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Bacterial colonisation of jejunal mucosa in acute tropical sprue
Abstract:
Fifteen of sixteen Caucasians with acute tropical sprue were founc to have numerous aerobic bacteria closely associated with the mucosal layer of the proximal jejunum. Four species of Enterobacteria were grown in eleven patients, and concentrations were higher in the mucosal patients than in the jejunal fluid. Only one of eight control cases with similar tropical exposure but without mucosal morphological abnormalities had any similar bacteria in the mucosal biopsy. In no case were Bacteroides isolated. Since clinical and biochemical improvement only occurred on treatment with tetracycline when enterobacteria were eliminated from the mucosa, it is suggested that these organisms may be responsible for persisting jejunal abnormalities in tropical sprue.
Insights
Aerobic bacteria, specifically Enterobacteria, were found in the jejunal lining of patients with tropical sprue. Eliminating these bacteria with tetracycline improved symptoms, suggesting their role in the disease.
Area of Science:
- Gastroenterology
- Microbiology
- Infectious Diseases
Background:
- Tropical sprue is a malabsorption syndrome common in the tropics.
- The exact etiology of tropical sprue remains incompletely understood.
- Previous studies have suggested a potential role for bacterial overgrowth.
Purpose of the Study:
- To investigate the presence and significance of aerobic bacteria in the jejunal mucosa of patients with acute tropical sprue.
- To determine if specific bacterial species are associated with the disease pathology.
- To explore the impact of bacterial elimination on clinical outcomes.
Main Methods:
- Biopsies of the proximal jejunum were obtained from patients with tropical sprue and healthy controls.
- Bacterial cultures were performed on mucosal biopsies and jejunal fluid.
- Enterobacteria and Bacteroides species were specifically identified.
- Clinical and biochemical responses to tetracycline treatment were monitored.
Main Results:
- Fifteen of sixteen Caucasians with acute tropical sprue had aerobic bacteria associated with the jejunal mucosa.
- Enterobacteria were identified in eleven patients, with higher concentrations in the mucosa than in jejunal fluid.
- Control subjects with similar tropical exposure but no mucosal abnormalities showed minimal bacterial presence.
- Bacteroides were not isolated in any case.
- Clinical and biochemical improvement correlated with the elimination of enterobacteria from the mucosa following tetracycline treatment.
Conclusions:
- Aerobic bacteria, particularly Enterobacteria, are frequently found in the jejunal mucosa of patients with acute tropical sprue.
- These bacteria may play a causative or perpetuating role in the jejunal abnormalities observed in tropical sprue.
- Antibiotic treatment targeting these bacteria, such as tetracycline, can lead to clinical improvement.