Rectal histopathology in endemic Shigella and Salmonella diarrhea.
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."
Sachdev
H P
HP
Department of Pediatrics, Maulana Azad Medical College, New Delhi, India.
Chadha
V
V
Malhotra
V
V
Verghese
A
A
Puri
R K
RK
D000667:Ampicillin / Q000627:therapeutic use; D002506:Cephalexin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D004405:Dysentery, Bacillary / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D009268:Nalidixic Acid / Q000627:therapeutic use; D012007:Rectum / Q000473:pathology*; D012480:Salmonella Infections / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D012762:Shigella dysenteriae; D012763:Shigella flexneri; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D005839:Gentamicins; D009268:Nalidixic Acid; D000667:Ampicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D002506:Cephalexin