The role of Yersinia enterocolitica and Yersinin pseudotuberculosis in granulomatous appendicitis -: A histologic and molecular study
The role of Yersinia enterocolitica and Yersinin pseudotuberculosis in granulomatous appendicitis -: A histologic and molecular study
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DOI：
10.1097/00000478-200104000-00011
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发表时间：
2001-04-01
影响因子：
5.6
通讯作者：
Scott, MA
中科院分区：
文献类型：
--
作者：
Lamps, LW;Madhusudhan, KT;Scott, MA
肉芽肿性阑尾炎是一种神秘的疾病。据称的原因包括克罗恩病、异物反应、结节病和传染源；然而，大多数病例仍然是特发性的。小肠结肠炎耶尔森菌 (YE) 和假结核耶尔森菌 (YP) 被认为是阑尾炎、回肠结肠炎和肠系膜腺炎的病因。作者使用组织学和分子方法研究了 YE 和 YP 在肉芽肿性阑尾炎中的潜在作用。对 40 例肉芽肿性阑尾炎的组织学特征进行了评估，包括透壁炎症；肉芽肿的数量和特征以及粘膜变化。对 Twort Gram、Grocott 六胺银 (GMS) 和 Ziehl-Neelsen 染色进行评估，并进行聚合酶链反应 (PCR) 分析以鉴定致病性 YP 和 YE。通过 PCR 检测，25% 的病例（40 例中的 10 例）呈致病性耶尔森氏菌阳性（4 例 YE，4 例 YP，2 例两种菌种都有）。突出的组织学特征包括上皮样肉芽肿伴淋巴套囊、伴淋巴聚集的透壁炎症、粘膜溃疡和隐窝炎。 1 例耶尔森氏菌阳性病例含有壁革兰氏阴性杆菌；真菌和抗酸杆菌染色均为阴性。除一例培养阴性病例外，未进行血清学和培养或无法获得结果。两名耶尔森氏菌阳性患者随后被诊断患有克罗恩病，这表明这两个实体之间可能存在关系。没有其他患者出现明显的后遗症。 YE 和 YP 是肉芽肿性阑尾炎的重要病因，耶尔森氏菌感染可能与克罗恩病相似。没有组织学特征可靠地区分耶尔森菌属物种，或耶尔森氏菌阳性和耶尔森氏菌阴性病例。由于特殊染色和培养通常无法诊断，因此 PCR 分析是诊断耶尔森氏菌的绝佳技术。
Granulomatous appendicitis is an enigmatic entity. Purported causes include Crohn's disease, foreign body reactions, sarcoidosis, and infectious agents; however, most cases remain idiopathic. Yersinia enterocolitica (YE) and Y. pseudotuberculosis (YP) have been implicated as causes of appendicitis, ileocolitis, and mesenteric adenitis. The authors examined the potential role of YE and YP in granulomatous appendicitis using histologic and molecular methods. Forty cases of granulomatous appendicitis were evaluated for histologic features including transmural inflammation; number and character of granulomas, and mucosal changes. Twort Gram, Grocott methenamine-silver (GMS), and Ziehl-Neelsen stains were evaluated, and polymerase chain reaction (PCR) analysis was performed to identify pathogenic YP and YE. Twenty-five percent (10 of 40) of the cases were positive for pathogenic Yersinia by PCR (four YE, four YP, and two with both species). Prominent histologic features included epithelioid granulomas with lymphoid cuffing, transmural inflammation with lymphoid aggregates, mucosal ulceration, and cryptitis. One Yersinia-positive case contained mural Gram-negative bacilli; fungal and acid-fast bacilli stains were all negative. Except fur one culture-negative case, serologies and cultures were not done or results were unavailable. Two Yersinia-positive patients were diagnosed subsequently with Crohn's disease, suggesting a possible relationship between the two entities. No other patients developed significant sequelae. YE and YP are important causes of granulomatous appendicitis, and Yersinia infection may mimic Crohn's disease. No histologic features distinguish reliably between Yersinia species, or between Yersinia-positive and Yersinia-negative cases. Because special stains and cultures are often not diagnostic, PCR analysis is an excellent technique for the diagnosis of Yersinia.