Infectious colitis

Acute self limited colitis

Last author update: 1 January 2014
Last staff update: 18 July 2022

Copyright: 2003-2022,, Inc.

PubMed Search: Acute self limited[title]colitis

Lili Lee, M.D.
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Cite this page: Lee L. Acute self limited colitis. website. Accessed August 17th, 2022.
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
  • 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
  • Stool cultures
  • Colonoscopy with mucosal biopsy
  • 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
  • Supportive therapy with rehydration
  • Rarely may require antibiotics or steroids
Clinical images

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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

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Decreased number of goblet cells

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Numerous crypt abscess, cryptitis

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Purulent cryptitis and dense inflammation

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Mucosal bleeding and non-specific inflammation

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Neutrophils in surface epithelium

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Mild superficial increase in chronic inflammation

Differential diagnosis
Additional references
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