What is streptococcal colitis?

Streptococcal Colitis: Diagnosis, Clinical Features, and Management

Streptococcal colitis is an inflammatory condition of the colon caused by streptococcal bacterial infection, characterized by bloody diarrhea, abdominal pain, and potential systemic symptoms that requires prompt diagnosis and appropriate antimicrobial therapy.

Definition and Pathophysiology

Streptococcal colitis is a form of bacterial hemorrhagic enterocolitis caused by streptococcal species. While not as commonly discussed as other bacterial causes of colitis, it belongs to the category of infectious colitis that results in inflammation of the colon. The pathophysiologic changes can range from superficial exudative enterocolitis to transmural inflammation with ulceration 1.

Clinical Presentation

Patients with streptococcal colitis typically present with:

• Bloody diarrhea (often the cardinal symptom)
• Abdominal pain (often severe and crampy)
• Tenesmus (painful straining during bowel movements)
• Fever
• Purulent or mucoid stool
• Potential systemic symptoms in severe cases

In more severe cases, patients may develop:

• Tachycardia
• Dehydration
• Weight loss
• Abdominal distension
• Reduced bowel sounds 2

Diagnosis

The diagnosis of streptococcal colitis requires:

1. Clinical evaluation: Assessment of symptoms including onset, stool characteristics, abdominal pain, and systemic symptoms 2

2. Laboratory tests:

   • Full blood count (may show leukocytosis)
   • Inflammatory markers (elevated CRP and ESR)
   • Electrolytes and liver function tests 2, 3

3. Stool studies:

   • Stool culture for isolation of streptococcal species
   • Exclusion of other pathogens (C. difficile, Salmonella, Shigella, Campylobacter)
   • Fecal calprotectin (marker of colonic inflammation) 2, 3

4. Endoscopic evaluation:

   • Colonoscopy or flexible sigmoidoscopy to visualize inflammatory changes
   • Potential findings include erythema, edema, friability, and ulcerations
   • In severe cases, pseudomembranes may be present 2, 4

5. Histological analysis:

   • Biopsy samples to confirm inflammation and exclude other causes
   • May show acute inflammatory infiltrates, crypt abscesses, and mucosal damage 2

Differential Diagnosis

The differential diagnosis for streptococcal colitis includes:

• Other bacterial causes of colitis (Salmonella, Shigella, Campylobacter, E. coli)
• Clostridioides difficile infection
• Inflammatory bowel disease (ulcerative colitis, Crohn's disease)
• Ischemic colitis
• Parasitic infections
• Viral colitis (CMV)
• Drug-induced colitis 2, 5, 4

Management

Treatment of streptococcal colitis should follow these principles:

1. Antimicrobial therapy:

   • Appropriate antibiotics based on culture and sensitivity results
   • Empiric therapy may be initiated while awaiting results in severe cases 1

2. Supportive care:

   • Fluid and electrolyte replacement
   • Nutritional support as needed
   • Management of symptoms (pain control, antidiarrheals if appropriate) 5

3. Monitoring for complications:

   • Toxic megacolon
   • Perforation
   • Sepsis
   • Dehydration 6

Prognosis and Follow-up

Most cases of bacterial colitis, including streptococcal colitis, are self-limiting with appropriate treatment. However, severe cases may require hospitalization and intensive management. Follow-up should include:

• Confirmation of symptom resolution
• Repeat stool studies if symptoms persist
• Consideration of underlying conditions that may predispose to infection 1, 5

Prevention

Preventive measures include:

• Proper hand hygiene
• Safe food handling practices
• Appropriate sanitation
• Avoiding high-risk foods and water sources 2

Special Considerations

• Immunocompromised patients may have more severe disease and require more aggressive management
• Elderly patients and those with comorbidities are at higher risk for complications
• Recurrent infections should prompt investigation for underlying conditions 2, 5

It's important to note that while streptococcal colitis is less commonly discussed than other forms of bacterial colitis in the literature, the principles of diagnosis and management follow similar patterns to other bacterial causes of colitis, with specific antimicrobial therapy directed at streptococcal species.