Typhlitis (Neutropenic Enterocolitis)

Medically reviewed by Judith Marcin, MD on November 22, 2017Written by Jacquelyn Cafasso on November 22, 2017

Overview

Typhlitis refers to inflammation of a part of the large intestine known as the cecum. It’s a severe condition that usually affects people with a weakened immune system. They can’t fight off infections like people with healthy immune systems. Typhlitis may also be called neutropenic enterocolitis, necrotizing colitis, ileocecal syndrome, or cecitis.

Typhlitis mostly affects those receiving very intensive chemotherapy drugs to treat cancer. While the exact cause of typhlitis isn’t completely understood, the condition generally occurs when the intestine is damaged, usually as a side effect of the chemotherapy treatment. The intestinal damage along with the person’s weakened immune system makes them more vulnerable to serious infections. These infections can be fatal.

Symptoms

The signs and symptoms of typhlitis are similar to those of a severe intestinal infection. They often come on suddenly and include:

  • nausea
  • vomiting
  • chills
  • high fever
  • diarrhea
  • stomach pain or tenderness
  • bloating

People undergoing chemotherapy may also have neutropenia. Neutropenia is a side effect of chemotherapy. It occurs when the immune system has abnormally low levels of neutrophils, a type of white blood cell important for fighting off infections. Symptoms will often appear around two weeks following a course of chemotherapy.

Causes

Researchers believe that typhlitis occurs when the lining of the intestine (mucosa) becomes damaged. This damage is typically caused by a chemotherapy drug. It’s thought that most cases of typhlitis in adults are due to the increasing use of a specific type of cancer treatment known as cytotoxic chemotherapy.

The damaged intestine is then invaded with opportunistic bacteria or fungi. Normally, a person’s immune system would react to this invasion and kill the microorganism. However, people who are immunocompromised won’t be able to fight off the infection.

Typhlitis is most commonly reported in people with the following conditions:

  • leukemia (most common), a cancer of the blood cells
  • lymphoma, a group of cancers that begins in cells of the immune system
  • multiple myeloma, a type of cancer that affects plasma cells found in the bone marrow
  • aplastic anemia, a form of anemia where the bone marrow stops making blood cells
  • myelodysplastic syndromes, a group of disorders that causes low levels of red blood cells, white blood cells, and platelets
  • HIV or AIDS, a virus that destroys cells of the immune system known as T cells

It’s also reported in people who’ve received a solid organ or bone marrow transplant.

Treatment

Typhlitis is a medical emergency and requires treatment right away. Doctors haven’t yet determined the best way to manage typhlitis.

Currently, treatment involves prompt administration of IV antibiotics, general supportive care (such as intravenous fluids and pain relief), and bowel rest. Bowel rest is when you aren’t allowed to eat or drink anything. Instead, you receive fluids and nutrients through a tube connected to a vein. A suction tube may also be placed through the nose into the stomach to help keep the stomach emptied of digestive juices.

Emergency surgery may be needed to treat complications, such as hemorrhage and bowel perforation. However, surgery in people with neutropenia can be very risky and may be delayed, if possible, until the neutropenia has improved.

If the typhlitis was caused by a specific type of chemotherapy, later courses of chemotherapy might require a change to a different agent.

Complications

The inflammation can spread to other parts of the intestine. If the blood supply is cut off to the intestine because of the swelling and injury, the tissues may die (necrosis). Other complications include the following:

Outlook

The prognosis for typhlitis is generally very poor. One research paper found that the mortality rate could be as high as 50 percent in people with typhlitis. Those who are able to recover faster from a low white blood cell count tend to have better outcomes. Though not common, typhlitis can recur even after treatment.

Early diagnosis and aggressive treatment for typhlitis is needed for a good outcome, but advances in medical technology are expected to improve outcomes in the future.

CMS Id: 137876