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PubMed2002

(18)F-FDG positron emission tomography in the early diagnosis of enterocolitis: preliminary results.

Collagenous and eosinophilic colitis are rare diseases characterised by chronic watery diarrhoea. Radiographic evaluation of the gastrointestinal tract and colonoscopy are usually non-diagnostic since as many as one-third of patients will have minor abnormalities. To date a few investigators have reported increased fluorine-18 fluorodeoxyglucose ((18)F-FDG) uptake on positron emission tomography (PET) in patients with acute enterocolitis, but there have been no reports on the use of (18)F-FDG PET for the diagnosis of collagenous or eosinophilic colitis in an early clinical stage. The aim of this preliminary study was to evaluate the usefulness of (18)F-FDG PET in the early diagnosis of patients with colitis. We investigated five women (mean age 61.2+/-12.1 years) who had been diagnosed as having colitis in an early clinical stage. In all but one of the patients, the diagnosis of colitis was based on biopsy. Magnetic resonance colonography, ultrasonography and colonoscopy were performed in all but one of the patients. Two women were identified as having collagenous colitis in an early clinical stage. Another two patients had eosinophilic colitis. The morphological imaging methods, magnetic resonance colonography and ultrasonography, yielded no suspicious findings, and the results of colonoscopy similarly showed no abnormalities. One patient had colitis due to bacterial infection. In all patients (18)F-FDG PET showed a pathological increase in tracer uptake in the large bowel, suggestive of colitis. In four of the five patients, colitis was confirmed by histology, and in one, by bacterial analysis. (18)F-FDG PET was able to detect colitis in an early clinical stage, when morphological imaging methods and colonoscopy were non-diagnostic. The early performance of (18)F-FDG PET imaging in patients with possible colitis is encouraging.

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PubMed1995

Radiologic investigation of acute inflammatory and infectious bowel disease.

Definitive diagnosis of infectious or idiopathic inflammatory bowel disease ultimately rests on histologic and bacteriologic documentation. Nevertheless, radiologic studies play an important role in the evaluation and management of patients with acute enterocolitis. Plain abdominal films can give a gross estimate of disease extent in the colon and detect complications, such as perforation or toxic megacolon. Double-contrast barium enema allows visualization of the mucosal pattern and the overall configuration of the bowel, which are important for determining the extent and severity of disease and its most likely cause. Cross-sectional imaging depicts the mural and mesenteric involvement as well as intraperitoneal complications of inflammatory bowel disease, thus providing a critically important perspective that complements the information afforded by endoscopic and conventional radiographic techniques.

Acute Disease↗
PubMedDate not supplied

[Clinical manifestation of acute dysentery caused by the polyagglutinable strain of Shigella sonnei].

It was established, that clinical manifestation of acute dysentery caused by the polyagglutinable strain of Sonne shigellosis is characterized by acute onset of the disease, general toxic syndrome (high body temperature up mild pyrexia, chill, headache, low appetite) and in 6-24 hours followed by gastric indigestion resembling acute enterocolitis. In general, there have not been severe and lingering forms of the disease. Etiotropic and pathogenetic treatments are leading procedure in care of such patients.

Acute Disease↗
PubMed1983

The classification of feline colitis.

Clinical and pathological features of a variety of forms of feline colitis or enterocolitis were examined and classified into 9 separate entities: Salmonella enterocolitis, the colitis of feline infectious peritonitis, mycotic enterocolitis, acute angiopathic colitis, acute angiopathic colitis with ischaemic ulcers, feline granulomatous colitis, the colitis of feline panleucopenia, feline histiocytic colitis, and feline ulcerative, lymphocytic mucosal-submucosal colitis.

Animals↗
PubMed2004

Intestinal epithelial antigen induces mucosal CD8 T cell tolerance, activation, and inflammatory response.

Intestinal autoimmune diseases are thought to be associated with a breakdown in tolerance, leading to mucosal lymphocyte activation perhaps as a result of encounter with bacterium-derived Ag. To study mucosal CD8(+) T cell activation, tolerance, and polarization of autoimmune reactivity to self-Ag, we developed a novel (Fabpl(4x at -132)-OVA) transgenic mouse model expressing a truncated form of OVA in intestinal epithelia of the terminal ileum and colon. We found that OVA-specific CD8(+) T cells were partially tolerant to intestinal epithelium-derived OVA, because oral infection with Listeria monocytogenes-encoding OVA did not elicit an endogenous OVA-specific MHC class I tetramer(+)CD8(+) T cell response and IFN-gamma-, IL-4-, and IL-5-secreting T cells were decreased in the Peyer's patches, mesenteric lymph nodes, and intestinal mucosa of transgenic mice. Adoptive transfer of OVA-specific CD8(+) (OT-I) T cells resulted in their preferential expansion in the Peyer's patches and mesenteric lymph nodes and subsequently in the epithelia and lamina propria but failed to cause mucosal inflammation. Thus, CFSE-labeled OT-I cells greatly proliferated in these tissues by 5 days posttransfer. Strikingly, OT-I cell-transferred Fabpl(4x at -132)-OVA transgenic mice underwent a transient weight loss and developed a CD8(+) T cell-mediated acute enterocolitis 5 days after oral L. monocytogenes-encoding OVA infection. These findings indicate that intestinal epithelium-derived "self-Ag" gains access to the mucosal immune system, leading to Ag-specific T cell activation and clonal deletion. However, when Ag is presented in the context of bacterial infection, the associated inflammatory signals drive Ag-specific CD8(+) T cells to mediate intestinal immunopathology.

Acute Disease↗
PubMed2002

[An elderly case of cytomegalovirus enterocolitis associated with a malignant tumor].

An 83-year-old man was given a diagnosis of left parotid cancer in our hospital in November 1997. He refused to undergo a surgical procedure because of his advanced age. Therefore chemotherapy and radiotherapy were used. Chemotherapy with CAP (Cyclophosphamide, Adriacin, and CDDP) was conducted on 6 occasions between December 1997 to July 2000. Prednisolone (15 mg) was administered daily from July 15, 2000. The patient started suffering from diarrhea on August 2, 2000. As the patient also began to suffer high grade fevers and stomachaches, he was admitted on a diagnosis of acute enterocolitis. He had bloody stool on August 11. On emergency colonoscopy, an ulceration with bleeding was located in the lower rectum. The biopsy specimen revealed intranuclear inclusion bodies and positively staining cells for monoclonal antibody to cytomegalovirus through the immunohistochemical technique, and it was diagnosed as cytomegalovirus enterocolitis. He was treated with ganciclovir. One month later, his clinical symptoms had improved. Cytomegalovirus enterocolitis is an opportunistic infection, so immunocompromised hosts (such as cancer patients, patients using immunosuppressants, old people) have a greater probability of contracting cytomegalovirus infection. A ganciclovir is an effective treatment. A cytomegalovirus enterocolitis should considered in the differential diagnosis of enterocolitis, when alimentary symptoms like diarrhea or bloody stool are found in immunocompromised hosts.

Aged↗
PubMedDate not supplied

[Reactive arthritis in young men in organized collectives].

The authors followed up 398 young males with reactive arthritis who had been admitted from organized collectives to hospital settings. Only one third of them could connect the development of reactive arthritis (ReA) with a survived infection: acute nasopharyngeal (26%), acute enterocolitis (7%), urethritis venerea (1%). Analysis of the clinical picture demonstrated that in case of indefinite ReA etiology together with the signs of myocardiac involvement one should not only exclude the presence of rheumatic attack but also to establish a possible relation of the disease with a prior survived poorly manifest intestinal infection. This fact should be taken into account if in the collectives, where from the patients were hospitalized, epidemic outbreaks of acute dysentery or cases of ReA and Reiter's disease etiologically connected with manifest intestinal infection were documented. Postenterocolitic origin of ReA could be suspected in patients with its continuous course and resistance to antiinflammatory therapy in whom arthralgia was preserved for a long time as was joint rigidity after a subsidence of joint changes due to the effect of acute inflammation. Besides, the detection of certain features of the articular syndrome and separate extraarticular signs characteristic of Reiter's disease and other conditions which comprised the group of seronegative HLA--B27-positive spondyloarthropathy are of high diagnostic value.

Adolescent↗
PubMed1982

[Campylobacter jejuni--a "recent" pathogen worthy of study. Present knowledge on its clinical aspects, diagnosis, therapy and epidemiology].

The frequency of human infections caused by Campylobacter (C.) jejuni is thought to be at present as significant as that of the gastroenteric salmonelloses. The clinical symptoms are mostly like enteritis, enterocolitis, acute abdomen or ileitis terminalis. Post-infection reactions are possible not only as arthritis or septicemia but also as meningitis, conjunctivitis, carditis, pneumonia, cholecystitis, peritonitis, urinary tract infection and abortion. Only cultural examinations confirm the diagnosis of an infection with C. jejuni. If chemotherapy is required, erythromycin is the remedy of choice. Animals are an important reservoir for C. jejuni, but the epidemiology of human infections with this microorganism is not well understood.

Adult↗
PubMed2000

Crohn's disease in Japan: diagnostic criteria and epidemiology.

New diagnostic criteria for Crohn's disease and a review of Japanese epidemiologic studies are presented. New diagnostic criteria for Crohn's disease were established by the Research Committee of Inflammatory Bowel Disease, set up by the Japanese Ministry of Health and Welfare. For a definite diagnosis one of the following three conditions is required: 1) longitudinal ulcer or luminal deformity induced by longitudinal ulcer or cobblestone pattern, 2) intestinal small aphthous ulcerations arranged in a longitudinal fashion for at least three months plus noncaseating granulomas, and 3) multiple small aphthous ulcerations in both the upper and lower digestive tract not necessarily with longitudinal arrangement, for at least three months, plus noncaseating granulomas. Moreover, ulcerative colitis, ischemic enterocolitis, and acute infectious enterocolitis should be excluded. Data from the Japanese Ministry of Health and Welfare, in addition to data collected from two study groups, these being the two largest studies in Japan, are reviewed with regard to epidemiology. The number of patients with Crohn's disease has increased remarkably. The prevalence and the annual incidence of patients with Crohn's disease in Japan were estimated to be approximately 2.9 and 0.6 per 10(5) population in 1986, respectively, and 13.5 and 1.2 per 10(5) population in 1998. Characteristic features of Crohn's disease in Japan are that the male-female ratio exceeds 2, and that there is no second peak of incidence in the age group of 55 to 65 years. Clinically, Crohn's disease with only multiple small aphthous ulcerations, which is the earliest stage of the disease that is diagnosable, was found in 5 percent of patients.

Adolescent↗
PubMed1977

Fine structural changes in the gastro-intestinal tract of the hypoxic puppy: a study of natural history.

The present study demonstrates that a 2 hr period of sustained hypoxia results in a focally destructive process, a process which resolves by 5 days. That the changes described in earlier work are not overwhelming to the animal suggest that an early, focal, and reversible stage of the development of acute enterocolitis in the puppy can be described with the aid of electron microsocpy.

Animals↗
PubMed1991

Campylobacter: pathogenicity and significance in foods.

In the last 10 years Campylobacter jejuni has emerged as the most frequent cause of bacterial gastroenteritis in man. Acute enterocolitis, the most common presentation of C. jejuni infection, can affect persons of all ages. C. jejuni has been found in virtually every country where investigations have been carried out. The frequent finding of dysenteric stools suggests that mucosal damage due to an invasive process analogous to that seen in shigellosis is important in the pathogenesis. Campylobacteriosis in man is mainly a foodborne infection in which foods of animal origin, particularly poultry, play an important role. Epidemiological investigations have demonstrated a significant correlation between the handling and consumption of poultry meat and the occurrence of Campylobacter enteritis. Barbecues appear to present special hazards for infection, because they permit easy transfer of bacteria from raw meats to hands and other foods and from these to the mouth. Milk is sometimes found to be contaminated and consumption of raw milk has caused several outbreaks of campylobacteriosis. Campylobacter can remain viable in fresh cheese for only a short period of time. The organism is also found in shellfish, such as clams. Campylobacter is probably very vulnerable to factors such as high temperatures and dry environments, and also to the presence of oxygen in atmospheric concentrations. Therefore, it is assumed that the organism does not persist in products like pelleted feed, meals, egg powder and spices, which are often contaminated by Salmonella. A number of preventive measures on different levels, taken simultaneously, are needed to reduce the incidence of campylobacteriosis in man.

Animals↗
PubMed1992

Campylobacter peritonitis in continuous ambulatory peritoneal dialysis: report of eight cases and a review of the literature.

Continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis remains the most common complication of this form of renal replacement therapy and the potential causative organisms are many and varied. Campylobacter bacteria are unusual causes of peritonitis in CAPD patients and we report our experience with eight cases and review those cases reported in the literature. In many episodes, there is a strong association with acute enterocolitis, which may precede the onset of cloudy dialysate by many days. The method of spread of these organisms from the gastrointestinal tract to the peritoneal cavity remains speculative. Bacteremic transfer would appear the most likely route, although it is probable that no single mode of spread explains all episodes. The treatment of choice of Campylobacter peritonitis is with intraperitoneal aminoglycoside in combination with oral erythromycin. An awareness of the potential for Campylobacter to cause CAPD-associated peritonitis, particularly when diarrhea is a prominent feature, has resulted in this organism becoming increasingly isolated in our unit.

Campylobacter Infections↗
PubMed2003

Neonatal thromboembolism.

In neonates and infants numerous clinical and environmental conditions such as the use of central lines, cardiac diseases and polycythemia, renal diseases such as congenital nephrotic syndrome and neonatal hemolytic uremic syndrome, peripartal asphyxia, infants of diabetic mothers, dehydration, septicemia, necrotizing enterocolitis, acute respiratory distress syndrome, and extracorporeal membrane oxygenation lead to elevated thrombin generation and subsequent thrombus formation. Genetic prothrombotic defects [protein C, protein S and antithrombin deficiency, mutations of coagulation factor V and factor II, elevated lipoprotein (a)] have been established as risk factors for thromboembolic events. The interpretation of laboratory results relies on age-dependent normal reference values. Because appropriate clinical trials are missing in these age groups, treatment recommendations are adapted from small-scale studies in neonates and infants and from guidelines relating to adult patient protocols. Secondary long-term anticoagulation should be administered on an individual basis.

Blood Proteins↗
PubMed1997

[Bilateral vestibular loss as a post-infection complication of yersiniosis?].

BACKGROUND: Yersinia infections other than plaque are caused by Yersinia pseudotuberculosis and Yersinia enterocolitica. Food and water contamination as well as animal-to-person and person-to-person contact are common pathways of transmission. Clinical manifestations include enteritis, enterocolitis, acute appendicitis, inflammation of the terminal ileum, and mesenteric adenitis. Y. enterocolitica may cause bacteremia with subsequent septicemia predominantly in patients with underlying illnesses such as diabetes mellitus or malignancy. More frequently enteritis is followed by immunological post-infectious syndromes such as arthritis and erythema nodosum. The present case report discusses bilateral vestibular loss possibly caused by an infection with Y. enterocolitica. PATIENTS: A 27-year-old caucasian woman initially presented with the otologic symptom of spinning vertigo accompanied by nausea and vomiting. RESULTS: Physical exam revealed spontaneous nystagmus to the left. Bithermal caloric responses were absent. Pure tone audiometry showed a bilateral symmetric high-frequency sensorineural hearing loss. Neurologic exams did not reveal involvement of the central vestibular system. Perilymphatic fistula on the left side was excluded by tympanoscopy. Serology for rheumatoid factors and HLA B27 was negative. Lead or mercury intoxication was also excluded. In her medical history the patient reported intermittent watery diarrhea and stress dependent arthralgia that had commenced during a stay in Argentina three years ago. Serology was positive, revealing elevated titers for Y. enterocolitica type 3 (1:200) and type 9 (1:400). DISCUSSION: Bilateral vestibular loss is rare. The main cause is aminoglycoside ototoxicity or meningitis. Yersina infections have not yet been described as inducing disease of the labyrinth. Present pathophysiologic knowledge of yersinia infections is described as follows: After peroral infection, gastrointestinal permeability is increased. Low-molecular-weight substances may enter the bloodstream and stimulate the formation of circulating immune complexes. These are held responsible for extraintestinal manifestations of yersinosis. Whether these circulating immune complexes and antibodies against Y. enterocolitica have an effect on the inner ear remains unclear. CONCLUSION: Because the coincidence of yersiniosis and a bilateral vestibular loss with no other identified cause, a postinfectious immune response is suggested as possible pathogenic mechanism.

Adult↗
PubMed1991

[Uveitis after Yersinia enterocolitica infection].

Yersiniosis is a food-born infection. It may cause an acute enterocolitis and trigger an anterior uveitis. We report a case of bilateral panuveitis with chorioretinitis - thus with the involvement of anterior and posterior uvea. Because the agglutination titer against the Yersinia enterocolitica type 3 was increased, we consider it as the most probable etiology of the panuveitis. A serological test for Yersinia should be done in patients with uveitis, who consume food from various sources e.g. tourists or with diarrhea in anamnesis.

Adult↗
PubMed1998

Surveillance of human Yersinia enterocolitica infections in Belgium: 1967-1996.

Between 1967 and 1996, > 18,700 strains of Yersinia species, excluding Yersinia pestis, were recovered in Belgium from a variety of gastrointestinal and extraintestinal sites in patients. Full identification and serotyping were performed by the two Belgian reference laboratories. Yersinia enterocolitica serogroup O:3 predominated (79.4% of strains), followed by serogroup O:9 (11.1%). The remaining 9.5% of isolates belonged to serogroups and related species generally considered nonpathogenic. Acute enterocolitis was the most common clinical form of Y. enterocolitica infection, affecting primarily children younger than 5 years of age. Since 1967, there was a steady increase in isolations every year, with 305 cases in 1975 and up to 1,469 in 1986. From 1987 on, there was a clear decrease in the number of reported cases, although the number of participating laboratories and culture techniques remained constant. This significant decrease in the occurrence of Y. enterocolitica infections may be explained by changes in the slaughtering procedures and eating habits of the population.

Adolescent↗
PubMed1994

5-fluorouracil and high dose folinic acid in hormone-refractory metastatic prostate cancer: a phase II study.

BACKGROUND: The response of hormone-refractory metastatic prostate cancer to chemotherapy is poor. The antitumour activity of single agent 5-fluorouracil (5-FU) is approximately 15%. Folinic acid is a reduced folate which when combined with 5-FU augments the activity of 5-FU by stabilizing the ternary complex of 5-deoxyuridine monophosphate-thymidylate synthetase-5,10 methylene tetrahydrofolate, resulting in increased DNA inhibition and in increased cytotoxicity of 5-FU. PATIENTS AND METHODS: We used the combination of 5-FU at 300-370 mg/m2 and folinic acid at 200 mg/m2 daily for five days in 16 patients with hormone-refractory metastatic prostate cancer. RESULTS: A total of 15 evaluable patients were treated. There were no complete or partial responses. Seven patients had stable disease. Diarrhea constituted the most common non-hematologic toxicities (67%). Four patients experienced grade 3 and 4 neutrophil toxicity. There was one treatment-related death from an acute enterocolitis and peritonitis in a patient with grade 4 neutropenia. CONCLUSION: High dose folinic acid did not increase the cytotoxicity of 5-FU in hormone-refractory metastatic prostate cancer.

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