Rectal Histopathology in Endemic Shigella and Salmonella Diarrhea

J Pediatr Gastroenterol Nutr. 1993 Jan;16(1):33-8. doi: 10.1097/00005176-199301000-00006.

Abstract

Rectal histopathology was evaluated in 34 cases (2 months-12 yrs old) of endemic "invasive diarrhea" [> 20 WBCs per high-power field on stool microscopy with (RBC positive) or without (RBC negative) associated RBCs] where S. dysenteriae (n = 9), S. flexneri (n = 11), and nontyphoidal Salmonella were isolated as the sole identifiable enteropathogens. Persistent diarrhea (> 14 days duration) was more common with Salmonella infection whereas RBC-positive "invasive diarrhea" was more frequent with Shigella, particularly S. dysenteriae (all cases) infection. The histopathological profile was comparable to the earlier descriptions of infective colitis to a large extent and the nature of the infecting organism could not be determined on the basis of rectal histology alone. The other noteworthy features were as follows: (i) mild crypt distortion (26%) and branching (21%) in both Shigella and Salmonella infection; in Salmonella infection, dilation of the glands was significantly greater with persistent diarrhea; (ii) presence of chronic inflammatory cells either alone or in combination with neutrophils in 62%; a predominant neutrophilic response was significantly higher with S. dysenteriae infection and an acute presentation; (iii) pseudomembrane formation (six subjects; 18%) especially in S. dysenteriae (four cases); and (iv) a significant association of neutrophilic response, edema, and neutrophils within the vessels in the lamina propria and mucin depletion in the glands with RBC-positive "invasive diarrhea."

MeSH terms

  • Ampicillin / therapeutic use
  • Cephalexin / therapeutic use
  • Child
  • Child, Preschool
  • Diarrhea / drug therapy
  • Diarrhea / microbiology
  • Diarrhea / pathology*
  • Dysentery, Bacillary / complications
  • Dysentery, Bacillary / drug therapy
  • Dysentery, Bacillary / pathology*
  • Female
  • Gentamicins / therapeutic use
  • Humans
  • Infant
  • Male
  • Nalidixic Acid / therapeutic use
  • Rectum / pathology*
  • Salmonella Infections / complications
  • Salmonella Infections / drug therapy
  • Salmonella Infections / pathology*
  • Shigella dysenteriae
  • Shigella flexneri
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use

Substances

  • Gentamicins
  • Nalidixic Acid
  • Ampicillin
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Cephalexin