Histopathology of infectious colitisASLC, then, is of acute inflammation with normal crypt architecture. This can be :,een in coliti, due to camryln-166 ASLC Ulcerative colitis Crohn's

REVIEW

Histopathology of infectious colitis

u m1..;11,, 1\1. "t "·'"It 1. 1\m

ABSTRACT: I l1stupath11lng) Gin pl.ty an 11npnrt,tnl role in diagnu,mg 111foc-tlllll~ LOl1tb fur ,cvcrnl reason:,. hr,t, cokm1( muLnsal biopsy Gm often reliably d1ftcrcnt1,llL' arnte ,cll lim,tcd cnl1t1, (ASLC'). nr 111fcct1nus I ype Loln1,, frnm 1d1op,nh1c 1nflammawry howel d1sca:,c (!RD). In ASL(', crypt ,m httccture is norm.ii and the 1nfl.unm.nmy mfdtratL' 111 the lam111a propna 1, prL'dommantly arntc, 1c, p1 ll) morphonuclcar cells. In IBD, in umt r,1.,1. crypt arch itt'Cl urc 1, often ahnnrmal nd the 111flammat1lr) mfdtrate in the lam111,1propri,1111 hoth acute and chnin1c, IL', pnlymorphnnuclear Leib, pln:,ma cells ,tnd lymphocyte, are present in mc.:rca,ed numher,. Seu ind, h1opsy may J.!IH' ,\ due to l he ,pccific 111foct iun. B111ps) m,l) re, cal thL· prc,L·nce 1if specific parasites such a, Enwmoeha hmol)'tica, cry ptl>spnrtdta nr ,chi-ios1lmiasi-... Viral inclu,11 ms ,ire seen whL·n C)'tmm1,•n1 of ( ,,1,1rnc1H,·rolol!'', l 'nm.'r.rn,· of \\''mltmgwn, 51.'aul.:. \v'm/1111.(!Wll, USA C:11111.',/>1111,l..:m,· ml11l't, 32~ i\.mch \i,·rnrltm1c (2L)(1) !23 ~11 I 7

R,·t",'tt d /111 />11h/1,·,m11n \ lm,·/1 { I , I •l,"19 \

Sl IRA Wll "/

souvent anom1a le et l ' infil tra t ion i nflammawire darn, k cho rion de la membrane est a la fois a igue et chron ique; c'esc-a-dire que !cs gran ulocytes, le:, plasmocytes ct le, lymphocytes sonr presents en nombres accrus. Oeuxicmement, la hiopsie peut fournir un indice sur la spccificite de !' infection : clle peur reve ler In presence de parasites tels Entamoeba hiscol)'tica, c ryptospo ridia nu la sch istosom1ase. Le~ inclusions virales sont repcrccs quanJ le c ylOmcgnlovirus ou k virus Jc l'herpb, de type ll infccte le colon. Les granulllmes 111diquen t habitucllc menc la ma ladie

Histopathology of infectious colitis

Figure 2) fl.t'cwl hwf>w from ,t /)r, ,a1 t'c/; ihi.:rt' 1, a d,jjme 1111/d mrn>ml.' 111 J>ol-vmc,r, ph11n11clt'cn cdls m th,· /rnnn1t1 />m/>na ( X 20 5)

that srecif1L patlHlgen \\'hich killed

2200 people 111 an epidemic affeu111g 78,000 rc11rk. Cr)rt architecture may ab11 he .1hnormnl 111 healed 1,t hem1L eolith. C'linil.1l n1m.:l,1t 1,m m.i, hdp tu

clarify rh 1,.

DIAGNOSI OF SPECIFIC INFECTION

Muc11s.1l h1ops) Lan dwgnose ,pecihc 111fecuon, \\'hen tht' folln\\'lllg h1stologk kature, ,Hl' r rcsent: para~1 te~. , ind mclu,1ons, granu lomm,

11r pscudomemhranl'' .md ,p1rod1etn~,, (Tahle 2) Parasites: Most in tesu nal parasite, 111-kct the small mtesune, hut Enrmnoeha h11wlwica ,md sd1 istns,1111 ias1s abo C.IUSl' colonic d 1,easl'. In col()n11. ameh1.isb, superf1c1al muu)sal ulceratHm is seen.

When h1upsied, tht' da"1c fmd1ng 1, l'rt\Sl\llls 1we1 hmpho1d fnll,tiL's. There 1, usu.i ll ) In t k- ,1ssoc1.1tcd 1nfl,1mm,nor) rL'.lLllnn 111 1 he n1llln1c mucos.1. h gure 4 ,hl 1\1', at1H1eh,1 trophll:ones m t hL· muu1s adhL'rl'lll w the hHip,, ,urf,Kl'. I I 1ghcr po\\'er 1s neLessary tn 1denr1f) the organisms, often\\ tth phagoq tusl'd rl'd hlnl11.I cdls. 111d1L,ll mg mucns.tl in-

' ;\3(011.

SLh1stnsum1as1s 1s rnre Ill Nunhern AmeriL.i and usu,tlh lllCUrs ,n 1m-m1grant , from arl'as \\'here the dbe,\se b endL·m11.. Muubal h 1op.,), reveals

foreign hnJ) grnnulomas which form .1 n1tmd ilw \l\'a ( Figure 5). l t " not ,1lways pllss1hle to d 1agn,ise t he ,pecifll infctriun unless ch,1raucn,t 1l mnr-

phnlogy 1if thl' 11,·um 1, present. Cryp1osp11r1d1a usua lly mfec ts the

Figure 4) Rt'cta/ h10/>.,, from a /kl!l1a.,1, .,h,111, l.'\ll&ttt! adhaenr ro the hmpsy surface. The crypt., arr ran.~en11a/ d11t' to ,rrnmm1.~ cntl.'fall ( X 21 5) l l1~her fiou'l.'T 1•1eu' (n.~ht) ret•eals amoehc,.- ,n rh.- ,11rj,Kt' 11111rn., (

SL R \ \'(Ill'/

Figure 5) l{eual h10/>.1y from ,1 Yl'me11i1e u·11h 1rl111to"m11ds1,. Lotl'er /lott·cr t'lt'H ' (lejd .,how, rwmwl m11cmc1 imh /orc·gn h1kh ~rcm11/11nw, m 1h, 1uhm11rnsa ( t1m1w.,) ( X 47.'i). A /11.~h.:r /)(Jm:r t'll'll' ( nglu) of gnn111/oma (,1rnw111111 cm11mJ 1h.: ,dm111\lm1.- 111·(1 1rn1 wl,L'11 /rnm ,m,ilhl'r ,1n:a (XI !i)

suggc,t associated sacral nerve rnot in-n1h-cment.

l li,tologic,dly, ,icu1e and chn1111L 111-flammauon is present ll1 the lamina propria and s1 1bmuu,sa. Vira l inclw,ion, arc infrequent, as t h e virus ha~ a prnp en, i ty to 1n fu.t , quam l1u,

epithe lial cell,. The rectal mucusa has ,m intense in fl,1mmmory innltrare in the t1mina prnpri;1 and/or \ UhmuCllsa.

Mult inuclem cells and intrnnuc lear in-clusions can he ,een; inclusion cell, arc usually seen l,nly i( the ha,~· of an ulcer is b1op,ied.

Cytomega ll1 vi ru s causes a se lf limited colitis in 1mmunncompeten t individuals ( 11) but th is is n t11 widely

168

recogni:ed. It i,, a n o ppnnunbtil path,1gcn 111 immunodefiucnt pHt1ent, and 1, a lrcqucnt u1u,e ul di,ea,c in persuns ll' ith the acqui red immune defich:ncy ,yndromc (A IDS). Culonic inv11lvcment ll'ith C)'tlll11cga lov irus

ranges fnm1 aph1 hnus ulcer, to d1:q1 ulcers to diffuse coliti s. ThL· ,·i ru, in feels endothelial celb most commonly and is

rarely seen in epithelial ce ll s. A typic,11 cytom cgalo\'iru~ cell is large, with a l,1 rge intrnnuclcM incl usion surrounded hy a c lear hal1l; the cytopla,m i, en-larged and 111::iy he granular, indic1ung the C)'\\lplasmic component n f the ,·iru,

(Figure 6). When an ulcer 1s presen t, biopsies fro m t he edge arc mo,t likel y

tn rc\'eal cy1 omega lp,·1 ru, inc lusI()ll

celk G ranulo mas: Al th uugh Ll,1,,1L epitheli11id gra nulom ,1, .ire the h,ill mmk of Crohn \ disc:1sL', they L,lll 11ccur wnh spec if1L mf'ccti1m,. Tw1H1r g;ini~ms wh1Lh L.tu,c prlH.; t11is 1n

humnscxual ly ac 11,·L· men ctr~ Chlmnydw m1clwinau, ( Figure 7) ,ind Trt>/)rmcnw Jwllid11m . Yrn1111a erncrncolnirn c.111 al,n cause granulom.1~ and m,1y m1m iL Crnhn\di,e,1,c ( 12) In add it i1111, 1 uherLlilo,1, 1, , t i II f rn 1uem 111 M\11le pnns of the world ,1, a muse 111 col\lnic disca,e.

F igu r.: 6) A r.:cwl lno/ll'I (lej1) jrnm ,1 lwmcJs,•,1wl I I I\' negam·c ma11 u•11h rw mflw11111({1i1111 and 1~·/>1c1i/ r,r, mq~a/ot·11·111 induwm (mToH I ( X90). A hr)!h,r /}ou•a t•il:u· ( c1lmw) cJj ch,· cv11mwg,1lu1mcs ,elf ,how, a /(IJ')?t' Olll'(lllllcbll' mc/11.\11111 H'llh (I rbir \lnTmmtlm)! /111/0 and enlill'.~('d L''llll/>lt111n u 11h grnn11lc1rn~· ( X 'iL\1)

Fii:urc 7 ) l{l', ral Inn/"' /rnm a l111rnmn11,i/ nwn 11'11/i l 'hl.11nvd1.1 1 r.1l h, 1111,111, />rncru" ,lwu·,·,1 uml'rrim glw111/,mw, r/11, lii.~lia />nu a 11cu ,Ii, m·, ,1 ~..,·,1111110111r) holl'cl d1,ca,l· ( ~a,t r, ,,·n tl·n 11. ,g, I 9~4;86· I l~4 I 1.

' Noscr,1111 IT, Kumar NI\, App,·lman Ill). I li,t,ipathol,,g) difkrenti.lll'' ,ICule sclt-l11n11L·d 01l11is fn1m uker,1t1 H' .:1>liu,. C,,Nrocntl'rnl11g\ I lJt->7;92: 319-2,'-.

l. All1son t--1( •. H.1mdt,H1 nu11t SI, Dh1ll11n AP. Pnumk•1 RE. The \Ct luc ot rcua l h1op,~ 111 d1,t111gui,h1ng ,t·li-l11111tcd t:Pl111, tmm l',1 ri\ 111tl.1111-m.1tor) h11\\ l'I d1,c.t,l' QI :-.tc,1 1987;92: \ I 1-,-2~.

4 Sur,1111L: ( ' t\f, (,0,1,kll SE. Quinn TC. ct ;11. Spl'l t rum , >f rl'l r.1 I h1op,\ ahn, >r-m.ii me, in h,,m,i-l·,u.11 mcn "nh mce, 1111:1[ S)ll1J'hlll1S. ( J,1'1 l'lll'llll'fOlllg)' 1986;91 :651-lJ. 'iur,l\\ It : ( ' I\,(. [)1,tgllpiroc he to~is: I nte,1111,d

B1op,y 1, hc,t. l ~n,trlll'llt l'n>l11g1 19~7;92:'i l8 40.

6.1'.kU,n·crn \ _I, '-,l,11u11n LJ. 1'.itlwl"g' , ,t ,,tlmoncll,1 c "'" 1, . .\m I ~urg l',tt lwl 1979; 1:48 \ 9L\

7. l'ml' l\H.Jl'\\kl·, I. -;,mdl'1,,,n Pr t\l Ull' ,li.1rrhnl',t: l ·,,mp\ loh,ll t l'I u >In 1, .tnd thl' nik ,,t r,•t:t.tl hu,p,1. _I ( '1111 l\11 h, ,I 1979; 3 2 :990-7.

1clcll Sr., Qumn Tl', 1'.ll..rt1lh1.111 E. l't .11. I krpc, ,1111pll'\ 11111, prn,1111, Ill h

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Histopathology of infectious colitisASLC, then, is of acute inflammation with normal crypt architecture. This can be :,een in coliti, due to camryln-166 ASLC Ulcerative colitis Crohn's