Fecal Leukocytes in Diarrheal Illness

Abstract

Stools from subjects with diarrhea were examined microscopically for leukocytes, using methylene blue stain. The study included 169 patients: 114 volunteers who ingested known enteric pathogens and 55 patients with naturally acquired disease. Fecal leukocytes were found in patients with shigellosis, salmonellosis, typhoid fever, invasive Escherichia coli colitis, and idiopathic ulcerative colitis. The exudates of shigellosis, salmonellosis, invasive E. coli colitis, and ulcerative colitis were primarily polymorphonuclear, whereas that of typhoid was mononuclear. There were no leukocytes in stools of patients with cholera, viral diarrhea, noninvasive toxigenic E. coli diarrhea, and naturally acquired "nonspecific" diarrhea and in those of 65 healthy control subjects. Examination of stool for leukocytes is a rapid and reliable procedure that may be a valuable aid toward early diagnosis of the cause of diarrhea. The presence of fecal leukocytes appears to indicate a colitis with disruption of the distal intestinal mucosa.