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Dr QM Leong
Dr QM Leong

Infectious Colitis: Symptoms, Causes, and Treatment Strategies

Infectious colitis is a significant concern in the spectrum of gastrointestinal disorders, often interlinked with conditions like inflammatory bowel disease (IBD) and ulcerative colitis. 

In this article we will explain the symptoms of infectious colitis, citing its primary cause, differentiating it from chronic inflammatory bowel diseases, and highlighting advanced treatment strategies.

What Is Infectious Colitis?

Infectious colitis is a type of colitis caused by infections from bacteria, viruses, or parasites. It’s characterised by inflammation of the colon, which is the body’s response to these infectious agents and can lead to gastrointestinal symptoms.

It differs from other types of colitis, such as ulcerative colitis, an inflammatory bowel disease not caused by infectious agents but by an abnormal immune response. Other forms, like ischemic colitis, result from reduced blood flow to the colon. 

Symptoms Of Infectious Colitis

Key symptoms of infectious colitis include:

  • Abdominal Pain and Cramping: A common manifestation, often confused with other conditions like inflammatory bowel diseases. The pain can range from mild and manageable to severe and debilitating, depending on the type of pathogen involved and the individual’s overall health.
  • Diarrhoea: Ranging from watery to bloody diarrhoea, signalling severe inflammation or ulceration in the colon. Infections from bacteria like Escherichia coli O157:H7, a strain known for causing severe foodborne illness, can lead to profuse, often bloody, diarrhoea.
  • Fever: This symptom indicates the body’s immune response to the infection. Fever is a natural defence mechanism, activating the immune system to fight off the infectious agent.
  • Nausea and Vomiting: These symptoms occur as the body attempts to expel the offending pathogens and are a direct response to irritation and inflammation in the gastrointestinal tract caused by the infection.
  • Urgency to Defecate: This is caused by the irritation and inflammation of the colon. The inflamed colon becomes more sensitive and reactive, leading to a frequent and sometimes uncontrollable urge to pass stool. This urgency is a hallmark of the active inflammation within the digestive tract associated with infectious colitis.

Bacteria Causing Infectious Colitis

Infectious colitis can be caused by a variety of infectious agents:

  • Bacteria: These include E. coli, Salmonella, Shigella, and Campylobacter, which are often contracted through contaminated food or water.
  • Viruses: Like norovirus and rotavirus, common in children and often spread through contaminated food or direct contact.
  • Parasites: These include Giardia lamblia and Entamoeba histolytica, which are often contracted through contaminated water in endemic areas.

Risk Factors Of Infectious Colitis

  • Individuals at risk of developing infectious colitis include:
  • People with weakened immune systems, such as those with chronic diseases or taking immunosuppressive drugs.
  • Travellers to areas with poor sanitation, where contaminated food and water are more common.
  • Individuals are practising poor hygiene, especially in food handling and personal cleanliness.
  • Young children and the elderly are generally more susceptible to infections.
  • People eating undercooked or improperly stored food are more prone to consuming harmful bacteria or parasites.
  • Those living or working in close quarters, like daycare centres or nursing homes, where infections can spread more easily.

How Does Infectious Colitis Spread?

Infectious colitis is primarily spread through the faecal-oral route. This occurs when pathogens present in an infected person’s faeces contaminate food or water, which is then ingested by others. Key factors contributing to its spread include:

  • Contaminated Food and Water: Ingesting food or water contaminated with bacteria, viruses, or parasites. This contamination often occurs due to poor food handling practices or contaminated water sources.
  • Poor Hygiene: Inadequate handwashing, particularly after using the bathroom or handling raw food, can lead to the spread of pathogens.
  • Close Contact: Being in close contact with someone who has infectious colitis can increase the risk, especially in environments like daycare centres or nursing homes.
  • Travel to High-Risk Areas: Travelling to regions with poor sanitation can increase the likelihood of contracting infectious colitis due to exposure to contaminated food and water.

Infectious Colitis Prevention And Long-term Management

Infectious colitis can contribute to significant morbidity and mortality worldwide, particularly in cases involving specific pathogens like enterohemorrhagic Escherichia coli (EHEC) O157:H7, Salmonella, Shigella, Campylobacter, and Entamoeba histolytica.

Advances in understanding the epidemiology and pathobiology of infectious colitis have been significant, but the condition still poses a considerable health threat, necessitating improved prevention strategies​​.

Currently, here are the measures to prevent infectious colitis:

  • Maintain Good Hygiene: Regular handwashing, especially before eating and after using the restroom, is crucial.
  • Safe Food Handling and Preparation: Cook meat thoroughly, wash fruits and vegetables, and avoid cross-contamination in the kitchen.
  • Be Cautious with Water: In areas with questionable water safety, drink bottled or boiled water and avoid ice.
  • Be Vigilant When Travelling: In regions with lower sanitation standards, be extra careful about food and water consumption.
  • Strengthen Your Immune System: A healthy lifestyle, including a balanced diet and regular exercise, can bolster your immune defences.

Diagnosing Infectious Colitis

Diagnosing bacterial colitis and differentiating it from other forms of colitis and gastrointestinal disorders is crucial for effective treatment. Here’s an overview of the diagnostic approach and how to differentiate bacterial colitis from other conditions:

  • Medical History and Physical Examination: Understanding the patient’s symptoms, history of travel, food intake, and exposure to contaminated sources. Physical examination may reveal abdominal tenderness.
  • Stool Tests: Three types of stool tests are usually performed for diagnosis. These include stool culture to identify specific bacteria causing the infection, microscopy to look for white blood cells indicating an inflammatory process, and stool antigen tests to detect specific bacterial toxins (e.g., for C. difficile).
  • Blood Tests: Can show systemic infection or inflammation, including elevated white blood cell count, and C-reactive protein.
  • Imaging Tests: Computed Tomography scan or CT scan and ultrasound are rarely used for bacterial colitis, but can help rule out other conditions.
  • Colonoscopy or Sigmoidoscopy: Colonoscopy is used if the diagnosis is unclear or to assess the extent of colonic involvement. Biopsies can be taken for histological examination.

Treatment Strategies For Infectious Colitis

Infectious colitis requires a treatment approach that addresses the specific pathogen involved, managing symptoms and preventing complications.

Here are the treatment options categorised based on the type of infection and general management strategies:

Treatment Based On Pathogen Type

  • Bacterial Colitis: Common antibiotics used include Ciprofloxacin or Azithromycin, which are effective against various general bacterial infections. In cases of Clostridioides difficile infections, Vancomycin or Fidaxomicin are typically prescribed.
  • Viral Colitis: When it comes to viral colitis, most cases of viral gastroenteritis are self-limiting, meaning they resolve independently without needing specific antiviral treatments.

The primary focus of treatment in these instances is supportive care, emphasising the importance of hydration and rest. Maintaining fluid balance and allowing the body to rest is crucial to recovery in viral colitis cases.

  • Parasitic Colitis: Treatment involves using antiparasitic medications, which are chosen based on the specific type of parasite causing the infection. Metronidazole or Tinidazole are commonly used for treating infections such as Giardiasis.

However, different specific antiparasitic drugs, such as albendazole or ivermectin, may be necessary for other parasites, depending on the parasite identified. These treatments are essential for effectively eliminating the parasitic infection and alleviating colitis symptoms.

General Management Strategies

Infectious colitis treatment highly depends on the causative agent and the severity of the symptoms. Antibiotics, antivirals, or antiparasitics are used based on the specific pathogen, while supportive care remains a cornerstone of treatment across all types.

  • Hydration and Electrolyte Management: In severe cases, oral rehydration solutions or intravenous fluids.
  • Dietary Modifications: Initially, a clear liquid diet progressed to a low-fibre diet as tolerated. Avoidance of dairy products if lactose intolerance is suspected post-infection.
  • Probiotics: May be considered to help restore normal gut flora.
  • Nutritional Support: Particularly if significant weight loss or prolonged diarrhoea exists.
  • Hospitalisation: For severe cases, especially if there’s significant dehydration, sepsis, or toxic megacolon.

Conclusion About Infectious Colitis

Infectious colitis, while distinct from chronic inflammatory bowel diseases, presents its own set of significant health challenges. Early diagnosis, understanding the cause, and implementing appropriate treatment strategies are crucial for managing this condition.

You can trust Advanced Colorectal and General Surgery when treating and managing gastrointestinal conditions. We have facilities and specialists who can provide comprehensive care for those suffering from symptoms of infectious colitis and other conditions.

Book an appointment today!

Frequently Asked Questions About Infectious Colitis

How Long Does Infectious Colitis Last?

The duration of infectious colitis varies depending on the causative agent and the patient’s overall health. Typically, symptoms can last from a few days to a couple of weeks. However, some infections may linger or recur, especially if not adequately treated.

Will Colitis Go Away On Its Own?

Mild cases of infectious colitis often resolve on their own with supportive care, such as staying hydrated. However, medical intervention is necessary if symptoms persist beyond a few days or there’s a high risk of complications.

What Are The Potential Complications Of Infectious Colitis?

Potential complications include dehydration, hemolytic uremic syndrome (particularly with certain E. coli infections), sepsis, toxic megacolon, and perforation of the colon. These complications can be severe and require immediate medical attention.

Can Children And Adults Be Affected Differently By Infectious Colitis?

Yes, infectious colitis can affect children and adults differently. Children, especially young ones, are more susceptible to dehydration and may show symptoms more rapidly. Adults might have more varied symptoms and are at a different risk for certain complications.