DOI: https://doi.org/10.22263/2312-4156.2021.6.56
Rutskaya I.А.1, Pimanov S.I.2
Echographic characteristics of the colon in patients with pseudomembranous colitis in case of COVID-19
1Vitebsk Regional Clinical Infectious Diseases Hospital, Vitebsk, Republic of Belarus
2Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2021;20(6):56-66.
Abstract.
Objectives. To analyze the colon echographic images of patients suffering from pseudomembranous colitis (PMC) with COVID-19.
Material and methods. 24 patients with PMC and COVID-19 (group 1), 24 patients with COVID-19 infection without diarrhea (group 2) and 24 practically healthy subjects (group 3, the control one) were examined. The diagnosis of coronavirus infection was verified by isolating SARS-CoV-2 RNA by polymerase chain reaction from the mucous membrane of the upper respiratory tract. Clostridioides difficile infection was detected by means of an immunochromatographic test with the determination of microbial toxins in the feces of patients. Ultrasound investigation (US) was performed using convex 3.5-4.0 MHz and linear 9.0-10.0 MHz probes without special preparation of patients for the examination.
Results. All patients of group 1 had a thickened colon wall from 3.5 up to 11.2 mm. Among the patients of the 2nd group, the thickness of the intestinal wall in 25% of cases was up to 2 mm inclusively, in 75% – 2.1 mm or more, of which in every fourth case it exceeded 3 mm. The thickness of the bowel wall between the 1st and the 2nd groups of patients, as well as the 1st and the 3rd groups of patients, had statistically significant differences, no such pattern was found between the 2nd and the 3rd groups. The progression of ultrasound signs of colon lesions in patients suffering from PMC with COVID-19 was accompanied by a worsening of their clinical condition and the aggravation of characteristic laboratory changes.
With a positive response to PMC therapy regression of ultrasound changes in the intestinal wall occurs, but there is some delay in the normalization of structural changes recorded by ultrasound. In all cases of PMC with COVID-19, a loss or weakening of the stratification of the bowel wall is observed. Tocompletion of PMC treatment when the intestinal wall thickness exceeds 4.5 mm is accompanied by the occurrence of relapses.
Conclusions. Ultrasound of the intestine in patients having PMC with COVID-19 makes it possible to objectify the condition of the bowel wall and to adjust the management of patients.
Key words: ultrasonography, COVID-19, SARS-CoV-2, pseudomembranous colitis, Clostridioides difficile, colon.
References
1. Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020 May;115(5):766-73. doi: http://dx.doi.org/10.14309/ajg.0000000000000620
2. Pimanov SI, Dikareva EA. Gastroenterological manifestations of COVID-19: first generalizations. Klin Razbor Obshchei Meditsine. 2020;1(1):6-13. (In Russ.)
3. Bhayana R, Som A, Li MD, Carey DE, Anderson MA, Blake MA, et al. Abdominal Imaging Findings in COVID-19: Preliminary Observations. Radiology. 2020 Oct;297(1):E207-E15. doi: http://dx.doi.org/10.1148/radiol.
4. Goldberg-Stein S, Fink A, Paroder V, Kobi M, Yee J, Chernyak V. Abdominopelvic CT findings in patients with novel coronavirus disease 2019 (COVID-19). Abdom Radiol (NY). 2020 Sep;45(9):2613-23. doi: http://dx.doi.org/10.1007/s00261-020-02669-2
5. Calcagno E, Sogunro O, Nepal P, Assaker R, Sapire J. COVID-19 induced mesenteric venous infarction. Radiol Case Rep. 2021 Aug;16(8):1999-2002. doi: http://dx.doi.org/10.1016/j.radcr.2021.04.083
6. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. BMJ. 2020 Mar;368:m1091. doi: http://dx.doi.org/10.1136/bmj.m1091
7. Granata G, Bartoloni A, Codeluppi M, Contadini I, Cristini F, Fantoni M, et al. The Burden of Clostridioides Difficile Infection during the COVID-19 Pandemic: A Retrospective Case-Control Study in Italian Hospitals (CloVid). J Clin Med. 2020 Nov;9(12):3855. doi: http://dx.doi.org/10.3390/jcm9123855
8. Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020 Dec;26(12):1622-1629. doi: http://dx.doi.org/10.1016/j.cmi.2020.07.016
9. M-vo zdravookhraneniia Rossiiskoi Federatsii. Temporary Methodological Recommendations of the Ministry of Health of the Russian Federation. «Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)». Version 13 (14.10.2021). Versiia 13 (14.10.2021). Available from: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/058/211/original/BMP-13.pdf. [Accessed 25th November2021]. (In Russ.)
10. Lewandowski K, Rosołowski M, Kaniewska M, Kucha P, Meler A, Wierzba W, et al. Clostridioides difficile infection in coronavirus disease 2019 (COVID–19): an underestimated problem? Pol Arch Intern Med. 2021 Feb;131(2):121-127. doi: http://dx.doi.org/10.20452/pamw.15715
11. Petruk MN, Neshitov SP. Pseudomembranous colitis. Khirurgiia Zhurn im NI Pirogova. 2009;(4):55-60. (In Russ.)
12. Alekseechkina OA, Dubrov EIa, Vladimirova ES, Pinchuk TP, Titova GP. Possibilities of ultrasound in the diagnosis of pseudomembranous colitis in surgical patients. Ros Zhurn Gastroenterologii Gepatologii Koloproktologii. 2012;22(2):29-35. (In Russ.)
13. Пиманов СИ. Ультразвуковая диагностика в гастроэнтерологии. Москва, РБ: Практ медицина Pimanov SI. Ultrasound diagnostics in gastroenterology. Moscow, RB: Prakt meditsina; 2016. 415 р. (In Russ.)
14. Lui K, Wilson MP, Low G. Abdominal imaging findings in patients with SARS-CoV-2 infection: a scoping review. Abdom Radiol (NY). 2021 Mar;46(3):1249-55. doi: http://dx.doi.org/10.1007/s00261-020-02739-5
15. Nylund K, Maconi G, Hollerweger A, Ripolles T, Pallotta N, Higginson A, et al. EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound Part 1: Examination Techniques and Normal Findings (Long version). Ultraschall Med. 2017 Jun;38(3):e1-15. doi: http://dx.doi.org/10.1055/s-0042-115853
16. Bremer SCB, Knoop RF, Porsche M, Amanzada A, Ellenrieder V, Neesse A, et al. Pathological gallbladder wall thickening is associated with advanced chronic liver disease and independent of serum albumin. J Clin Ultrasound. 2021 Oct. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jcu.23077. [Accessed 25th November2021]. doi: http://dx.doi.org/10.1002/jcu.23077
Information about authors:
Rutskaya I.А. – physician, Vitebsk Regional Clinical Infectious Diseases Hospital;
Pimanov S.I. – Doctor of Medical Sciences, professor, head of the Chair of Internal Diseases & Ultrasound Diagnostics of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University.
Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Internal Diseases & Ultrasound Diagnostics of the Faculty for Advanced Training & Retraining. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Sergey I. Pimanov.
