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Canadian Journal of Gastroenterology
Volume 3, Issue 4, Pages 165-169

Histopathology of Infectious Colitis

Christina M. Surawicz

Department of Gastroenterology, University of Washington, Seattle, Washington, USA

Received 31 March 1989; Accepted 30 May 1989

Copyright © 1989 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Histopathology can play an important role in diagnosing infictious colitis for several reasons. First, colonic mucosal biopsy can often reliably differentiate acute self limited colitis (ASLC). or infectious type colitis, from idiopathic inflammatory bowel disease (IBD). In ASLC, crypt architecture is normal and the inflammatory infiltrate in the lamina propria predominantly acute, ie, polymorphonuclear cells. In IBD, in contrast, crypt architecture is often abnormal nd the inflammatory infiltrate in the lamina propria in both acute and chronic, ie, polymorphonuclear cells, plasma cells ,and lymphocyte are present in increased numbers. Second, biopsy may give a clue to the specific infection. Biopsy may reveal the presence of specific parasites such as Entamoeba histolytica, cryptosporidia or schistosomiasis. Viral inclusions are seen when cytomegalovirus or herpes simplex type II virus infect the colon. Granulomas usually indicate Crohn's disease but can he seen with infections due to Chlamydia trachomatis, Treponema pallidum and Mycobacterium tuberculosis. Both chlamydial and syphilitic proctitis are rare and usually seen in homosexually active men. Finally, pseudomembranes, when present, suggest pseudomembranous colitis due to an overgrowth of toxigenic Clostridium difficile. In summary, mucosal biopsy is helpful in differentiating ASLC from IBD in most cases. Sometimes, it provides a clue to the specific infection.