Can Bacterial Infections be Confused for Crohn's Disease?

Patient Expert

My Crohn's Disease has been acting up of late. I had been on a trip in upstate NY and a few other people I was with were diagnosed with Giardia. Could I have it too, and what should I do?

Giardiasis is a parasite infection caused by Giardia lamblia, the most common intestinal parasite in the United States. Most infections result from fecal-oral transmission or ingestion of contaminated water. Contaminated food is a less common etiology. It is commonly spread among people, with 25% of family members with infected children becoming infected. The incubation period averages 1-2 weeks, with a mean of 9 days. The average duration of symptoms ranges from 3-10 weeks. Most infections are asymptomatic, but when symptoms do occur, they can be very similar to that of Crohn's disease. Some patients develop abrupt onset of explosive, watery diarrhea, abdominal cramps, vomiting, fever, and malaise lasting a few days. More commonly, patients experience a more insidious onset of symptoms which can be recurrent. Upper GI symptoms are common and include upper and midabdominal cramping, nausea, foul-smelling belches and heartburn. If your symptoms are suggestive of giardia, you should see your physician. He can make a diagnosis by collecting stool samples for ova and parasites as well as stool samples for giardia antigen. Once the diagnosis is made, treatment with Flagyl is effective 90% of the time. As Flagyl can also be effective in a Crohn's disease flare, it might be reasonable to begin therapy in any event. You should check with your doctor to see how he wants to proceed.

I was recently hospitalized with abdominal pain and fever and diagnosed with Crohn's disease. I was treated with antibiotics and Pentasa and have improved. Stool cultures from my hospitalization just came back revealing Yersinia. I am now confused. Do I have Crohn's disease as well? What treatments do I need?

While you need to follow-up with your physician that saw you in the hospital, most likely you do not have Crohn's disease. Yersinia is an invasive infectious pathogen (Yersinia enterocolitica) that causes right lower quadrant pain, fever and diarrhea. It commonly occurs as a result of ingestion of contaminated foods, water, and milk. Arthritis and skin lesions occur as well. CT scan can show thickening of the terminal ileum and can easily be confused with Crohn's disease. Often, symptoms may be confused with appendicitis. As many as 6% of patients that undergo appendectomy are ultimately found to have Yersinia. Colonoscopy usually reveals inflammation of the terminal ileum and cecum, with ulcerations in those areas. Fecal WBC will be positive, and stool cultures should be positive as well. Treatment with antibiotics is usally not necessary, unless the bacteria has gotten into the bloodstream. In that case, antibiotics such as Levaquin, Cipro and Bactrim are all usually effective. While you should check with your doctor, this is probably good news. Most likely, your infection has resolved, and you should have no long-term effects.

I was recently operated on for Crohn's disease of the terminal ileum. Since surgery I have been asymptomatic. My internist suggested I start on Pentasa. Is this a good idea?

Studies have shown that post-operative prophylactic Pentasa decreases the incidence of recurrence of disease in patients that undergo surgical resection for Crohn's disease. Typically maintenance doses of Pentasa at 2 grams a day, usually at 1 gram twice a day is recommended. Side effects are extremely rare and therefore the risk:benefit ratio very low. You should see your gastroenterologist and inquire about maintenance therapy.

Got Flagyl?

Or Pentasa?

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