THE ROLE OF YERSINIA ENTEROCOLITICA IN AETIOPATHOGENETIC OF ACUTE APPENDICITIS AND CHRONIC DIARROEA

ΣΤΗΝ ΕΡΓΑΣΙΑ ΑΥΤΗ ΜΕΛΕΤΗΘΗΚΑΝ 88 ΕΝΗΛΙΚΕΣ ΑΣΘΕΝΕΙΣ ΚΑΙ 59 ΠΑΙΔΙΑ ΠΟΥ ΧΕΙΡΟΥΡΓΗΘΗΚΑΝ ΜΕ ΣΥΜΠΤΩΜΑΤΟΛΟΓΙΑ ΟΞΕΙΑΣ ΣΚΩΛΗΚΟΕΙΔΙΤΙΔΑΣ.ΣΤΟΥΣ ΑΣΘΕΝΕΙΣ ΑΥΤΟΥΣ ΠΡΟΣΔΙΟΡΙΣΘΗΚΑΝ ΑΝΤΙΣΩΜΑΤΑ ΕΝΑΝΤΙ ΤΗΣ YERSINIA ENTEROCOLITICA ΣΤΟΝ ΟΡΟ,ΕΓΙΝΑΝ ΚΑΛΛΙΕΡΓΕΙΕΣ ΙΣΤΟΤΕΜΑΧΙΩΝ ΣΚΩΛΗΚΟΕΙΔΩΝ ΑΠΟΦΥΣΕΩΝ ΓΙΑ ΤΗΝ ΑΠΟΜΟΝΩΣΗ ΤΟΥ ΜΙΚΡΟΒΙΟΥ,ΑΝΑΖΗΤΗΘΗΚΑΝ ΜΙΚΡΟΣΚΟΠΙΚΑ ΕΥΡΗΜΑΤΑ ΣΤΙΣ ΑΦΑΙΡΕΘΕΙΣΕΣ ΣΚΩΛΗΚΟΕΙΔΕΙΣ ΑΠΟΦΥΣΕΙΣΚΑΙ ΤΕΛΟΣ ΕΓΙΝΕ ΕΠΑΝΕΛΕΓΧΟΣ ΤΟΥ ΤΙΤΛΟΥ ΤΩΝ ΑΝΤΙΣΩΜΑΤΩΝ ΣΤΟΝ ΟΡΟ ΤΩΝ ΑΣΘΕΝΩΝ ΠΟΥ ΒΡΕΘΗΚΑΝ ΑΡΧΙΚΑ ΘΕΤΙΚΟΙ,6 ΜΗΝΕΣ ΜΕΤΑ ΤΗΝ ΕΠΕΜΒΑΣΗ.ΤΑ ΟΡΟΛΟΓΙΚΑ ΕΥΡΗΜΑΤΑΣΥΓΚΡΙΘΗΚΑΝ ΜΕ ΕΚΕΙΝΑ 150 ΥΓΙΩΝ ΜΡΤΥΡΩΝ.ΣΤΟΝ ΟΡΟΛΟΓΙΚΟ ΕΛΕΓΧΟ ΒΡΕΘΗΚΑΝ ΘΕΤΙΚΑ ΑΝΤΙΣΩΜΑΤΑ ΣΕ 4 ΕΝΗΛΙΚΕΣ ΑΣΘΕΝΕΙΣ(4,54%)ΣΕ 4 ΠΑΙΔΙΑ(6,77%) ΚΑΙ ΣΕ ΚΑΝΕΝΑΝ ΑΠΟ ΤΟΥΣ ΥΓΙΕΙΣ ΜΑΡΤΥΡΕΣ.ΟΙ ΔΙΑΦΟΡΕΣ ΗΤΑΝ ΣΤΑΤΙΣΤΙΚΑ ΣΗΜΑΝΤΙΚΕΣ ΚΑΙ ΣΤΙΣ ΔΥΟ ΠΕΡΙΠΤΩΣΕΙΣ(Ρ<0,01 ΚΑΙ Ρ<0,01,ΑΝΤΙΣΤΟΙΧΑ).ΑΠΟ ΤΙΣ ΙΣΤΟΚΑΛΛΙΕΡΓΕΙΕΣ ΤΩΝ ΙΣΤΟΤΕΜΑΧΙΔΙΩΝ ΤΟ ΜΙΚΡΟΒΙΟ ΑΠΟΜΟΝΩΘΗΚΕ ΣΕ ΕΝΑ ΜΟΝΟ ΕΝΗΛΙΚΑ ΑΣΘΕΝΗ.ΠΑΘΟΛΟΓΟΑΝΑΤΟΜΙΚΑΕΥΡΗΜΑΤΑ ΣΥΜΒΑΤΑ ΜΕ ΛΟΙΜΩΞΗ ΑΠΟ YERSINIA ENTEROCOLITICA ΒΡΕΘΗΚΑΝ ΣΕ4 ΑΠΟ ΤΟΥΣ8 ΣΥΝΟΛΙΚΑ ΑΣΘΕΝΕΙΣ (ΕΝΗΛΙΚΕΣ ΚΑΙ ΠΑΙΔΙΑ)ΜΕ ΘΕΤΙΚΑ ΑΝΤΙΣΩΜΑΤΑ ΣΤΟΝ ΟΡΟ.ΑΠΟ ΤΟΝ ΟΡΟΛΟΓΙΚΟ ΕΠΑΝΕΛΕΓΧΟ ΑΥΞΗΣΗ ΤΟΥ ΤΙΤΛΟΥ ΤΩΝ ΑΝΤΙΣΩΜΑΤΩΝ ΔΙΑΠΙΣΤΩΘΗΚΕ ΣΕ 2 ΑΠΟ ΤΟΥΣ 8 ΑΣΘΕΝΕΙΣ.ΜΕΛΕΤΗΘΗΚΑΝ ΕΠΙΣΗΣ 30 ΕΝΗΛΙΚΕΣ ΑΣΘΕΝΕΙΣ ΜΕ ΧΡΟΝΙΟ ΔΙΑΡΡΟΙΚΟ ΣΥΝΔΡΟΜΟ ΣΤΟΥΣ ΟΠΟΙΟΥΣ ΕΓΙΝΕ ΠΡΟΣΔΙΟΡΙΣΜΟΣ ΑΝΤΙΣΩΜΑΤΩΝ ΕΝΑΝΤΙ ΤΗΣ YERSINIA ENTEROCOLITICA ΣΤΟΝ ΟΡΟ,ΚΑΛΛΙΕΡΓΕΙΕΣ ΚΟΠΡΑΝΩΝ ΓΙΑ ΑΠΟΜΟΝΩΣΗ ΤΟΥ ΜΙΚΡΟΒΙΟΥ ΚΑΙ ΤΕΛΟΣ ΕΠΑΝΕΛΕΓΧΟΣ ΤΟΥ ΤΙΤΛΟΥ ΑΝΤΙΣΩΜΑΤΩΝ.THIS STUDY INCLUDES 88 PEDIATRIC PATIENTS OPERATED FOR ACUTE APPENDICITIES.INALL PATIENTS THE SERUM ANTIBODIES FOR YERSINIA ENTEROCOLITICA WERE CHECKED,APPENDIX SECTIONS WERE CULTURED TO ISOLATE THE MICROORGANISM AND THE HISTILOGICAL SECTIONS WERE EXAMINED MACRO- AND MICROSCOPICALLY.PATIENTS WITH POSITIVESERUM ANTIBODIES.THE SEROLOGICAL FINDINGS WERE COMPARED TO THAT OF 150 HEALTHY CONTROL SUBJECTS.FOUR ADULT(4,54%) AND 4 PEDIATRIC PATIENTS(6,77%) HAD POSITIVE ANTIBODIES.ALL THE HEALTHY CONTROL SUBJECTS WERE NEGATIVE FOR ANTIBODIES.IN BOTH GROUPS THERE WAS A STATISTICALLY SIGNIFICANT DIFFERENCE(P<0,01 AND P<0,01 REPRECTIVELY).YERSINIA WAS ISOLATED IN THE CULTURES OF PATHOLOGICAL SECTIONS IN ONE ADULT PATIENT,IN 4 OUT OF 8 PATIENTS WITH POSITIVE ANTIBODIES WAS FOUND IN 2 PATIENTS.THIRTY ADULT PATIENTS WITH CHRONIC DIARRCHOEA WERE ALSO STUDIED FOR THE LEVEL OF SERUM ANTIBODIES AGAINST YERSINIA ENTEROCOLITICA.IN ADDITION,STOOLS FROM THESE PATIENTS WERE CULTURED TO ISOLATE THE BACTERIA AND THE LEVEL OF SERUM ANTIBODIES WAS CHECKED 6 MONTHS LATER.THREE PATIENTS(10%)HAD POSITIVE SERUM ANTIBODIES,STATISTICALLY MORE,COMPARED TO THE 150HEALTHY CONTROL SUBJECTS(P<0,001).ALL STOOL CULTURES WERE NEGATIVE AND NO SIGNIFICANT CHANGES OF THE LEVEL OF SERUM ANTIBODIES WERE FOUND IN THE 6 MONTHS FOLLOW UP

First Diagnosis of Inflammatory Bowel Disease in a 91-Year-Old Man

Inflammatory bowel diseases (IBDs) are diseases that occur primarily in adolescence and early adult life. A second peak of IBD incidence occurs at the age of 50–80 years, while reports of first diagnosis after the age of 80 years are extremely rare. It is difficult to establish the true incidence of IBD in older patients due to problems of case definition, population, and particularly because it may be confused with other clinical conditions. A 91-year-old man was admitted to the Emergency Department with progressively worsening abdominal pain and 2–4 episodes of bloody diarrhea daily for the last month. Similar symptoms were not reported by the patient or his family during the past. Complete blood count and biochemical tests were normal, while stool examination showed erythrocytes and white blood cells. Pelvic CT showed inflammatory changes and loss of homogeneity in the perirectal fat together with considerable bowel wall thickening of both the rectum and sigmoid. Colonoscopy revealed edema, hyperemia and spontaneous friability, as well as microulcerations of the rectosigmoid mucosa. Tissue biopsies revealed histopathological lesions compatible with IBD. Finally the patient was treated with metronidazole, ciprofloxacin and mesalazine, with clear clinical improvement during the 5th day of treatment, and was finally discharged with almost normal stools. In conclusion, we report the case of first diagnosis of IBD in a 91-year-old man. The prevalence of IBD in patients aged >80 years is difficult to determine. Diagnostic tools are the same as for other age groups, but diagnosis may be difficult because there are a number of clinical conditions that may mimic IBD at this age. The treatment options are those used in younger patients, but special precautions should be taken

Small intestinal bacterial overgrowth is associated with irritable bowel syndrome and is independent of proton pump inhibitor usage

Background: Current knowledge suggests that small intestinal overgrowth participates in the pathogenesis of irritable bowel syndrome. It is questionable if this association is modulated by intake of proton pump inhibitors (PPIs). Methods: In a prospective study, quantitative cultures of duodenal aspirates were performed for aerobic species in 897 consecutive patients undergoing upper GI tract endoscopy. SIBO was defined as equal to or more than 10(3) cfu/ml. The effect of PPI intake on the relationship between SIBO and IBS was the primary endpoint. Results: Analysis among patients without any history of PPI intake (n = 713) showed that odds ratio (OR) for IBS in the event of SIBO was 5.63 (3.73-8.51, p &lt; 0.0001); this was 4.16 (1.91-9.06) when analysis was done among patients with history of PPI intake (n = 184, p: 0.498 between patients without and with PPI intake). Multiple logistic regression analysis found that factors independently associated with SIBO were age above or equal to 60 years (OR: 2.36), body mass index more than or equal to 22 kg/m(2) (OR: 0.60), presence of IBS (OR: 6.29), type 2 diabetes mellitus (OR: 1.59) and gastritis (OR: 0.47). Conclusions: The association between IBS and SIBO was completely independent from PPI intake. Although gastritis was protective against SIBO, results show that PPI intake cannot prime SIBO

In vitro activity of rifaximin against isolates from patients with small intestinal bacterial overgrowth

Rifaximin, a non-absorbable rifamycin derivative, has published clinical efficacy in the alleviation of symptoms in patients with irritable bowel syndrome (IBS). Small intestinal bacterial overgrowth (SIBO) is associated with the pathogenesis of IBS. This study describes for the first time the antimicrobial effect of rifaximin against SIBO micro-organisms from humans. Fluid was aspirated from the third part of the duodenum from 567 consecutive patients; quantitative cultures diagnosed SIBO in 117 patients (20.6%). A total of 170 aerobic micro-organisms were isolated and the in vitro efficacy of rifaximin was studied by (i) minimum inhibitory concentration (MIC) testing by a microdilution technique and (ii) time-kill assays using bile to simulate the small intestinal environment. At a breakpoint of 32 mu g/mL, rifaximin inhibited in vitro 85.4% of Escherichia coli, 43.6% of Klebsiella spp., 34.8% of Enterobacter spp., 54.5% of other Enterobacteriaceae spp., 82.6% of non-Enterobacteriaceae Gram-negative spp., 100% of Enterococcus faecalis, 100% of Enterococcus faecium and 100% of Staphylococcus aureus. For the time-kill assays, 11 E. coli, 15 non-E. coli Gram-negative enterobacteria and three E. faecalis isolates were studied. Rifaximin produced a &gt;3 log(10) decrease in the starting inoculum against most of the tested isolates at 500 mu g/mL after 24 h of growth. The results indicate that rifaximin has a potent effect on specific small bowel flora associated with SIBO. This conclusion should be regarded in light of the considerable time-kill effect at concentrations lower than those achieved in the bowel lumen after administration of conventional doses in humans. (C) 2014 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved

Soluble triggering receptor expressed on myeloid cells (sTREM-1): a new mediator involved in the pathogenesis of peptic ulcer disease

Objectives Triggering receptor expressed on myeloid cells (TREM-1) is a promoter of cytokine production triggered by microbial components. To investigate the significance of its soluble counterpart, sTREM-1, for the pathogenesis of peptic ulcer disease, sTREM-1 was compared with the proinflammatory mediators and the pathology score of gastritis. Methods Forty patients with dyspepsia were enrolled: 20 with peptic ulcer and 20 controls without any macroscopic abnormalities. All patients were examined by endoscopy; gastric juice was aspirated and biopsy specimens were collected from the antrum and corpus of the stomach. sTREM-1 was estimated by at hand-made enzyme immunoassay. Interleukin-8 was estimated by enzyme-linked immunosorbent assay and lipid peroxidation, indexed by malondialdehyde, by the thiobarbituric assay, after passage through a high-performance liquid chromatography system. Results The median (+/- SE) of sTREM-1 of controls and patients with ulcer was 3.91 +/- 0.57 and 44.27 +/- 241.55 R U, respectively (P=0.006). The median (+/- SE) of interleukin-8 of controls and patients with ulcer was 1802.97 +/- 122.10 and 2030.66 +/- 64.44 pg/ml, respectively (P = 0.023). sTREM-1 was positively correlated with the density of neutrophil and mononuclear infiltration scores and the total Sydney score (P=0.029, 0.043 and 0.041, respectively). sTREM-1 was positively correlated with interleukin-8 (P=0.042). Conclusions sTREM-1 might be an independent factor involving with the peptic ulcerative inflammatory process that is positively correlated with histopathological abnormalities of gastritis

Can soluble triggering receptor expressed on myeloid cells (sTREM-1) be considered an anti-inflammatory mediator in the pathogenesis of peptic ulcer disease?

Soluble triggering receptor expressed on myeloid cells (sTREM-1) is a novel mediator involved in the pathogenesis of peptic ulcer disease. To investigate the potential role of sTREM-1 in the anti-inflammatory response in chronic gastritis, sTREM-1 was compared with other anti-inflammatory mediators of gastritis. Forty patients with dyspepsia were enrolled: 20 with peptic ulcer and 20 controls without any macroscopic abnormalities. All patients were examined by endoscopy; gastric juice was aspirated and biopsy specimens were collected from the antrum and corpus of the stomach. sTREM-1, interleukin (IL)-8, and IL-10 were estimated by enzyme immunoassays. Median sTREM-1 in patient controls and in patients with peptic ulcer disease was 3.91 and 44.27 pg/ml, respectively (P=0.006). Respective values of IL-8 were 1856.97 and 2030.66 pg/ml (P=0.023); those of IL-10 were 16.92 and 18.43 pg/ml (NS). The odds ratio for the presence of peptic ulcer in the event of a concentration of sTREM-1 higher than 15 pg/ml was 23.22 (95% CI, 2.58-208.62; P=0.002). A positive correlation was found between the ratios of IL-8/sTREM-1 and IL-8/IL-10 (r (s), + 0.365; P=0.021). In conclusion, sTREM-1 is an independent factor for the generation of peptic ulcer disease and might behave as an anti-inflammatory mediator in chronic gastritis

Molecular assessment of differences in the duodenal microbiome in subjects with irritable bowel syndrome

Objective. Breath testing and duodenal culture studies suggest that a significant proportion of irritable bowel syndrome (IBS) patients have small intestinal bacterial overgrowth. In this study, we extended these data through 16S rDNA amplicon sequencing and quantitative PCR (qPCR) analyses of duodenal aspirates from a large cohort of IBS, non-IBS and control subjects. Materials and methods. Consecutive subjects presenting for esophagogastroduodenoscopy only and healthy controls were recruited. Exclusion criteria included recent antibiotic or probiotic use. Following extensive medical work-up, patients were evaluated for symptoms of IBS. DNAs were isolated from duodenal aspirates obtained during endoscopy. Microbial populations in a subset of IBS subjects and controls were compared by 16S profiling. Duodenal microbes were then quantitated in the entire cohort by qPCR and the results compared with quantitative live culture data. Results. A total of 258 subjects were recruited (21 healthy, 163 non-healthy non-IBS, and 74 IBS). 16S profiling in five IBS and five control subjects revealed significantly lower microbial diversity in the duodenum in IBS, with significant alterations in 12 genera (false discovery rate &lt; 0.15), including overrepresentation of Escherichia/Shigella (p = 0.005) and Aeromonas (p = 0.051) and underrepresentation of Acinetobacter (p = 0.024), Citrobacter (p = 0.031) and Microvirgula (p = 0.036). qPCR in all 258 subjects confirmed greater levels of Escherichia coli in IBS and also revealed increases in Klebsiella spp, which correlated strongly with quantitative culture data. Conclusions. 16S rDNA sequencing confirms microbial overgrowth in the small bowel in IBS, with a concomitant reduction in diversity. qPCR supports alterations in specific microbial populations in IBS