Infectious colitis

Abstract

The incidence of gastrointestinal infections continues to increase and infectious colitis contributes to significant morbidity and mortality worldwide. The purpose of this review is to highlight the recent advances in knowledge of pathogens causing infectious colitis. We describe the various pathogens and specifically focus on enterohemorrhagic Escherichia coli (EHEC) O157:H7, Salmonella, Shigella, Campylobacter, and Entamoeba histolytica infections, and their impact on long-term effects, including postinfectious irritable bowel syndrome and inflammatory bowel disease. Salmonella, Campylobacter, and EHEC outbreaks continue to occur with disturbing regularity. Peanut butter and peppers were recently responsible for outbreaks of nontyphoid Salmonella. Recent research has identified Salmonella genes required for colonization of various hosts and transposon-mediated differential hybridization was recently used to identify genes required during infection in different animal models. A number of other strains of EHEC in addition to O157:H7 are emerging as serious threats to food safety in the USA. Campylobacter jejuni isolates are of interest because of absence of genes encoding for classical enterotoxins, and lack of plasmids encoding genes promoting bacterial invasion. Recent research has identified that the organism is able to invade and replicate in infected epithelia via Toll-like receptor (TLR)-2 and TLR-4. Also patients with infectious colitis, in particular Salmonella and Campylobacter, are at increased risk of postinfectious irritable bowel syndrome and inflammatory bowel disease on long-term follow-up. The paradigm of Entamoeba histolytica infection is changing with recent reports of detection of E. dispar deoxyribonucleic acid sequences, previously considered nonpathogenic. There has been an explosion in the understanding of the epidemiology, pathobiology, and mechanisms underlying infectious colitis. Additional studies to address prevention strategies and strict screening modalities for these infections are necessary.