Causative role of Yersinia and other enteric pathogens in the appendicular syndrome

Eur J Clin Microbiol Infect Dis. 1991 Sep;10(9):735-41. doi: 10.1007/BF01972498.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Appendectomy
  • Appendicitis / epidemiology
  • Appendicitis / microbiology*
  • Appendix / microbiology
  • Belgium / epidemiology
  • Campylobacter Infections / epidemiology
  • Campylobacter Infections / microbiology
  • Campylobacter jejuni / isolation & purification
  • Crohn Disease / diagnosis
  • Crohn Disease / epidemiology
  • Female
  • Humans
  • Male
  • Mesenteric Lymphadenitis / diagnosis
  • Mesenteric Lymphadenitis / epidemiology
  • Prospective Studies
  • Salmonella / isolation & purification
  • Salmonella Infections / epidemiology
  • Salmonella Infections / microbiology
  • Time Factors
  • Yersinia Infections / epidemiology
  • Yersinia Infections / microbiology*
  • Yersinia enterocolitica / isolation & purification*