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Acute appendicitis is characterised by local invasion with Fusobacterium nucleatum/necrophorum
  1. Alexander Swidsinski1,2,
  2. Yvonne Dörffel3,
  3. Vera Loening-Baucke1,
  4. Franz Theissig4,
  5. Jens C Rückert5,
  6. Mahmoud Ismail5,
  7. Walter A Rau6,
  8. Dagmar Gaschler6,
  9. Michael Weizenegger7,
  10. Sigmar Kühn8,
  11. Johannes Schilling1,
  12. Wolf V Dörffel9
  1. 1Humboldt University, Charité Hospital, CCM, Laboratory for Molecular Genetics, Polymicrobial Infections and Bacterial Biofilms, Berlin, Germany
  2. 2Department of Medicine, Section of Gastroenterology, Charité Universitätsmedizin Berlin, CCM, Berlin, Germany
  3. 3Outpatient Clinic, Charité Universitätsmedizin Berlin, Berlin, Germany
  4. 4Carl-Thiem-Klinikum, Pathology, Cottbus, Germany
  5. 5Department of General, Visceral, Thoracic and Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
  6. 6Department of Surgery, Oberhavel Kliniken Hennigsdorf, Hennigsdorf, Germany
  7. 7Molekulare Genetik und Mikrobiologie, Limbach Laboratory, Heidelberg, Germany
  8. 8Department of General, Visceral and Thoracic Surgery, Helios Klinikum Bad Saarow, Bad Saarow, Germany
  9. 9Department of Cardiology, Pulmonology, Helios Klinikum Bad Saarow, Bad Saarow, Germany
  1. Correspondence to Dr Alexander Swidsinski, Laboratory for Molecular Genetics, Polymicrobial Infections and Bacterial Biofilms, Charité Universitätsmedizin Berlin, Campus Mitte 10098 Berlin, Germany; alexander.swidsinski{at}


Background Acute appendicitis is a local intestinal inflammation with unclear origin. The aim was to test whether bacteria in appendicitis differ in composition to bacteria found in caecal biopsies from healthy and disease controls.

Methods and patients We investigated sections of 70 appendices using rRNA-based fluorescence in situ hybridisation. Four hundred caecal biopsies and 400 faecal samples from patients with inflammatory bowel disease and other conditions were used as controls. A set of 73 group-specific bacterial probes was applied for the study.

Results The mucosal surface in catarrhal appendicitis showed characteristic lesions of single epithelial cells filled with a mixed bacterial population (‘pinned cells’) without ulceration of the surroundings. Bacteria deeply infiltrated the tissue in suppurative appendicitis. Fusobacteria (mainly Fusobacterium nucleatum and necrophorum) were a specific component of these epithelial and submucosal infiltrates in 62% of patients with proven appendicitis. The presence of Fusobacteria in mucosal lesions correlated positively with the severity of the appendicitis and was completely absent in caecal biopsies from healthy and disease controls. Main faecal microbiota represented by Bacteroides, Eubacterium rectale (Clostridium group XIVa), Faecalibacterium prausnitzii groups and Akkermansia muciniphila were inversely related to the severity of the disease. The occurrence of other bacterial groups within mucosal lesions of acute appendicitis was not related to the severity of the appendicitis. No Fusobacteria were found in rectal swabs of patients with acute appendicitis.

Conclusions Local infection with Fusobacterium nucleatum/necrophorum is responsible for the majority of cases of acute appendicitis.

  • FISH
  • acute appendicitis
  • infection
  • Fusobacteria
  • Fusobacterium nucleatum
  • Fusobacterium necrophorum
  • inflammatory bowel disease
  • invasive bacteria
  • mucosal flora
  • intestinal microbiota
  • polymicrobial infection
  • FISH
  • fluorescence in situ hybridisation
  • Alexa488
  • Cy3, Cy5
  • DAPI
  • different fluorescent dyes corresponding to green, orange, dark red, and blue colours
  • FISH probes abbreviations used in text: Ato291
  • Atopobium
  • Bac303
  • Bacteroides
  • Bif164
  • Bifidobacteriaceae
  • Chis150
  • Clostridium histolyticum
  • Ebac1790
  • Enterobacteriaceae
  • Ecyl1387
  • Eubacterium cylindroides
  • Erec482
  • Clostridium group XIVa
  • Eub338
  • Eubacteria (virtually all bacteria)
  • Fprau
  • Faecalibacterium prausnitzii
  • Fnec
  • Fusobacterium necrophorum
  • Fnuc
  • Fusobacterium nucleatum
  • Fuso
  • Fusobacteria
  • Lab158
  • Lactobacillus
  • Muc1437
  • Akkermansia muciniphila
  • Pasco
  • Phascolarctobacterium faecium
  • Pnig657
  • Prevotella nigrescens
  • Ser1410
  • Serpulina
  • Veil223
  • Veillonella

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  • Competing interests None.

  • Ethics approval The investigations were approved by the Institutional Review Board of the Charité Universitätsmedizin Berlin.

  • Provenance and peer review Not commissioned; externally peer reviewed.