Enumeration and presumptive identification of bacteria from the small intestine of sheep

Microflora of the small intestine of sheep was examined. Samples of tissue and digesta were taken from four sites along the small intestine (3, 8, 13, and 18 m from the pylorus) and maintained under anaerobic conditions. The pH of the digesta taken at the 3rd, 8th, 13th, and 18th m sections were 5.44, 6.37, 7.24, and 6.79. Digesta and tissue samples were diluted serially and plated within the anaerobic glove box on complex medium containing rumen fluid. In addition, each sample was plated on the same medium and incubated aerobically. As determined by growth under anaerobic conditions, viable counts of the digesta ranged from 5 X 10(4) to 7 X 10(6) cells/g, whereas counts for the tissue ranged from 2 X 10(2) to 4 X 10(4) cells/g. Viable counts determined aerobically for the digesta ranged from 1 X 10(4) to 5 X 10(6) cells/g, whereas the counts for the tissue ranged from 5 X 10 to 6 X 10(4) cells/g. Tentative identification of 50 isolates from samples of tissue and digesta in the 13th m section revealed a predominance of streptococcal organisms and rod shaped organism morphologically similar to Propionibacterium. An indigenous population of acid-tolerant bacteria with the ability to ferment simple sugars and starch was in the small intestine.

The normal cultivable microflora in upper jejunal fluid in healthy adults

Bacteriological studies of uncontaminated upper jejunal fluid were performed in 85 normal subjects. Fifty-three per cent of the samples were sterile (less than 10(1) CFU/ml). In 10% of the cases the total number of microorganisms exceeded 10(5) CFU/ml. The main groups of microorganisms isolated were Streptococcus sp ('Viridans group'), Lactobacillus sp., Veillonella parvula, Actinomyces sp., Haemophilus sp., Corynebacterium sp., and Candida albicans, each found in more than 10% of the subjects. Only the Streptococcus sp. exceeded 10(5) CFU/ml, and enterobacteria were found in 5% of the subjects, the number not exceeding 10(3) CFU/ml. No other typical members of the lower gastrointestinal tract were isolated. The number of subjects harbouring bacteria and the distribution of bacterial species were the same in both sexes and in different age groups.

Jejunal microflora in patients with chronic alcohol abuse

The types and numbers of bacteria were examined in aspirates from the jejunums of 27 chronic alcoholics and 13 hospitalized control patients of comparable age distribution without alcohol abuse or diseases of the liver. Samples of jejunal juice were aspirated in the fasting state. The mean number of microorganisms obtained during anaerobic incubation was distinctly higher in the alcoholics (log10, mean +/- SD: alcoholics 4.9 +/- 2.2, controls 3.2 +/- 1.5, p less than 0.025). A similar difference was found for the number of aerobic bacteria (alcoholics 4.7 +/- 1.9, controls 3.3 +/- 2.1, p less than 0.05). Significant counts (greater than 10(5)/ml) of bacteria obtained during anaerobic incubation were more frequent in the alcoholics (48.1%) than in the controls (7.6%, p less than 0.001). Coliform microorganisms were cultured much more frequently from the jejunal fluid of the alcoholics (alcoholics 55.6%, controls 15.4%, p less than 0.025). In addition the incidence of Gram-negative anaerobic bacteria and endospore-forming rods was higher in the aspirates from alcoholics (p less than 0.05). In both groups the number of microorganisms in jejunal fluid correlated closely with the pH found in the gastric juice. No correlation was found between the numbers or types of microorganisms in the jejunum and the type or degree of liver disease in the alcoholics. It is concluded that bacterial overgrowth might contribute to functional and/or morphological abnormalities of the small intestine commonly found in patients with chronic alcohol abuse.

Biochemical aspects of malabsorption in marasmus

Sixty marasmic children and fifteen normal age-matched controls were investigated for the absorption of fats and proteins. Their duodenal juice samples were also analysed for bile salts and microflora. A significant amount of malabsorption, with respect to both the dietary ingredients, was observed in the majority of the marasmic children. The levels of conjugated bile acids in the duodenal juice samples of marasmic children were significantly lower as compared with those of normal controls, while the reverse was true for free bile acids and bacterial counts. Significant correlations were observed between bile acid levels and fat absorption and also between microflora and free bile acids. The pathophysiology of malabsorption in marasmus is discussed in the light of these findings.

Bacterial overgrowth associated with a naturally occurring enteropathy in the German shepherd dog

Quantitative and qualitative bacteriological studies were performed on duodenal juice from 19 dogs with chronic small intestinal disease. Bacterial overgrowth was demonstrated in seven German shepherd dogs with minimal histological but specific biochemical abnormalities in the jejunal mucosa. Most frequently this overgrowth comprised bacteria of the normal flora, particularly Escherichia coli and enterococci, but these were occasionally accompanied by bacteria rarely present in the proximal small intestine of the normal dog, particularly Clostridium species. In most cases this overgrowth was associated with raised serum folate and reduced serum vitamin B12 concentrations, a finding consistent with the capacity of many enteric bacteria to synthesise folate and bind vitamin B12.

Duodenal microflora in infants with acute and persistent diarrhoea

The duodenal bacterial population was determined qualitatively and quantitatively in 3 groups of infants with diarrhoeal disease of varying duration. Infants with acute self limiting diarrhoea (group 1) had an abnormal overgrowth of organisms in the upper small bowel which was similar to that found in infants whose diarrhoea persisted after 4 days in hospital (group 2). The total duodenal organism count in infants with diarrhoea persisting after 7 days in hospital (group 3) was almost 100 times greater than either of the other groups. The findings may have important implications in preventing persistent diarrhoea from becoming protracted.

Comparison of an open and a closed tube system for collection of jejunal juice

When jejunal juice is obtained by means of open pernasal tubes, the risk of the aspirates being contaminated is presumably high. The present study compares jejunal aspirates obtained from an open and from a closed tube system. Ten patients suspected of having abnormal jejunal flora and five healthy human volunteers were investigated. The pH values of aspirates obtained from the open tubes were significantly lower than the values registered in aspirates from the closed tube system, with a median difference of 0.70 (p less than 0.02). No differences between the two types of aspirate were registered with regard to total number of bacteria, number of bacterial species, lipase, total protein, total amylase or its fractions of pancreatic and salivary isoamylases. For the investigation of pH-sensitive substances in jejunal juice, a closed tube system is therefore recommended, whereas the use of such a device does not seem necessary for the study of bacterial microflora and pancreatic enzymes.

Tube for sampling of uncontaminated small-bowel juice

A tube system for the collection of uncontaminated small-bowel juice is described. It consists of an outer guide tube, its distal end being closed by a membrane, and an inner aspiration tube. When the outer tube is placed at the desired site of aspiration, the membrane is perforated by advancing the sterile inner tube. The device was tested in 90 healthy human volunteers. The procedure was completely or partly unsuccessful in 9 cases (95% confidence limits, 4.7-18.0). Median intubation time was 12 min; range, 5-14 min. The time used for aspiration of 5 ml of intestinal juice varied from 1 to 30 min; median, 10 min. The site of aspiration in jejunum distal to the ligament of Treitz varied from 0 to 14 cm; median, 3 cm. No complications of the procedure were registered.

Simultaneous culture of saliva and jejunal aspirate in the investigation of small bowel bacterial overgrowth

Both saliva and jejunal aspirate were cultured from 22 patients with suspected small bowel bacterial overgrowth and from eight controls. Large numbers of organisms (greater than 10(6)/ml) were recovered from the jejunal aspirate of 16 subjects, in five of whom the same organisms were present in similar relative proportions in the saliva, suggesting contamination of the sample with saliva, while in 11 the jejunal organisms differed from those in saliva. In eight of these the jejunal flora was a typical 'faecal' flora usually associated with small bowel bacterial overgrowth but, in three, the jejunal floral was superficially similar to that of saliva. Distinct subpopulations of bacteria, typically Gram-positive non-sporing rods, were, however, evident in the jejunum of these patients, and were also recovered, in smaller numbers, from the jejunum of controls, suggesting that they form a distinct jejunal microflora. Culture of saliva in addition to jejunal aspirate may be useful in the recognition of contamination of the proximal small bowel with saliva, and in the diagnosis of small bowel bacterial overgrowth.

[Antibody deficiency syndrome of the "common variable type" with intestinal lymphatic hyperplasia and secondary gastric carcinoma]

Case report on a patient with agammaglobulinaemia, repeated respiratory infections, diarrhoea and nodular lymphoid hyperplasia of the small intestine. Giardia lamblia was seen in duodenal aspirates. B-lymphocytes were not decreased, but no plasma cells could be found. Later the patient developed a gastric carcinoma, which was also described in previous case reports.

[Characterization of the microflora of the small intestine (author's transl)]

Normal and abnormal microflora of the upper small intestine was studied in 356 patients. Low counts are characteristic of normal microbial colonization (eubiosis), changes in quality and/or quantity are pathological (dysbiosis). The latter status is described as overgrowth syndrome. We found some types of dysbiosis. Prevalent was type Dys1 with the highest counts and the greatest variety of bacteria and yeasts. In contrast to this, type Dys2 showed higher germ counts of only one genus like coliforms (Dys2 Coli), streptococci (Dys2 Str.), lactobacilli (Dys2 L.) or yeasts (Dys2 Y.). In dysbiosis, we frequently saw bifidobacterium and bacteroides. Simultaneous sampling from stomach, duodenum, and jejunum indicated different modes of colonization of these parts (oral or fecal type).

Modes of action of enterotoxins from Vibrio cholerae and EScherichia coli

Current information on the intestinal secretory mechanism and on the actions of the enterotoxins from Vibrio cholerae and Escherichia coli are reviewed. These enterotoxins, through their effects on the metabolism of cyclic nucleotides, both inhibit active absorption and stimulate active secretion of water and electrolytes in the small intestine. the enterotoxin of V. chol erae and the heat-labile enterotoxin of E. coli affect these activities by stimulating adenylate cyclase, and the heat-stable enterotoxin of E. coli does so by stimulating guanylate cyclase.

Synergistic protection against experimental cholera by immunization with cholera toxoid and vaccine

Rabbits were immunized with two parenteral injections of Wellcome toxoid PX389A, Wyeth toxoid 20101, or Merck bivalent vaccine. Other groups of rabbits were immunized with combinations of the Merck vaccine and each of the two toxoids. Antitoxin responses were monitored in each group of rabbits before livecell challenge of each animal by the ligated intestinal loop assay. Inaba and Ogawa strains of Vibrio cholerae were used for challenge experiments. Basically, the data indicate that the toxoids were equivalent in antigenic potency and antitoxin responses were unaffected by combination of the toxoids with the whole-cell vaccine. The 50 microgram doses of each toxoid as well as the 4 X 10(9) cells of the bivalent vaccine provided the same magnitude of protection against live-cell challenge with either Inaba or Ogawa vibrios. Immunization with either toxoid in combination with the bivalent vaccine resulted in a synergistic protective response against live-cell challenge of intestinal loops with V. cholerae. Synergistic protection was observed when toxoid and vaccine were administered together by the oral and parenteral routes. Maximum protection was obtained when rabbits were immunized with the combined toxoid-whole-cell vaccine administered by both oral and parenteral routes.

Identification of gallbladder typhoid carriers by a string device

The efficiency of a gelatin capsule containing a nylon string for collection of duodenal specimens was investigated in carriers of Salmonella typhosa (typhi). Cultures of duodenal specimens obtained by means of the string capsule were compared with cultures of duodenal specimens obtained by a conventional duodenal tube and with stool cultures Duodenal contents obtained with either the string or tube were more often positive for S. typhosa than were stool cultures. The string, which is as efficient as tube collection but simpler and more comfortable, may be useful in identifying carriers of S. typhosa.

A clinical study of young infants after small intestinal resection

We prospectively studied 15 infants who, before 3 months of age, underwent resection of the small intestine-proximal in 3 infants, mid in 6, and distal in 6. Two died before one year of age. Many required prolonged parenteral nutrition, but by one year, 12 of the 13 survivors were on oral feedings only, and seven were above the third percentile for height and weight. Developmental delay occurred in the early postoperative period but diminished with time. There was compensatory adaptation of the remaining gut, shown by improving fat and B12 absorption and duodenal bile-salt concentrations. Bacterial contamination complicating end-to-side anastomoses occurred in two cases (P), gastric hyperacidity in four of 12 (1P, 3M), and hyperoxaluria in eight of 14 (1P, 5M, 2D). Studies of immune competence revealed normal cellular immune function (11/11), transient hypogammaglobulinemia (3/14), hypocomplementemia (1/12), and serum autoantibodies (3/10). Thus, massive resection of the small intestine did not preclude spontaneous improvement in absorptive function, growth, and development.

Effects of intestinal micro-organisms on fluid and electrolyte transport in the jejunum of the rat

Culture filtrates of micro-organisms isolated from the upper intestinal secretions of malnourished children and grown in pure culture were shown to impair the intestinal absorption of water and electrolytes in live rats. Decreased net movement out of the intestinal lumen, or actual secretion of water, sodium or potassium into the intestinal lumen, was found with culture filtrates of single isolates of Staphylococcus epidermidis, Escherichia coli 055, Escherichia coli B7A, Shigella sonnei, Klebsiella pneumoniae, Candida albicans and Candida tropicalis. These organisms have been found to contaminate upper intestinal secretions in malnourished children and it is suggested that the effects observed in these experiments might be relevant to the production of the diarrhoea that is a dominant clinical feature of childhood malnutrition.