Campbell Lucas K, Havens Jennifer M, Scott Margie A, Lamps Laura W
Department of Pathology, University of Chicago, IL, USA.
Mod Pathol. 2006 Aug;19(8):1042-6. doi: 10.1038/modpathol.3800640. Epub 2006 May 19.
The role of enteric bacteria in the pathogenesis of acute appendicitis is a controversial subject. Campylobacter jejuni has been previously demonstrated in a minority of cases of acute appendicitis using microbiological or immunohistochemical methods, notably in cases where inflammation was limited to the mucosa/submucosa. Our goal was to evaluate cases of acute appendicitis for C. jejuni DNA using molecular methods, and to compare our findings to the histologic features. In total, 50 archival cases of acute appendicitis were selected, and PCR was performed using primers targeting a 286-bp fragment of the mapA gene specific to C. jejuni. Twenty histologically unremarkable appendectomy specimens served as negative controls. Cases were reviewed with attention to particular histological features including mucosal ulceration, cryptitis, depth of inflammatory infiltrate, and the presence of mural necrosis. Of acute appendicitis cases, 22% (11/50) were positive for C. jejuni DNA by PCR analysis. Control cases were negative for C. jejuni DNA. All patients presented with signs and symptoms typical of acute appendicitis. Of the C. jejuni positive cases, only 27% contained acute inflammation limited to the mucosa/submucosa, whereas the remainder had mural or transmural inflammation; therefore, the histological features of C. jejuni-positive acute appendicitis cases were indistinguishable from C. jejuni-negative cases. In summary, C. jejuni DNA was detected in a significant percentage (22%) of acute appendicitis cases, a much higher percentage than previous studies using other methodologies. As C. jejuni is an enteric pathogen that does not exist as a commensal or nonpathogenic organism, the presence of C. jejuni DNA implies current or recent infection. Further study is needed to determine whether the presence of C. jejuni DNA in acute appendicitis indicates appendiceal involvement by C. jejuni enteritis, or if there is a true causative role for C. jejuni in acute appendicitis.
肠道细菌在急性阑尾炎发病机制中的作用是一个有争议的话题。先前使用微生物学或免疫组织化学方法在少数急性阑尾炎病例中发现了空肠弯曲菌，特别是在炎症仅限于黏膜/黏膜下层的病例中。我们的目标是使用分子方法评估急性阑尾炎病例中的空肠弯曲菌DNA，并将我们的发现与组织学特征进行比较。总共选择了50例急性阑尾炎存档病例，并使用靶向空肠弯曲菌特异性mapA基因286bp片段的引物进行聚合酶链反应（PCR）。20例组织学无异常的阑尾切除标本作为阴性对照。对病例进行了复查，关注特定的组织学特征，包括黏膜溃疡、隐窝炎、炎症浸润深度和壁层坏死的存在。通过PCR分析，22%（11/50）的急性阑尾炎病例空肠弯曲菌DNA呈阳性。对照病例空肠弯曲菌DNA为阴性。所有患者均表现出急性阑尾炎的典型症状和体征。在空肠弯曲菌阳性病例中，只有27%的病例急性炎症仅限于黏膜/黏膜下层，而其余病例有壁层或透壁性炎症；因此，空肠弯曲菌阳性急性阑尾炎病例的组织学特征与空肠弯曲菌阴性病例无法区分。总之，在相当比例（22%）的急性阑尾炎病例中检测到了空肠弯曲菌DNA，这一比例远高于以往使用其他方法的研究。由于空肠弯曲菌是一种肠道病原体，不存在作为共生菌或非致病生物体的情况，空肠弯曲菌DNA的存在意味着当前或近期感染。需要进一步研究以确定急性阑尾炎中空肠弯曲菌DNA的存在是否表明空肠弯曲菌肠炎累及阑尾，或者空肠弯曲菌在急性阑尾炎中是否存在真正的致病作用。
