Rautio M, Saxén H, Siitonen A, Nikku R, Jousimies-Somer H
Anaerobe Reference Laboratory, National Public Health Institute, Helsinki, Finland.
Pediatr Infect Dis J. 2000 Nov;19(11):1078-83. doi: 10.1097/00006454-200011000-00010.
Acute appendicitis is the most common surgical emergency in childhood. However, the pathogenesis and detailed microbiology are obscure.
To determine in detail the bacterial etiology of appendicitis in children in relation to the histologic tissue pathology.
Tissue samples obtained at surgery from 41 children with suspected acute appendicitis were examined histologically and by culture for aerobic and anaerobic bacteria. The patients were analyzed according to histopathologic and clinical findings.
Aerobic and anaerobic species were isolated from 40 of 41 (98%) samples; on average, 14.1 isolates per specimen (10.4 anaerobes and 3.7 aerobes). Specimens from patients with gangrenous appendices yielded significantly higher numbers of anaerobic isolates per specimen than did specimens from patients with healthy appendices (11.7 vs. 7.7; P < 0.01). Bacteria belonging to the Bacteroides fragilis group were the most frequently isolated anaerobic microorganisms (95%). Other organisms frequently isolated in all histology groups were Peptostreptococcus micros (66%), Bilophila wadsworthia (63%), Fusobacterium nucleatum (44%), Eggerthella lenta (44%) and a hitherto undescribed bile-resistant, pigment-producing Gram-negative rod (41%). Of the aerobes Escherichia coli (88%) and Streptococcus anginosus group (former Streptococcus "milleri" group) organisms (61%) were the most frequent findings.
The shift from histologically normal toward gangrenous appendices was clearly associated with markedly elevated anaerobic bacterial counts in terms of species. The unusually high frequencies of B. wadsworthia (75%) and the hitherto undescribed bile-resistant, pigment-producing Gram-negative rod (56%) in gangrenous appendices represent unique and different findings from those reported in adults.
急性阑尾炎是儿童最常见的外科急症。然而，其发病机制和详细的微生物学情况尚不清楚。
详细确定儿童阑尾炎的细菌病因及其与组织学组织病理学的关系。
对41例疑似急性阑尾炎儿童手术时获取的组织样本进行组织学检查，并进行需氧菌和厌氧菌培养。根据组织病理学和临床发现对患者进行分析。
41份样本中的40份（98%）分离出需氧菌和厌氧菌；每个标本平均分离出14.1株菌株（10.4株厌氧菌和3.7株需氧菌）。坏疽性阑尾患者的标本中，每个标本分离出的厌氧菌数量显著高于健康阑尾患者的标本（11.7株对7.7株；P<0.01）。脆弱拟杆菌属细菌是最常分离出的厌氧微生物（95%）。在所有组织学组中经常分离出的其他微生物有微小消化链球菌（66%）、沃兹沃思嗜胆菌（63%）、具核梭杆菌（44%）、迟缓埃格特菌（44%）和一种迄今未描述的耐胆汁、产色素革兰氏阴性杆菌（41%）。在需氧菌中，大肠埃希菌（88%）和咽峡炎链球菌群（原“米勒链球菌”群）微生物（61%）是最常见的发现。
从组织学正常的阑尾向坏疽性阑尾的转变明显与厌氧菌数量的显著增加有关。坏疽性阑尾中沃兹沃思嗜胆菌（75%）和迄今未描述的耐胆汁、产色素革兰氏阴性杆菌（56%）的异常高频率代表了与成人报道不同的独特发现。
