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Infective colitis

Overview

Infective colitis refers to inflammation of the colon (large intestine) caused by an infection, typically resulting from bacterial, viral, or parasitic pathogens. It is a common cause of diarrhoea and abdominal discomfort, and it can vary in severity from mild to severe, depending on the underlying infection and the patient's overall health.

Infective colitis can be caused by a variety of pathogens, including:

  • Bacterial infections: Common bacterial causes include:
    • Escherichia coli (E. coli): Particularly E. coli O157:H7, which produces toxins that can lead to severe gastrointestinal symptoms.
    • Salmonella spp: Often contracted from contaminated food or water.
    • Campylobacter jejuni: A leading cause of bacterial diarrhoea worldwide.
    • Shigella spp: Highly contagious bacteria that cause severe diarrhoea and abdominal cramping.
    • Clostridium difficile (C. diff): Typically arises after antibiotic use, leading to an overgrowth of the bacteria in the colon and causing severe colitis.
  • Viral infections:
    • Norovirus: A highly contagious virus that causes gastroenteritis.
    • Rotavirus: A common cause of gastroenteritis in children.
    • Adenovirus: Can also lead to gastroenteritis, particularly in children.
  • Parasitic infections:
    • Entamoeba histolytica: A parasitic infection that can cause amoebic dysentery.
    • Giardia lamblia: A protozoan parasite that can cause watery diarrhoea.
    • Cryptosporidium spp: Often contracted through contaminated water sources.

The symptoms of infective colitis vary based on the causative pathogen but generally include:

  • Diarrhoea: Can be watery, bloody, or mucoid, depending on the pathogen.
  • Abdominal pain and cramping
  • Fever (especially with bacterial infections like Salmonella or Shigella)
  • Nausea and vomiting (more common with viral infections)
  • Fatigue
  • Dehydration (from severe diarrhoea)

In severe cases, the infection can lead to complications such as:

  • Sepsis
  • Toxic megacolon
  • Intestinal perforation
  • Haemorrhage

Diagnosis is typically made through:

  • Stool cultures: To identify the specific pathogen, especially for bacterial and parasitic infections.
  • Polymerase chain reaction (PCR): For detecting specific viral or bacterial pathogens.
  • Blood tests: To check for signs of infection, dehydration, and systemic involvement (e.g., elevated white blood cell count).
  • Endoscopy/Colonoscopy: In some cases, to directly visualise the colon and take biopsy samples for further testing.

The treatment of infective colitis depends on the causative organism and the severity of symptoms:

  • Supportive care:
    • Hydration: Oral rehydration solutions or intravenous fluids for dehydration.
    • Electrolyte replacement: Especially if diarrhoea is severe or prolonged.
  • Antibiotics:
    • For bacterial infections: Specific antibiotics (e.g., ciprofloxacin for Salmonella, metronidazole for C. diff, or azithromycin for Campylobacter).
    • C. difficile colitis: Treated with oral vancomycin or fidaxomicin.
    • Antibiotics for parasitic infections (e.g., metronidazole for Giardia or Entamoeba histolytica).
  • Antiviral treatment: For certain viral infections, antiviral medications may be considered, but most viral infections (like norovirus or rotavirus) are self-limiting.
  • Avoiding antibiotics for self-limited infections: In some cases, such as with Shigella or Salmonella infection, antibiotics may not be needed and can even cause harm (e.g., in the case of non-typhoidal Salmonella).
  • Probiotics: In some cases, probiotics may be recommended to help restore the normal gut flora, especially after treatment with antibiotics, although their role is still debated.

Prevention strategies for infective colitis include:

  • Hand hygiene: Thorough handwashing, especially before eating and after using the restroom.
  • Food safety: Proper food handling, cooking, and storage to prevent bacterial contamination.
  • Water safety: Ensuring access to clean water and avoiding untreated water sources.
  • Vaccination: Vaccines for rotavirus can prevent viral gastroenteritis in children.
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