Infectious Colitis
Cryptosporidiosis of Colon.

Video Endoscopic Sequence 1 of 3.

Cryptosporidiosis of Colon.

A 65 year-old man with a 6 month diarrhea syndrome
infected with HIV.
The mucosa of the Sigmoid Colon and rectum presented
with hyperplasia and with some clusters of brown maculas.
Biopsies showed intestinal cryptosporidiosis.
Crystosporidiosis can cause severe chronic and
cholera-like diarrhea.

Click here to see the biopsies.


 

Endoscopy of Cryptosporidiosis of Colon.

Video Endoscopic Sequence 2 of 3.

Endoscopy of Cryptosporidiosis of Colon.

The rectal mucosa displays some degree of hyperplasia and a cluster of brownish maculas. Cryptosporidium, a protozoan member of the family of coccidia that also includes Pneumocystis carinii and Toxoplasma gondii. Cryptosporidiosis accounts for about 10% of the cases of chronic diarrhea in patients with AIDS.

Diarrhea due to Cryptosporidium is being recognized with increasing frequency, both in normal and inmunocompromised patients. In inmunocompetent persons diarrhea is self-limited and characterized by copious amounts of watery stool. Inmunocompromised patients develop chronic watery diarrhea with stool volume often in excess of 3 L.a day. Biliary tract involvement with crytosporidiosis has been described and extra-intestinal infection may be observed in compromised patients.

 

 

 

Colonoscopy of Cryptosporidiosis of Colon.

Video Endoscopic Sequence 3 of 3.

Colonoscopy of Cryptosporidiosis of Colon.

Close up image with zoom.

The mucosa has a mosaic pattern.

Endoscopic features of cryptosporidiosis of the colon. The involved mucosa may be reddened and may be covered with a mucoid exudate. The major histologic findings in the small intestine are parcial villus atrophy and crypt hyperplasia, associated with marked acute and chronic inflammation. The lesions are diffuse in the small intestine and cause a spruelike patterns on a barium x-ray enema.

In the colon, crypt epithelial cell damage associated with cryptosporidiosis may be seen focally or diffusely. Cryptosporidium infections have been described to infect the epithelium in every portion of the gastrointestinal tract from the pharynx to the rectum.

 

 

 

Unspecific Colitis due to Shigellosis.

Video Endoscopic Sequence 1 of 7.

Unspecific Colitis due to Shigellosis.

A 58 year-old female that 22 days previously was hospitalized, due to acute diarrhea with bloody and mucoid feces.

Colonoscopy revealed mucosal inflammation with erythema (redness), edema (swelling), multiple ulcerations, granularity and loss of the normal vascular pattern. Stool culture grew Shigella Sonnei. The gross appearance resembles that of inflammatory bowel disease.

Shigellosis is an acute bacterial infection caused by the genus Shigella, that produces an unspecific colitis, affecting preferably the rectosigmoid colon. "Bacilar dysentery ". 

Colitis due to Shigellosis

Video Endoscopic Sequence 2 of 7.

“Colitis due to Shigellosis”.

The entire colon was affected. (pancolitis)

The illness usually starts abruptly, with diarrhea, lower abdominal cramps, and tenesmus. The diarrheal stool often is mixed with blood and mucus. Systemic symptoms are fever, chills, anorexia and malaise, and headache. The abdomen is tender. Sigmoidoscopic examination reveals an inflamed, engorged mucosa with punctate and sometimes large areas of ulceration.

Causes:

Shigella sonnei and Shigella flexneri cause 90% of the cases of shigellosis.

S dysenteriae has produced epidemic shigellosis.

 

Colitis due to Shigellosis

Video Endoscopic Sequence 3 of 7.

Colitis due to Shigellosis

Ascending colon, where we found multiple ulcers of
different sizes, edema and exudate.

Those macroscopic images are ruling out Crohn´s
disease and amebic colitis.

Shigellosis is a major diarrheal disease throughout the
world. Shigellae are lactose nonfermenting, non-motile
gram-negative rods that are comprised of four subgroups
that are responsible for bacillary dysentery.

 

Colitis due to Shigellosis

Video Endoscopic Sequence 4 of 7.

Endoscopic View of Colitis due to Shigellosis

Pathologically, shigellosis is characterized by an acute diffuse inflammation of the colon with initial hyperemia of the mucosa, followed by edema, hemorrhage, and infiltration with leukocytes and macrophages. This process often extends into the submucosa, causing marked thickening of the intestinal wall..

Epithelial necrosis and desquamation with formation of a membrane are followed by sinuous ulceration, originating on the tops of the intestinal folds and often extending deep into the submucosa and occasionally into the muscularis; perforation is rare. Inflammation is not usually uniformly distributed throughout the colon but is most severe in the distal portion from sigmoid colon to anus. The terminal ileum is occasionally involved. Secondary bacteri infection occurs once ulcerative lesions have developed, and may be important in the subsequent development of a chronic state of the disease. In patients in whom dysentery has been of long duration, adjacent ulcers may be joined by ulcerating channels beneath bridges of hyperplastic mucosa.

 

 

 

Colitis due to Shigellosis

Video Endoscopic Sequence 5 of 7.

“Colitis due to Shigellosis”.

Several tiny ulcers (aphtas). In chronic bacillary dysentery, there is usually extensive scarring and fibrosis of the colon, indolent ulceration, and a continued subacute or chronic inflammation which periodically becomes acute. There are successive periods of exacerbation and remission, and the disease differs little, both clinically and pathologically, from chronic idiopathic ulcerative colitis. During periods of active disease there may be fever and diarrhea with varying amounts of blood, mucus, and cellular debris in the stools. There is often disturbance of normal motor function with retention in the right colon. Considerable fibrosis of the mucosa and submucosa may complicate such chronically recurrent infections. Mucosal retention cysts may form as the result of incomplete healing, and these cysts may harbor Shigella bacilli which are intermittently discharged by chronic carriers.

In severe dysentery caused by the Shiga bacillus, toxic nephritis is a common cause of death and emboli are often seen in the liver and spleen.

 

Image View of Colitis due to Shigellosis.

Video Endoscopic Sequence 6 of 7.

Image View of Colitis due to Shigellosis.

Anus and rectum.

Findings: Endoscopy reveals friable, hyperemic mucosa
that involves that rectum and sigmoid colon in a confluent
pattern very similar to ulcerative colitis. Approximately 50
% of patients have involvement to the splenic flexure but
it is rare to have ulcerations in the terminal ileum.

Image View of Colitis due to Shigellosis.

Video Endoscopic Sequence 7 of 7.

“Colitis due to Shigellosis”.

The rectum and anus in retroflexed image, the image and
the video display edema and ulcerations.

Humans are the only natural host and the organism
primarily affects only the colon. The mode of transmission
is fecal-oral and the organisms invade colonocytes but
rarely invade the blood stream. There is often a biphasic
illness with initial symptoms of fever, abdominal pain, and
nonbloody watery diarrhea followed 3 to 5 days later by
tenesmus and small volume bloody stools. There is an
extensive list of extraintestinal manifestations.

 

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