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 22 May 2018

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Enteric infection in relapse of inflammatory bowel disease and the importance of microbiological examination of stool

A study in the European Journal of Gastroenterology and Hepatology has highlighted the importance of microbiological examination of stool samples in patients with inflammatory bowel disease where enteric infection is common.

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According to Maria Mylonaki and colleagues, previous reports have suggested that diarrheal relapses of inflammatory bowel disease (IBD) may be associated or confused with enteric infection, and that treatment of such infections with appropriate antibiotics may be beneficial.

Her team therefore set out to re-evaluate the suggestion that enteric infection is rare and microbiological testing of stool not routinely necessary in patients presenting with relapse of IBD.

They did this by reviewing the incidence of concurrent infection in patients presenting in relapse over a recent 5-year period (1997 Ė 2001).

Clostridium difficile toxin was detected in 5.5% of relapses of IBD
European Journal of Gastroenterology and Hepatology

Stool microbiology results relating to relapses of IBD during this period were obtained retrospectively, while relapse was confirmed by standard clinical, sigmoidoscopic and laboratory criteria.

A total of 237 relapses occurred in 213 patients during the study period, with enteric infection identified in 25 (10.5%) relapses in 24 patients.

In 7 patients the infection was associated with the initial presentation of their IBD.

Clostridium difficile toxin was detected in 13 (5.5%) instances; the 12 other infections (5% relapses) were Campylobacter spp. (5), Entamoeba histolytica (3), Salmonella spp. (1), Plesiomonas shigelloides (1), Strongyloides stercoralis (1) and Blastocystis hominis (1).

The researchers identified a significant association between infection and the need for hospital admission.

Of the 13 relapses associated with C. difficile, 10 were in outpatients, 7 patients had undergone previous antibiotic treatment, and 4 patients were presenting with IBD for the first time.

All relapses resolved satisfactorily after treatment with antibiotics, with, or without, corticosteroids.

Commenting on the lessons to be learnt from the findings of the study, Dr Mylonaki said, " The high prevalence of enteric infections, of which C. difficile was the most common, indicates that all patients presenting with relapse of IBD should have stool examined microbiologically."

Eur J Gastroenterol Hepatol2004; 16 (8): 775 - 778
20 July 2004

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