Appendiceal spirochaetosis in children

Laurens J Westerman,Herbert V Stel,Johannes G Kusters,Marc Jm Bonten,Marguerite Ei Schipper

doi:10.1186/1757-4749-5-40

Laurens J Westerman, Herbert V Stel + Show 3 more

Open Access

https://doi.org/10.1186/1757-4749-5-40

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Journal: Gut Pathogens	Publication Date: Dec 1, 2013
Citations: 32	License type: cc-by

Affiliation: University Medical Center Utrecht

Abstract

BackgroundAcute appendicitis is a surgical emergency in which the appendix is surgically removed to prevent peritonitis due to perforation of the appendix. Depending on age and gender, up to 17% of removed appendices do not show the histopathological changes pathognomonic for acute appendicitis and are called ‘pseudo-appendicitis’. Intestinal spirochaetes have been reported in up to 12.3% of these non-inflamed appendices obtained from adults. Although children carry the highest risk for acute appendicitis, not much is known on the prevalence of intestinal spirochaetes in children. The aim of this study was to determine whether there is an association between pseudo-appendicitis and appendiceal spirochaetosis in children.MethodsArchival appendix specimens from paediatric patients (less than 18 years old) were obtained from two Dutch hospitals (acute appendicitis, n = 63; pseudo-appendicitis, n = 55; control appendices, n = 33) and microscopically analysed by H&E staining and spirochaete-specific immunohistochemistry and Brachyspira species specific real-time PCR.ResultsFive out of 142 appendices were found to be positive, all in male patients: one in the acute appendicitis group, two in the pseudo-appendicitis group and two in the control group.ConclusionThe results obtained do not provide evidence for a role of Brachyspira species infection in the aetiology of acute appendicitis in children.

Highlights

Acute appendicitis is a surgical emergency in which the appendix is surgically removed to prevent peritonitis due to perforation of the appendix
Deoxyribonucleic acid (DNA) was re-extracted from a second sample and this resolved the inhibition in 74 samples, leaving 142 samples for analysis (59 with acute appendicitis (27 females and 32 males), 50 with pseudo-appendicitis
One sample in the pseudo-appendicitis group was positive by real-time Polymerase chain reaction (PCR), but not by immunohistochemistry, increasing the prevalence in this group to 4.0% (n = 2)

Summary

Introduction

Acute appendicitis is a surgical emergency in which the appendix is surgically removed to prevent peritonitis due to perforation of the appendix. Numerous infectious agents have been implied in the aetiology of acute appendicitis, such as common intestinal pathogens (Salmonella species, Campylobacter species, Clostridium species, various intestinal parasites) and intestinal spirochaetes [1,2,3,4,5,6,7] The latter are anaerobic gram-negative bacteria and are occasionally found in the colon and appendix of humans with abdominal complaints where they cause a condition called human intestinal spirochaetosis (HIS) [8]. In 1982, Hovind-Hougen et al reported the first culture of a spirochaete isolated from a colon biopsysample, and named it Brachyspira aalborgi [10] Our knowledge regarding both the prevalence and pathogenic potential of these putative human pathogens is scarce, as they can only be cultured under strict anaerobic conditions. PCR detection on formalin-fixed paraffinembedded (FFPE) samples does not depend on intact mucosal structure and allows species identification, as was demonstrated recently [11]

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