RESUMO
OBJECTIVE: Helicobacter pylori (H pylori) represents a potential initiator of cholesterol crystallization and it has been proposed that it is related to gallstone formation. In this study, any possible association between the H pylori identification in the mucosa of gallbladder and cholesterol gallstone formation was evaluated. METHODS: Gallbladders containing pure or mixed cholesterol gallstones (cholelithiasis group, n = 89) and gallbladders without gallstones (control group, n = 42) were submitted to standard histopathological examination for H pylori detection, as well as to nested polymerase chain reaction amplification for H pylori DNA detection. RESULTS: Helicobacter pylori was identified in the gallbladder's epithelium in four patients with cholelithiasis and in two patients in the control group by histology. In all the cases which were found to be H pylori positive by histological examination, H pylori DNA were also detected. No correlation between gallstone formation and H pylori detection in the biliary epithelium was found. A higher incidence of acute inflammation in the cholelithiasis (22.5% vs 9.5%, p = not significant [ns]) and in the H pylori positive groups (33% vs 17.6%, p = ns) were histologically detected. A higher incidence (10% vs 0%), p = ns) of H pylori in gallbladders with gallstones and acute inflammation, compared to gallbladders with acute inflammation but without gallstones, was noticed. CONCLUSION: Helicobacter pylori is detectable in low frequency in the mucosa of the gallbladder and it does not seem to act as a lithogenic component for cholesterol gallstone formation. Its higher incidence in gallbladders with gallstones and acute inflammation, suggests a possible accessory role in a subset of patients with cholelithiasis.
OBJETIVO: Helicobacter pylori (H pylori) representa un iniciador potencial de la cristalización del colesterol, y se ha propuesto que guarda relación con la formación del cálculo biliar. En este estudio, se evaluó cualquier posible asociación entre la identificación de H pylori en la mucosa de la vesícula y la formación del cálculo biliar de colesterol. MÉTODOS: Las vesículas que contienen cálculos biliares de colesterol puros o mixtos (grupo de colelitiasis, n = 89) y vesículas sin cálculos biliares (grupo control, n = 42) fueron sometidos a un examen histopatológico estándar con el fin de detectar el H pylori descubrimiento, así como a la amplificación de la reacción en cadena de polimerasa para la detección de ADN H pilori. RESULTOS: El Helicobacter pylori fue identificado mediante histología en el epitelio de la vesícula en cuatro pacientes con el colelitiasis y en dos pacientes en el grupo de control. En todos los casos que resultaron ser H pylori positivo por el examen histológico, se halló también DNA H pylori. No se halló correlación ninguna entre la formación del cálculo biliar y la detección de H pylori en el epitelio biliar. Se detectó histológicamente una incidencia más alta de inflamación aguda en la colelitiasis (22.5% contra 9.5%, p = no significativo [ns]) y en los grupos H pylori positivos (33% contra 17.6%, p = ns). Se observó una incidencia más alta (10% contra 0%), p = ns) de H pylori en las vesículas con los cálculos biliares e inflamación aguda, en comparación con las vesículas con la inflamación aguda pero sin cálculos biliares. CONCLUSIÓN: Helicobacter pylori es detectable en baja frecuencia en la mucosa de la vesícula y no parece actuar como un componente litogénico en la formación del cálculo biliar de colesterol. Su mayor incidencia en las vesículas con cálculo biliar e inflamación aguda, hace pensar en un posible papel auxiliar en un subconjunto de pacientes con colelitiasis.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vesícula Biliar/microbiologia , Cálculos Biliares/microbiologia , Helicobacter pylori/isolamento & purificação , Mucosa Intestinal/microbiologia , Estudos de Casos e Controles , DNA Bacteriano/análise , Histocitoquímica , Reação em Cadeia da PolimeraseRESUMO
OBJECTIVE: Helicobacter pylori (H pylori) represents a potential initiator of cholesterol crystallization and it has been proposed that it is related to gallstone formation. In this study, any possible association between the H pylori identification in the mucosa of gallbladder and cholesterol gallstone formation was evaluated METHODS: Gallbladders containing pure or mixed cholesterol gallstones (cholelithiasis group, n = 89) and gallbladders without gallstones (control group, n = 42) were submitted to standard histopathological examination for H pylori detection, as well as to nested polymerase chain reaction amplification for H pylori DNA detection. RESULTS: Helicobacter pylori was identified in the gallbladder's epithelium in four patients with cholelithiasis and in two patients in the control group by histology. In all the cases which were found to be H pylori positive by histological examination, H pylori DNA were also detected. No correlation between gallstone formation and H pylori detection in the biliary epithelium was found. A higher incidence of acute inflammation in the cholelithiasis (22.5% vs 9.5%, p = not significant [ns]) and in the H pylori positive groups (33% vs 17.6%, p = ns) were histologically detected. A higher incidence (10% vs 0%), p = ns) of H pylori in gallbladders with gallstones and acute inflammation, compared to gallbladders with acute inflammation but without gallstones, was noticed CONCLUSION: Helicobacter pylori is detectable in low frequency in the mucosa of the gallbladder and it does not seem to act as a lithogenic component for cholesterol gallstone formation. Its higher incidence in gallbladders with gallstones and acute inflammation, suggests a possible accessory role in a subset of patients with cholelithiasis.
Assuntos
Vesícula Biliar/microbiologia , Cálculos Biliares/microbiologia , Helicobacter pylori/isolamento & purificação , Mucosa Intestinal/microbiologia , Idoso , Estudos de Casos e Controles , DNA Bacteriano/análise , Feminino , Histocitoquímica , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da PolimeraseRESUMO
AIM: The present study was designed to investigate the microbiology of choledochal bile of patients with cholangitis and choledocholithiasis. METHODS: We identified and determined the antimicrobial susceptibility of bacteria isolated in the bile of patients with cholangitis and choledocholithiasis diagnosed by endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: Nineteen (82.6%) of 23 patients with choledocholithiasis had positive bile cultures. A single agent was detected in 11 patients (57.9%), while a mixed growth, with pathogens ranging from two to three species, were seen in eight patients (42.1%). Patients with clinical manifestations of cholangitis had significantly higher counts of colonies per mL of bile (> 105 cfu/mL). The predominant Gram-negative aerobic bacteria isolated were Escherichia coli (9, 31.0%), Klebsiella pneumoniae (5, 17.2%), Enterobacter cloacae (2, 6.9%), Pantoea agglomerans (1, 3.4%), and Pseudomonas aeruginosa (1, 3.4%). The predominant Gram-positive bacteria were Enterococcus faecalis (5, 17.2%) and Streptococcus sp. (5, 17.2%). Bacteroides fragilis was isolated in one patient with mixed growth. All Gram-positive bacteria isolated in bile were sensitive to ampicillin, and all Gram-negative bacteria isolated were sensitive to gentamicin with a minimum inhibitory concentration (CIM90) ranging from 0.5 to 1.0- micro g/mL. Gram-negative bacteria were also sensitive to imipenem, fluorquinolones, second and third generation cephalosporins. Although all five isolates of E. faecalis were sensitive to ampicillin, two of five (40%) E. faecalis isolates demonstrated high levels of resistance to gentamicin. CONCLUSION: E. coli, K. pneumoniae, E. faecalis and Streptoccocus sp. were the most common bacteria isolated in the bile of patients with cholangitis and choledocholithiasis, which were sensitive to a simple therapeutic regimen, such as the combination of ampicilin and gentamicin.
Assuntos
Ducto Colédoco/microbiologia , Ducto Colédoco/patologia , Cálculos Biliares/microbiologia , Cálculos Biliares/terapia , Admissão do Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Brasil , Cefalosporinas/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica , Ducto Colédoco/diagnóstico por imagem , Suscetibilidade a Doenças/diagnóstico , Suscetibilidade a Doenças/microbiologia , Suscetibilidade a Doenças/terapia , Feminino , Cálculos Biliares/diagnóstico , Gentamicinas/uso terapêutico , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/terapia , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Imipenem/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND/AIMS: The number of colonies of bacteria and the number of pyocites present per ml of choledochal bile was studied. PATIENTS AND METHODS: There were 42 controls, 100 patients with symptomatic gallstones, 42 patients with common duct stones without cholangitis and 24 patients with common duct stones and acute cholangitis. RESULTS: Control subjects had no bacteria present at gallbladder bile. Only 3% of patients with gallstones had more than 10(5) colonies per ml which increased to 36% in patients with common duct stones without cholangitis and to 84% among patients with acute cholangitis (p < 0.001). There were more polybacterial flora among patients with acute cholangitis and anaerobic bacteria were not seen in patients with gallstones. Patients with acute cholangitis had significantly more pyocites present at choledochal bile. CONCLUSION: There is a direct correlation between the number of colonies present per ml of choledochal bile and the severity of biliary tract disease. Patients with acute cholangitis had significantly more pyocites present at choledochal bile compared to gallstones or patients with CBD stones without cholangitis.
Assuntos
Bile/microbiologia , Colangite/microbiologia , Colelitíase/microbiologia , Cálculos Biliares/microbiologia , Doença Aguda , Idoso , Bile/citologia , Estudos de Casos e Controles , Colangite/etiologia , Colelitíase/complicações , Contagem de Colônia Microbiana , Feminino , Cálculos Biliares/complicações , Humanos , Macrófagos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: To determine the simultaneous prevalence of bacteria in bile from the gallbladder and common bile duct and to determine the influence of the number of stones present on bacteriologic findings. METHODS: A prospective study was performed in 467 subjects divided into seven groups: 42 control subjects with normal biliary tracts, 221 patients with symptomatic gallstone disease, 12 patients with hydropic gallbladder, 52 patients with acute cholecystitis, 67 patients with common bile duct stones without cholangitis, 49 patients with common bile duct stones and acute cholangitis, and 24 patients with previous cholecystectomy and common bile duct stones. In all except controls, bile samples from the gallbladder and common bile duct were taken simultaneously for aerobic and anaerobic cultures. RESULTS: Control subjects had no bacteria in gallbladder bile. Patients with gallstones, acute cholecystitis, and hydropic gallbladder had similar rates of positive cultures in the gallbladder and common bile duct, ranging from 22% to 46%, but the rate was significantly higher in patients with common bile duct stones without cholangitis (58.2%). Patients with cholangitis or previous cholecystectomy had a high rate of positive cultures of common duct bile (93% to 100%). Age greater than 60 years had a significant influence on the rate of positive bile cultures. There was no relationship between the number of stones in the gallbladder or common bile duct and the percentage of positive cultures. In 98% of the patients, the same bacteria were isolated from gallbladder and common duct bile. CONCLUSIONS: In normal subjects, no bacteria were present in the biliary tract. Among patients with common bile duct stones, there was an increasing percentage of positive cultures according to the severity of the disease. Age had an important influence, but sex and the number of common bile duct stones had no influence on positive cultures.
Assuntos
Bactérias/isolamento & purificação , Bile/microbiologia , Colelitíase/microbiologia , Cálculos Biliares/microbiologia , Doença Aguda , Adulto , Fatores Etários , Idoso , Colecistite/etiologia , Colecistite/microbiologia , Colelitíase/complicações , Doença Crônica , Ducto Colédoco , Feminino , Vesícula Biliar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND/AIMS: The presence of aerobic and/or anaerobic bacteria in the liver parenchyma, gallbladder bile, and common bile duct was investigated. MATERIALS AND METHODS: There were 15 control subjects, 32 cases with symptomatic gallstones, 16 patients with common bile duct stones without acute cholangitis and 8 cases with common bile duct stones with an acute suppurative cholangitis. RESULTS: No bacteria were isolated in controls. The percentage of positive cultures in liver parenchyma increased in proportion to the severity of the biliary tract disease. There was no clear correlation between normal and altered hepatic histology and the presence or absence of bacteria except in patients with acute cholangitis. CONCLUSIONS: When biliary tract obstruction is present, the biliary tract is more vulnerable to invasion of bacteria and therefore increases the chance of spread into the liver parenchyma.
Assuntos
Bactérias Aeróbias/isolamento & purificação , Bactérias Anaeróbias/isolamento & purificação , Colangite/microbiologia , Colelitíase/microbiologia , Cálculos Biliares/microbiologia , Fígado/microbiologia , Doença Aguda , Idoso , Bile/microbiologia , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Manejo de EspécimesRESUMO
OBJECTIVE: To compare the presence of bacteria of bile from the gallbladder in control subjects, patients with gallstones, and patients with carcinoma of the gallbladder. DESIGN: Prospective open study. SETTING: University department of surgery. SUBJECTS: 372 patients of whom 36 had no signs of gallbladder disease; 211 underwent cholecystectomy for either symptomatic gallstone disease (n = 165) or acute cholecystitis (n = 46); 67 had common bile duct stones and 58 were operated on for carcinoma of the gallbladder. INTERVENTIONS: Aspiration of bile from the gallbladder. MAIN OUTCOME MEASURES: Prevalence of pathogenic bacteria in bile from the gallbladder and correlations between the presence of bacteria, the presence of cancer, and age. RESULTS: No pathogenic bacteria were grown from the bile of the patients who had no signs of gallstones disease. Among the 165 with symptomatic gallstone disease 52 (32%) had pathogens in their bile, and among the 46 with acute cholecystitis the corresponding figure was 19 (41%) while among patients with common bile duct stones this figure was 39 (58%). Among the 58 patients with carcinoma of the gallbladder the bile grew organism in 47 (81%). Patients over the age of 60 years tended to be more likely to have organism in their bile than patients aged 60 or less, and the difference was significant for symptomatic gallstone disease (p < 0.003). Significant differences were also found between patients with symptomatic gallstone disease and those with carcinoma of the gallbladder in both age groups (p < 0.002 in each case). Most of the organism were aerobic or anaerobic Gram negative species, irrespective of type of disease or age. CONCLUSION: Bacteria may have a role in the development of carcinoma of the gallbladder.
Assuntos
Bile/microbiologia , Colelitíase/microbiologia , Neoplasias da Vesícula Biliar/microbiologia , Vesícula Biliar/microbiologia , Cálculos Biliares/microbiologia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
La bilis de pacientes con enfermedad calculosa puede estar colonizada por bacterias. Este trabajo busca determinar la frecuencia de cultivos, tipo de germenes, factores de alto riesgo para la colonizacion y numero de bacterias que podria sugerir infeccion biliar. Se llevo a cabo un estudio prospectivo de 49 pacientes consecutivos sometidos a cirugia por enfermedad lisiatica de vesicula y/o via biliar. Los cultivos fueron positivos en 21 pacientes (43//), la bacteria predominante fue Scherichia coli en 48//. La frecuencia de colonizacion biliar en pacientes del grupo de alto riesgo fue de 67//, y de 35// en aquellos pacientes sin factores de riesgo. En 18// de los casos existian 3 o mas factores de riesgo. El recuento de colonias fue menor de 100.000 en 86// de los pacientes. Los resultados sugieren que la colonizacion bacteriana de la bilis podria ser mayor cuando existen factores de riesgo. Los microorganismos aislados son similares a los senalados por otros autores con la exepcion de Salmonella typhi que no fue identificada en este estudio. En el recuento de colonias no se logro determinar una cifra que nos pueda indicar especificamente infeccion biliar
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Bactérias/patogenicidade , Bile/microbiologia , Bolívia/epidemiologia , Células Cultivadas , Colangite , Colelitíase/cirurgia , Empiema/microbiologia , Escherichia coli/crescimento & desenvolvimento , Cálculos Biliares/microbiologia , Icterícia/fisiopatologia , Características de Residência , Fatores de RiscoRESUMO
1. La bacteriobilia cursa sin síntomas ni signos de infección en aproximadamente el 25% de los pacientes portadores de colecisto y coledocolitiasis. 2. El recuento de colonias bacterianas, en la bilis del colédoco no es un parámetro bacteriológico confiable para precisar la gravedad de la infección biliar. 3. El examen directo es un método sensible pero inespecífico para el diagnóstico de colangitis. 4. La prevalencia de gérmenes infectantes de la bilis, no se ha modificado y la Escherichia coli, la Klebsiella pneumoniae y el Estreptococo viridans siguen ocupando los primeros lugares. 5. Los anaerobios (Clostridium y Bacteroides fragilis) están presentes en la bilis del 10 a 30% de las colangitis agudas y constituyen un elemento de mal pronóstico. 6. Existen otros factores, independientes del número de bacterias, que determinan la gravedad del cuadro clínico de la infección biliar
Assuntos
Humanos , Masculino , Feminino , Bile/microbiologia , Cálculos Biliares/microbiologia , ColecistectomiaRESUMO
A clinicobacteriological survey was undertaken in 55 patients undergoing biliary surgery, because of chronic and acute cholecystitis. Some radiological preoperative and operative aspects were analised in order to detect any relation of these aspects with biliary tract infection. The bile cultures were positive in 34,5% and 20,0% for aerobes an anaerobes microorganisms respectively. The microorganisms most frequently isolated were Escherichia coli, Pseudomonas aeruginosa, Klebsiella, Bacteroides sp and Clostridium sp, as aerobian and anaerobian. The statistical analysis showed significance between the presence of bacteria in the biliary tract and pathological operative cholangiography. It had not significance with the radiological preoperative aspects.