Correlation between severity of ulcerative colitis and co-infection with parasites, cytomegalovirus and/or Clostridium difficile.

Venkatakrishnan, H Iyer (2011) Correlation between severity of ulcerative colitis and co-infection with parasites, cytomegalovirus and/or Clostridium difficile. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : Ulcerative colitis (colitis ulcerosa, UC) is a chronic idiopathic inflammatory disease of the gastrointestinal tract that affects the large bowel and is a major disorder under the broad group of conditions termed inflammatory bowel diseases (IBDs). Etiopathogenesis of ulcerative colitis largely remains hypothetical. It arises from a complex interaction between genetic, immune and environmental factors. Inflammation first affects the rectum and extends proximally along a variable length of the colon. In most of the cases, the disease follows a chronic relapsing, remitting course. Treatment is mainly immunosuppressive. Control of disease includes long term medical management and regular monitoring for complications. Enteric infections are known to be associated with exacerbations of UC. India, being a tropical country has a high prevalence of enteric pathogens. There is scant literature from India on what are the interactions of enteric pathogens with disease severity of UC. AIM OF THE STUDY : To perform a prospective cross-sectional observational study in patients with ulcerative colitis - To determine whether there is any association between intestinal infection (with parasites, cytomegalovirus or Clostridium difficile) and clinical disease severity in patients with ulcerative colitis. CONCLUSIONS : The presence of pathogens (parasites, cytomegalovirus and/or Clostridium difficile) was very significantly associated with moderate/severe UC (p value = 0.02). 86% of patients testing positive for the above pathogens had moderate to severe UC while 51% of patients without pathogens had moderate to severe UC. Ten patients (11.5%) had a parasitic infestation. Eight out of these ten patients had moderate to severe disease. Three patients (3.4%) had Clostridium difficile toxin positivity in stools. All had severe disease. They improved with medical treatment. Two patients (2.3%) had cytopathic changes suggestive of cytomegalovirus infection on biopsy. Both had severe disease. One of them responded only partially to ganciclovir and subsequently required subtotal colectomy while the other improved with ganciclovir and medical therapy for ulcerative colitis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: severity of ulcerative colitis ; co-infection ; parasites ; cytomegalovirus ; Clostridium difficile.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 14 Jul 2017 05:14
Last Modified: 14 Jul 2017 05:14

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