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Acute appendicitis is characterized by local invasion with Fusobacterium nucleatum/necrophorum
  1. Alexander Swidsinski1,*,
  2. Yvonne Doerffel1,
  3. Vera Loening-Baucke2,
  4. Franz Theissig3,
  5. Jens C Rückert4,
  6. Mahmoud Ismail4,
  7. Walter A Rau5,
  8. Dagmar Gaschler5,
  9. Michael Weizenegger6,
  10. Sigmar Kühn7,
  11. Johannes Schilling1,
  12. Wolf V. Doerffel8
  1. 1 Humboldt University, Charite, Germany;
  2. 2 Charite Hospital, United States;
  3. 3 Carl-Thiem-Klinikum, Pathology, Germany;
  4. 4 Department of General, Visceral, Thoracic and Vascular Surgery, Charité, Germany;
  5. 5 Department of Surgery, Oberhavel Kliniken Hennigsdorf, Germany;
  6. 6 Molekulare Genetik und Mikrobiologie, Labor Dr. Limbach, Heidelberg, Germany;
  7. 7 Department of General, Visceral and Thoracic Surgery, Helios Klinikum Bad Saarow, Germany;
  8. 8 Department of Cardiology, Pumunology, Helios Klinikum Bad Saarow, Germany
  1. Correspondence to: Alexander Swidsinski, Gastroenterology, Humboldt University, Charite, Humboldt Universität, Charite, Campus Mitte, Berlin, 10247, 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 cecal biopsies from healthy and disease controls.

Methods and patients: We investigated sections of 70 appendices using rRNA-based fluorescence in situ hybridization. Four hundred cecal 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 cecal biopsies from healthy and disease controls. Main fecal microbiota represented by Bacteroides, Eubacterium rectale, 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.

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