Is there a correlation between helicobacter pylori and enterohepatic helicobacter species and gallstone cholecystitis?

Background: Cholecystitis is a common surgical condition. Recently, several authors have reported that DNA of bile tolerant Helicobacter spp. has been found in the human bile colonizing the biliary tract. The aim of this study was to evaluate the association between the presence of Helicobacter spp. and gallstone cholecystitis

Methods: In this case-control study, gallstones, bile, and gallbladder mucosa were collected from 25 patients without gallstone disease, 24 with acute cholecystitis, and 28 with chronic cholecystitis. The presence of Helicobacter pylori [H. pylori], Helicobacter bilis [H. bilis], Helicobacter hepaticus [H. hepaticus], and Helicobacter pullorum [H. pullorum] were investigated by polymerase chain reaction [PCR] using species-specific primers

Results: In this study, 77 subjects with acute and chronic cholecystitis and control groups with a mean age of 46.85 +/- 14.53 years, including 58 [67.25%] women and 19 [32.75%] men were included. DNA of 10 Helicobacter spp. was detected in the bile of the patients with cholecystitis including eight H. pylori and two H. bilis. However, we could not detect H. hepaticus and H. pullorum DNA in the samples. Moreover, there was an association between H. pylori and acute cholecystitis [p = 0.048], which was found to be stronger in 31-40-year-olds group [p = 0.003]

Conclusion: We found an association between the presence of H. pylori DNA and acute gallstone cholecystitis. There is not statistically significant correlation between three enterohepatic Helicobacter spp. [H. bilis, H. hepaticus, and H. pullorum] and cholelithiasis. Given the low sample size of the patients, more studies are required to clear the clinical role of Helicobacter spp. in the gallstone disease and cholecystitis

Candida famata-induced fulminating cholecystitis

Lithiasic cholecystitis is classically associated with the presence of enterobacteria, such as Escherichia coli, Enterococcus, Klebsiella, and Enterobacter, in the gallbladder. Cholecystitis associated with fungal infections is a rare event related to underlying conditions such as diabetes mellitus, steroid use, and broad-spectrum antibiotic use for prolonged periods, as well as pancreatitis and surgery of the digestive tract. Here, we present the first reported case of a gallbladder infection caused by Candida famata.

Prevalence of Helicobacter spp in chronic cholecystitis and correlation with changes on the histological pattern of the gallbladder / Prevalência do Helicobacter spp na colecistite crônica calculosa e correlação com as alterações histológicas da vesícula biliar

PURPOSE: Establish the prevalence of Helicobacter spp in chronic cholecystitis and its correlation with the gallbladder's histological findings. METHODS: 100 patients were operated for chronic cholecystitis with cholecystolithiasis. In pathological examination of the gallbladder, were evaluated the presence of metaplasia, dysplasia, lymphoid follicles, anaplasia and tumors that might be related to the presence of Helicobacter plus the presence of the bacilli Giemsa by optical microscopy. From the DNA extracted from the gallbladder's bile, PCR was performed by using specific primers for the identification of Helicobacter spp with amplification of the 400bp segment of rRNA gene16S, with positive control DNA from Helicobacter pylori. All the cases negative for isolation of genetic material were excluded. The cases of PCR and Giemsa were used as negative control group. The histological findings were compared to the presence of bacilli and PCR data using a chi-square and Fisher's Exact test (CI = 95.0 percent, p <0.05). RESULTS: Of 68 patients, 42 (61.8 percent) were PCR for Helicobacter spp and 19 (27.9 percent) had Giemsa. There was no correlation between the two findings. The PCR for Helicobacter spp was not correlated to the histological findings. The presence of lymphoid follicles and metaplasia was related to the Giemsa (p = 0.025 and p= 0.039). CONCLUSION: There is high prevalence of Helicobacter spp in patients with chronic cholecystitis and cholecystolithiasis without be correlated with the histological patterns studied.

OBJETIVO: Estabelecer a prevalência do Helicobacter spp nos doentes com colecistopatia crônica calculosa e correlacioná-la com as alterações histológicas da vesícula biliar. MÉTODOS: Foram operados 100 doentes portadores de colecistite crônica calculosa. No anátomo-patológico foram avaliadas a presença de, metaplasias, displasias, folículos linfóides, anaplasias e tumores que pudessem se relacionar à presença do helicobacter e a presença de bacilos Giemsa à microscopia. A partir do DNA extraído da bile foi realizada PCR utilizando-se primers específicos para identificação de Helicobacter spp com amplificação de segmento de 400bp do gene16S rRNA, com controle positivo de DNA de Helicobacter Pylori. Os casos negativos para isolamento de material genético na bile foram excluídos. Os casos de PCR e Giemsa negativos foram utilizados como grupo controle. Os achados histológicos foram comparados ao Giemsa e à PCR utilizando-se Teste do Qui-Quadrado e Exato de Fisher (IC=95,0 por cento; p<0,05). RESULTADOS: De 68 doentes, 42(61,8 por cento) apresentaram PCR para Helicobacter spp e 19(27,9 por cento) Giemsa. Não houve correlação entre os dois achados. Não houve correlação entre alterações histológicas e a PCR (p=0,378). A presença de folículos linfóides e metaplasia estiveram relacionadas ao Giemsa (p=0,025 e 0,039). CONCLUSÃO: Há prevalência elevada de Helicobacter spp nos doentes com colecistite crônica calculosa sem haver correlação com os achados histológicos estudados.

Proportion of bile micro-organisms and their culture and sensitivity to various antibiotics in patients with gallstones

To provide scientific basis for selecting a prophylactic antibiotic in the cases of elective cholecystectomy, according to our local conditions. Descriptive Study. General Surgery department of Abbasi Shaheed Hospital Karachi from 1st Jan, 2004 to 31st Dec 2004. Fifty patients with chronic cholecystitis ranged between 20 to 65 years were admitted through outpatient department. These patients also included high risk patients with diabetes mellitus, ischaemic heart diseases, hypertension and immunocompromised patients. Patients with acute cholecystitis, empyema, obstructive jaundice, common bile duct stone, carcinoma of gallbladder or biliary tree, cirrhosis and patients having septic foci elsewhere were excluded. Patients were selected according to convenient sampling. During cholecystectomy bile was sent for culture and sensitivity. For analysis of data SPSS-10 was used. In this study positive bile culture was found in 44 percent of cases and most prevelant organisms were E.coli and Klebsiella. With regard to antibiotic sensitivity. Amikacin, quinolone, imipiname and piperacillin has shown almost 90% sensitivity. Prophylactive antibiotic should be used in all cases of elective cholecystectomy

Relation between gallbladder neoplasm and Helicobacter hepaticus infection.

OBJECTIVE: The main objective of this study was to see the various histopathological changes in the gallbladder with cholelithiasis and to correlate them with Helicobacter hepaticus infection. METHODS: A total of 380 cholecystectomy specimens were received during a study period from 2058/11/29 to 2059/11/4 at Department of Pathology, TU Teaching Hospital, Institute of Medicine. RESULTS: Among 380 cases, 249 (65.53%) were found to have chronic cholecystitis, 52 (13.68%) cholesterolosis, 29 (7.63%) adenomyosis, 20 (5.26%) metaplasia, 15 (3.95%) low grade dysplasia, 10(2.63%) malignancy, 4(1.05%) xanthogranulomatous change and 1(0.26%) carcinoma in situ. Out of these, 100 cases that were willing to provide gallbladder for study were taken as a study group. Sections were stained with Haematoxylin & Eosin for microscopic features and with Warthin Starry Silver stain for Helicobacter hepaticus. Among the study group, 43% cases were found to have chronic cholecystitis, 17% adenomyosis, 13% cholesterolosis, 9% low grade dysplasia, 9% metaplasia, 7% malignancy, 1% carcinoma in situ and 1% xanthogranulomatous change. All the malignant cases were found to be Adenocarcinoma. Out of total 100 cases, 82% cases were found to have Helicobacter hepaticus infection. Only one out of 7 malignant cases (14.29%) was found to be negative for Helicobacter Hepaticus infection. Gallbladder neoplasm was found to be common in Nepal comprising 2.63%. Helicobacter hepaticus infection was found in 82% of gallbladders and it was found in 87.5% of malignant cases. Whether Helicobacter hepaticus that might be the number one cause for the gallstone formation that ultimately leads to malignancy or itself acts as a risk factor for the pathogenesis of carcinoma gallbladder is yet to be determined.

Analysis of etiology and drug resistance of biliary infections / 华中科技大学学报（医学）（英德文版）

The bile was collected from fro patients with biliary infections, with the bacterium isolated to study the sensitivity of each kind of the bacterium to several antibiotics in common use. Except G- bacterium, we also found some kinds of G+ bacterium in infection bile. G- bacterium were not sensitive to Clindamycin, G+ bacterium were sensitive to Ciprofloxacin. Escherichia coli, Xanthomonas maltophilia, Enterobacter cloacae, Pseudomonas aeruginosa were sensitive to Ampicillin. G+ bacterium were not sensitive to Azactam. Enterococcus faecalis, Enterococcus faecium, Enterobacter cloacae were not sensitive to Ceftazidime. Enterococcus faecalis, Staphylococcus coagulase negative, Staphylococcus epidermidis, Pseudomonas aeruginosa were not sensitive to Ceftriaxone Sodium. We didn't found any bacterium resistance Imipenem. The possibility of the existence of G+ bacterium as well as drug resistance should be considered n patients with biliary infections. The value of susceptibility test should be respected to avoid drug abuse of antibiotics.

Estudos dos fatores de risco pré-operatórios para bacteriobilia em doentes portadores de colecistite aguda calculosa / Study of preoperative risk factors for bactibilia in patients with calculosis acute cholecystitis

OBJETIVO: Determinar uma associaçäo entre o quadro clínico pré-operatório e os resultados das culturas de bile e da parece vesicular. CASUISTICA E METODOS: Foram estudadas 28 variáveis considerando-se história clínica, exame físico e investigaçäo laboratorial em 38 doentes portadores de colecistite aguda calculosa, submetidos à cirurgia de urgência. Este estudo prospectivo foi realizado em 19 meses, entre novembro de 1995 a maio de 1997. Foram realizadas culturas para agentes anaeróbios e aeróbios, em três diferentes meios de cultura (BACTEC 9240, BHI e HEMOBAC). RESULTADOS: Foram isoladas bactérias em pelo menos um meio de cultura em 68,2 por cento dos doentes. Pela anßlise univariada, foram identificadas cinco variáveis pré-operatórias como preditivas de bacteriobilia: idade acima de 55 anos, temperatura diferencial axilo-retal maior do que 0,4 C, leucocitose acima de 12000 cels/mmÝ, neutrofilia acima de 75 por cento e neutrófilos bastonetes acima de 4 por cento. Devido ao pequeno tamanho da amostra, näo pôde ser observada significância estatística por regressäo logística, embora pudesse ser observada em 98 por cento uma tendência para determinaçäo pré-operatória dos indivíduos com cultura positiva por meio do modelo baseado na idade e porcentagem de neutrófilos bastonetes. Pela análise em conjunto dos fatores preditivos, pôde-se observar que doentes com mais de um fator preditivo têm uma possibilidade significantemente maior para cultura positiva, quando comparado com aqueles com fator preditivo de bacteriobilia. CONCLUSAO: Conclui-se, portanto, que pela utilizaçäo de dados facilmente disponíveis em doentes com colecistite aguda calculosa, a bacteriobilia pode ser previsível no pré-operatório,

Antibioticoprofilaxis en las colecistectomías: ¿cuál es la mejor alternativa? / Antibiotic prophylaxis in cholecystectomy

Se estudió microbiologicamente el líquido vesicular (LV) de 132 pacientes litiásicos sometidos a colecistectomía. Hubo predominio del sexo femenino (66 por ciento). La presencia de infección fue predominante en aquellos pacientes de mayor edad. Se recuperaron microorganismos en 34 pacientes (20 por ciento); en su gran mayoría fueron aislamientos monomicrobianos (71 por ciento). En la mayoría de los casos el examen directo (Gram) predijo los cultivos positivos. Esto es muy importante, ya que su correlación con los cultivos es alta, por lo que constituye un elemento de guía para la elección racional de la terapia con antibióticos (ATB), sugiere el tipo de ATB, selecciona a los pacientes susceptibles al mismo, ya sea para su prolongación o la transformación de la profilaxis en tratamiento

Actinomycotic cholecystitis.

Actinomycotic cholecystitis is rare. We report a 65-year-old woman who was admitted with repeated attacks of pain in the abdomen and vomiting. Clinical and laboratory findings suggested the diagnosis of cholecystitis with cholelithiasis. At cholecystectomy the gall bladder was inflamed with a small perforation, and contained many calculi. Gram's staining of the gall bladder wall revealed Gram-positive actinomycotic colonies.

Uso de la colecistostomía percutánea en el tratamiento de la colecistitis aguda / Percutaneous cholecystectomy in the treatment of acute cholecystitis

Entre junio de 1988 y abril de 1994, fueron tratados 587 pacientes con colecistitis aguda. En 29 pacientes considerados de alto riesgo (4,8 por ciento) se realizaron colecistectomías percutáneas (CP). Diecisiete eran hombres y 12 mujeres, con una edad promedio de 61,3 años (r19-88). En quince casos la colecistitis fue litiásica (CAL) y en catorce alitiásica (CAA). En 22 casos se utilizó la técnica de Seldinger, y en 7 la de trócar ambas con acceso transhepático. En 27 casos se realizó bajo control ecográfico y en 2 con control tomográfico. En tres casos la respuesta inicial no fue satisfactoria (2 gangrenas vesiculares y 1 persistencia de falla multiorgánica). La morbilidad del método fue del 13 por ciento (2 bacteremias, 1 hemobilia y 1 reacción vagal). La mortalidad de la serie es del 20 por ciento no estando asociada a complicaciones del método. Ocho de los pacientes con CAA se curaron sin requerir cirugía, 4 fallecieron y 2 fueron colecistectomizados por presentar gangrena vesicular. A 9 pacientes con CAL se les resolvió la litiasis vesicular por vía percutánea, 3 fueron a cirugía en condiciones electivas, 2 fallecieron y 1 se negó a completar el tratamiento. La CP es un método seguro y efectivo para el tratamiento de la colecistitis aguda en pacientes de alto riesgo. Representa el tratamiento definitivo para la colecistitis alitiásica, y puede ser transitorio o definitivo para los casos de colecistitis aguda litiásica; permitiendo llevar al paciente en condiciones electivas a la cirugía, o aportando un acceso percutáneo para el tratamiento de litiasis vesicular

Estudo da sensibilidade de germes a antimicrobianos in vitro: resultados iniciais em colecistite aguda litiásica / Sensibility assay in vitro of microorganisms to antibiotics: preliminary results in gallstone acute cholecystitis

Pretende-se atualizar os dados microbiológicos em colecistite aguda litásica identificando os microorganismos eventualmente presentes nesta situaçäo, bem como verificar o aspecto de açäo de algumas drogas antimicrobianas atualmente disponíveis. Com este objetivo, säo incluídos 22 doentes operados em regime de urgência, com diagnósticos pré-operatórios de colecistite aguda litiásica. A bile vesicular, colhida por punçäo no intra-operatório, foi semeada em preparados apropriados para o crescimento de germes aeróbios e de anaeróbios. Verificou-se crescimento bacteriano constituído exclusivamente de germes aeróbios, únicos ou associados. Dos germes identificados, houve predominância de Gram-negativso (75,0%). Entre os microorganismos mais freqüentemente identificados figuravam a Escherichia coli, a Klebsiela pneumoniae e o Streptococcus sp. Foram testados 16 antimicrobianos para Gram-negativos e 19 para Gram-positivos. Verificaram diferentes níveis de resistência bacteriana a cada uma destas drogas. As melhores respostas foram obtidas com o Cloranfenicol (Gram+) e com a Cefotaxima sódica e Pefloxacin (Gram-). A Escherichia coli, germe mais freqüente entre aqueles identificados, mostrou-se, mais vezes, sensível à Gentamicina, Pefloxacin, Cefotaxima sódica e Tobramicina. Conclui-se, ao cotejar com os dados disponíveis na literatura, que a microflora nestas situaçöes näo sofreu alteraçäo ao longo do tempo, porém, qualitativamente, há necessidade periódica de se avaliar a sensibilidade destes germes em relaçäo aos antimicrobianos em uso. Atualmente, os antimicrobianos acima relacionados parecem constituir as melhores opçöes terapêuticas frente a infecçöes agudas das vias biliares

Estudio bacteriológico de la colecistitis aguda / Bacteriological studies of acute cholecystites

El estudio bacteriológico en los pacientes portadores de colecistitis aguda ha permitido establecer una correlación entre los gérmenes hallados, los antibióticos utilizaods y la evolución postoperatoria. De los 143 enfermos con colecistitis aguda, confirmados en la operación y por anatomía patológica, 60,13% mostraron cultivos positivos. La Escherichia coli sola o asociada fue el germen más frecuente, siguiendo en orden de frecuencia: Klebsiella, Estreptococo alfa hemolítico y enterococo. Las tasas de morbimortalidad no guardaron relación con el tipo de germen hallado sino con la positividad o negatividad de los cultivos. Las colecistitis perforadas y las alitiásicas presentaron mayor morbilidad y mortalidad. Cuando los antibióticos fueron utilizados en forma racional no encontramos diferencias significativas entre los distintos esquemas

Bilicultivo de colecistectomizados en el Hospital Nacional Edgardo Rebagliati Martins del IPSS / Cholescistectomized biliculture at the Hospital Nacional Edgardo Rebagliati Martins del IPSS

Se hicieron bilicultivos a 111 pacientes de ambos sexos, colecistectomizados entre mayo y noviembre de 1984, en el Hospital Nacionar "E. Rebagliati M." del I.P.S.S.. El 360% fue del sexo masculino y el 64% del sexo femenino. El 37.8% de los bilicultivos resultaron positivos, el 50% de los bilicultivos hechos a los hombres resultaron positivos mientras que en las mujeres fue sólo el 31%. La positividad estuvo más relacionada a la myor edad. Se relaciona la positividad con la patología vesicular encontrada. La bacteria más frecuentemente aislada fue Escherichia coli. Se identifica por primera vez a Plesiomonas shigelloides en bilicultivos. En el 3.6% del total de cultivos se aisla Salmonella typhi--paratyphy A. El 5% de los jombres y el 2.8% de las mujeres portadoras de S. typhy-paratyphi A