Gallstones Containing Bacteria are Biofilms: Bacterial Slime Production and Ability to Form Pigment Solids Determines Infection Severity and Bacteremia

Abstract

Bacteria-laden gallstones are biofilms whose characteristics influence illness severity. Factors creating colonization surface (beta-glucuronidase/phospholipase) facilitated bacteremia and severe infections; but abundant slime production, while facilitating colonization, inhibited detachment and cholangiovenous reflux. This shows how properties of the gallstone biofilm determine the severity of the associated illness.

Chronic and acute infection of the gall bladder by Salmonella Typhi: understanding the carrier state

“…must first access and colonize the gall bladder or biliary tract. The bacteria must then attach to the surface of gallstones as well as persist in the presence of natural host defences 59 . It is thought that bile stasis, which can occur in the presence or absence of gallstones, contributes to successful colonization 28 .…”

Population-Level Virulence Factors Amongst Pathogenic Bacteria: Relation to Infection Outcome

“…• Osteomyelitis [18,19] • Gall bladder disease [20,21] • Prostatitis [22] • Otitis media with effusion, recurrent otitis media and otorrhea [2,[23][24][25] • Chronic rhinosinusitis [26,27] • Cholesteatoma [28] • Tonsillitis [29] • Adenoiditis [30] • Diabetic foot ulcers [31] • Periodontitis [32][33][34][35][36][37][38] Biofilms also represent the overwhelming bacterial phenotype associated with infections of implantable medical devices and indwelling catheters. These foreign body infections are nearly impossible to eradicate without removal of the device and have become the bain of many permanent and long-term interventional strategies, including arthoplasties, central lines, urinary catheriterizations, pacemakers, defibrillators, ventricular-peritoneal shunts and dialysis ports (reviewed in [39]).…”

Fewer Infectious Manifestations are Induced By Bacteria Entrapped in Cholesterol Stones Than By Bacteria in Brown Pigment Gallstone

“…First of all, Stewart, et al stated in the introduction that their group was the first to identify bacterial microcolonies in pigment stones. 1 Actually, the presence of bacterial microcolonies was first documented by SEM, both in the center and in the periphery of brown stones, in our paper 3 1 year before their paper on microcolonies. 4 In addition, we would like to stress, on the basis of our prospective study on 2,000 consecutive patients with gallstones 5 and who had systematic analysis of bile and stones, that even if bacterial microcolonies could be sometimes present in other types of stones, it is important to consider cholesterol or mixed stones from one hand, and entirely brown stones on the other hand, as two distinct entities for both epidemiological/pathophysiological and clinical purposes.…”