Typhlitis

What is typhlitis?

Typhlitis (tuh-FLY-tis) is severe inflammation in your digestive system that may cause bacterial and fungal infections. This is a rare condition that can happen after intensive chemotherapy for certain blood cancers, like:

• Leukemia
• Lymphoma
• Multiple myeloma

Typhlitis can affect different parts of your intestines, including:

• Your cecum, a part of your colon in your large intestine, which is where typhlitis is most likely to appear
• Your ascending colon
• Your ileum in your small intestine

Healthcare providers may call this condition neutropenic enterocolitis, typhlenteritis or ileocecal syndrome.

People who have HIV/AIDS may develop typhlitis. It can also affect people who take immunosuppressants after stem cell (bone marrow) transplant or organ transplant.

The condition can be life-threatening. But early diagnosis and treatment may cure it.

What are the symptoms of typhlitis?

Typhlitis symptoms can feel like a bad case of stomach flu. Common symptoms include:

• Abdominal pain and cramps
• Distended (swollen) belly
• Diarrhea
• Fever
• Nausea and vomiting

What causes typhlitis?

Researchers think a combination of factors triggers typhlitis. Those factors are:

• Mucositis. This is inflammation of the mucus membranes that line your large and small intestine.
• Neutropenia. Neutropenia is when you have low levels of neutrophils, a type of white blood cell that fights infection.
• Weak immune system. Cancer treatments like chemotherapy and infections like HIV/AIDS can weaken your immune system.

Typhlitis starts when mucositis damages the lining of your intestine. That makes it easier for harmful bacteria and fungi to invade your intestine. Neutropenia and a weak immune system make it hard for your body to fend off infection. The result is severe infections that cause life-threatening complications like:

• Gastrointestinal bleeding
• Gastrointestinal perforation
• Sepsis and septic shock

What’s the most common pathogen in typhlitis?

Research shows several kinds of bacteria and fungi (pathogens) can cause typhlitis. Some common bacteria are:

• Clostridium septicum
• Enterococci
• Gram-negative enterobacteria
• Pseudomonas aeruginosa
• Staphylococcus aureus
• Streptococcus

Common fungi are:

• Aspergillus
• Candida

How do healthcare providers diagnose typhlitis?

A healthcare provider will do a physical exam. They’ll ask questions about your medical history. For example, they’ll ask if you’re receiving treatment for cancer, had a stem cell or organ transplant, or have HIV/AIDS. They may order blood tests and imaging tests.

Blood tests

Your provider may order blood tests like:

• Complete blood count (CBC)
• Kidney function tests
• Liver function tests
• Prothrombin time test

Imaging tests

The most common test is computed tomography (CT) scan. This test shows if sections of your large intestine wall are unusually thick. Inflammation can make your intestinal wall thicker.

How is typhlitis treated?

There’s no standard treatment for typhlitis. In general, treatment focuses on managing the infection and supporting your immune system. But everyone’s situation is a bit different. You may need a different combination of treatments. Common typhlitis treatments are:

• Antibiotics
• Blood transfusion
• Decompressive laparotomy to relieve pressure inside your abdomen
• Granulocyte colony-stimulating factor (G-CSF) to boost your neutrophil level
• IV fluids
• Total parenteral nutrition that delivers nutrients directly to your stomach so your digestive system can rest and heal

Your oncologist may make changes in your cancer treatment while you recover. You may need surgery if typhlitis causes bowel perforation.

What’s the mortality rate?

Typhlitis is a serious illness that can be fatal. Once, nearly everyone with typhlitis died from complications like sepsis. Now, early diagnosis and treatment mean more people are recovering from typhlitis. A recent study showed more than 60% of people with fungal infections from typhlitis recovered after treatment.

When should I see my healthcare provider?

Typhlitis symptoms may feel like other, more common issues with your gut. But typhlitis symptoms are more than an upset stomach. Don’t hesitate to contact your provider if you have symptoms like:

• Fever
• Nausea and vomiting
• Severe abdominal pain and cramping

These symptoms don’t mean typhlitis has come back. But it’s always good to touch base when you notice concerning changes in your body.

What questions should I ask my healthcare provider?

You may have typhlitis because you have a condition that affects your immune system or you’re receiving cancer treatment. Here are some questions you may want to ask your healthcare provider:

• Do you know why I developed typhlitis?
• Will it come back?
• Will I need to stop cancer treatment?