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Causative role of Yersinia and other enteric pathogens in the appendicular syndrome
R Van Noyen1, R Selderslaghs, J Bekaert
1Imelda Hospital, Bonheiden, Belgium.
Abstract:
In 2,861 consecutive patients undergoing appendicectomy for clinically suspected appendicitis an enteric pathogen was isolated from the appendix in almost 7% using an optimal combination of culture media. The pathogenic Yersinia enterocolitica serotypes 03 and 09 predominated (3.6%), followed by Campylobacter and nontyphoid Salmonella. The same pathogen was isolated from the stool in 72.5% of patients with a culture-positive appendix and in 84.1% of those positive for a pathogenic Yersinia. Conversely, no pathogenic Yersinia were isolated in 326 gynaecologic control patients, in whom a normal appendix was removed. No frank appendicitis but mesenteric adenitis and/or terminal ileitis were found in 62.3% of 138 patients with a culture positive appendix, and in 74.6% of those positive for a pathogenic Yersinia. Histologic findings available in 135 patients showed acute suppurative appendicitis in only six (4.5%) patients, and in only one of 73 (1.4%) positive for a pathogenic Yersinia. In contrast, 46.8% of a group of 345 culture-negative appendices showed acute inflammation. A positive stool culture in a patient with suspected appendicitis, if consistent with sonographic and clinical findings, should be taken as strong evidence against the presence of true appendicitis.
Insights
In suspected appendicitis cases, enteric pathogens like Yersinia enterocolitica were found in nearly 7% of appendices. A positive stool culture may indicate conditions other than true appendicitis.
Area of Science:
- Gastroenterology
- Microbiology
- Surgical Pathology
Background:
- Appendicitis is a common surgical diagnosis, but its etiology is often unclear.
- Enteric pathogens are occasionally implicated in appendiceal inflammation.
Purpose of the Study:
- To investigate the prevalence of enteric pathogens in surgically removed appendices.
- To correlate pathogen isolation with histological findings and clinical diagnoses.
Main Methods:
- Analysis of 2,861 consecutive appendicectomy specimens for enteric pathogens using optimal culture media.
- Comparison with 326 gynecologic controls with normal appendices.
- Histopathological examination of appendices and correlation with stool cultures.
Main Results:
- Enteric pathogens isolated from 6.9% of appendices, with Yersinia enterocolitica (03, 09) being most common (3.6%).
- Pathogens found in stool in 72.5% of culture-positive appendix cases.
- Histological acute suppurative appendicitis was rare (4.5%) in culture-positive cases, contrasting with 46.8% in culture-negative appendices.
Conclusions:
- A positive stool culture in suspected appendicitis, especially with Yersinia, often indicates mesenteric adenitis or ileitis, not true appendicitis.
- Culture-negative appendices are more likely to show histological signs of acute inflammation.
- Findings challenge the routine surgical approach for all suspected appendicitis cases.