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PubMed2002

Typhlitis complicating induction therapy in adult acute myeloid leukemia.

In a retrospective analysis of 161 consecutive adult patients with de novo acute myeloid leukemia undergoing induction therapy, including cytarabine, etoposide and anthracyclines, seven patients (4.3%) developed typhlitis. All presented severe neutropenia, fever, abdominal pain and tenderness within 16 days from starting chemotherapy (median 11 days; range 5-16). Three patients underwent surgery and survived, four were treated only with supportive therapy: two recovered and two died. In our experience early recognition of typhlitis and rapid recovery of the neutrophils are the most important determinants of the results of surgical and/or medical approaches. The management of typhlitis, a life-threatening condition, is controversial and depends on many factors characterizing each patient, which must be evaluated in collaboration between the surgeon and the hematologist.

Adolescent↗
PubMed1980

Typhlitis: a treatable complication of acute leukemia therapy.

Heretofore, pseudomembranous enterocolitis, or more specifically typhlitis, occurring as a complication of the cytotoxic chemotherapy of acute leukemia has nearly always resulted in a fatal outcome. Recent surgical literature states that if cecitis is found as a consequence of therapy for leukemia, the surgeon should refrain from operating because standard procedures, including hemicolectomy, have not improved survival. This paper reports two patients with acute typhlitis resulting from induction therapy of acute leukemia with cytosine arabinoside and hydroxydaunorubicin. Both patients underwent subtotal colectomy, while their marrows were aplastic from therapy, and survived their surgery. Both are living and well in maintained remission, 1 year from surgery. We review the pathogenesis of this disorder and discuss its clinical, x-ray, and laboratory features. Close oncologic/surgical teamwork is stressed as the patient is followed closely into the time frame when the decision is made whether to operate. Factors contributing to this decision are discussed. Preoperative recommendations are made in order to bring the patient into a state of physiologic stability. The operative procedure is described along with the postoperative complications encountered. We strongly recommend that laparotomy be considered in selected patients with typhlitis occurring as a complication of treated leukemia.

Adolescent↗
PubMed1995

Use of antibiotics to prevent hepatitis and typhlitis in male scid mice spontaneously infected with Helicobacter hepaticus.

The use of antibiotic combinations to prevent acute and progressive chronic hepatitis and proliferative typhlitis associated with Helicobacter hepaticus infection in male scid/NCr mice was evaluated. The drug combinations used were amoxicillin-metronidazole-bismuth, tetracycline-metronidazole-bismuth, amoxicillin-neomycin, neomycin alone, and amoxicillin alone. Treatments were administered per os for 14 days beginning at 4 weeks of age. All mice remained clinically normal throughout the study. Specimens from mice were evaluated histologically at 21, 60, 90, and 120 days after initiation of the antibiotic treatments. Results of histologic examination and use of special stains indicated that the antibiotic regimens containing amoxicillin prevented progressive chronic hepatitis and typhlitis. Helical bacteria were not observed histologically in the liver or cecum of amoxicillin-treated mice. Helical bacteria were observed in the liver and cecum of untreated mice and in the cecum of mice treated with antibiotic regimens not containing amoxicillin. Untreated mice and those treated with amoxicillin were evaluated by culture for presence of H. hepaticus at 60 and 90 days and by polymerase chain reaction at 90 days after initiation of the antibiotic treatment. All untreated mice were test-positive by fecal/cecal culture, and three of five were positive by polymerase chain reaction. All mice treated with amoxicillin were negative for H. hepaticus by results of culture and polymerase chain reaction. The oral administration of amoxicillin to young scid mice via the drinking water prevents hepatitis and typhlitis caused by H. hepaticus.

Amoxicillin↗
PubMed1975

Chronic typhlitis in baboons fed a semisynthetic low-fibre diet.

Baboons were fed a low-fibre, semisynthetic diet for 20 months. After this period, 19 of 20 animals were found to have chronic typhlitis at postmortem examination. In contrast, baboons that had been fed a similar diet for approximately 3 months, did not show this inflammatory change of the caecum. One baboon that was sacrificed after 10 months on the diet also did not have typhlitis. As no indications of an infectious or other cause could be found, it was ocncluded that the low fibre content of the diet might have been a causative factor of the typhlitis observed.

Animals↗
PubMed2005

Neutropenic enterocolitis (typhlitis) associated with infectious mononucleosis.

Neutropenic enterocolitis (typhlitis) is an unusual acute complication of neutropenia, most often associated with leukaemia and lymphoma and characterized by segmental caecal and ascending colonic ulceration that may progress to necrosis, perforation, and septicaemia. We present a unique case of an 8-year-old girl with recently diagnosed infectious mononucleosis having findings consistent with typhlitis on abdominal CT.

Cecum↗
PubMed1981

Neutropenic typhlitis in adults.

Typhlitis is a necrotizing process of the cecum, occurring in neutropenic patients who are usually receiving combined chemotherapy. The atonic cecum is affected because of its poor arterial perfusion, the presence of colonic bacteria, and the milieu of immunosuppression. It is a serious but not inevitably fatal complication of the patient's basic illness. Resection of necrotic bowel is necessary. Because this will usually be done on an emergency basis in a very ill patient with unprepared bowel, a two-stage procedure rather than primary anastomosis is advisable. Surgical results may be better in adult than pediatric patients. The incidence of the problem has probably increased since the advent of aggressive drug therapy of the leukopathic states. Judging from the low number of reported adult cases and the apparent inaccuracy of preoperative diagnosis, there may be inadequate physician awareness of typhlitis.

Agranulocytosis↗
PubMed1997

Acute lymphoblastic leukemia presenting with typhlitis.

We report an unusual case of acute lymphoblastic leukemia (ALL) that presented as right lower quadrant pain in a 17-year-old boy. Ultrasonographic findings were consistent with typhlitis. The clinical and imaging symptoms resolved upon treatment with antibiotics and conservative care, only to recur after initiation of chemotherapy. Familiarity with the clinical presentation and imaging findings of typhlitis is important for its correct diagnosis and management.

Adolescent↗
PubMed1979

Typhlitis in acute leukemia: successful treatment by early surgical intervention.

Inflammation of the cecum ("typhlitis") has been an unusual, but generally fatal complication of severe granulocytopenia and immunosuppression, occurring during the therapy of hematological malignancies. The diagnosis has usually been made only at autopsy, and early surgical intervention has often been withheld because of the patient's precarious hematological status. We report here a patient in whom the clinical diagnosis of typhlitis led to early operation, with intensive blood component support. The successful outcome suggests that such an approach might improve the usually grim prognosis in patients whose underlying malignancy offers a clear chance for remission.

Agranulocytosis↗
PubMed2001

Typhlitis (neutropenic enterocolitis) after a single dose of vinorelbine.

We report a case of a 50-year-old man with pretreated adenocarcinoma of the lung, who developed fatal neutropenic enterocolitis (typhlitis) after a standard dose of the cytotoxic drug vinorelbine. Blood cultures were negative for all microorganisms tested for. Stool cultures were negative for enteric rods but direct examination of fresh stool revealed the presence of Giardia lamblia. Abdominal pain and diarrhoea developed very rapidly while the patient was only moderately neutropenic. Metronidazole was prescribed without clinical benefit: the abdominal pain remained stable. The duration of neutropenia was very short (4 days). The abdominal catastrophe ending in shock occurred after complete recovery of the neutrophil count. Neutropenic colitis has been reported with increasing frequency in solid tumours after the introduction of taxanes. This complication has been observed mainly in phase I studies, near the maximally tolerated doses (MTD). The combined use of vinorelbine has recently been reported to exacerbate the toxic effects of taxane on the colon. The case presented here demonstrates that typhlitis can occur even with vinorelbine alone, used at a standard recommended dose (30 mg/m2).

Adenocarcinoma↗
PubMed1998

SCID/NCr mice naturally infected with Helicobacter hepaticus develop progressive hepatitis, proliferative typhlitis, and colitis.

Hepatitis, proliferative typhlitis, and colitis were characterized in young adult and older SCID/NCr mice naturally infected with Helicobacter hepaticus. Liver lesions consisted of Kupffer, Ito, and oval cell hyperplasia along with multifocal to coalescing coagulative hepatocyte necrosis. Numerous Warthin-Starry-positive bacteria were observed in the parenchyma, and there were minimal to mild accumulations of monocytic cells and neutrophils. Proliferative typhlitis was characterized by moderate to marked mucosal epithelial cell hyperplasia with mild monocytic and neutrophilic infiltration. Minimal to mild colitis with mucosal epithelial cell hyperplasia of the colon was most marked in older mice. Comparable gastrointestinal lesions were not observed in uninfected control SCID/NCr mice. H. hepaticus was cultured from fetal viscera of 2 of 11 pups sampled late in gestation from infected SCID/NCr females, suggesting transplacental infection of H. hepaticus. As expected, most of the naturally infected SCID/NCr mice had no serum immunoglobulin G response against H. hepaticus. These findings contrast with those in infected immunocompetent A/JCr mice, which develop a significant immune response to H. hepaticus associated with prominent multifocal mononuclear cell infiltrates in the liver, with only rare bacteria observable at the periphery of inflammatory foci or in the biliary canaliculi. The results demonstrate that chronic inflammatory and proliferative lesions simultaneously affecting the liver, cecum, and colon are associated with natural infection of SCID/NCr mice with H. hepaticus and that lesions are progressive with age. Concurrent infection with H. hepaticus may confound studies that have been attributed to similar lesions due to other experimental manipulations of SCID/NCr mice.

Animals↗
PubMed1981

Typhlitis presenting as toxic cecitis.

Typhlitis and enterotyphlitis are complications of chemotherapy and are occurring more frequently due to the increased and successful use of cytotoxic agents. The usual finding on radiographs is a lack of bowel gas in the right lower quadrant. A case of typhlitis presenting as toxic cecitis is presented.

Antineoplastic Agents↗
PubMed1983

Childhood typhlitis: its increasing association with acute myelogenous leukemia. Report of five cases.

Five children with acute myelogenous leukemia (AML) are described in whom typhlitis developed early in the course of the disease. The plain and barium-enema radiographic findings of mass effect and bowel edema ("thumbprinting") were similar among the cases, although nonspecific. The increasing association of typhlitis with AML and its earlier appearance in the course of the disease should be recognized.

Adolescent↗
PubMed1987

Sonographic diagnosis of neutropenic typhlitis.

Five immunosuppressed patients with neutropenic typhlitis were studied with sonography. In four, sonography was the imaging technique that first suggested the diagnosis. In each case, sonography showed thickening of the right colon wall (1-2.5 cm) with low- or high-level echoes. Serial sonograms were used to monitor the daily progress of the disease in two patients. Sonography appears to be a useful tool not only to detect typhlitis in patients with symptoms suggestive of the disease, but also to follow their clinical course.

Adult↗
PubMed2000

Typhlitis as a presenting manifestation of acute myelogenous leukemia.

We describe a case of typhlitis with onset before diagnosis of acute myelogenous leukemia or initiation of chemotherapy. Typhlitis is usually seen as a complication of chemotherapy for hematologic malignancies. It is being reported with increasing frequency in association with other disease states that produce profound neutropenia.

Adult↗
PubMed2003

Acute typhlitis in inmunocompromised patient: an eight year experience.

INTRODUCTION: Acute typhlitis is usually associated with severe immunosuppressive conditions. Initially described as closely associated with infantile myeloid leukaemia, its incidence increased along the last decade. DESIGN: retrospective review. PATIENTS: 12 immunodepressed patients affected of acute typhilis in our hospital between 1994 and 2001. Suspected diagnosis was established by clinical symptoms and abdominal CT findings, and was confirmed with pathological finding in the surgical specimen. Clinical and radiological diagnosis, treatment, complications and survival of patients are discussed. RESULTS: 3 patients with a previous diagnosis af acute myeloid leukemia, 2 patients with non-Hodgkin lymphoma, 2 patients with aplastic anaemia, one patient with AIDS, and 4 patients with kidney transplantation were included in our study. Prednisone, cyclosporine, Ara-C and vincristine were the most frequently involved drugs. Most frequent clinical findings included abdominal pain, fever, nausea-vomiting and abdominal distension. CT diagnosis revealed caecum and colic involvement with rarefaction of pericaecal fat. Medical treatment was successful in only 33% of all patients, the other patients requiring a surgical procedure including right hemicolectomy with or without intestinal anastomosis. Mortality reached 58.3 per cent, representing multiorganic sepsis the main cause of death. CONCLUSIONS: although early diagnosis of acute typhlitis bears a better prognosis, mortality rates are up 50 % in spite of an established treatment.

Acquired Immunodeficiency Syndrome↗
PubMed2006

[Evolution of the methods of peritonization of the vermiform process stump in acute destructive appendicitis complicated by typhlitis].

A comparative assessment of effectiveness of various non-traditional and non-typical variants of appendectomy was made with using non-standard (non-classical) methods of treatment and peritonization of the vermiform stump developed by different authors for destructive forms of acute appendicitis complicated by inflammatory infiltration of the blind gut cupola and typhlitis. An analysis of results of using the proposed non-typical technical methods and techniques as well as an assessment of the authors' technique used in 43 patients suggests that the above variants of peritonization of the vermiform process stump should not be considered as competing. Each of the methods can be successfully used depending on the concrete clinical situations and for the corresponding indications as the most optimal method of choice or as an alternative of the classical variant of appendectomy in patients with acute destructive appendicitis complicated by inflammatory infiltration of the blind gut cupola and typhlitis.

Acute Disease↗
PubMed1991

Clostridium difficile typhlitis associated with cecal mucosal hyperplasia in Syrian hamsters.

A sudden increase in mortality occurred in a closed breeding colony of Syrian hamsters (Mesocricetus auratus). The colony consisted of approximately 40 hamsters, 8 of which were affected. Four adult males died suddenly. One pregnant female and one weanling died after having been observed as depressed for 1 day and 2 weeks respectively. One weanling and one adult male were euthanized. All affected hamsters had signs of diarrhea. At necropsy, hemorrhagic fluid-filled ceca were noted in five of eight animals. Clostridium difficile cytotoxin B was present in high titers [10(-3) to 10(-8)] in cecal contents of six of six animals tested, whereas C. difficile culture yielded positive results in only one of six animals. Histopathologically, findings consistent with Clostridium-induced typhlitis including necrosis, epithelial denudation, vascular congestion, and hemorrhage were present in six of six ceca evaluated. In addition, signs of a more chronic disease process included cecal mucosal hyperplasia in five of six hamsters. A silver stain of cecal hyperplastic mucosa for intracellular organisms including Campylobacter-like organisms was negative in all affected hamsters. Antibiotics had not been administrated to any hamster in this colony, nor had the affected animals been experimentally manipulated. Testing for antibiotic residues in the feed was negative, and C. difficile was not isolated from feed, water, or feces of unaffected hamsters. Thus C. difficile-induced typhlitis should be included in the differential diagnosis of deaths in hamsters which have no clinical histories of prior antibiotic administration or experimental manipulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[Typhlitis as a complication of acute leukemia].

The authors describe the clinical history of two adult patients with acute myeloid leukemia, who had severe neutropenia and thrombocytopenia. After chemotherapy in both patients had developed typhlitis with fatal outcome caused by sepsis. They discuss the etiopathogenesis and clinical features of necrotizing typhlitis as a complication of treated acute leukemia and point out the difficulty of the differential diagnosis and management.

Adult↗