[Bacterial ileocecitis, a "new" disease]. / Bacteriële ileocaecitis, een 'nieuwe' ziekte.

786 patients with suspected acute appendicitis or appendiceal mass were examined by ultrasonography to distinguish appendicitis from bacterial enteritis. 533 of these patients were described before. In 91 (11.6%) ultrasonography revealed the characteristic picture associated with bacterial enteritis of the ileocaecal region-enlarged mesenteric lymph nodes and mural thickening of the terminal ileum and caecum--but no image of an inflamed appendix. In 64 of these a bacterial infection was confirmed (Yersinia enterocolitica in 28, Campylobacter jejuni in 24, Salmonella enteritidis in 11, Yersinia pseudotuberculosis in one). In the other 27, bacteriological tests were negative (17) or not performed (10). Only 34 of 91 had diarrhoea. Six of the 91 patients underwent surgery, in all of them the removed appendix was normal. The other 85 patients recovered with conservative treatment. In 38 a planned appendicectomy was cancelled because of the sonographic findings. Bacterial enteritis limited to the ileocaecal region (bacterial ileocecitis) appears to be responsible for an appreciable number of unnecessary appendicectomies. It has characteristic sonographic features which distinguish it from appendicitis.

Incidence and sonographic diagnosis of bacterial ileocaecitis masquerading as appendicitis.

533 consecutive patients with suspected acute appendicitis or appendiceal mass were examined by ultrasonography to distinguish acute appendicitis from bacterial enteritis. In 61 (11.4%) ultrasonography revealed the characteristic picture associated with bacterial enteritis of the ileocaecal region--enlarged mesenteric lymph nodes and mural thickening of the terminal ileum and caecum--but no image of the appendix. In 41 of these a bacterial infection was confirmed: infection due to Yersinia enterocolitica in 21, Campylobacter jejuni in 15, Salmonella B in 3, Salmonella C in 1, and Yersinia pseudotuberculosis in 1. In the other 20 bacteriological tests were negative (10) or not done (10). Oral barium studies, done in 15 patients, showed thickening of the terminal ileum in all of them. Only 22 of the 61 patients had diarrhoea. Yersinia enteritis clinically simulated an appendiceal mass in 17 of 22 patients, 6 of the 61 patients underwent surgery, and in all of them the appendix removed was normal. The other 55 patients recovered with conservative treatment. In 26 a planned appendicectomy was cancelled because of the sonographic findings. Bacterial enteritis limited to the ileocaecal region (bacterial ileocaecitis) seems to be responsible for an appreciable number of unnecessary appendicetomies. It has characteristic sonographic features that distinguish it from appendicitis.

Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study.

The efficacy of a relatively cheap regimen of selective decontamination (SDD) was evaluated in a diverse population of ICU patients. Patients requiring prolonged ICU stay (greater than 5 days) were randomly allocated to a treatment group or control group. Control patients (n = 52) received perioperative antimicrobial prophylaxis and antibiotic treatment was instituted only on sound clinical and bacteriological criteria. Treated patients (n = 48) received gastro-intestinal and oro-pharyngeal decontamination with polymyxin E, norfloxacin, amphotericin B and systemic antibiotic prophylaxis with trimethoprim until decontamination was achieved. The rate of gram-positive infections was not altered by SDD. The incidence of gram-negative respiratory tract, urinary tract and line infections was significantly reduced from 44%, 27% and 15% respectively in the control group to 6%, 4% and 0% in the treatment group. Mortality from nosocomial sepsis and overall mortality were also significantly reduced from 15% and 54% to 0% and 31% respectively. The ICU stay was not reduced by SDD, nor was time on the ventilator or use of therapeutic antibiotics. The reduction in morbidity and mortality was achieved at a relatively low cost.

Basal meningovasculitis and occlusion of the basilar artery in two cases of Borrelia burgdorferi infection.

We present two cases in which a meningovasculitis and occlusion of the basilar artery were found in young adults with a Borrelia burgdorferi infection. We introduce the designation "neuroborreliosis," because both the central and peripheral nervous systems can be involved in the infection.

Surveillance of the antibiotic susceptibility of non-penicillinase producing Neisseria gonorrhoeae in The Netherlands from 1983 to 1986.

From 1983 to 1986 more than 2000 non-penicillinase producing Neisseria gonorrhoeae from Amsterdam, The Hague and Rotterdam were auxotyped and screened for susceptibility to 10 antibiotics by MIC determination. By far the commonest auxotypes were N.R. (non-requiring; 40%) and Pro- (proline requiring; 30%). During that period there was a substantial shift in the ratio of both auxotypes-roughly from 1:2 to 2:1-in The Hague. Pro- isolates were generally less susceptible than N.R. isolates, and there was a strong positive correlation between the MICs of the different drugs. The prevalence of isolates with a penicillin MIC equal to or above 0.5 IU/ml amounted to 14%, while in only 1% was the MIC above 1 IU/ml. Comparing our results with an earlier study by Stolz, Zwarte & Michel (1975, British Journal of Venereal Diseases 51, 257-64), the level of resistance to penicillin among non-PPNG has not significantly increased in The Netherlands since 1972. The prevalence of isolates showing relative resistance towards tetracycline and thiamphenicol (MIC 2-4 mg/l) decreased from approximately 20% in 1983/84 to approximately 10% in 1985/86, coinciding with a drop in the prevalence of Pro- isolates. All strains were susceptible to cefuroxime and spectinomycin and highly susceptible to cefotaxime and ciprofloxacin.

Campylobacter ileocolitis mimicking acute appendicitis: differentiation with graded-compression US.

In nine patients with clinical symptoms of acute appendicitis, graded-compression ultrasound (US) did not depict the appendix but instead demonstrated mural thickening of the terminal ileum and part of the colon, as well as moderately enlarged mesenteric lymph nodes. In one patient a normal appendix was removed; eight patients recovered without treatment. Infection with Campylobacter jejuni was proved in all nine patients. In four patients, an unnecessary appendectomy was avoided because of the US findings. Graded-compression US enables differentiation between acute appendicitis and Campylobacter ileocolitis, a vital differentiation, since surgery is almost certainly not indicated for the latter.