Diagnosis and Management of Acute Infectious Colitis
Clinical Assessment
- The combination of abdominal pain, diarrhea, and leukocytosis strongly suggests an invasive bacterial pathogen rather than viral or parasitic etiology, with neutrophilia characteristic of invasive bacterial pathogens 1
- Bacterial enterocolitis presents with watery, mucoid, or bloody diarrhea, abdominal tenderness, fever, and neutrophilia, and must be differentiated from other causes such as C. difficile infection 3, 4
- C. difficile infection must be ruled out immediately, as it can present with abdominal pain, diarrhea, fever, and leukocytosis, even with minimal or absent diarrhea in severe cases 5
Immediate Diagnostic Workup
- Stool studies should be collected immediately and include C. difficile toxin A and B testing, bacterial stool culture for Salmonella, Shigella, Yersinia, and Campylobacter, and fecal lactoferrin or microscopy for leukocytes to document colonic inflammation 1, 3, 5, 7
- Additional blood work should include complete metabolic panel, C-reactive protein, and procalcitonin to assess severity of inflammation, as well as blood cultures if fever is present 2, 3, 8
Imaging Studies
- Contrast-enhanced CT scan of the abdomen and pelvis is strongly recommended to detect bowel wall thickening, identify complications, and differentiate between infectious colitis and other causes 2, 4, 6
Empiric Treatment Strategy
- Empiric broad-spectrum antibiotics should be initiated immediately while awaiting culture results, given the leukocytosis and clinical presentation suggesting bacterial infection, with options including vancomycin, ciprofloxacin, and azithromycin 3, 4, 10
- Supportive care should include intravenous fluid resuscitation, avoidance of antiperistaltic agents, and consideration of bowel rest in severe cases 5, 8, 11