title: Causative role of Yersinia and other enteric pathogens in the appendicular syndrome.
abstract: In 2,861 consecutive patients undergoing appendicectomy for clinically suspected appendicitis an enteric pathogen was isolated from the appendix in almost 7% using an optimal combination of culture media. The pathogenic Yersinia enterocolitica serotypes 03 and 09 predominated (3.6%), followed by Campylobacter and nontyphoid Salmonella. The same pathogen was isolated from the stool in 72.5% of patients with a culture-positive appendix and in 84.1% of those positive for a pathogenic Yersinia. Conversely, no pathogenic Yersinia were isolated in 326 gynaecologic control patients, in whom a normal appendix was removed. No frank appendicitis but mesenteric adenitis and/or terminal ileitis were found in 62.3% of 138 patients with a culture positive appendix, and in 74.6% of those positive for a pathogenic Yersinia. Histologic findings available in 135 patients showed acute suppurative appendicitis in only six (4.5%) patients, and in only one of 73 (1.4%) positive for a pathogenic Yersinia. In contrast, 46.8% of a group of 345 culture-negative appendices showed acute inflammation. A positive stool culture in a patient with suspected appendicitis, if consistent with sonographic and clinical findings, should be taken as strong evidence against the presence of true appendicitis.
authors.affiliation: Imelda Hospital, Bonheiden, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Van Noyen
authors.forename: R
authors.initials: R
authors.lastname: Selderslaghs
authors.forename: J
authors.initials: J
authors.lastname: Bekaert
authors.forename: G
authors.initials: G
authors.lastname: Wauters
authors.forename: J
authors.initials: J
authors.lastname: Vandepitte
mesh_terms: D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000453:epidemiology / Q000382:microbiology*; D001065:Appendix / Q000382:microbiology; D001530:Belgium / Q000453:epidemiology; D002169:Campylobacter Infections / Q000453:epidemiology / Q000382:microbiology; D016123:Campylobacter jejuni / Q000302:isolation & purification; D003424:Crohn Disease / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008640:Mesenteric Lymphadenitis / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D012475:Salmonella / Q000302:isolation & purification; D012480:Salmonella Infections / Q000453:epidemiology / Q000382:microbiology; D013997:Time Factors; D015009:Yersinia Infections / Q000453:epidemiology / Q000382:microbiology*; D015008:Yersinia enterocolitica / Q000302:isolation & purification*