عزل وتوصيف البكتيريا المرتبطة بالتهاب الزائدة الدودية الحاد وبعض التغيرات النسجية المرضية

Isolation and Characterization of Bacteria Associated with Acute Appendicitis and Some Histopathological Changes

abstract

The current study included (135) samples , excluded only 35 patients with abdominal pain at any location and with no particular suspicion of appendicitis, other patients excluded were those that had peritonitis from ruptured appendix and those that had incidental appendectomy whereby appendix was removed during laparotomy for indication other than acute appendicitis , divided into two groups : group Ι , included (50) patients who suffered from fever, diarrhea , nausea, vomiting and abdominal pain which migrate to the right iliac fossa , to explain the presence of acute appendicitis , samples were collected from patients who were attending to Imam Hussein medical city in Holy Karbala during the period of January 2024- June 2024 . Patients samples included appendix and blood in compere with (50) blood samples collected from healthy (group ΙΙ) that were identical to patients group but not suffered from any symptoms of acute appendicitis.

Current study demonstrates on demography pictures that include: age, sex and clinical feature. Our results showed that appendicitis effects all age group, samples collected from patients between (8 – 60) years old .The majority rate of appendicitis were recorded (16-30) years with a percentage 44% from the total cases , then (1-15) years with a percentage 40% , (31 – 45) years with 14% and the minority rate was 2 % which belongs to years (46 – 60) , also this study shows that appendicitis affects both sex with no significant differences between both groups but it effect males (54%) more than females
( 46%). The present study recorded common clinical symptoms accompanying acute appendicitis such as: abdominal pain , vomiting , nausea, fever and diarrhea 50(100%) , 38(76%) , 37(74%) , 13(26%) , 5(10%) respectively and show high significant difference between patients with acute appendicitis and associated symptoms.

Current study isolated types of bacteria habitation in human appendices and evaluating the sensitivity of some antibiotics against them, all samples showed positive growth . G+ bacteria were isolated at a lower rate (6%) than G− bacteria (94%) ,there where highly significant difference between G+ and G−bacteria (p-value= 0.00001**) . Escherichia coli which accounted for 29(58%) isolates, followed by Klebsiella pneumoniae isolates 8 (16 %) , 5(10%) isolates of Psedomonas aeruginosa, 2(4%) isolates of Enterococcus faecalis, 1(2%) isolates of Enterobacter aerogenes, 1(2%) isolates of Salmonella typhi and 1(2%) of Proteus mirabilis . Staphylococcus aureus 2(4%).Whereas Staphylococcus epidermmidis was accounted as 1(2%).

The antibiotics sensitivity test performed on all isolates; both Imipenem and Amikacin were effective antibiotics against G− bacteria; meanwhile, Vancomycin , Penicillin , Rifampicin and Ticarcillin were effective against G+bacteria, all species of gram positive bacteria had be isolated were resistance to Benzyl penicillin and Oxacillin, most G−isolates were resistance to Ticarcillin and Piperacillin 92.8%. G−isolates showed to have more resistance than G+ isolates.
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The hematological results showed there were a high significant elevation in the count of total white blood cell (WBC) and neutrophils in the acute appendicitis patients group compared to the healthy group , there was non- significances decrease in count of the platelets in acute appendicitis patients group compared to the healthy group. Current study showed a significant decrease in the lymphocyte, RBCs, and HCT count in patients compare with the healthy .

The serological results demonstrated that there were high significant difference for Procalcitonin , Interleukin-8(IL-8) , Interleukin-10(IL-10) , Interleukin IL-1Ra , Monocyte chemotactic protein- 1 (MCP-1) , Macrophage inflammatory protein (MIP)-1α (p-value = 0.0001**) in the serum levels of appendicitis group and healthy Healthy group

Current study showed histopathological changes which included macroscopic and microscopic examination of all appendices . Some of these appendices were enlarged and tissue surrounded by vesicles , and some have fibrous and ulcerated walls of varying colors. The tissue changes showed changes in the histological structure of appendix, represented by expansion of its lumen and congestion of the venous blood vessels in the mucosa and sub mucosa , and increasing amount of lymphatic tissue spread through the layers of appendix , lymphoid follicular hyperplasia , infiltration of inflammatory cells that spread through the layers of appendix.