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Microbic superinfection in relapse of inflammatory bowel disease
P Weber1, M Koch, W R Heizmann
1Department of Internal Medicine, University of Tübingen, Germany.
Abstract:
To assess the association between symptomatic relapse of inflammatory bowel disease (IBD) and superinfection with enteropathogenic microorganisms, we determined prospectively the incidence of infections with enteropathogenic bacteria, protozoa, and helminths in patients with confirmed longstanding IBD. Sixty-four patients with IBD (49 with Crohn's disease [CD] and 15 with ulcerative colitis [UC]) were consecutively enrolled in the study when relapse occurred. Multiple biopsies for histological and microbiological investigations were taken from all patients who were evaluated by colonoscopy. Parallel stool specimens were investigated for the presence of enteropathogenic bacteria, protozoa, and helminths. In six patients, we detected Clostridium difficile or toxin B (five CD, one UC), in one patient Campylobacter jejuni (CD), and in another patient Salmonella typhimurium (UC). Enteropathogenic Escherichia coli were isolated from three patients. Investigation of biopsies for Mycobacteria, microscopic examination of stool samples for helminths, and immunofluorescence for chlamydia were negative in all patients. In summary, as we found enteropathogenic microorganisms so infrequently in patients with relapse of IBD, despite intensive microbiological screening by tissue sampling for detection of gut adherent bacteria, we believe that microorganisms play only a minor role in the exacerbation of IBD.
Insights
Infections with enteropathogenic microorganisms were rarely found in patients experiencing a relapse of inflammatory bowel disease (IBD). This suggests that gut infections play a minimal role in IBD exacerbations.
Area of Science:
- Gastroenterology
- Microbiology
- Immunology
Background:
- Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is a chronic condition.
- The role of enteropathogenic microorganisms in triggering or exacerbating IBD relapses remains an area of investigation.
Purpose of the Study:
- To prospectively assess the association between symptomatic IBD relapse and superinfection with enteropathogenic microorganisms.
- To determine the incidence of infections by bacteria, protozoa, and helminths in IBD patients during relapse.
Main Methods:
- Prospective enrollment of 64 IBD patients (49 CD, 15 UC) during symptomatic relapse.
- Colonoscopy with multiple biopsies for histological and microbiological analysis.
- Stool specimen analysis for enteropathogenic bacteria, protozoa, and helminths; biopsy analysis for Mycobacteria and chlamydia.
Main Results:
- Enteropathogenic microorganisms were infrequently detected in patients with IBD relapse.
- Clostridium difficile/toxin B detected in 6 patients; Campylobacter jejuni in 1; Salmonella typhimurium in 1; Enteropathogenic E. coli in 3.
- Mycobacteria, helminths, and chlamydia were not detected in any patient.
Conclusions:
- Enteropathogenic microorganisms appear to play a minor role in the exacerbation of inflammatory bowel disease.
- Intensive microbiological screening, including tissue sampling, revealed a low incidence of infection during IBD relapse.