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Acute Appendicitis and the Microbiome: A Review of Microbial Signatures
Ioannis Karikis1, Yasmin Arda1, Ritwik Sanyal2
1Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Surgical Infections
|December 30, 2025
Summary
Appendicitis pathogenesis is linked to gut microbiota, not just obstruction. Different microbial signatures distinguish complicated from uncomplicated appendicitis, impacting treatment strategies.
Area of Science:
- Microbiology
- Gastroenterology
- Surgical Pathology
Background:
- Appendicitis is a common surgical emergency with unclear pathogenesis.
- Mechanical obstruction is a traditional theory, but the role of the appendix microbiome is increasingly recognized.
Purpose of the Study:
- To review current data on the role of microbiota in appendicitis.
- To differentiate microbial roles in complicated versus uncomplicated appendicitis.
Main Methods:
- Narrative review of high-throughput sequencing studies.
- Analysis of microbial composition in appendicitis cases.
Main Results:
- Specific bacteria like *Fusobacterium* and oral genera (*Gemella*, *Parvimonas*) are enriched in appendicitis.
- *Faecalibacterium prausnitzii* and *Akkermansia muciniphila* are depleted.
- Microbial profiles differ significantly between complicated and uncomplicated appendicitis.
Conclusions:
- Appendicitis may have diverse microbial signatures, not a single cause.
- The appendix serves as a microbial reservoir with implications for health post-removal.
- Microbiome analysis can guide antibiotic selection for appendicitis management.
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