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Infectious colitis

Definition
  • Infectious colitis: Inflammation of the colon due to a microbial infection.
Causes
  • Bacteria: E. coli (especially EHEC), Campylobacter, Salmonella, Shigella, Yersinia, Clostridium difficile.
  • Viruses: CMV, Rotavirus, Norovirus.
  • Parasites: Entamoeba histolytica, Giardia lamblia, Cryptosporidium.
Clinical Presentation
  • Diarrhoea, which may be bloody.
  • Abdominal pain.
  • Fever and chills.
  • Dehydration.
  • Urgency to defecate.
  • Malaise.
Investigations
  • Stool microscopy, culture, and sensitivity: Identify causative organism.
  • Stool for Clostridium difficile toxin: Especially if a history of recent antibiotic use.
  • Colonoscopy: Can help identify the site and severity of inflammation; biopsy may be taken.
  • Full blood count: Elevated white cell count suggests bacterial infection.
Management
  • Hydration: Oral or intravenous rehydration.
  • Antibiotics: If bacterial cause confirmed or suspected; e.g., ciprofloxacin or metronidazole. Not always necessary and can worsen certain conditions, like EHEC infections which can progress to hemolytic uremic syndrome.
  • Antiparasitic drugs: Metronidazole for Giardia or Entamoeba; nitazoxanide for Cryptosporidium.
  • Supportive care.
Complications
  • Dehydration.
  • Hemolytic uremic syndrome (HUS): Especially with EHEC.
  • Perforation or toxic megacolon (rare).
Prevention
  • Hand hygiene.
  • Safe food preparation and storage.
  • Boil or treat water in endemic areas.
  • Prophylactic antibiotics in certain high-risk scenarios (e.g., travellers to high-risk countries).

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