A population-based study of the appearances of enteric Campylobacter and non-typhoidal Salmonella infections on computed tomography

BACKGROUND

Swift identification and diagnosis of gastrointestinal infections are crucial for prompt treatment, prevention of complications, and reduction of the risk of hospital transmission. The radiological appearance on computed tomography could potentially provide important clues to the etiology of gastrointestinal infections. We aimed to describe features based on computed tomography of patients diagnosed with Campylobacter, Salmonella or Shigella infections in South Sweden.

METHODS

This was a retrospective observational population-based cohort study conducted between 2019 and 2022 in Skåne, southern Sweden, a region populated by 1.4 million people. Using data from the Department of Clinical Microbiology combined with data from the Department of Radiology, we identified all patients who underwent computed tomography of the abdomen CTA two days before and up to seven days after sampling due to the suspicion of Campylobacter, Salmonella or Shigella during the study period.

RESULTS

A total of 215 CTAs scans performed on 213 patients during the study period were included in the study. The median age of included patients was 45 years (range 11-86 years), and 54% (114/213) of the patients were women. Of the 215 CTAs, 80% (n = 172) had been performed due to Campylobacter and 20% (n = 43) due to Salmonella enteritis. CTA was not performed for any individual diagnosed with Shigella during the study period. There were no statistically significant differences in the radiological presentation of Campylobacter and Salmonella infections.

CONCLUSION

The most common location of Campylobacter and Salmonella infections was the cecum, followed by the ascending colon. Enteric wall edema, contrast loading of the affected mucosa, and enteric fat stranding are typical features of both infections. The CTA characteristics of Campylobacter and Salmonella are similar, and cannot be used to reliably differentiate between different infectious etiologies.

Abdominal ultrasonographic findings in typhoid fever: a comparison between typhoid patients and those with non-typhoidal Salmonella and Campylobacter jejuni enterocolitis

Typhoid fever is a major health problem in many developing countries and its clinical features are similar to other types of bacterial enterocolitis. Definitive diagnosis by blood culture requires several days and is often unfeasible to perform in developing countries. More efficient and rapid diagnostic methods for typhoid are needed. We compared the pathological changes in the bowel and adjacent tissues of patients having typhoid fever with those having bacterial enterocolitis using ultrasonography. A characteristic of patients with non-typhoidal Salmonella and Campylobacter jejuni enterocolitis was mural thickening of the terminal ileum; only mild mural swelling or no swelling was observed in patients with typhoid fever. Mesenteric lymph nodes in patients with typhoid fever were significantly more enlarged compared to patients with other types of bacterial enterocolitis. Our findings suggest typhoid fever is not fundamentally an enteric disease but rather resembles mesenteric lymphadenopathy and ultrasound is a promising modality for diagnosing typhoid fever in developing countries.

Campylobacter fetus as cause of prosthetic valve endocarditis

A 65-year-old woman who had previously undergone aortic root replacement with a bioprosthetic valve (Bentall operation) in treatment of annuloaortic ectasia became feverish after developing dental caries and was admitted to our hospital. Transesophageal echocardiography showed an 18 × 4-mm vegetation on her prosthetic valve. Campylobacter fetus was isolated on blood cultures, and she was diagnosed with infectious endocarditis. Aggressive combined antibiotic treatment was effective for her recovery. C. fetus infection is a rarely reported cause of prosthetic valve endocarditis.

Campylobacter gastritis simulating Menetrier's disease by upper gastrointestinal radiography

Within this decade it has been determined that primary gastritis in both children and adults is frequently associated with infection of the gastric mucosa with Campylobacter pylori. It is characterized by a chronic inflammatory process in which the mucosa of the gastric antrum is typically most severely involved. Other regions of the stomach may be involved and associated peptic ulcers of the stomach and duodenal bulb are frequent. A case of C. pylori gastritis is reported in which involvement of the gastric fundus and body produced severe rugal hypertrophy that resembled Menetrier's disease.

Florid computed tomographic appearance of acute Campylobacter enterocolitis

A 28-year-old male presented with severe abdominal pain and bloody diarrhoea. Computed tomographic scan showed marked swelling of the distal ileum and entire colorectum. The patient recovered and Campylobacter jejuni was subsequently grown from his faeces.

Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella: clinical, radiological and US findings

Yersinia, Campylobacter, and Salmonella are pathological microorganisms which incidentally may specifically infect the ileocecal area (infectious ileocecitis). In such cases pain in the right lower quadrant is the predominant symptom, and diarrhea is absent or only mild. This symptomatology can lead to an unnecessary laparotomy for suspected appendicitis. At surgery a normal appendix is removed, while there is edematous thickening of ileum and cecum, and enlarged mesenteric lymph nodes. These ileocecal abnormalities give rise to a fairly characteristic US image, enabling the radiologist to rapidly differentiate infectious ileocecitis from appendicitis, thus preventing an unnecessary laparotomy. Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella is a common mimicker of appendicitis, and its incidence at this moment is grossly underestimated. Ultrasound is presently the only means to prevent an unnecessary operation for this condition which is principally self-limiting and innocuous.

Multiple abscesses of the liver caused by Campylobacter jejuni

A 37-year-old woman developed multiple liver abscesses caused by Campylobacter jejuni, as a consequence of unrecognized and inadequately treated Campylobacter enteritis. The diagnosis was established by isolation of Campylobacter jejuni from blood and pus obtained from one of the liver abscesses during laparoscopy. The abscesses were successfully treated with intravenously and orally administrated antibiotic drugs, without further percutaneous drainage.

Enlarged gastric folds in association with Campylobacter pylori gastritis

Enlarged gastric folds in pediatric patients are uncommon. Fifteen patients with upper gastrointestinal (GI) tract symptoms of chronic epigastric abdominal pain, vomiting, or hematemesis underwent radiologic upper GI barium studies and were found to have Campylobacter pylori gastritis at endoscopic biopsy. Seven patients (47%) with C pylori gastric disease had radiologic evidence of enlarged folds. There was no clinical or pathologic evidence of Ménétrier disease. Therefore, C pylori gastritis should be considered in the differential diagnosis of children with upper GI tract symptoms and radiologic evidence of enlarged folds.

The role of radiology in Campylobacter enterocolitis

A series of 18 patients with diarrhoea and positive stool cultures for Campylobacter jejuni is presented. The most important radiological features were thickening of ileal mucosal folds, of interhaustral indentations and of the ileocaecal valve, lymphoid hyperplasia and microulcerations. Radiology, as well as endoscopy, are both nonspecific in Campylobacter jejuni enterocolitis. The importance of radiology is to exclude more typical features of other causes of inflammatory bowel diseases. Moreover, before the result of the stool culture is available, the radiological features should suggest the suspicion of an acute infectious enterocolitis by Campylobacter jejuni as possible diagnosis.

Roentgenologic changes of the colon in Campylobacter infection

A double-contrast examination of the colon was performed during diarrheal illness in 5 patients with Campylobacter infection. The findings in these 5 patients were aphthoid ulcers and stippled appearance. In 1 patient with stool culture positive for Campylobacter, double-contrast study of the colon 9 days later showed no abnormalities. In a 12-year-old boy lymphoid hyperplasia could be observed as well as the aphthoid ulcers. All the abnormalities were segmental, more often localized in the rectosigmoid. No changes were found in the ascending colon. Histopathologic studies of the biopsy specimens taken endoscopically in 3 patients showed a nonspecific inflammatory reaction.

The colitides

Diverse signs may be seen on barium enema in the various forms of colitis. Barium enema is only reasonably specific in the diagnosis of Crohn's disease and ulcerative colitis once the other possible diseases have been excluded from consideration by biopsy, microscopy, culture, or therapeutic trial. In particular, campylobacter colitis has proved to be such a common entity that many patients originally thought to have had one attack of ulcerative colitis, ischemic colitis, or Crohn's colitis may never have had these diseases. Many of the relatively specific signs can be seen in a variety of conditions. For example, aphthae in the colon may be seen in Crohn's disease, yersinia enterocolitis, Behçet's syndrome, amebiasis, ischemia, tuberculosis, and campylobacter colitis. Continuity of disease is characteristic in ulcerative colitis. Nevertheless, patches of healing may occur, so that a rare patient may be seen during a resolving attack of ulcerative colitis in whom only scattered patches of active disease can be seen on barium enema. In general, few radiologic signs on barium enema are truly specific for one disease, with penumatosis cystoides coli being an exception to this rule. However, the sensitivity of barium enema with currently available materials for double-contrast techniques is such that radiology continues to be useful at present in diagnosing the colitides and in managing patients.

Campylobacter colitis: a common infectious form of acute colitis

A case of acute ulcerating colitis due to Campylobacter fetus is presented. The radiographic and endoscopic findings are indistinguishable from those of idiopathic acute ulcerative colitis. The clinical and bacteriological data relating to Campylobacter are discussed.