross description
  • Ulceration, erosion, pseudomembranes, pseudopolyps, hyperemia
Microscopic (histologic) description
  • Inflammation of lamina propria (active much greater than chronic), edema, hemorrhage
  • Usually lacks features of chronicity (crypt architectural distortion, lymphoplasmacytosis, pyloric gland metaplasia, Paneth cell metaplasia in the left colon)
  • Neutrophil induced epithelial injury (cryptitis)
  • Severe cases have crypt abscesses, extensive necrosis, hemorrhage and microthrombi
Microscopic (histologic) images

Images hosted on other servers:
Missing Image

Decreased number of goblet cells

Missing Image Missing Image

Numerous crypt abscess, cryptitis

Missing Image Missing Image

Purulent cryptitis and dense inflammation


Missing Image

Mucosal bleeding and non-specific inflammation

Missing Image

Neutrophils in surface epithelium

Missing Image Missing Image Missing Image

Mild superficial increase in chronic inflammation

Differential diagnosis
Additional references
Back to top
Image 01 Image 02