RESUMO
Routine culture and cold enrichment were compared in a prospective study on the isolation of Yersinia enterocolitica from patients with intestinal disease. Healthy controls were examined with the cold enrichment method only. Y enterocolitica was isolated from 5.9% of 1635 patient stools, 3.4% of 206 appendices, and 4.0% of 555 control stools. Serotypes 0:3 and 0:9 were eight times more prevalent in patients than in controls. Other serotypes were twice as prevalent in controls than in patients. Cold enrichment did not significantly increase the recovery of serotypes 0:3 and 0:9 in acute enteritis, but it was responsible for all isolates of the other serotypes. Evidence is presented that the other serotypes are not pathogenic. In patient stools, Y enterocolitica was demonstrated less frequently than Salmonella (9.1%), and more often than Campylobacter jejuni (1.8%) and Shigella (0.1%).
Assuntos
Yersinia/isolamento & purificação , Adolescente , Adulto , Apêndice/microbiologia , Técnicas Bacteriológicas , Criança , Pré-Escolar , Temperatura Baixa , Fezes/microbiologia , Gastroenteropatias/microbiologia , Humanos , Estudos Prospectivos , Sorotipagem , Yersinia/classificaçãoRESUMO
In an average-sized peripheral hospital in Belgium, Y. enterocolitica has been isolated from 1.1% of stool cultures, using an unmodified routine technique. In a group of unselected patients undergoing appendicectomy, 1.3% of patients had a positive culture, either from the mesenteric lymph nodes or the appendix, or from both sources. In the same group of patients, 1.7% of cultures grew a Salmonella. In more than half of the patients, the diagnosis of mesenteric adenitis was made during the surgical intervention. The clinical picture of Yersinia infection was greatly influenced by the age of the patients. Bacteriological (serotypes, antibiotic sensitivity, associated enteric pathogens), epidemiological (sex distribution, seasonal influence and secondary infection among family contacts) and clinical data confirm previous experience with human yersiniosis in this country.
Assuntos
Gastroenteropatias/epidemiologia , Yersiniose/epidemiologia , Adolescente , Adulto , Antibacterianos/farmacologia , Apêndice/microbiologia , Bélgica , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Escherichia coli/isolamento & purificação , Fezes/microbiologia , Feminino , Humanos , Lactente , Linfonodos/microbiologia , Masculino , Mesentério , Pessoa de Meia-Idade , Salmonella/isolamento & purificação , Estações do Ano , Yersinia/efeitos dos fármacos , Yersinia/isolamento & purificaçãoRESUMO
In 2,861 consecutive patients undergoing appendicectomy for clinically suspected appendicitis an enteric pathogen was isolated from the appendix in almost 7% using an optimal combination of culture media. The pathogenic Yersinia enterocolitica serotypes 03 and 09 predominated (3.6%), followed by Campylobacter and nontyphoid Salmonella. The same pathogen was isolated from the stool in 72.5% of patients with a culture-positive appendix and in 84.1% of those positive for a pathogenic Yersinia. Conversely, no pathogenic Yersinia were isolated in 326 gynaecologic control patients, in whom a normal appendix was removed. No frank appendicitis but mesenteric adenitis and/or terminal ileitis were found in 62.3% of 138 patients with a culture positive appendix, and in 74.6% of those positive for a pathogenic Yersinia. Histologic findings available in 135 patients showed acute suppurative appendicitis in only six (4.5%) patients, and in only one of 73 (1.4%) positive for a pathogenic Yersinia. In contrast, 46.8% of a group of 345 culture-negative appendices showed acute inflammation. A positive stool culture in a patient with suspected appendicitis, if consistent with sonographic and clinical findings, should be taken as strong evidence against the presence of true appendicitis.