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Clusters of acute appendicitis: further evidence for an infectious aetiology
R Andersson1, A Hugander, A Thulin
1Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
Background:
The aetiology of appendicitis, the commonest cause of acute abdomen, is unknown. Infection has been proposed but the evidence has been unconvincing. The purpose of the present study was to investigate if temporo-spatial clustering and outbreaks, characteristics of infectious diseases, could be found in appendicitis cases in a defined Swedish population.
Methods:
Temporo-spatial clustering among 1155 cases from three districts of Jönköping County in 1984-1990 was identified by Knox space-time cluster analysis. Outbreaks were identified by retrospective study of temporal variations in 3590 consecutive cases of acute appendicitis from the city of Jönköping in 1969-1990.
Results:
Space-time clustering was found among patients with operations less than 60 days apart (observed/expected [O/E]-ratio 1.46, P = 0.016). Subset analysis revealed clustering to be commonest among patients from the same households (O/E-ratio 6.52, P = 0.012), among patients younger than 15 years (O/E-ratio 3.61, P = 0.004) and among females (O/E-ratio 2.28, P = 0.004). Three outbreaks with a significantly increased number of cases were observed during the 22-year study period (O/E-ratio 1.6-2.2, P = 0.001-0.049).
Conclusions:
The finding of temporo-spatial interaction and outbreaks among appendicitis cases supports the concept that appendicitis may be caused by infectious agents.
Insights
This study found temporo-spatial clustering and outbreaks in appendicitis cases, suggesting infectious agents may cause this common condition. These patterns indicate a potential infectious origin for appendicitis.
Area of Science:
- Epidemiology
- Infectious Disease Epidemiology
- Public Health
Background:
- Appendicitis, a leading cause of acute abdomen, has an unknown etiology.
- Infectious causes for appendicitis have been proposed but lack strong evidence.
- Investigating disease patterns can reveal underlying causes.
Purpose of the Study:
- To determine if appendicitis cases exhibit temporo-spatial clustering.
- To identify potential outbreaks of appendicitis.
- To explore the infectious disease characteristics of appendicitis in Sweden.
Main Methods:
- Knox space-time cluster analysis used for 1155 cases (1984-1990).
- Retrospective analysis of temporal variations in 3590 cases (1969-1990) to identify outbreaks.
- Study population from Jönköping County, Sweden.
Main Results:
- Significant space-time clustering of appendicitis cases observed (O/E-ratio 1.46, P=0.016).
- Clustering was most pronounced within households, among individuals under 15, and females.
- Three distinct outbreaks of appendicitis were identified over 22 years.
Conclusions:
- Temporo-spatial clustering supports an infectious etiology for appendicitis.
- Observed outbreaks suggest infectious agents may trigger appendicitis.
- Findings indicate appendicitis may be an infectious disease.