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==Overview==
==Overview==
Diagnostic laboratory tests to identify the pathogen causing infectious colitis include stool and blood culture, serology, or polymerase chain reaction (PCR). Non specific laboratory findings in infectious colitis are also done and helpful to rule out development of complications.
Diagnostic laboratory tests to identify the [[Pathogen|pathogens]] causing infectious colitis may include [[stool examination]] (such as [[microscopy]], [[Stool examination|culture]] and fecal leukocytes), [[blood culture]], [[serology]], and molecular tests such as [[polymerase chain reaction]] (PCR). Non specific laboratory findings in infectious colitis are also done and helpful to rule out development of complications.


==Laboratory Findings==
==Laboratory Findings==
The table below displays nonspecific laboratory abnormalities associated with Infectious colitis, including:<ref name=NCBI>{{cite web | title = Diarrhoea and Vomiting Caused by Gastroenteritis
The table below displays nonspecific laboratory abnormalities associated with Infectious colitis, including:<ref name="NCBI1">{{cite web | title = Diarrhoea and Vomiting Caused by Gastroenteritis
| url = http://www.ncbi.nlm.nih.gov/books/NBK63841/ }}</ref><ref name="pmid8039632">{{cite journal| author=Agarwal R, Afzalpurkar R, Fordtran JS| title=Pathophysiology of potassium absorption and secretion by the human intestine. | journal=Gastroenterology | year= 1994 | volume= 107 | issue= 2 | pages= 548-71 | pmid=8039632 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8039632  }} </ref><ref name="pmid3785323">{{cite journal| author=Wang F, Butler T, Rabbani GH, Jones PK| title=The acidosis of cholera. Contributions of hyperproteinemia, lactic acidemia, and hyperphosphatemia to an increased serum anion gap. | journal=N Engl J Med | year= 1986 | volume= 315 | issue= 25 | pages= 1591-5 | pmid=3785323 | doi=10.1056/NEJM198612183152506 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3785323  }} </ref><ref name="pmid4555786">{{cite journal| author=Welbourne T, Weber M, Bank N| title=The effect of glutamine administration on urinary ammonium excretion in normal subjects and patients with renal disease. | journal=J Clin Invest | year= 1972 | volume= 51 | issue= 7 | pages= 1852-60 | pmid=4555786 | doi=10.1172/JCI106987 | pmc=PMC292333 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4555786  }} </ref><ref name="pmid3796685">{{cite journal| author=Batlle DC, von Riotte A, Schlueter W| title=Urinary sodium in the evaluation of hyperchloremic metabolic acidosis. | journal=N Engl J Med | year= 1987 | volume= 316 | issue= 3 | pages= 140-4 | pmid=3796685 | doi=10.1056/NEJM198701153160305 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3796685  }} </ref>
| url = http://www.ncbi.nlm.nih.gov/books/NBK63841/ }}</ref><ref name="pmid8039632">{{cite journal| author=Agarwal R, Afzalpurkar R, Fordtran JS| title=Pathophysiology of potassium absorption and secretion by the human intestine. | journal=Gastroenterology | year= 1994 | volume= 107 | issue= 2 | pages= 548-71 | pmid=8039632 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8039632  }} </ref><ref name="pmid3785323">{{cite journal| author=Wang F, Butler T, Rabbani GH, Jones PK| title=The acidosis of cholera. Contributions of hyperproteinemia, lactic acidemia, and hyperphosphatemia to an increased serum anion gap. | journal=N Engl J Med | year= 1986 | volume= 315 | issue= 25 | pages= 1591-5 | pmid=3785323 | doi=10.1056/NEJM198612183152506 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3785323  }} </ref><ref name="pmid4555786">{{cite journal| author=Welbourne T, Weber M, Bank N| title=The effect of glutamine administration on urinary ammonium excretion in normal subjects and patients with renal disease. | journal=J Clin Invest | year= 1972 | volume= 51 | issue= 7 | pages= 1852-60 | pmid=4555786 | doi=10.1172/JCI106987 | pmc=PMC292333 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4555786  }} </ref><ref name="pmid3796685">{{cite journal| author=Batlle DC, von Riotte A, Schlueter W| title=Urinary sodium in the evaluation of hyperchloremic metabolic acidosis. | journal=N Engl J Med | year= 1987 | volume= 316 | issue= 3 | pages= 140-4 | pmid=3796685 | doi=10.1056/NEJM198701153160305 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3796685  }} </ref>
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 30%;"
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 30%;"
|+ '''Laboratory findings'''
|+ '''Laboratory findings'''
|-
|-
! style="width: 75px; background: #4479BA; text-align: center;"|{{fontcolor|#FFF|Test}}
! style="width: 75px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Test}}
! style="width: 200px; background: #4479BA; text-align: center;"| {{fontcolor|#FFF|Findings}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Findings}}
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Complete Blood Count]]'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Complete Blood Count]]'''
| style="background: #DCDCDC; padding: 5px;"|
| style="background: #DCDCDC; padding: 5px;" |
*[[Leukocytosis]] is often present
*[[Leukocytosis]] is often present
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Electrolytes]]'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Electrolytes]]'''
| style="background: #DCDCDC; padding: 5px;"|
| style="background: #DCDCDC; padding: 5px;" |
*[[Hypokalemia]] may be present
*[[Hypokalemia]] may be present
*[[Hypernatremia]] may be present
*[[Hypernatremia]] may be present
*[[Hyponatremia]] may be present if patient ingests much free water
*[[Hyponatremia]] may be present if patient ingests much free water
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''Inflammatory Markers'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Inflammatory Markers'''
| style="background: #DCDCDC; padding: 5px;"|
| style="background: #DCDCDC; padding: 5px;" |
*[[CRP]] is often elevated
*[[CRP]] is often elevated
*[[ESR]] may be elevated
*[[ESR]] may be elevated
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Blood cultures]]'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Blood cultures]]'''
| style="background: #DCDCDC; padding: 5px;"|  
| style="background: #DCDCDC; padding: 5px;" |  
*Indicated in the presence of prolonged or recurrent fever
*Indicated in the presence of prolonged or recurrent fever
*May reveal presence of the [[bacteria]], in case of [[bacteremia]]
*May reveal presence of the [[bacteria]], in case of [[bacteremia]]
*Commonly positive in endovascular infections
*Commonly positive in endovascular infections
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Urinalysis]]'''
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Urinalysis]]'''
| style="background: #DCDCDC; padding: 5px;"|
| style="background: #DCDCDC; padding: 5px;" |
*[[Hypercalciuria]] may be present
*[[Hypercalciuria]] may be present
*[[Hypocitraturia]] may be present
*[[Hypocitraturia]] may be present
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|-
|-
|}
|}
==Stool Cultures==
[[Stool culture]]s in adequate [[culture media]], allow the correct identification of the [[pathogen]] responsible for infectious colitis. The organism should be isolated from fresh stool. The sample should be planted in different selective and nonselective culture agar media, such as:<ref name="NCBI2">{{cite web | title = Salmonella | url = http://www.ncbi.nlm.nih.gov/books/NBK8435/ }}</ref>
*[[Blood]]
*McConkey
*[[Bismuth sulfite agar|Bismuth sulfite]]
*[[Eosin methylene blue|Eosin-methylene blue]]
*Salmonella-Shigella
In cases where there is reduced number of [[pathogens]], enrichment broths, such as [[tetrathionate]] or [[Selenite broth|selenite]], may be used prior to culture of bacteria.<ref name="NCBI">{{cite web | title = Salmonella| url = http://www.ncbi.nlm.nih.gov/books/NBK8435/ }}</ref>
Fecal [[leukocytes]] may also be identified in the specimen.<ref name="pmid15004086">{{cite journal| author=Granville LA, Cernoch P, Land GA, Davis JR| title=Performance assessment of the fecal leukocyte test for inpatients. | journal=J Clin Microbiol | year= 2004 | volume= 42 | issue= 3 | pages= 1254-6 | pmid=15004086 | doi= | pmc=PMC356889 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15004086  }} </ref>
The identification of the organism allows specific treatment of the disease, as well as appropriate follow-up recommendations.<ref name="pmid11170940">{{cite journal| author=Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV et al.| title=Practice guidelines for the management of infectious diarrhea. | journal=Clin Infect Dis | year= 2001 | volume= 32 | issue= 3 | pages= 331-51 | pmid=11170940 | doi=10.1086/318514 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11170940  }} </ref><ref>{{cite book | last = Longo | first = Dan | title = Harrison's principles of internal medicine | publisher = McGraw-Hill | location = New York | year = 2012 | isbn = 007174889X }}</ref>
This test is not routinely performed due to its high cost, when compared with the accuracy of the results. Results from fecal cultures are often delayed and show an elevated rate of false-negatives.<ref name="pmid8815110">{{cite journal| author=Choi SW, Park CH, Silva TM, Zaenker EI, Guerrant RL| title=To culture or not to culture: fecal lactoferrin screening for inflammatory bacterial diarrhea. | journal=J Clin Microbiol | year= 1996 | volume= 34 | issue= 4 | pages= 928-32 | pmid=8815110 | doi= | pmc=PMC228919 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8815110  }} </ref>
[[Stool culture]] may remain positive for 4 to 5 weeks, and in rare cases (chronic) for more than 1 year.<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426  }} </ref>
'''Laboratory findings''' of infectious colitis depending on the [[pathogen]] causing the infectious colitis as follows:
*[[Shigellosis laboratory findings|''Shigella spp.'']]
*[[Campylobacteriosis laboratory findings|''Campylobacter jejuni'']]
*[[Clostridium difficile infection laboratory findings|''Clostridium difficile'']]
*[[Escherichia coli enteritis laboratory findings|''Escherichia coli'']]
*[[Salmonellosis laboratory tests|Nontyphoidal ''Salmonella'']]
*[[Amoebiasis laboratory tests|''Entameoba histolytica'']]
*[[Lymphogranuloma venereum laboratory findings|''Chlamydia trachomatis'']]
*[[Cytomegalovirus infection laboratory findings|''Cytomegalovirus'']]
*[[Yersinia enterocolitica infection laboratory findings|''Yersinia enterocolitica'']]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WS}}{{WH}}
{{WS}}{{WH}}
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Gastroenterology]]
[[Category:Surgery]]

Latest revision as of 22:22, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qasim Salau, M.B.B.S., FMCPaed [2]

Overview

Diagnostic laboratory tests to identify the pathogens causing infectious colitis may include stool examination (such as microscopy, culture and fecal leukocytes), blood culture, serology, and molecular tests such as polymerase chain reaction (PCR). Non specific laboratory findings in infectious colitis are also done and helpful to rule out development of complications.

Laboratory Findings

The table below displays nonspecific laboratory abnormalities associated with Infectious colitis, including:[1][2][3][4][5]

Laboratory findings
Test Findings
Complete Blood Count
Electrolytes
Inflammatory Markers
  • CRP is often elevated
  • ESR may be elevated
Blood cultures
  • Indicated in the presence of prolonged or recurrent fever
  • May reveal presence of the bacteria, in case of bacteremia
  • Commonly positive in endovascular infections
Urinalysis

Stool Cultures

Stool cultures in adequate culture media, allow the correct identification of the pathogen responsible for infectious colitis. The organism should be isolated from fresh stool. The sample should be planted in different selective and nonselective culture agar media, such as:[6]

In cases where there is reduced number of pathogens, enrichment broths, such as tetrathionate or selenite, may be used prior to culture of bacteria.[7]

Fecal leukocytes may also be identified in the specimen.[8]

The identification of the organism allows specific treatment of the disease, as well as appropriate follow-up recommendations.[9][10]

This test is not routinely performed due to its high cost, when compared with the accuracy of the results. Results from fecal cultures are often delayed and show an elevated rate of false-negatives.[11]

Stool culture may remain positive for 4 to 5 weeks, and in rare cases (chronic) for more than 1 year.[12]

Laboratory findings of infectious colitis depending on the pathogen causing the infectious colitis as follows:

References

  1. ↑ "Diarrhoea and Vomiting Caused by Gastroenteritis".
  2. ↑ Agarwal R, Afzalpurkar R, Fordtran JS (1994). "Pathophysiology of potassium absorption and secretion by the human intestine". Gastroenterology. 107 (2): 548–71. PMID 8039632.
  3. ↑ Wang F, Butler T, Rabbani GH, Jones PK (1986). "The acidosis of cholera. Contributions of hyperproteinemia, lactic acidemia, and hyperphosphatemia to an increased serum anion gap". N Engl J Med. 315 (25): 1591–5. doi:10.1056/NEJM198612183152506. PMID 3785323.
  4. ↑ Welbourne T, Weber M, Bank N (1972). "The effect of glutamine administration on urinary ammonium excretion in normal subjects and patients with renal disease". J Clin Invest. 51 (7): 1852–60. doi:10.1172/JCI106987. PMC 292333. PMID 4555786.
  5. ↑ Batlle DC, von Riotte A, Schlueter W (1987). "Urinary sodium in the evaluation of hyperchloremic metabolic acidosis". N Engl J Med. 316 (3): 140–4. doi:10.1056/NEJM198701153160305. PMID 3796685.
  6. ↑ "Salmonella".
  7. ↑ "Salmonella".
  8. ↑ Granville LA, Cernoch P, Land GA, Davis JR (2004). "Performance assessment of the fecal leukocyte test for inpatients". J Clin Microbiol. 42 (3): 1254–6. PMC 356889. PMID 15004086.
  9. ↑ Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV; et al. (2001). "Practice guidelines for the management of infectious diarrhea". Clin Infect Dis. 32 (3): 331–51. doi:10.1086/318514. PMID 11170940.
  10. ↑ Longo, Dan (2012). Harrison's principles of internal medicine. New York: McGraw-Hill. ISBN 007174889X.
  11. ↑ Choi SW, Park CH, Silva TM, Zaenker EI, Guerrant RL (1996). "To culture or not to culture: fecal lactoferrin screening for inflammatory bacterial diarrhea". J Clin Microbiol. 34 (4): 928–32. PMC 228919. PMID 8815110.
  12. ↑ Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.

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