The Bacteriology of Gangrenous and Perforated Appendicitis—Revisited

Bennion, Robert S.; Baron, Ellen Jo; Thompson, Jesse E.; Downes, Julia; Summanen, Paula; Talan, David A.; Finegold, Sydney M.

doi:10.1097/00000658-199002000-00008

Cited by 197 publications

(105 citation statements)

References 13 publications

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“…We speculate that the bacterium may have been in the gut flora of our patient and may have translocated through the inflamed intestinal mucosa to the bloodstream. Although other anaerobic bacteria, such as the Bacteroides fragilis group and C. perfringens, have been associated with or implicated in the pathogenesis of acute appendicitis (2,9), the role of C. hathewayi in the development of the acute appendicitis in the present patient cannot be determined. The failure to isolate the bacterium from her peritoneal swab could be due to its stringent transport and growth requirements and the overgrowth of the less fastidious E. coli.…”

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confidence: 76%

Bacteremia Due to Clostridium hathewayi in a Patient with Acute Appendicitis

et al. 2004

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Clostridium hathewayi is a newly described Clostridium species isolated from the feces of healthy human individuals, but its clinical significance is not known. We describe a case of human infection associated with C. hathewayi. The bacterium (strain HKU18) was isolated from the blood culture of a 39-year-old patient with acute gangrenous appendicitis complicated by septic shock. The cells were strictly anaerobic, nonmotile rods that stained gram negative. Conventional phenotypic tests and commercial identification systems failed to identify HKU18 to the species level. 16S rRNA gene analysis showed 1.4% nucleotide difference between the sequence of HKU18 and that of C. hathewayi, indicating that HKU18 was a strain of C. hathewayi. The patient responded to appendectomy and antibiotic treatment. 16S rRNA gene sequencing would be useful in further characterizing the clinical disease spectrum of C. hathewayi. CASE REPORTA 39-year-old Indonesian woman was admitted to the hospital because of fever, chills, and rigor for 1 day. She also complained of lower abdominal pain which radiated to the right loin. There were no urinary or bowel symptoms. Her past medical history was unremarkable. On admission, her oral temperature was 39°C. The physical examination revealed tenderness, guarding, and rebound tenderness over the right loin and suprapubic areas. Bowel sounds were active. Her total leukocyte count was 10.2 ϫ 10 9 /liter (neutrophils, 9.5 ϫ 10 9 / liter; and lymphocytes, 0.6 ϫ 10 9 /liter), a hemoglobin level of 13.7 g/dl, and a platelet count of 272 ϫ 10 9 /liter. Her renal and liver function tests were within normal limits. An abdominal radiograph was unremarkable. Blood culture was performed. She went into septic shock with metabolic acidosis soon after admission. Fluid resuscitation was administered, and empirical intravenous cefuroxime and metronidazole were commenced. Contrast-computed tomography of the abdomen showed a swollen appendix with fecalith and free fluid in the pouch of Douglas. An emergency appendectomy was performed. Intraoperatively, an acutely inflamed and gangrenous appendix pending perforation was found. Culture of the peritoneal swab grew only scanty Escherichia coli. The patient recovered uneventfully after the operation and was discharged after 4 days of hospitalization.Clostridium is a heterogeneous genus that consists of over 150 species. Besides Clostridium perfringens, C. difficile, C. tetani, and C. botulinum, of which the epidemiology and clinical disease spectra are better defined, studies of the pathogenic potential and disease association of the other Clostridium species have been hampered by difficulties in accurately identifying these bacteria. Since the recognition of the 16S rRNA gene as a new standard for classification and identification of bacteria (12, 13), most Clostridium species have been subjected to 16S rRNA gene sequence analysis, with revisions being made in their classifications and with new species being identified (3,4,14,15,17). Recently, the use of this technique...

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Bacteremia Due to Clostridium hathewayi in a Patient with Acute Appendicitis

et al. 2004

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“…The colon is the most densely populated environment in the human body, and the genus Bacteroides, which contains Gramnegative, obligate anaerobes, is one of the most abundant genera in the intestinal microbiota. In the clinical setting, Bacteroides strains are considered opportunistic pathogens that can occasionally cause infections, such as peritoneal abscesses, appendicitis, and septicemia (3,4,23). In the genus Bacteroides, B. fragilis is considered the most virulent species, and its capsular polysaccharides are especially linked to its pathogenesis (8,13,22).…”

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Efficient Electrotransformation of Bacteroides fragilis

Ichimura

Nakayama‐Imaohji

Wakimoto

et al. 2010

Appl Environ Microbiol

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This study describes refined electroporation parameters for efficient transformation of Bacteroides fragilis by plasmids prepared from laboratory strains of Escherichia coli. Development of the method used included determination of the optimal growth conditions for competent cell preparation, selectable antimicrobial resistance markers, electric field strength, and postpulse incubation time. Of the four E. coli-Bacteroides shuttle plasmids tested (pVAL-1, pVAL-2, pNLY1, and pLYL05), pLYL05 containing the cefoxitin resistance marker was found to be the most suitable for B. fragilis transformation, and it generated 2-to 900-fold more transformants (about 10 4 transformants per g pLYL05 DNA) than the other plasmids. Numerous microbes inhabit the human intestine, and the number of microbial cells can be nearly 10 11 cells per g of feces. The colon is the most densely populated environment in the human body, and the genus Bacteroides, which contains Gramnegative, obligate anaerobes, is one of the most abundant genera in the intestinal microbiota. In the clinical setting, Bacteroides strains are considered opportunistic pathogens that can occasionally cause infections, such as peritoneal abscesses, appendicitis, and septicemia (3,4,23). In the genus Bacteroides, B. fragilis is considered the most virulent species, and its capsular polysaccharides are especially linked to its pathogenesis (8, 13, 22). However, recent reports have highlighted the symbiotic properties of B. fragilis since the capsular polysaccharide displayed by this species can modify the human immune system (21). Another example of a host-Bacteroides interaction is a B. thetaiotaomicron interaction; this species can repress host inflammatory responses by promoting the binding of peroxisome proliferator-activated receptor gamma (PPAR-␥) to the NF-b subunit RelA (11). B. thetaiotaomicron is also known to induce production of antimicrobial peptides from Paneth cells in host intestinal epithelia (10).The recent accumulation of genomic information about several Bacteroides species (2) has enabled us to search for the genes responsible for the symbiotic properties of intestinal Bacteroides described above. However, screening for genes involved in host-Bacteroides symbioses requires development of a suitable, simple, and efficient genetic manipulation system. Although transconjugation by filter mating can be performed with Bacteroides species (19, 24 ), this technique is labor-intensive and time-consuming. Electroporation is a simple and reproducible procedure that is widely used for introduction of foreign nucleic acids into various bacteria. While Smith et al. previously described an electroporation protocol for Bacteroides species that could transform Bacteroides with plasmids from homologous hosts, plasmids derived from Escherichia coli laboratory strains could be transformed into Bacteroides only with difficulty (20). Recently, Patrick et al. described an efficient electrotransformation method for B. fragilis using purified T7 antirestriction protein Ocr...

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“…Literatürde; Escherichia coli, Bacteroides melaninogenicus, Bacteroides fragilis, Provetella spp., Bilophila wadsworthia, Peptostreptococcus spp., enterik basiller ve viridan steptokokların (özellikle Streptococcus anginosus) etken olduğu apandisit olguları bildirilmiştir (10) . Olgumuza benzer olarak Aye ve ark.…”

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