title: Life-threatening chronic enteritis due to colonization of the small bowel with Stenotrophomonas maltophilia.
abstract: Chronic diarrheal illness and malabsorption are challenging diagnostic and clinical problems. The identification of the causative pathogens that are involved in gastrointestinal infections is often difficult. It took 85 years after the first description of a case of intestinal lipodystrophy by Georg Whipple in 1907 until the causative bacterium was characterized by using molecular genetics techniques. We here report the complicated clinical course of a young patient with chronic diarrhea accompanied by severe, life-threatening malabsorption with extensive weight loss. Histology and glucose hydrogen breath test were suggestive of a bacterial overgrowth syndrome in the small bowel, but standard culture-based techniques and serology failed to identify the causative bacteria. Thus, bacterial ribosomal DNA (16S ribosomal DNA) was extracted from duodenal biopsy samples and analyzed by community fingerprinting and species-specific polymerase chain reaction. Stenotrophomonas maltophilia was identified as the cause of chronic infectious enteritis. Only specific long-term antibiotic treatment with co-trimoxazole had a durable clinical effect and led to normalization of 16S ribosomal DNA profiles. This case shows the role of rare and uncommon bacteria in refractory and chronic human gastrointestinal infections. Genomic techniques, including 16S-based single-strand conformation polymorphism analysis, will play an increasing role in the diagnosis of chronic infections with facultatively pathogenic bacteria or in the clinical analysis of complex bacterial communities such as the intestinal bacterial microflora. Future enhancements in detection techniques will show that chronic bacterial infections are more frequent as a cause of gastrointestinal malfunction than commonly thought.
authors.affiliation: Department of General Internal Medicine, Christian-Albrechts-University, University Hospital Schleswig-Holstein, Kiel, Germany. s.hellmig@mucosa.de
authors.forename: Stephan
authors.initials: S
authors.lastname: Hellmig
authors.forename: Stephan
authors.initials: S
authors.lastname: Ott
authors.forename: Meike
authors.initials: M
authors.lastname: Musfeldt
authors.forename: Markus
authors.initials: M
authors.lastname: Kosmahl
authors.forename: Phillip
authors.initials: P
authors.lastname: Rosenstiel
authors.forename: Eckhard
authors.initials: E
authors.lastname: Stüber
authors.forename: Jochen
authors.initials: J
authors.lastname: Hampe
authors.forename: Ulrich R
authors.initials: UR
authors.lastname: Fölsch
authors.forename: Stefan
authors.initials: S
authors.lastname: Schreiber
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D002908:Chronic Disease; D016638:Critical Illness; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology; D016099:Endoscopy, Gastrointestinal; D004751:Enteritis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007150:Immunohistochemistry; D007421:Intestine, Small / Q000382:microbiology / Q000473:pathology; D008286:Malabsorption Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D018570:Risk Assessment; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents