• Infection leads to acute enteritis (acute inflammation of the small intestine) and mesenteric lymphadenitis (inflammation of regional small intestinal lymph nodes)
• Small intestinal infections often mimic surgical conditions of the abdomen such as acute appendicitis
• May also cause complications (such as perforation or bleeding) that require surgical intervention
• HIV-associated enteropathy
• Yersinia enteritis: Associated withacute gastroenteritis, terminal ileitis, mesenteric lymphadenitis, hepatic and splenic abscesses
• Campylobacter jejuni: Raw milk, untreated drinking water, and undercooked poultry are recognized vehicles of transmission
-Most infections due to swallowing the human tubercle bacillus
-About 1% of patients with pulmonary TB have intestinal involvement
-Recent immigration from endemic areas and infection with HIV are risk factors
-Often affects the distal ileum
• Salmonella typhi: May cause ulcers in the distal ileum or cecum
• Elevated WBC count with eosinophilia
• Culture of stool or tissue obtained by biopsy may allow isolation and identification of the pathogen
• Organisms may be visualized by microscopic exam of stool or biopsy specimens
• Plain film radiography or CT scan:
-Findings are nonspecific
-Intestinal dilation, bowel wall thickening, and fat stranding in the mesentery may be observed
• Endoscopy: May reveal mucosal lesions, inflammation, and ulcerations and allow biopsy for potential isolation and identification of the infectious pathogen
• Pathogens associated with HIV-Associated enteropathy include:
• Tuberculosis: The pathologic reaction is hypertrophic (causing stenosis and obstruction) or ulcerative (causing abdominal pain, diarrhea, free perforation, fistula formation, or hemorrhage)
• Severe bleeding
• If operation is performed for a diagnosis of appendicitis and the entire distal small bowel is grossly inflamed, appendectomy is usually performed
• Resection is indicated for complications
• Uncertain diagnosis
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