Cord colitis syndrome

Cord colitis syndrome
Differential diagnosisGraft-versus-host disease

Cord colitis syndrome is a diarrheal illness in recipients of umbilical cord blood transplant. It causes a granulomatous inflammation of the upper and lower gastrointestinal tract and responds to antimicrobial treatment including metronidazole.[1] It was first described in 2011.[2] In 2013, a sequencing study identified a newly discovered bacterium, called Bradyrhizobium enterica, in biopsy samples from two patients. That this bacterium is responsible for this syndrome can be suggested, but not yet confirmed.[2] Subsequent studies showing that Bradyrhizobium species are common contaminants of laboratory kit reagents have thrown this connection into doubt.[3]

Diagnosis

The presence of enterica in the colon-biopsy samples has been suggested to help in identification of patients with cord colitis.[4] However, this may be an erroneous report confounded by contamination, and others have not detected Bradyrhizobium in cord colitis samples.[5] Patients with cord colitis syndrome frequently have granulomatous inflammation on upper and lower GI tract biopsies, along with chronic injury characteristics like distal colon Paneth cell metaplasia. Abdominal CT imaging typically reveals focal or diffuse thickening of the colonic wall, which is radiographically consistent with colitis.[6]

Treatment

Cord colitis syndrome responds quickly to antibacterial treatment, which is typically a fluoroquinolone and metronidazole. Relapse is common following the discontinuation of antibacterial agents and may necessitate lengthy treatment courses.[6]

References

  1. ^ Gupta, NK; Masia, R (July 2013). "Cord colitis syndrome: a cause of granulomatous inflammation in the upper and lower gastrointestinal tract". The American Journal of Surgical Pathology. 37 (7): 1109–13. doi:10.1097/pas.0b013e31828a827a. PMC 3687023. PMID 23715165.
  2. ^ a b Bhatt, AS; Freeman, SS; Herrera, AF; Pedamallu, CS; Gevers, D; Duke, F; Jung, J; Michaud, M; Walker, BJ; Young, S; Earl, AM; Kostic, AD; Ojesina, AI; Hasserjian, R; Ballen, KK; Chen, YB; Hobbs, G; Antin, JH; Soiffer, RJ; Baden, LR; Garrett, WS; Hornick, JL; Marty, FM; Meyerson, M (Aug 8, 2013). "Sequence-based discovery of Bradyrhizobium enterica in cord colitis syndrome". The New England Journal of Medicine. 369 (6): 517–28. doi:10.1056/nejmoa1211115. PMC 3889161. PMID 23924002.
  3. ^ Yong, Ed. "Contaminomics: Why some Microbiome Studies may Be Wrong". Archived from the original on November 13, 2014. Retrieved 31 October 2016.
  4. ^ Bhatt, Ami S; Freeman, Samuel S; Herrera, Alex F; Pedamallu, Chandra Sekhar; Gevers, Dirk; Duke, Fujiko; Jung, Joonil; Michaud, Monia; Walker, Bruce J (2013-08-08). "Sequence-Based Discovery of Novel Bacteria, Bradyrhizobium Enterica, in Cord Colitis Syndrome". New England Journal of Medicine. 369 (6): 517–528. doi:10.1056/NEJMoa1211115. ISSN 1533-4406. PMC 3889161. PMID 23924002.
  5. ^ Gorkiewicz, G; Trajanoski, S; Högenauer, C (Nov 7, 2013). "Bradyrhizobium enterica in Cord Colitis Syndrome". The New England Journal of Medicine. 369 (19): 1866–7. doi:10.1056/NEJMc1311318. PMID 24195569.
  6. ^ a b Herrera, Alex F.; Soriano, Gabriela; Bellizzi, Andrew M.; Hornick, Jason L.; Ho, Vincent T.; Ballen, Karen K.; Baden, Lindsey R.; Cutler, Corey S.; Antin, Joseph H.; Soiffer, Robert J.; Marty, Francisco M. (2011). "Cord Colitis Syndrome in Cord-Blood Stem-Cell Transplantation". New England Journal of Medicine. 365 (9). Massachusetts Medical Society: 815–824. doi:10.1056/nejmoa1104959. ISSN 0028-4793. Retrieved November 20, 2023.

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