ESCHERICHIA-COLI O157-H7-ASSOCIATED COLITIS - A CLINICAL AND HISTOLOGICAL STUDY OF 11 CASES
ESCHERICHIA-COLI O157-H7-ASSOCIATED COLITIS - A CLINICAL AND HISTOLOGICAL STUDY OF 11 CASES
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DOI：
10.1016/0016-5085(90)91241-w
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发表时间：
1990-07-01
期刊：
影响因子：
29.4
通讯作者：
PETRAS, RE
中科院分区：
文献类型：
--
作者：
GRIFFIN, PM;OLMSTEAD, LC;PETRAS, RE
出血性结肠炎的特征是腹部绞痛、血性腹泻、无发热或低热。大多数病例是由产志贺样毒素的细菌大肠杆菌0157：H7引起的。19例结肠活检标本和1例切除标本来自11例大肠埃希氏菌。大肠杆菌0157：H7相关性结肠炎，以确定组织学特征是否可以在诊断或提示发病机制有用。所有标本均显示固有层出血和水肿。来自9名患者的标本为局灶性坏死，并显示浅表粘膜出血和急性炎症，保留了深隐窝，与急性缺血性结肠炎相关的损伤模式相似。5例患者的标本显示嗜中性粒细胞局灶性浸润固有层和隐窝，类似于感染性结肠炎中观察到的损伤模式。除1例患者外，在所有患者的标本中均观察到一种或两种组织学模式。4例患者的标本有不良形成的炎性假膜。结论：E. coli 0157：H7相关性结肠炎类似于缺血性和感染性损伤的组合，类似于毒素介导的艰难梭菌相关性结肠炎中描述的那些。这表明这些E.大肠杆菌在结肠损伤中起一定作用。感染E.大肠杆菌0157：H7在缺血性和感染性结肠炎的鉴别诊断中应予以考虑。
Hemorrhagic colitis is characterized by abdominal cramps, bloody diarrhea, and no or low-grade fever. Most cases are caused by the Shiga-like toxin-producing bacteria, Escherichia coli 0157:H7. Nineteen colonic biopsy specimens and one resection specimen were reviewed from 11 patients with E. coli 0157:H7-associated colitis to determine whether histologic features could be useful in diagnosis or in suggesting pathogenesis. All specimens showed hemorrhage and edema in the lamina propria. Specimens from nine patients were focally necrotic and showed hemorrhage and acute inflammation in the superficial mucosa with preservation of the deep crypts, similar to the pattern of injury associated with acute ischemic colitis. Specimens from five patients showed neutrophils focally infiltrating the lamina propria and crypts, resembling the pattern of injury seen in infectious colitis. One or both of these histologic patterns were observed in specimens from all but one patient. Specimens from four patients had poorly formed inflammatory pseudomembranes. It is concluded that the histologic features of E. coli 0157:H7-associated colitis resemble a combination of ischemic and infectious injuries similar to those described in toxin-mediated Clostridium difficile-associated colitis. This suggests that the toxin(s) produced by these E. coli play a role in the colonic injury. Infection with E. coli 0157:H7 should be considered in the differential diagnosis of ischemic and infectious colitis.