Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella: clinical, radiological and US findings

Abstract

Infectious ileocecitits caused by yersinia, campylobacter, and salmonella -clinical, radiological and us findings Puylaert, J.B.C.M.; van der Zant, F.M.; Mutsaers, J.A.E.M. Published in: European Radiology DOI:10.1007/s003300050098Link to publication Citation for published version (APA): Puylaert, J. B. C. M., van der Zant, F. M., & Mutsaers, J. A. E. M. (1997). Infectious ileocecitits caused by yersinia, campylobacter, and salmonella -clinical, radiological and us findings. European Radiology, 7(1), 3-9. https://doi.org/10.1007/s003300050098 General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Download date: 20 Jun 2019 IntroductionIt is well known that the bacteria Yersinia enterocolitica, Campylobacter jejuni, and Salmonella enteritidis are important causes of diarrhea in humans. It is less known that the same microorganisms may also cause an appendicitis-mimicking syndrome, in which case the infection is confined to the ileocecal area [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. In these patients right lower abdominal pain is the predominant symptom, whereas diarrhea is absent or only mild. Due to this symptomatology, this otherwise innocuous and self-limiting bowel infection may lead to an unnecessary laparotomy for suspected appendicitis.The use of US with graded compression has greatly enhanced the diagnostic accuracy in patients with acute right lower abdominal pain [21][22][23][24]. In patients with the above-described appendicitis-mimicking syndrome due to Yersinia, Campylobacter, or Salmonella, a fairly characteristic US pattern can be demonstrated. This enables a rapid diagnosis and therewith exclusion of appendicitis [25][26][27][28][29][30][31]. In view of the constant clinical and morphological features and its common bacterial origin, the condition has been named bacterial ileocecitis (Table 1) [19]. Because analogous clinical, sonographic, and barium findings have also been described in viral, fungal, protozoan, and helminthic infections of the ileocecal area, the term infectious ileocecitis may be more appropriate [32][33][34][35][36].This article reflects a 9-year experience with infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella and describes its clinical, microbiological, epidemiological, radiolog...

Acute Appendicitis Mimicking Infectious Enteritis

“…7,12,13 Abdominal sonographic signs of typhoid fever, such as thickening of the ileal and colonic walls and lymph node enlargement, also have been reported previously. [8][9][10][11][12][13][14] Secondary wall thickening of the ileum and cecum sometimes can be seen in AA. If the inflamed appendix is overlooked and only the thickened ileum and cecum are seen, an erroneous diagnosis of infectious ileocecitis leading to a serious surgical delay could be made.…”

“…If the inflamed appendix is overlooked and only the thickened ileum and cecum are seen, an erroneous diagnosis of infectious ileocecitis leading to a serious surgical delay could be made. 12 However, in our series, the clinical follow-up and laboratory tests excluded the diagnosis of AA in 61 patients with sonographic signs of ileocecitis.…”

“…1 In the last decade, it was reported that bowel wall thickening and mesenteric lymph node enlargement are sensitive diagnostic signs of enteritis and colitis. [8][9][10][11][12][13] Because of the usually self-limiting clinical course of IE, however, sonographic signs of enteritis have been used principally in the differential diagnosis of more severe abdominal diseases (e.g., abscesses, AA, and perforation) rather than as a useful means for the diagnosis and treatment of intestinal infectious diseases. 13,14 Because AA and IE from S typhi or other bacterial agents can cause both fever and pain in the right lower abdominal quadrant, patients with unusual clinical manifestations of AA (e.g., mild diffuse pain, irregular fever, and a normal white blood cell count) can frequently be admitted to infectious diseases units for suspected IE or typhoid fever.…”

“…13,14 Because AA and IE from S typhi or other bacterial agents can cause both fever and pain in the right lower abdominal quadrant, patients with unusual clinical manifestations of AA (e.g., mild diffuse pain, irregular fever, and a normal white blood cell count) can frequently be admitted to infectious diseases units for suspected IE or typhoid fever. 1,2,[11][12][13][14] Although this is not a common event in an average hospital, it might occur in areas of the world where bacterial IE and typhoid fever are endemic. 11 Conversely, although highly sensitive, clinical and laboratory features of typhoid fever are certainly not pathognomonic.…”

Colonization of Cecum Is Important for Development of Persistent Infection by Yersinia pseudotuberculosis

“…In these animals, bacteria localize to the cecum and are shed into feces, suggesting that bacteria reside in the cecum as a persistent infection, possibly as a natural reservoir that allows spreading in nature by shedding in feces (39). Interestingly, as a niche for bacterial infection in humans, the cecum has been reported as a site for infections by Yersinia, Salmonella, and Campylobacter, which all specifically infect the ileocecal area (43), suggesting that the organ is also a specifically beneficial habitat for these pathogens in humans. It remains unknown why some people develop a chronic carrier state whereas others do not.…”