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Doshi P, Sivaram G, Sievers C. An Atypical Case of Yersinia enterocolitica Infection in a Patient Suspected With Ulcerative Colitis Flare-Up. Cureus 2024; 16:e53780. [PMID: 38465053 PMCID: PMC10923545 DOI: 10.7759/cureus.53780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Ulcerative colitis (UC), one of the two major inflammatory bowel diseases (IBD), is a chronic immune-mediated inflammatory disorder with varying degrees of colonic mucosal involvement. Patients often present with inflammation limited to the rectum, also known as ulcerative proctitis, proximal colonic involvement, or pancolitis which affects the entire colon. Clinical manifestations of UC flare-ups include hematochezia, diarrhea, and abdominal pain. Yersinia enterocolitica, an acute cause of infectious diarrhea, is usually caused by the ingestion of food products contaminated with toxins and pathogens. The most common clinical presentation of a patient with acute Y. enterocolitica infection is self-limiting gastroenteritis. Microbial properties such as tissue invasion and immunological capability may be associated with the development of chronic conditions such as UC. IBD has been extensively studied, but the inter-relationship between IBD and infectious causes of diarrhea is still up for debate. We present a case of atypical Y. enterocolitica infection with a long-standing history of UC that was initially misdiagnosed as an acute UC flare-up.
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Affiliation(s)
- Priyam Doshi
- Internal Medicine, Western Reserve Hospital, Cuyahoga Falls, USA
| | - Ghomathy Sivaram
- Internal Medicine, Western Reserve Hospital, Cuyahoga Falls, USA
| | - Corey Sievers
- Gastroenterology, Western Reserve Hospital, Cuyahoga Falls, USA
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2
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Naraoka K, Ikenouchi H, Miyamoto T, Ikeda K, Endo K. Fatal Community-Acquired Clostridioides difficile Infection as a Cause of Listeria Meningitis: A Case Report. Cureus 2024; 16:e54371. [PMID: 38500906 PMCID: PMC10948194 DOI: 10.7759/cureus.54371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/20/2024] Open
Abstract
A 77-year-old woman with a history of total gastrectomy was transferred to our hospital with complaints of fever and consciousness disturbance for five days. She had fever and consciousness disturbance with positive meningeal signs. Laboratory findings indicated an elevated inflammatory response and hypoalbuminemia, and computed tomography (CT) of the body indicated intestinal gas retention and mild ascites. Cerebrospinal fluid analysis revealed pleocytosis with elevated protein levels and a diagnosis of Listeria meningitis was made. Treatment with ampicillin/sulbactam was started, and her fever and consciousness disturbance resolved on day 2. However, on day 3, her fever and conscious disturbance deteriorated, and she went into shock subsequently. Laboratory findings revealed deteriorated inflammatory response and hypoalbuminemia. Body CT showed an obvious distended bowel loop and intestinal edema. A stool culture revealed positive Clostridioides difficile toxin B, and we diagnosed her with Clostridioides difficile infection (CDI). Although intravenous metronidazole was initiated, she died due to prolonged hypovolemic shock. We considered she had community-acquired CDI because her CDI emerged immediately after the initiation of antibiotics, symptom deterioration within 48 hours of admission, and abnormal abdominal CT findings at admission. Listeria meningitis can develop based on community-acquired CDI. Because CDI can have a very rapid and fatal course and is sometimes complicated by other infectious diseases, clinicians should pay attention to this complication.
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Affiliation(s)
- Kai Naraoka
- Neurology, Sendai City Hospital, Sendai, JPN
| | | | | | | | - Kaoru Endo
- Neurology, Sendai City Hospital, Sendai, JPN
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3
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Bathobakae L, Wilkinson T, Yasin S, Bashir R, Mateen N, Yuridullah R, Cavanagh Y, Baddoura W, Suh J. An Unpleasant Souvenir: Whipworm as an Incidental Finding During a Screening Colonoscopy. J Investig Med High Impact Case Rep 2024; 12:23247096231224328. [PMID: 38193443 PMCID: PMC10777755 DOI: 10.1177/23247096231224328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
Trichuriasis is a neglected tropical disease caused by Trichuris trichiura that spreads through the ingestion of embryonated eggs in contaminated soil, water, or food. In nonendemic areas, T trichiura infestation is very rare and sporadic and is often diagnosed in immigrants from endemic countries such as the Philippines. Whipworms feed on human blood and also erode the colonic mucosa, thereby evoking an inflammatory response. In milder forms, trichuriasis can be asymptomatic and often an incidental diagnosis on screening colonoscopy. Heavily infested patients usually present with abdominal pain, nausea, vomiting, tenesmus, chronic diarrhea, iron deficiency anemia, or stunted growth. T trichiura worms can be removed with biopsy forceps during a colonoscopy; however, most patients require a course of albendazole, mebendazole, or ivermectin. We describe a unique case of T trichiura as an incidental finding during a screening colonoscopy. The whipworms were retrieved using biopsy forceps and the patient was treated with albendazole. At the time of the colonoscopy, the patient did not exhibit any specific symptoms related to the worm infestation.
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Affiliation(s)
| | | | - Saif Yasin
- St. George’s University, Grenada, West Indies
| | | | - Nargis Mateen
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | | | - Yana Cavanagh
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Walid Baddoura
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Jin Suh
- St. Joseph’s University Medical Center, Paterson, NJ, USA
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4
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Teh R, Lee D, Tee YC, Menon T. Bowel Ischemia Secondary to Campylobacter Enterocolitis: A Case Series and Review of the Literature. Cureus 2023; 15:e39183. [PMID: 37332410 PMCID: PMC10276580 DOI: 10.7759/cureus.39183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/20/2023] Open
Abstract
Campylobacter is the most common cause of diarrheal illness worldwide and is generally self-limiting. We present two cases of Campylobacter enterocolitis complicated by bowel ischemia in a 79-year-old male and a 53-year-old male, both presenting with abdominal pain and diarrhea and elevated lactate and C-reactive protein (CRP) levels. CT demonstrated common findings of pneumatosis intestinalis (PI) and portal venous gas. Exploratory laparotomy performed on the former demonstrated extensive small bowel infarction that was noncompatible with life and he was palliated postoperatively. The latter improved clinically after resection of the ischemic section of the small bowel with primary stapled anastomosis and closure. Clinicians need to be aware of the potentially fatal complications of Campylobacter-associated enterocolitis and should maintain a high clinical index of suspicion so that early surgical intervention can be considered in this patient population.
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Affiliation(s)
- Ryan Teh
- General Surgery, Fiona Stanley Hospital, Perth, AUS
| | - Daniel Lee
- General Surgery, Fiona Stanley Hospital, Perth, AUS
| | | | - Tulsi Menon
- General Surgery, Fiona Stanley Hospital, Perth, AUS
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5
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Duhan S, Keisham B, Salim A. Fulminant Clostridioides difficile Colitis With SARS-CoV-2 Infection. Cureus 2023; 15:e38401. [PMID: 37265903 PMCID: PMC10231867 DOI: 10.7759/cureus.38401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/03/2023] Open
Abstract
Clostridioides difficile (C. difficile)and coronavirus disease 2019 (COVID-19) infections can have overlapping symptoms. Recently, the association and outcomes of coinfection have been studied. We present the case of an 83-year-old lady with Parkinson's disease (PD) who was admitted with pneumonia secondary to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. She was treated with empiric antibiotics ampicillin-sulbactam and azithromycin, along with antiviral therapy remdesivir and baricitinib, and dexamethasone. The patient developed severe C. difficile infection with a leukemoid reaction. She was treated with intravenous metronidazole and oral vancomycin without any improvement. Before she could receive a fecal microbiota transplant, her infection progressed to fulminant colitis, and she required emergent surgery. The patient developed several complications post-surgery and succumbed to the severe illness. Our patient's multiple comorbidities and an underlying COVID-19 infection predisposed her to severe illness. This case emphasizes the long-standing discussion on antibiotic stewardship and encourages a debate on the role of immunosuppressant antiviral medications and underlying PD in predisposing patients to a severe C. difficile infection.
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Affiliation(s)
- Sanchit Duhan
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | - Bijeta Keisham
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | - Ahlaa Salim
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
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6
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Lagarto M, Santos A, Freitas BD, Anastácio M, Jesus S. The Overlooked Agent: Cytomegalovirus Colitis in an Immunocompetent Patient. Cureus 2023; 15:e36926. [PMID: 37128542 PMCID: PMC10148746 DOI: 10.7759/cureus.36926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/03/2023] Open
Abstract
Cytomegalovirus (CMV) colitis is usually associated with immunosuppressed patients, which by the classic definition are individuals who have immunosuppressed associated conditions (human immunodeficiency virus [HIV], oncology diseases, inflammatory bowel disease, transplant patients) or who are submitted to immunosuppressing therapies (for instance, corticosteroids, chemotherapeutic agents or immunomodulation therapies). In immunocompetent patients, this diagnosis tends to be often missed, leading to a delay in initiating proper management. We present a case of a 91-year-old woman that was diagnosed with CMV colitis without any identified formal immunocompromising factors. We intend to highlight the need to review the definition of an immunosuppressed individual and emphasize that CMV colitis should be considered in the differential diagnosis, especially in elderly patients and those with underlying conditions that can possibly affect their immune status, since prompt diagnosis and treatment are essential and influence the prognosis.
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Affiliation(s)
- Margarida Lagarto
- Medical Oncology, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
| | - Ana Santos
- Internal Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
| | - Bruno D Freitas
- Internal Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
| | - Marta Anastácio
- Internal Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
| | - Susana Jesus
- Internal Medicine, Centro Hospitalar de Lisboa Ocidental, Lisboa, PRT
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7
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Guimarães P, Finkler H, Reichert MC, Zimmer V, Grünhage F, Krawczyk M, Lammert F, Keller A, Casper M. Artificial-intelligence-based decision support tools for the differential diagnosis of colitis. Eur J Clin Invest 2023; 53:e13960. [PMID: 36721878 DOI: 10.1111/eci.13960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/19/2022] [Accepted: 01/21/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Whereas Artificial Intelligence (AI) based tools have recently been introduced in the field of gastroenterology, application in inflammatory bowel disease (IBD) is in its infancies. We established AI-based algorithms to distinguish IBD from infectious and ischemic colitis using endoscopic images and clinical data. METHODS First, we trained and tested a Convolutional Neural Network (CNN) using 1796 real-world images from 494 patients, presenting with three diseases (IBD [n = 212], ischemic colitis [n = 157], and infectious colitis [n = 125]). Moreover, we evaluated a Gradient Boosted Decision Trees (GBDT) algorithm using five clinical parameters as well as a hybrid approach (CNN + GBDT). Patients and images were randomly split into two completely independent datasets. The proposed approaches were benchmarked against each other and three expert endoscopists on the test set. RESULTS For the image-based CNN, the GBDT algorithm and the hybrid approach global accuracies were .709, .792, and .766, respectively. Positive predictive values were .602, .702, and .657. Global areas under the receiver operating characteristics (ROC) and precision recall (PR) curves were .727/.585, .888/.823, and .838/.733, respectively. Global accuracy did not differ between CNN and endoscopists (.721), but the clinical parameter-based GBDT algorithm outperformed CNN and expert image classification. CONCLUSIONS Decision support systems exclusively based on endoscopic image analysis for the differential diagnosis of colitis, representing a complex clinical challenge, seem not yet to be ready for primetime and more diverse image datasets may be necessary to improve performance in future development. The clinical value of the proposed clinical parameters algorithm should be evaluated in prospective cohorts.
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Affiliation(s)
- Pedro Guimarães
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany.,Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Helen Finkler
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | | | - Vincent Zimmer
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.,Department of Medicine, Knappschaft Hospital Saar, Püttlingen, Germany
| | - Frank Grünhage
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.,Chair for Health Sciences, Hannover Medical School (MHH), Hannover, Germany
| | - Andreas Keller
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany.,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Markus Casper
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
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Thirumalapura NR, Livengood J, Beeby J, Wang W, Goodrich EL, Goodman LB, Erol E, Tewari D. Improved molecular detection of Neorickettsia risticii with a duplex real-time PCR assay in the diagnosis of Potomac horse fever. J Vet Diagn Invest 2023; 35:62-66. [PMID: 36373552 PMCID: PMC9751466 DOI: 10.1177/10406387221135184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Neorickettsia risticii, an obligate intracellular bacterium, is the causative agent of Potomac horse fever (PHF). Diagnosis of PHF is based on demonstration of serum antibodies, isolation of N. risticii, and/or detection of nucleic acid by a PCR assay. An existing real-time PCR assay targeting the N. risticii 16S rRNA has been validated using blood samples from horses with colitis, and snails; to our knowledge, the performance of the assay for other sample types has not been reported. We describe here a modification of the 16S rRNA gene assay by the addition of a set of primers and probe targeting the N. risticii p51 gene to form a duplex assay. We validated the new assay using diagnostic specimens from 56 horses with suspected PHF. The assay consistently detected down to 5 copies of synthetic targets, and did not show any cross-reaction with common equine enteric pathogens. Although we did not establish the diagnostic sensitivity and specificity of the duplex assay, results for both gene targets were in complete agreement, with the exception of 4 fecal samples that tested positive for the 16S rRNA gene only. Further analysis indicated that testing of fecal samples using our 16S rRNA gene assay alone can produce a false-positive result.
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Affiliation(s)
| | - Julia Livengood
- Pennsylvania Veterinary Laboratory, Pennsylvania Department of Agriculture, Harrisburg, PA, USA
| | - John Beeby
- Animal Health Diagnostic Center, Departments of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Weihua Wang
- Animal Health Diagnostic Center, Departments of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Erin L. Goodrich
- Animal Health Diagnostic Center, Departments of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Laura B. Goodman
- Public & Ecosystem Health, Cornell Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Erdal Erol
- Veterinary Diagnostic Laboratory, Department of Veterinary Science, University of Kentucky, Lexington, KY, USA
| | - Deepanker Tewari
- Pennsylvania Veterinary Laboratory, Pennsylvania Department of Agriculture, Harrisburg, PA, USA
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9
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Osakowicz C, Fletcher L, Caswell JL, Li J. Protective and Anti-Inflammatory Effects of Protegrin-1 on Citrobacter rodentium Intestinal Infection in Mice. Int J Mol Sci 2021; 22:9494. [PMID: 34502403 DOI: 10.3390/ijms22179494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022] Open
Abstract
Infectious intestinal colitis, manifesting as intestinal inflammation, diarrhea, and epithelial barrier disruption, affects millions of humans worldwide and, without effective treatment, can result in death. In addition to this, the significant rise in antibiotic-resistant bacteria poses an urgent need for alternative anti-infection therapies for the treatment of intestinal disorders. Antimicrobial peptides (AMPs) are potential therapies that have broad-spectrum antimicrobial activity due to their (1) unique mode of action, (2) broad-spectrum antimicrobial activity, and (3) protective role in GI tract maintenance. Protegrin-1 (PG-1) is an AMP of pig origin that was previously shown to reduce the pathological effects of chemically induced digestive tract inflammation (colitis) and to modulate immune responses and tissue repair. This study aimed to extend these findings by investigating the protective effects of PG-1 on pathogen-induced colitis in an infection study over a 10-day experimental period. The oral administration of PG-1 reduced Citrobacter rodentium intestinal infection in mice as evidenced by reduced histopathologic change in the colon, prevention of body weight loss, milder clinical signs of disease, and more effective clearance of bacterial infection relative to challenged phosphate-buffered saline (PBS)-treated mice. Additionally, PG-1 treatment altered the expression of various inflammatory mediators during infection, which may act to resolve inflammation and re-establish intestinal homeostasis. PG-1 administered in its mature form was more effective relative to the pro-form (ProPG-1). To our knowledge, this is the first study demonstrating the protective effects of PG-1 on infectious colitis.
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10
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Stawinski P, Dziadkowiec KN, Marcus A. COVID-19-Induced Colitis: A Novel Relationship During Troubling Times. Cureus 2021; 13:e15870. [PMID: 34327095 PMCID: PMC8302258 DOI: 10.7759/cureus.15870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/05/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resulting disease called coronavirus disease 2019 (COVID-19) has initiated a global health crisis declared by the World Health Organization (WHO). As the nature of this novel virus unfolds, there have been a variety of extra-pulmonary clinical presentations of COVID-19 affecting the gastrointestinal tract. We present a novel relationship between this disease and its clinical manifestation as COVID-19-induced colitis. Providing insight into this association will invariably facilitate earlier recognition and resultant treatment of COVID-19 along with reducing unintended exposure to healthcare workers.
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Affiliation(s)
- Peter Stawinski
- Internal Medicine, University of Miami JFK Medical Center, Atlantis, USA
| | | | - Akiva Marcus
- Gastroenterology, University of Miami, JFK Regional Campus, Atlantis, USA
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11
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Villanacci V, Reggiani-Bonetti L, Leoncini G, Parente P, Cadei M, Albarello L, Mandelli G, Caputo A. Histopathology of Non-IBD Colitis. A practical approach from the Italian Group for the study of the gastrointestinal tract (GIPAD). Pathologica 2021; 113:54-65. [PMID: 33686310 PMCID: PMC8138693 DOI: 10.32074/1591-951x-234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022] Open
Abstract
Non-IBD colitides (NIBDC) are intestinal diseases clinically and endoscopically overlapping with Inflammatory Bowel Diseases (IBD), sometimes with a similar histological picture. NIBDC include entities such as infectious colitis, ischemic colitis, pseudomembranous colitis, eosinophilic colitis, autoimmune enterocolitis, segmental colitis associated with diverticulosis, drug-induced colitis, radiation-induced colitis, diversion colitis, and microscopic colitis, this last including two entities: collagenous and lymphocytic colitis. The knowledge of the most useful histological features and the main clinical data for each entity is mandatory in daily clinical practice, for correct pathological diagnosis and clinical management.
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Affiliation(s)
| | - Luca Reggiani-Bonetti
- Department of Diagnostic, Clinic and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Paola Parente
- Unit of Pathology, Fondazione IRCCS Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - Moris Cadei
- Institute of Pathology, Spedali Civili, Brescia, Italy
| | - Luca Albarello
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Alessandro Caputo
- University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, Salerno, Italy
- Correspondence Alessandro Caputo University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, via San Leonardo 1, 84131 Salerno, Italy E-mail:
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12
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Lake AD, Fields R, Guerrero F, Almuzaini Y, Sundaresh K, Staffetti J. Case of Enterococcus cecorum Human Bacteremia, United States. HCA Healthc J Med 2020; 1:495-498. [PMID: 37427050 PMCID: PMC10324793 DOI: 10.36518/2689-0216.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Description Enterococcus cecorum rarely serves as a human pathogen, and only 6 cases of this microbe inoculating humans have been documented. We present an elderly female with a marked vascular history presenting with epigastric pain and diarrhea, followed by shaking chills. Laboratory findings revealed leukocytosis, with imaging showing diffuse colonic thickening. She had a bout of bloody diarrhea, raising the likelihood of ischemic colitis with her vascular history. To our surprise, both sets of blood cultures drawn on admission grew Enterococcus cecorum. This case is unique as it is the first documented case of E. cecorum human infection in the United States.
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Affiliation(s)
| | - Ryan Fields
- Regional Medical Center Bayonet Point, Hudson, FL
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13
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Zöller J, Ebel JF, Khairnar V, Schmitt V, Klopfleisch R, Meiners J, Seiffart V, Hansen W, Buer J, Singer BB, Lang KS, Westendorf AM. CEACAM1 regulates CD8 + T cell immunity and protects from severe pathology during Citrobacter rodentium induced colitis. Gut Microbes 2020; 11:1790-1805. [PMID: 32521208 PMCID: PMC7524155 DOI: 10.1080/19490976.2020.1775464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The incidence of gastrointestinal infections continues to increase, and infectious colitis contributes significantly to morbidity and mortality worldwide. Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) has been discovered to be strongly involved in the intestinal homeostasis. However, whether intestinal CEACAM1 expression has an impact on the control of infectious colitis remains elusive. Citrobacter rodentium (C. rodentium) is a gram-negative enteric pathogen that induces colonic inflammation in mice, with a critical role for CD4+ T cell but not CD8+ T cell immunity to primary infection. Here, we show that Ceacam1-/- mice are much more susceptible to C. rodentium infection than wildtype mice, which is mediated by a defect in the intestinal barrier and, surprisingly, by a dysregulated CD8+ T cell but not CD4+ T cell response in the colon. CEACAM1 expression is essential for the control of CD8+ T cell immunity, as CEACAM1 deficiency during C. rodentium infection inhibits CD8+ T cell exhaustion. We conclude that CEACAM1 is an important regulator of CD8+ T cell function in the colon, and blocking CEACAM1 signaling to activate CD8+ T cells may have unforeseen side effects.
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Affiliation(s)
- Julia Zöller
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jana-Fabienne Ebel
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Vishal Khairnar
- Institute for Immunology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Department of Systems Biology, City of Hope Comprehensive Cancer Center, Monrovia, CA, USA
| | - Verena Schmitt
- Institute of Anatomy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Free University of Berlin, Berlin, Germany
| | - Jana Meiners
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Virginia Seiffart
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Wiebke Hansen
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bernhard B. Singer
- Institute of Anatomy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Karl S. Lang
- Institute for Immunology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Astrid M. Westendorf
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany,CONTACT Astrid M. Westendorf Infection Immunology, Institute of Medical Microbiology, University Hospital EssenEssen, Germany
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14
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Mandzhieva B, Taylor J, Zafar H, Rashid MU, Khan AH. Focal Active Colitis Presented With Chronic Diarrhea. Cureus 2020; 12:e8140. [PMID: 32550060 PMCID: PMC7294873 DOI: 10.7759/cureus.8140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
There are various etiologies of colonic injury and inflammation. The most commonly described colitides in clinical practice are associated with infection, inflammatory bowel disease, ischemia, radiation and medications. The colonic wall has a limited set of responses to different types of injury; therefore, there is overlap between many of these disorders. Focal active colitis is characterized by isolated neutrophilic cryptitis with the background mucosa displaying normal crypt architecture. This inflammatory pattern can be easily unnoticed by pathologists because on low-power examination the mucosa may have almost normal appearance. General practitioners also may not be familiar with this term, underlying etiologies, associated risk factors, course, available therapies and follow up. We present a case of an 82-year-old female with chronic diarrhea and weight loss. She had a negative infectious workup and normal radiology series. She subsequently underwent endoscopic evaluation in lieu of persistent and debilitating symptoms which revealed nonspecific macroscopic findings with pathology noting focal active colitis. She was empirically treated with a 14-day course of Xifaxan and responded well to management with almost complete resolution of her symptoms and no recurrence on six-month follow-up.
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Affiliation(s)
| | - John Taylor
- Internal Medicine, AdventHealth, Orlando, USA
| | | | | | - Abu H Khan
- Gastroenterology, AdventHealth, Orlando, USA
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15
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George NS, Cheung L, Luthria DL, Santin M, Dawson HD, Bhagwat AA, Smith AD. Pomegranate peel extract alters the microbiome in mice and dysbiosis caused by Citrobacter rodentium infection. Food Sci Nutr 2019; 7:2565-2576. [PMID: 31428344 PMCID: PMC6694437 DOI: 10.1002/fsn3.1106] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022] Open
Abstract
Treatment of mice with a pomegranate peel extract (PPX) decreased the pathogenicity of Citrobacter rodentium (Cr) infections. Here, we investigate the effects of PPX on the microbiome of uninfected or Cr-infected C3H/HeNCr mice by 16S rRNA gene sequencing. Mice were treated with water or PPX for 14 days, feces were collected, and then, the mice were infected with Cr and feces collected again at day 6 postinfection. DNA was isolated from the fecal samples and subjected to 16S rRNA gene sequencing to determine the microbial composition. Differences in the composition of the microbiome were observed for untreated and PPX-treated mice with PPX mice having decreased diversity. PPX treatment decreased the Firmicutes/Bacteroidetes ratio by increasing Bacteroidetes and decreasing Firmicutes levels. The decrease in Firmicutes was driven by a large reduction in Lactobacillus. PPX treatment increased the abundance of Proteobacteria and Verrucomicrobiae and decreased Actinobacteria. The relative abundance of Cr reached 22% in water-treated but only 5% in PPX-treated infected mice. These results suggest that consumption of pomegranate polyphenols altered the microbiome, making it more resistant to displacement by infection with Cr, indicating that pomegranate polyphenols may mitigate the pathogenic effects of food-borne bacterial pathogens.
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Affiliation(s)
- Nadja S. George
- Environmental Microbial and Food Safety LabBeltsville Agricultural Research CenterAgricultural Research Service, Department of AgricultureBeltsvilleMaryland
| | - Lumei Cheung
- Diet Genomics and Immunology LabBeltsville Human Nutrition Research CenterAgricultural Research Service, Department of AgricultureBeltsvilleMaryland
| | - Devanand L. Luthria
- Composition Methods Development LabBeltsville Human Nutrition Research CenterAgricultural Research Service, Department of AgricultureBeltsvilleMaryland
| | - Monica Santin
- Environmental Microbial and Food Safety LabBeltsville Agricultural Research CenterAgricultural Research Service, Department of AgricultureBeltsvilleMaryland
| | - Harry D. Dawson
- Diet Genomics and Immunology LabBeltsville Human Nutrition Research CenterAgricultural Research Service, Department of AgricultureBeltsvilleMaryland
| | - Arvind A. Bhagwat
- Environmental Microbial and Food Safety LabBeltsville Agricultural Research CenterAgricultural Research Service, Department of AgricultureBeltsvilleMaryland
- Present address:
Central Chinmaya Mission TrustPowaiMumbaiIndia
| | - Allen D. Smith
- Diet Genomics and Immunology LabBeltsville Human Nutrition Research CenterAgricultural Research Service, Department of AgricultureBeltsvilleMaryland
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Saha P, Yeoh BS, Xiao X, Golonka RM, Singh V, Wang Y, Vijay-Kumar M. PAD4-dependent NETs generation are indispensable for intestinal clearance of Citrobacter rodentium. Mucosal Immunol 2019; 12:761-771. [PMID: 30710097 PMCID: PMC6519124 DOI: 10.1038/s41385-019-0139-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/07/2019] [Accepted: 01/16/2019] [Indexed: 02/04/2023]
Abstract
Peptidyl arginine deiminase-4 (PAD4) is indispensable for generation of neutrophil extracellular traps (NETs), which can provide antimicrobial effects during host innate immune response; however, the role of PAD4 against gastrointestinal infection is largely unknown. Herein, we challenged PAD4-deficient (Pad4-/-) mice and wild-type (WT) littermates with Citrobacter rodentium (CR), and investigated bacteria clearance and gut pathology. Luminal colonization of CR in Pad4-/- mice peaked between 11-14 days post-infection, whereas WT mice suppressed the infection by 14 days. We demonstrated that Pad4-/- mice were unable to form NETs, whereas WT mice showed increased NETs formation in the colon during infection. Pad4-/- mice showed aggravated CR-associated inflammation as indicated by elevated systemic and colonic pro-inflammatory markers. Histological analysis revealed that transmissible colonic hyperplasia, goblet cell depletion, and apoptotic cell death were more pronounced in the colon of CR-infected Pad4-/- mice. Treating WT mice with deoxyribonuclease I, which can disrupt NETs generation, recapitulated the exacerbated CR infection and gut pathology associated with the loss of PAD4. Administration of the PAD4 inhibitor, Cl-amidine also aggravated CR infection, but to a lesser extent. Taken together, our findings highlight the importance of PAD4 in the mucosal clearance of CR and in resolving gut-associated inflammation.
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Affiliation(s)
- Piu Saha
- Department of Physiology & Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, 43614, USA
| | - Beng San Yeoh
- Graduate Program in Immunology & Infectious Disease, The Pennsylvania State University, University Park, Philadelphia, PA, 16802, USA
| | - Xia Xiao
- Division of Nephrology, MGH, Harvard Medical School, Boston, MA, 02114, USA
| | - Rachel M Golonka
- Department of Physiology & Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, 43614, USA
| | - Vishal Singh
- Department of Physiology & Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, 43614, USA
| | - Yanming Wang
- College of Life Sciences & Medicine, Henan University, Kaifeng, 475004, China
| | - Matam Vijay-Kumar
- Department of Physiology & Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, 43614, USA.
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McKee RS, Tarr PI, Dietzen DJ, Chawla R, Schnadower D. Clinical and Laboratory Predictors of Shiga Toxin-Producing Escherichia coli Infection in Children With Bloody Diarrhea. J Pediatric Infect Dis Soc 2018; 7:e116-e122. [PMID: 29617871 PMCID: PMC6097574 DOI: 10.1093/jpids/piy025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/12/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Children with acute bloody diarrhea are at risk of being infected with Shiga toxin-producing Escherichia coli (STEC) and of progression to hemolytic uremic syndrome. Our objective was to identify clinical and laboratory factors associated with STEC infection in children who present with acute bloody diarrhea. METHODS We performed a prospective cohort study of consecutive children younger than 18 years who presented with acute (<2-week duration) bloody diarrhea between August 1, 2013, and August 1, 2014. We excluded patients with a chronic gastrointestinal illness and/or an obvious noninfectious source of bloody stool. We obtained a standardized history and study laboratory tests, performed physical examinations, and recorded patient outcomes. RESULTS Of the 135 eligible patients, 108 were enrolled; 27 declined consent. The median patient age was 3 years, and 56% were male. Ten (9%) patients tested positive for STEC (E coli O157:H7, n = 8; E coli O111, n = 1; E coli O103, n = 1), and 62 had negative stool culture results. Children infected with STEC were older (8.5 vs 3 years, respectively) (P < .001) and more likely to have abdominal tenderness (83% vs 17%, respectively) than those in the other groups. D-Dimer concentrations had a 70% sensitivity and 55% specificity for differentiating children with STEC from those with another cause of bloody diarrhea and 75% sensitivity and 70% specificity in differentiating children with a bacterial etiology from those with negative stool culture results. CONCLUSION Clinical assessment and laboratory data cannot reliably exclude the possibility that children with bloody diarrhea have an STEC infection and are at consequent risk of developing hemolytic uremic syndrome. Abnormal D-dimer concentrations (>0.5 μg/mL) were insufficiently sensitive and specific for distinguishing patients with STEC from those with another bacterial cause of bloody diarrhea. However, this marker might be useful in identifying children whose bloody diarrhea is caused by a bacterial enteric pathogen.
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Affiliation(s)
- Ryan S McKee
- Washington University School of Medicine, St. Louis, Missouri
| | - Phillip I Tarr
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Rachit Chawla
- Washington University School of Medicine, St. Louis, Missouri
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18
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Martín R, Chain F, Miquel S, Motta JP, Vergnolle N, Sokol H, Langella P. Using murine colitis models to analyze probiotics-host interactions. FEMS Microbiol Rev 2018; 41:S49-S70. [PMID: 28830096 DOI: 10.1093/femsre/fux035] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/08/2017] [Indexed: 02/07/2023] Open
Abstract
Probiotics are defined as 'live microorganisms which when administered in adequate amounts confer a health benefit on the host'. So, to consider a microorganism as a probiotic, a demonstrable beneficial effect on the health host should be shown as well as an adequate defined safety status and the capacity to survive transit through the gastrointestinal tract and to storage conditions. In this review, we present an overview of the murine colitis models currently employed to test the beneficial effect of the probiotic strains as well as an overview of the probiotics already tested. Our aim is to highlight both the importance of the adequate selection of the animal model to test the potential probiotic strains and of the value of the knowledge generated by these in vivo tests.
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Affiliation(s)
- Rebeca Martín
- INRA, Commensals and Probiotics-Host Interactions Laboratory, Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France
| | - Florian Chain
- INRA, Commensals and Probiotics-Host Interactions Laboratory, Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France
| | - Sylvie Miquel
- Laboratoire Microorganismes: Génome et Environnement (LMGE), UMR CNRS 6023, Université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - Jean-Paul Motta
- Department of Biological Science, Inflammation Research Network, University of Calgary, AB T3E 4N1, Canada.,IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, F-31300 Toulouse, France
| | - Nathalie Vergnolle
- IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, F-31300 Toulouse, France
| | - Harry Sokol
- INRA, Commensals and Probiotics-Host Interactions Laboratory, Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France.,Sorbonne University - Université Pierre et Marie Curie (UPMC), 75252 Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Equipe de Recherche Labélisée (ERL) 1157, Avenir Team Gut Microbiota and Immunity, 75012 Paris, France.,Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique - Hopitaux de Paris, UPMC, 75012 Paris, France
| | - Philippe Langella
- INRA, Commensals and Probiotics-Host Interactions Laboratory, Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France
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19
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Duarte-Chavez R, Wojda TR, Zanders TB, Geme B, Fioravanti G, Stawicki SP. Early Results of Fecal Microbial Transplantation Protocol Implementation at a Community-based University Hospital. J Glob Infect Dis 2018; 10:47-57. [PMID: 29910564 PMCID: PMC5987372 DOI: 10.4103/jgid.jgid_145_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Clostridium difficile (CD) is a serious and increasingly prevalent healthcare-associated infection. The pathogenesis of CD infection (CDI) involves the acquisition of CD with a concurrent disruption of the native gut flora. Antibiotics are a major risk although other contributing factors have also been identified. Clinical management combines discontinuation of the offending antibiotic, initiation of CD-specific antibiotic therapy, probiotic agent use, fecal microbiota transplantation (FMT), and surgery as the “last resort” option. The aim of this study is to review short-term clinical results following the implementation of FMT protocol (FMTP) at our community-based university hospital. Methods: After obtaining Institutional Review Board and Infection Control Committee approvals, we implemented an institution-wide FMTP for patients diagnosed with CDI. Prospective tracking of all patients receiving FMT between July 1, 2015, and February 1, 2017, was conducted using REDCap™ electronic data capture system. According to the FMTP, indications for FMT included (a) three or more CDI recurrences, (b) two or more hospital admissions with severe CDI, or (c) first episode of complicated CDI (CCDI). Risk factors for initial infection and for treatment failure were assessed. Patients were followed for at least 3 months to monitor for cure/failure, relapse, and side effects. Frozen 250 mL FMT samples were acquired from OpenBiome (Somerville, MA, USA). After 4 h of thawing, the liquid suspension was applied using colonoscopy, beginning with terminal ileum and proceeding distally toward mid-transverse colon. Monitored clinical parameters included disease severity (Hines VA CDI Severity Score or HVCSS), concomitant medications, number of FMT treatments, non-FMT therapies, cure rates, and mortality. Descriptive statistics were utilized to outline the study results. Results: A total of 35 patients (mean age 58.5 years, 69% female) were analyzed, with FMT-attributable primary cure achieved in 30/35 (86%) cases. Within this subgroup, 2/30 (6.7%) patients recurred and were subsequently cured with long-term oral vancomycin. Among five primary FMT failures (14% total sample), 3 (60%) achieved medical cure with long-term oral vancomycin therapy and 2 (40%) required colectomy. For the seven patients who either failed FMT or recurred, long-term vancomycin therapy was curative in all but two cases. For patients with severe CDI (HVCSS ≥3), primary and overall cure rates were 6/10 (60%) and 8/10 (80%), respectively. Patients with CCDI (n = 4) had higher HVCSS (4 vs. 3) and a mortality of 25%. Characteristics of patients who failed initial FMT included older age (70 vs. 57 years), female sex (80% vs. 67%), severe CDI (80% vs. 13%), and active opioid use during the initial infection (60% vs. 37%) and at the time of FMT (60% vs. 27%). The most commonly reported side effect of FMT was loose stools. Conclusions: This pilot study supports the efficacy and safety of FMT administration for CDI in the setting of a community-based university hospital. Following FMTP implementation, primary (86%) and overall (94%) nonsurgical cure rates were similar to those reported in other studies. The potential role of opioids as a modulator of CDI warrants further clinical investigation.
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Affiliation(s)
- Rodrigo Duarte-Chavez
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Thomas R Wojda
- Department of Family Medicine, Warren Hospital, St. Luke's University Health Network, Phillipsburg, NJ, USA
| | - Thomas B Zanders
- Division of Pulmonary/Critical Care Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Berhanu Geme
- Division of Gastroenterology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Gloria Fioravanti
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
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20
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Cohen NA, Miller T, Na'aminh W, Hod K, Adler A, Cohen D, Guzner-Gur H, Santo E, Halpern Z, Carmeli Y, Maharshak N. Clostridium difficile fecal toxin level is associated with disease severity and prognosis. United European Gastroenterol J 2017; 6:773-780. [PMID: 30083340 DOI: 10.1177/2050640617750809] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/25/2017] [Indexed: 12/13/2022] Open
Abstract
Background Antibiotic-associated colitis caused by Clostridium difficile (C. difficile) is the most common cause of hospital-acquired diarrhea. The pathogenesis of C. difficile colitis is mediated by bacterial toxins. C. difficile infection (CDI) severity may be determined by the fecal level of these toxins. Objective The objective of this article is to determine whether fecal C. difficile toxin (CDT) levels are associated with disease severity and prognosis. Methods A cross-sectional study of patients admitted with CDI in a tertiary center between 2011 and 2015 was conducted. Fecal CDT levels were determined by quantitative ELISA. Severe CDI was defined as a leukocyte count of > 15 × 103 cells/μl, creatinine levels that deteriorated by > 1.5 times the baseline level, or albumin levels < 3 g/dl. Results Seventy-three patients were recruited for this study. Patients with severe CDI (n = 47) had significantly higher toxin levels compared to patients with mild to moderate CDI (n = 26) (651 ng/ml (IQR 138-3200) versus 164 ng/ml (IQR 55.2-400.1), respectively; p = 0.001). A high toxin level (>2500 ng/ml) was associated with an increased mortality rate (odds ratio 11.8; 95% confidence interval 2.5-56). Conclusions The fecal CDT level is associated with disease severity and mortality rate. Measuring CDT levels may be an objective and accurate way to define the severity of CDI.
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Affiliation(s)
- Nathaniel A Cohen
- Department of Internal Medicine "B," Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Miller
- Department of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Wasef Na'aminh
- Department of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Keren Hod
- Research Division, Assuta Medical Center, Tel Aviv, Israel
| | - Amos Adler
- Department of Clinical Microbiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Daniel Cohen
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Hanan Guzner-Gur
- Department of Internal Medicine "B," Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Erwin Santo
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zamir Halpern
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yehuda Carmeli
- Department of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nitsan Maharshak
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Bacteriotherapy Clinic, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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21
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Kumar A, Anbazhagan AN, Coffing H, Chatterjee I, Priyamvada S, Gujral T, Saksena S, Gill RK, Alrefai WA, Borthakur A, Dudeja PK. Lactobacillus acidophilus counteracts inhibition of NHE3 and DRA expression and alleviates diarrheal phenotype in mice infected with Citrobacter rodentium. Am J Physiol Gastrointest Liver Physiol 2016; 311:G817-G826. [PMID: 27634011 PMCID: PMC5130543 DOI: 10.1152/ajpgi.00173.2016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/12/2016] [Indexed: 01/31/2023]
Abstract
Impaired absorption of electrolytes is a hallmark of diarrhea associated with inflammation or enteric infections. Intestinal epithelial luminal membrane NHE3 (Na+/H+ exchanger 3) and DRA (Down-Regulated in Adenoma; Cl-/HCO3- exchanger) play key roles in mediating electroneutral NaCl absorption. We have previously shown decreased NHE3 and DRA function in response to short-term infection with enteropathogenic E coli (EPEC), a diarrheal pathogen. Recent studies have also shown substantial downregulation of DRA expression in a diarrheal model of infection with Citrobacter rodentium, the mouse counterpart of EPEC. Since our previous studies showed that the probiotic Lactobacillus acidophilus (LA) increased DRA and NHE3 function and expression and conferred protective effects in experimental colitis, we sought to evaluate the efficacy of LA in counteracting NHE3 and DRA inhibition and ameliorating diarrhea in a model of C rodentium infection. FVB/N mice challenged with C rodentium [1 × 109 colony-forming units (CFU)] with or without administration of live LA (3 × 109 CFU) were assessed for NHE3 and DRA mRNA and protein expression, mRNA levels of carbonic anhydrase, diarrheal phenotype (assessed by colonic weight-to-length ratio), myeloperoxidase activity, and proinflammatory cytokines. LA counteracted C rodentium-induced inhibition of colonic DRA, NHE3, and carbonic anhydrase I and IV expression and attenuated diarrheal phenotype and MPO activity. Furthermore, LA completely blocked C rodentium induction of IL-1β, IFN-γ, and CXCL1 mRNA and C rodentium-induced STAT3 phosphorylation. In conclusion, our data provide mechanistic insights into antidiarrheal effects of LA in a model of infectious diarrhea and colitis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Alip Borthakur
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago and Jesse Brown VA Medical Center, Chicago, Illinois
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Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for numerous infectious processes. Gastrointestinal tract involvement is rather rare and only a handful of cases of MRSA colitis have been reported in North America. We present a case of MRSA colitis in an adult without apparent risk factors. Abdominal computed tomography (CT) showed thickening of the sigmoid colon, indicative of colitis, and empiric therapy with ciprofloxacin and metronidazole was started. Initial work-up for infection—including blood and stool cultures, and stool Clostridium difficile toxin assay—was negative. The patient’s clinical status improved but his diarrhea did not abate. Repetition of stool culture demonstrated luxuriant growth of MRSA sensitive to vancomycin. Oral vancomycin was administered and the patient’s symptoms promptly ceased.
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Affiliation(s)
- Aditya Kalakonda
- State University of New York (SUNY) Upstate Medical University, Syracuse, NY, USA
| | - Shashank Garg
- Department of Gastroenterology, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Suraj Tandon
- Department of Gastroenterology, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Rakesh Vinayak
- Department of Gastroenterology, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Sudhir Dutta
- Department of Gastroenterology, Sinai Hospital of Baltimore, Baltimore, MD, USA
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23
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Nicholson MR, Thomsen IP, Slaughter JC, Creech CB, Edwards KM. Novel risk factors for recurrent Clostridium difficile infection in children. J Pediatr Gastroenterol Nutr 2015; 60:18-22. [PMID: 25199038 DOI: 10.1097/MPG.0000000000000553] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Clostridium difficile, a common cause of antibiotic-associated diarrhea, has been reported to recur in high rates in adults. The rates and risk factors for recurrent C difficile infection (rCDI) in children have not been well established. METHODS We conducted a retrospective cohort study of 186 pediatric patients seen at a tertiary care referral center for a 5-year period diagnosed as having a primary C difficile infection. Children with recurrent disease, defined as return of symptoms of C difficile infection and positive testing ≤60 days after the completion of therapy, were compared with children who did not experience an episode of recurrence. RESULTS Of the 186 pediatric patients included in this study, 41 (22%) experienced rCDI. On univariable analysis, factors significantly associated with rCDI included malignancy, recent hospitalization, recent surgery, antibiotic use, number of antibiotic exposures by class, acid blocker use, immunosuppressant use, and hospital-acquired disease. On multivariable analysis, malignancy (odds ratio [OR] 3.39, 95% confidence interval [CI] 1.52-7.85), recent surgery (OR 2.40, 95% CI 1.05-5.52), and the number of antibiotic exposures by class (OR 1.33, 95% CI 1.01-1.75) were significantly associated with recurrent disease in children. CONCLUSIONS The rate of rCDI in children was 22%. Recurrence was significantly associated with the risk factors of malignancy, recent surgery, and the number of antibiotic exposures by class.
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Abstract
Diverticulitis and Clostridium difficile infection (CDI) are common conditions in the surgical population. However, they are usually 2 distinct clinical entities. Here, we report the case of acute diverticulitis with concomitant pseudomembranous colitis, presumably due to CDI. The clinical course as well as gross and microscopic pathology findings are discussed. A literature search revealed a single previous report of these findings concomitant in a surgical specimen. A brief discussion of the pathophysiology of CDI and acute diverticulitis is included.
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Affiliation(s)
- Simon Byrns
- University of Alberta, Edmonton, Alberta, Canada
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25
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Li X, Wang Q, Xu H, Tao L, Lu J, Cai L, Wang C. Somatostatin regulates tight junction proteins expression in colitis mice. Int J Clin Exp Pathol 2014; 7:2153-2162. [PMID: 24966923 PMCID: PMC4069911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 04/11/2014] [Indexed: 06/03/2023]
Abstract
Tight junction plays a critical role in intestinal defence. The alteration and perturbation of tight junction proteins could induce intestine barrier damage, and lead to the malabsorption of electrolytes and water. Previous studies had showed that colonic infection and inflammation could lead to the alteration of tight junction function, and somatostatin could protect intestinal epithelia. Thus, this study could explore that whether somatostatin could regulate tight junction in colitis mice. Colitis mice with diarrhea were induced by Citrobacter rodentium (CR) and Dextran sulfate sodium (DSS). In CR infected model, cladudin-1 and claudin-3 expression significantly decreased compared with the control mice (P<0.05); after octreotide treatment, claudin-1 and claudin-3 expression significantly increased compared with untreated CR infected mice (P<0.05). In DSS colitis model, occludin and claudin-3 expression significantly decreased compared with the control mice (P<0.05); and octreotide treatment could only significantly upregulate claudin-3 expression compared with untreated DSS colitis mice (P<0.05). To testify our results in vivo, we repeated the models in caco-2 cells by exposed with enteropathogenic Escherichia coli (E. Coli) and Tumor necrosis factor α (TNF-α). The results in vitro were consistent with in vivo study. The results suggested that somatostatin play a role in intestinal barrier protection by modulating tight junction proteins expression.
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Affiliation(s)
- Xiao Li
- Department of Gastroenterology, West China Hospital of Sichuan UniversityGuoXue Street 37, Chengdu, China
| | - Qian Wang
- Department of Gastroenterology, West China Hospital of Sichuan UniversityGuoXue Street 37, Chengdu, China
| | - Hua Xu
- University of Arizona Health Science CenterTucson, Arizona
| | - Liping Tao
- Department of Gastroenterology, West China Hospital of Sichuan UniversityGuoXue Street 37, Chengdu, China
| | - Jing Lu
- Department of Gastroenterology, West China Hospital of Sichuan UniversityGuoXue Street 37, Chengdu, China
| | - Lin Cai
- Department of Gastroenterology, West China Hospital of Sichuan UniversityGuoXue Street 37, Chengdu, China
| | - Chunhui Wang
- Department of Gastroenterology, West China Hospital of Sichuan UniversityGuoXue Street 37, Chengdu, China
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Abstract
The incidence and severity of Clostridium difficile infection (CDI) have increased dramatically over the past decade. Its treatment, however, has largely remained the same with the exception of oral vancomycin use as a first-line agent in severe disease. From 1999 to 2004, 20,642 deaths were attributed to CDI in the United States, almost 7 times the rate of all other intestinal infections combined. Worldwide, several major CDI outbreaks have occurred, and many of these were associated with the NAP1 strain. This ‘epidemic’ strain has contributed to the rising incidence and mortality of CDI. The purpose of this article is to review the current management, treatment, infection control, and prevention strategies that are needed to combat this increasingly morbid disease.
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Affiliation(s)
- Fernando J Martinez
- Division of Gastroenterology, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA
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27
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Moussata D, Goetz M, Gloeckner A, Kerner M, Campbell B, Hoffman A, Biesterfeld S, Flourie B, Saurin JC, Galle PR, Neurath MF, Watson AJM, Kiesslich R. Confocal laser endomicroscopy is a new imaging modality for recognition of intramucosal bacteria in inflammatory bowel disease in vivo. Gut 2011; 60:26-33. [PMID: 20980342 PMCID: PMC3002833 DOI: 10.1136/gut.2010.213264] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Interaction of bacteria with the immune system within the intestinal mucosa plays a key role in the pathogenesis of inflammatory bowel disease (IBD). The aim of the current study was to develop a fluorescein-aided confocal laser endomicroscopy (CLE) method to visualise intramucosal enteric bacteria in vivo and to determine the involved mucosal area in the colon and ileum in patients with ulcerative colitis (UC) and Crohn's disease (CD). METHODS Initially, E coli strains expressing enhanced green fluorescent protein (pEGFP) were endomicroscopically imaged in mice. In addition, ex vivo and in vivo imaging of fluorescent human enteric bacteria was performed to specify the distinct endomicroscopic appearance of enteral bacteria. Targeted mucosal biopsies towards endomicroscopic identifiable intramucosal bacteria and negative mucosal areas were prospectively obtained during colonoscopy and correlated with bench-top fluorescence microscopy (FISH) to prove the endomicroscopic visualisation of intramucosal bacteria. Finally, a retrospective analysis as well as a prospective study was performed in patients with UC and CD to confirm the presence and distribution of intramucosal bacteria within the gut. RESULTS Confocal endomicroscopy was able to identify intramucosal pEGFP E coli in mice and strains of enteric microflora in the mucosa of humans. Using FISH as the gold standard, evaluation of 21 patients showed that CLE had a sensitivity of 89% and specificity of 100% to identify intramucosal bacteria. In a retrospective study, 113 patients with CD and UC had intramucosal bacteria significantly more often than 50 control patients (66% vs 60% vs 14%, p<0.001). This result was confirmed in a prospective study in which 10 patients with CD and 10 with UC had a significantly wider distribution of involvement with intramucosal bacteria in the colon and terminal ileum compared with 10 controls (85.2% vs 75.9% vs 16.8%, p<0.0001). CONCLUSIONS CLE is a new tool that can image intramucosal bacteria in vivo in patients with IBD. Intramucosal bacteria are found more frequently and with a wider distribution in patients with IBD than in patients with a normal intestine.
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Affiliation(s)
- Driffa Moussata
- Department of Gastroenterology, Lyon Sud Hospital, Claude Bernard University Pierre Benite, France
| | - Martin Goetz
- I Medical Clinic, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Annabel Gloeckner
- I Medical Clinic, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Marcus Kerner
- I Medical Clinic, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Barry Campbell
- Division of Gastroenterology, School of Clinical Sciences, University of Liverpool, Liverpool, UK
| | - Arthur Hoffman
- I Medical Clinic, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Stephan Biesterfeld
- Institute of Pathology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Bernard Flourie
- Department of Gastroenterology, Lyon Sud Hospital, Claude Bernard University Pierre Benite, France
| | - Jean-Christophe Saurin
- Department of Gastroenterology, Lyon Sud Hospital, Claude Bernard University Pierre Benite, France
| | - Peter R Galle
- I Medical Clinic, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Markus F Neurath
- I Medical Clinic, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Alastair J M Watson
- Division of Gastroenterology, School of Clinical Sciences, University of Liverpool, Liverpool, UK
| | - Ralf Kiesslich
- I Medical Clinic, Johannes Gutenberg University of Mainz, Mainz, Germany
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28
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Abstract
Parasitic infections are a major worldwide health problem, and they account for millions of infections and deaths each year. Most of the infections as well as the morbidity and mortality from these diseases occur in the developing world in rural regions. However, these diseases have become more common in Western countries and in big cities over the past 25 years. These changing disease patterns can be attributed to emigration from the third world to developed countries and migration of rural populations to the big cities in developing nations. These parasitic infections have protean manifestations and consequences. The medical problems range from chronic asymptomatic carrier to fulminant infections and even death. Several factors such as the host immune status, the infecting organism, and the availability of treatment all play key roles in the outcomes of parasitic colitides. The two major classes of parasites causing these infections are the helminthes (ascariasis, strongyloidiasis, enterobiasis, trichuriasis, and schistosomiasis) and the protozoa (Isospora, Cryptosporidium, Cyclospora, Trypanosoma cruzi, Giardia lamblia, and Balantidium coli). This article summarizes the salient features of each parasite with respect to epidemiology, transmission, pathogenesis, clinical features, diagnosis, and treatment. The vast majority of these infections have a self-limited clinical course or are easily treated with medical management, and surgery is rarely needed.
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Affiliation(s)
- Joel E Goldberg
- Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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29
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Herfarth HH, Long MD, Rubinas TC, Sandridge M, Miller MB. Evaluation of a non-invasive method to detect cytomegalovirus (CMV)-DNA in stool samples of patients with inflammatory bowel disease (IBD): a pilot study. Dig Dis Sci 2010; 55:1053-8. [PMID: 20165976 PMCID: PMC2865176 DOI: 10.1007/s10620-010-1146-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Accepted: 01/26/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND A severe flare of colitis in patients with IBD treated with immunosuppressive therapy may be complicated by an underlying CMV infection. The aim of this pilot study was to investigate the diagnostic efficacy of quantitative polymerase chain reaction (PCR) to detect CMV DNA in stool samples of IBD patients. METHODS Twenty-one patients with a severe flare of IBD, incompletely responding or refractory to either steroids or immunosuppressive agents, were included in the study. Nineteen patients completed the study according to the protocol undergoing an endoscopy with biopsies and collection of stool samples. Biopsy and stool samples were qualitatively and quantitatively analyzed for CMV DNA using real-time PCR. RESULTS Thirty-two percent (6/19) of the patients had detectable CMV DNA in colonic biopsies and in five (83%) of those patients CMV DNA was detected in the stool. Thirteen patients had negative findings for CMV DNA in biopsy and stool samples. The sensitivity, specificity, and accuracy of the PCR-based stool test for detection of CMV DNA compared to PCR-based detection of CMV in mucosal biopsies were 83, 93, and 90%, respectively. CONCLUSIONS The pilot study suggests a high accuracy of this non-invasive testing method to detect CMV DNA in stool samples as compared to mucosal biopsies. This approach may offer a non-endoscopic testing modality for underlying CMV infection in patients with a severe flare of IBD, which could also be applied more broadly to determine the prevalence of CMV infections in patients with IBD.
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Affiliation(s)
- Hans H. Herfarth
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Bioinformatics Bldg., CB#7080, Chapel Hill, NC 27599, USA
| | - Millie D. Long
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Bioinformatics Bldg., CB#7080, Chapel Hill, NC 27599, USA
| | - Tara C. Rubinas
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Mikki Sandridge
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Bioinformatics Bldg., CB#7080, Chapel Hill, NC 27599, USA
| | - Melissa B. Miller
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
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30
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Bennett WE, González-Rivera R, Puente BN, Shaikh N, Stevens HJ, Mooney JC, Klein EJ, Denno DM, Draghi A, Sylvester FA, Tarr PI. Proinflammatory fecal mRNA and childhood bacterial enteric infections. Gut Microbes 2010; 1:209-212. [PMID: 21327027 PMCID: PMC3023602 DOI: 10.4161/gmic.1.4.13004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 07/05/2010] [Accepted: 07/13/2010] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION: Assessment of specific mRNAs in human samples is useful in characterizing disease. However, mRNA in human stool has been understudied. RESULTS: Compared to controls, infected stools showed increased transcripts of IL-1β, IL-8 and calprotectin. mRNA and protein concentrations correlated for IL-8, but not for calprotectin. DISCUSSION: Stool mRNA quantification offers a potentially useful, noninvasive way to assess inflammation in the gastrointestinal tract, and may be more sensitive than EIA. METHODS: We purified fecal RNA from 46 children infected with Campylobacter jejuni, Escherichia coli O157:H7, Salmonella spp. or Shigella sonnei and 26 controls and compared the proportions of IL-1β, IL-8, osteoprotegerin and calprotectin mRNA between groups using qRT-PCR. We determined the concentrations of calprotectin, IL-8 and osteoprotegerin by enzyme immunoassays in cognate specimens.
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Affiliation(s)
- William E Bennett
- Washington University School of Medicine; Department of Pediatrics; Division of Pediatric Gastroenterology and Nutrition; St. Louis, MO USA
| | | | - Bao N Puente
- Washington University School of Medicine; Department of Pediatrics; Division of Pediatric Gastroenterology and Nutrition; St. Louis, MO USA
| | - Nurmohammad Shaikh
- Washington University School of Medicine; Department of Pediatrics; Division of Pediatric Gastroenterology and Nutrition; St. Louis, MO USA
| | - Harold J Stevens
- Washington University School of Medicine; Department of Pediatrics; Division of Pediatric Gastroenterology and Nutrition; St. Louis, MO USA
| | | | - Eileen J Klein
- Seattle Children's Hospital; Seattle, WA USA,University of Washington School of Medicine; Department of Pediatrics; Seattle, WA USA
| | - Donna M Denno
- Seattle Children's Hospital; Seattle, WA USA,University of Washington School of Medicine; Department of Pediatrics; Seattle, WA USA
| | - Andrew Draghi
- University of Connecticut School of Medicine; Department of Pediatrics; Farmington, CT USA
| | - Francisco A Sylvester
- University of Connecticut School of Medicine; Department of Pediatrics; Farmington, CT USA
| | - Phillip I Tarr
- Washington University School of Medicine; Department of Pediatrics; Division of Pediatric Gastroenterology and Nutrition; St. Louis, MO USA
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