Acute appendicitis is characterised by local invasion with Fusobacterium nucleatum/necrophorum
Acute appendicitis is characterised by local invasion with Fusobacterium nucleatum/necrophorum
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DOI：
10.1136/gut.2009.191320
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发表时间：
2011-01-01
期刊：
影响因子：
24.5
通讯作者：
Doerffel, Wolf V.
中科院分区：
文献类型：
--
作者：
Swidsinski, Alexander;Doerffel, Yvonne;Doerffel, Wolf V.
背景急性阑尾炎是一种病因不明的局限性肠道炎症。目的是测试阑尾炎中的细菌与健康和疾病对照组盲肠活检中发现的细菌在组成上是否存在差异。方法和患者采用基于rRNA的荧光原位杂交技术对70例阑尾切片进行检测。以400例盲肠活检和400例炎症性肠病等疾病患者的粪便标本作为对照。结果卡他性阑尾炎黏膜表面有特征性病变，单个上皮细胞充满混合菌群(钉状细胞)，周围无溃烂。细菌在化脓性阑尾炎的组织中有很深的渗透。梭杆菌(主要是核梭杆菌和坏死菌)是这些上皮和粘膜下浸润物的特殊成分，在62%的被证实为阑尾炎的患者中。粘膜病变中梭菌的存在与阑尾炎的严重程度呈正相关，而在健康和疾病对照组的盲肠活检中则完全不存在。以拟杆菌、直肠杆菌(Clostridium Group XIVa)、普氏假单胞菌和粘性阿克曼杆菌为代表的主要粪便微生物群与病情严重程度呈负相关。急性阑尾炎粘膜病变中其他细菌群的出现与阑尾炎的严重程度无关。急性阑尾炎患者直肠拭子中未检出梭菌。结论急性阑尾炎患者大部分为核梭杆菌/坏死菌局部感染。
Background Acute appendicitis is a local intestinal inflammation with unclear origin. The aim was to test whether bacteria in appendicitis differ in composition to bacteria found in caecal biopsies from healthy and disease controls.Methods and patients We investigated sections of 70 appendices using rRNA-based fluorescence in situ hybridisation. Four hundred caecal biopsies and 400 faecal samples from patients with inflammatory bowel disease and other conditions were used as controls. A set of 73 group-specific bacterial probes was applied for the study.Results The mucosal surface in catarrhal appendicitis showed characteristic lesions of single epithelial cells filled with a mixed bacterial population ('pinned cells') without ulceration of the surroundings. Bacteria deeply infiltrated the tissue in suppurative appendicitis. Fusobacteria (mainly Fusobacterium nucleatum and necrophorum) were a specific component of these epithelial and submucosal infiltrates in 62% of patients with proven appendicitis. The presence of Fusobacteria in mucosal lesions correlated positively with the severity of the appendicitis and was completely absent in caecal biopsies from healthy and disease controls. Main faecal microbiota represented by Bacteroides, Eubacterium rectale (Clostridium group XIVa), Faecalibacterium prausnitzii groups and Akkermansia muciniphila were inversely related to the severity of the disease. The occurrence of other bacterial groups within mucosal lesions of acute appendicitis was not related to the severity of the appendicitis. No Fusobacteria were found in rectal swabs of patients with acute appendicitis.Conclusions Local infection with Fusobacterium nucleatum/necrophorum is responsible for the majority of cases of acute appendicitis.