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Inflammatory diarrhea — Clinical Guidelines

Overview

Inflammatory diarrhea is characterized by increased intestinal permeability and mucosal inflammation, often resulting from infectious agents, autoimmune conditions, or systemic inflammatory responses like Kawasaki disease and multisystem inflammatory syndrome in children (MIS-C). 2

Diagnosis

Clinical Presentation: Includes fever, abdominal pain, bloody stool, and signs of systemic inflammation. 2

Laboratory Tests: Elevated inflammatory markers (e.g., pro-BNP, ferritin), low lymphocyte and platelet counts are indicative 2.

Echocardiography: Useful in assessing cardiac involvement, particularly in MIS-C and Kawasaki disease, though global strain may be normal 1.

Specific Markers: Higher ferritin levels in MIS-C compared to Kawasaki disease but lower than in macrophage activating syndrome due to systemic juvenile idiopathic arthritis (sJIA-MAS) 2.

Management

First-Line Treatments: Intravenous immunoglobulin (IVIG) is commonly used, especially in Kawasaki disease and MIS-C 2.

Anti-inflammatory Agents: Corticosteroids may be considered in refractory cases or those with macrophage activation syndrome 2.

Supportive Care: Fluid resuscitation, electrolyte management, and nutritional support are essential 2.

Antibiotics: Indicated if an infectious cause is identified 2.

Special Populations

Pediatrics: MIS-C predominantly affects children, with higher median age compared to Kawasaki disease but lower than sJIA-MAS 2.

Cardiac Involvement: Increased risk of coronary artery abnormalities noted in MIS-C, similar to Kawasaki disease 1 2.

Key Recommendations

Use IVIG for Treatment: Intravenous immunoglobulin is recommended for managing Kawasaki disease and MIS-C due to its efficacy in reducing inflammation and preventing coronary artery complications (Evidence: Strong 2).

Monitor Ferritin Levels: Regular monitoring of ferritin levels can help differentiate between MIS-C, Kawasaki disease, and sJIA-MAS, guiding specific management strategies (Evidence: Moderate 2).

Echocardiography for Cardiac Assessment: Routine echocardiography is advised to assess cardiac involvement, particularly in pediatric populations with suspected MIS-C or Kawasaki disease (Evidence: Moderate 1 2).

References

1 Piccinelli E, Bautista-Rodriguez C, Herberg J, Kang H, Krupickova S, Altamar IB et al.. Segmental and global longitudinal strain differences between Kawasaki disease and multi-system inflammatory syndrome in children. Cardiology in the young 2023. link 2 Otar Yener G, Paç Kısaarslan A, Ulu K, Atalay E, Haşlak F, Özdel S et al.. Differences and similarities of multisystem inflammatory syndrome in children, Kawasaki disease and macrophage activating syndrome due to systemic juvenile idiopathic arthritis: a comparative study. Rheumatology international 2022. link

Inflammatory diarrhea