Ierardi Enzo, Losurdo Giuseppe, Mileti Alessia, Paolillo Rosa, Giorgio Floriana, Principi Mariabeatrice, Di Leo Alfredo
Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, 70124 Bari, Italy.
Ph.D. Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, 70124 Bari, Italy.
Antibiotics (Basel). 2020 May 31;9(6):293. doi: 10.3390/antibiotics9060293.
() may enter a non-replicative, non-culturable, low metabolically active state, the so-called coccoid form, to survive in extreme environmental conditions. Since coccoid forms are not susceptible to antibiotics, they could represent a cause of therapy failure even in the absence of antibiotic resistance, i.e., relapse within one year. Furthermore, coccoid forms may colonize and infect the gastric mucosa in animal models and induce specific antibodies in animals and humans. Their detection is hard, since they are not culturable. Techniques, such as electron microscopy, polymerase chain reaction, loop-mediated isothermal amplification, flow cytometry and metagenomics, are promising even if current evidence is limited. Among the options for the treatment, some strategies have been suggested, such as a very high proton pump inhibitor dose, high-dose dual therapy, -acetycysteine, linolenic acid and vonoprazan. These clinical, diagnostic and therapeutic uncertainties will represent fascinating challenges in the future.
（）可能进入一种非复制、不可培养、低代谢活性状态，即所谓的球状体形式，以便在极端环境条件下生存。由于球状体形式对抗生素不敏感，即使不存在抗生素耐药性，它们也可能是治疗失败的原因，即在一年内复发。此外，球状体形式可能在动物模型中定植并感染胃黏膜，并在动物和人类中诱导特异性抗体。由于它们不可培养，因此很难检测到它们。即使目前的证据有限，电子显微镜、聚合酶链反应、环介导等温扩增、流式细胞术和宏基因组学等技术也很有前景。在治疗选择中，已经提出了一些策略，例如非常高剂量的质子泵抑制剂、高剂量双联疗法、乙酰半胱氨酸、亚麻酸和沃克拉唑。这些临床、诊断和治疗上的不确定性将在未来成为引人入胜的挑战。
