[Pathogenic bacteria in acute appendicitis]

Two hundred vermiform processes removed for acute appendicitis were examined bacteriologically. The authors recommend to choose antibiotics with regard to the sensitivity of microflora.

Epidemiological study of Yersinia enterocolitica and Yersinia pseudotuberculosis infections in Shimane Prefecture, Japan

In Shimane Prefecture, Japan, 175 Yersinia enterocolitica isolates from 6,479 stools and 347 appendixes of patients were separated into biotype 3B (VP-, sorbose-, inositol-) serotype O3 phage type II (22 isolates); biotype 4 (84 isolates), biotype 4 (ornithine-) (16 isolates) and biotype 4 (maltose-) (9 isolates) of serotype O3 phage type VIII, biotype 2 serotype O9 (1 isolate) and biotype 1 (43 isolates). This may be the first documentation of isolation of Y. enterocolitica biotype 3B serotype O3 phage type II from patients. Twenty-three Yersinia pseudotuberculosis isolates from stools of 23 patients were grouped into serotypes IB (13 isolates), III (2 isolates) and IVB (8 isolates). Clinical manifestations were more numerous in Y. pseudotuberculosis infections than Y. enterocolitica O3 infections. Y. enterocolitica O3 was more frequently isolated between summer and autumn but Y. pseudotuberculosis and Y. enterocolitica biotype 1 were isolated between winter and spring. Secondary infection with Yersinia among close family members was frequent. Y. enterocolitica O3 and Y. pseudotuberculosis infected persons excreted 10(4) to 10(9) viable cells per g stool during 27 and 19 days, but Y. enterocolitica biotype 1 strains were detected only when using enrichment techniques. Serological responses were not observed in under 2 year old persons infected with Y. enterocolitica O3.

Intestinal spirochetosis of the vermiform appendix

A series of 681 surgically removed appendices were examined for spirochetes. Five hundred seventy-four appendices were removed because of suspected acute appendicitis; the rest were removed per occasionem. One hundred six of the former were histologically normal, whereas 421 showed acute appendicitis. The remaining 47 specimens showed a variety of other pathological conditions, for example, tumors and diverticula. Spirochetes were found in 13 (12.3%) of the appendices removed from patients clinically suspected to suffer from acute appendicitis, but whose appendices were otherwise histologically normal (pseudoappendicitis). Only 3 patients (0.7%) with histologically confirmed acute appendicitis (p less than 0.05) did show spirochetes in their appendices. Of the 107 patients who had their appendices removed per occasionem, 2 patients (1.9%) had spirochetosis (p less than 0.05). The ultrastructure of the spirochetes obtained from appendices with spirochetosis was studied by means of negative staining and ultrathin sectioning. The morphology of these spirochetes was very similar to that of Brachyspira aalborgi, a spirochete recently isolated from rectal biopsy specimens obtained from patients with colorectal spirochetosis.

Prophylactic antibiotics in appendicectomy: a prospective double blind randomized study

Our double blind prospective randomized trial comparing intravenous cefoxitin with rectal metronidazole in appendicectomy reveals both groups to be similar regarding basic data, with no significant difference in the results between the two drugs. Nearly all the wound infections occurred after the patient went home. Most were minor infections and the overall infection rate was 6%. The intravenous route was the more certain but the more expensive. Bacteriology suggests that the same flora were present in the appendiceal wall of normal and acute non-perforated appendices. This would suggest bacteriologically that the same risks exist with non-inflamed appendicectomy as occurs with inflamed non-perforated appendices. These findings support the use of short course prophylaxis in appendicectomy.

Intestinal lesions containing coronavirus-like particles in neonatal necrotizing enterocolitis: an ultrastructural analysis

Since the outbreaks of neonatal necrotizing enterocolitis occurring in maternity hospitals of Paris and suburbs in 1979-1980, it has been possible to examine by light and electron microscopy gut specimens from ten newborns with this illness. Coronavirus-like particles, enclosed in intracytoplasmic vesicles of damaged epithelial cells of the intestinal mucosa, were observed in the small intestine, appendix, and colon. The ultrastructural study, supported by bacteriologic findings, suggests the role of coronavirus-like particles in the appearance of the lesions. Secondary proliferation of mainly anaerobic bacteria, probably responsible for pneumatosis, may aggravate the disease.

Isolation of Campylobacter jejuni from an appendix

Campylobacter jejuni Skirrow biotype 1, Lior serotype 8 was isolated from the appendix of an 11-year-old boy who had a 6-h history of acute abdominal pain. Histological diagnosis on the appendix section was early acute appendicitis. Dilute carbol fuchsin stain and indirect fluorescent antibody test performed on the appendix section also revealed the presence of Campylobacter sp. The patient developed a significant bactericidal antibody titer of 1,024, providing substantial clinical evidence of the pathogenicity of the isolate. This case indicated that not only may abdominal pain caused by Campylobacter enteritis mimic appendicitis, but the organism may actually be recovered from the infected appendix.

Infection caused by Yersinia enterocolitica serotype O:21

Yersinia enterocolitica serotype O:21, biotype 3 (Wauters) was isolated from the appendix and stool of a 7-year-old girl. The same organism was later isolated in pure culture from pus from a postoperative wound infection in this patient. She developed a significant serological response (titer of 800). There was thus strong clinical evidence of pathogenicity associated with this rather uncommon human serotype. Laboratory studies in vitro and in vivo pathogenicity showed that the organism was autoagglutinable, Serény test positive, and HeLa cell invasive; when given orally to mice, it produced diarrhea and subsequently death. The results of laboratory studies of virulence correlated closely with the clinical evidence of pathogenicity in this case.

Yersinia enterocolitica: its isolation by cold enrichment from patients and healthy subjects

Routine culture and cold enrichment were compared in a prospective study on the isolation of Yersinia enterocolitica from patients with intestinal disease. Healthy controls were examined with the cold enrichment method only. Y enterocolitica was isolated from 5.9% of 1635 patient stools, 3.4% of 206 appendices, and 4.0% of 555 control stools. Serotypes 0:3 and 0:9 were eight times more prevalent in patients than in controls. Other serotypes were twice as prevalent in controls than in patients. Cold enrichment did not significantly increase the recovery of serotypes 0:3 and 0:9 in acute enteritis, but it was responsible for all isolates of the other serotypes. Evidence is presented that the other serotypes are not pathogenic. In patient stools, Y enterocolitica was demonstrated less frequently than Salmonella (9.1%), and more often than Campylobacter jejuni (1.8%) and Shigella (0.1%).

Diarrhea due to Escherichia coli strain RDEC-1 in the rabbit: the peyer's patch as the initial site of attachment and colonization

A strain of Escherichia coli (RDEC-1) has been described that in rabbits colonizes the intestine; adheres to mucosal epithelial cells of the ileum, cecum, and colon; and causes diarrhea by an unknown mechanism. This study attempted to determine the location of the bacteria in the rabbit intestine during the unexplained six- to seven-day interval between bacterial inoculation and onset of diarrhea. Specimens of ileum, cecum, colon, ileal Peyer's patches, sacculus rotundus, and appendix from control rabbits and from rabbits killed at intervals after inoculation with RDEC-1 bacteria were examined by light and direct fluorescence microscopy. Bacteria in large numbers attach to the tips of the Peyer's patch lymphoid follicles by 24 hr, but they did not attached to ileal, cecal, or colonic mucosa until three days after inoculation. The lag time between inoculation and onset of diarrhea was probably due to the need for the bacteria first to attach to and then colonize the Peyer's patch lymphoid follicles. The intestinal mucosa was probably colonized by bacteria shed from the Peyer's patches.

Nonvalue of cold enrichment of stools for isolation of Yersinia enterocolitica serotypes 3 and 9 from patients

During an 8-year period 14,092 fecal specimens and 1,428 excised appendixes were examined for the presence of Yersinia enterocolitica, with different combinations of direct plating media and enrichment techniques. The combination of direct plating on SS agar and 2 days of enrichment in a modified Rappaport broth at room temperature resulted in the isolation of 100% of serotype 3 and 9 strains. Such strains were recovered from 3.7% of our fecal specimens. Cold enrichment in phosphate buffer further increased the isolation rate, but the additional isolates all belonged to biotype 1. Evidence is presented that biotype 1 strains, at least in Belgium, are not pathogenic for humans. There was a significant affinity of serotype 9 strains for patients suffering from an "appendicular syndrome."

Ornidazole and anaerobic bacteria: in vitro sensitivity and effects on wound infections after appendectomy

The sensitivities of 68 clinical isolates of Bacteroides fragilis, 18 of Clostridium perfringens, and 11 of other Clostridium species were tested against ornidazole alone and in combination with ampicillin and gentamicin. A concentration of 3.1 microgram of ornidazole/ml inhibited 98% of the strains of B. fragilis, with greater sensitivity when ampicillin and gentamicin were also present. A concentration of 6.2 microgram of ornidazole/ml inhibited 16 of 18 strains of C. perfringens and all 11 strains of other Clostridium species. Concentrations in serum and tissue were determined after intravenous infusion of 500 mg of ornidazole 15 min prior to appendectomy. During the operation the concentration in serum was 7.90 +/- 0.57 microgram/ml, and in appendix tissue, 5.26 +/- 0.60 microgram/g. In the series of 200 patients undergoing appendectomy, six patients treated with ornidazole and 12 patients treated with placebo developed a wound infection. In patients with perforated appendix, the rate of wound infection was 7.1% in those given ornidazole and 63.6% in those given placebo (P = 0.004). Not a single B. fragilis was isolated from appendix swabs or wound exudates after prophylaxis with ornidazole.

[The bacterial flora of the appendix in children]

Qualitative bacterial samples were taken from 53 appendices which were purulent, or had lymphoid hyperplasia or were normal. The results did not demonstrate a specific bacterial flora responsible for appendicular disease in childhood.

[Pathogenesis of abdominal actinomycosis]

According to the author's findings in 80 of 125 patients under observation the development of abdominal actinomycosis was related with inflammation in the appendicular process, in 65 patients the former starting after appendectomy. In examination of 100 patients with diagnosis of acute appendicitis actinomycosis of the ileocecal region was diagnosed in 5 patients. Actinomycosis was spreading from the ileocecal region by contact in retroperitoneal cellular tissue in 23 cases, in the left iliac region--in 12, in the lesser pelvis--in 8.

Streptococcus milleri in the appendix

The appendix was investigated as a possible habitat of Streptococcus milleri. Both normal and inflamed appendices were examined and the isolation rates compared. S. milleri was present in a quarter of the normal appendices and more than half of those associated with apendicitis--a difference that was statistically highly significant. The isolation rates throughout were indepencent of age. There was a pronounced connection between the presence of S. milleri in the appendix and the purulent manifestations of appendicitis. S. milleri was isolated from other abdominal sites associated with appendicitis. The frequency of isolation was increased by culture in an enrichment broth containing nalidixic acid and sulphadimidine.

The optimum duration of systemic antibiotic administration in the treatment of experimental peritonitis

The duration of antibiotic therapy for peritonitis is commonly decided on an empirical basis. There is obvious advantage in determining the shortest, yet most effective, period for such drug therapy. This study is a comparison of short-course and long-course antibiotic administration following periotonitis produced by experimental rupture of the rabbit appendix.

Prophylactic lincomycin in the prevention of wound infection following appendicectomy: a double blind study

The prophylactic use of a single dose of lincomycin in 100 patients undergoing appendicectomy reduced the incidence of postoperative wound infection from 17 to 6 per cent compared with a similar group of control patients. There was no correlation with the histological finding in the appendix, but patients with perforated appendicitis were excluded from the study. Bacteriological examination of the appendix area before surgery showed that Bacteroides fragilis and Escherichia coli were the organisms most frequently isolated. The majority of wound infections were due to B. fragilis, either alone or in association with aerobic organisms, but infection due to E. coli and Staphylococcus aureus also occurred. Systemic antibiotic therapy can successfully reduce the complications following appendicectomy but it is necessary to use a compound with activity against anaerobic organisms.