1887

Journal of Medical Microbiology logo

Volume 18, Issue 3

The Microbial Flora of the Rectal Mucosa and Faeces of Patients with Crohn’s Disease Before and During Antimicrobial Chemotherapy Free

Abstract

SUMMARY

The faecal flora and mucosa-associated flora (MAF) of rectal biopsy material from 12 patients with active Crohn’s disease were studied before and during treatment with a combination of metronidazole and cotrimoxazole given orally for at least 2 weeks. The total faecal flora was greater than the MAF although the proportions of bacterial groups were similar. The changes observed during treatment were: obligate anaerobes such as spp. decreased in faeces (p ≪ 0.05) and in MAF (p ≪ 0.02); the total count of facultative bacteria increased in the faeces (p≪ 0.002) but not in the MAF. Steptococci, predominantly enterococci, increased significantly in faeces (p≪0.001) and in MAF (p ≪ 0.02) such that they became predominant components of these florae. Facultative gram-negative bacilli were unaltered in faeces but significantly reduced in the MAF (p≪0.05). Sporing Clostridia were infrequently isolated from the MAF but were significantly reduced in the faeces (p ≪0.01).

During the treatment period, eight of the 12 patients showed clinical improvement, but this could not be related to the site or extent of disease or to specific changes in faecal flora or MAF. This combination of antibacterial agents causes profound alterations to the bacterial flora of mucosa and faeces and these changes may help to define the role of bacteria in the pathogenesis of Crohn’s disease.

  • Received:
  • Accepted:
  • Published Online:
© J. MED. MICROBIOL. 1984
Loading

Article metrics loading...

/content/journal/jmm/10.1099/00222615-18-3-335
1984-12-01
2023-05-29
Loading full text...

Full text loading...

/deliver/fulltext/jmm/18/3/medmicro-18-3-335.html?itemId=/content/journal/jmm/10.1099/00222615-18-3-335&mimeType=html&fmt=ahah

References

  1. Aluwihare A. P. R. 1971; Electron microscopy in Crohn’s disease.. Gut 12:509–518
     [Google Scholar]
  2. Bernstein L. H., Frank M. S., Brandt L. J., Boley S. J. 1980; Healing of perineal Crohn’s disease with metronidazole.. Gastroenterology 79:357–365
     [Google Scholar]
  3. Best W. R. 1970; On the logarithmic transformation of intestinal bacterial counts.. American Journal of Clinical Nutrition 23:1608–1609
     [Google Scholar]
  4. Blichfeldt P., Blomhoff J. P., Myhre E., Gjone E. 1978; Metronidazole in Crohn’s disease: A double-blind cross-over clinical trial.. Scandinavian Journal of Gastroenterology 13:123–127
     [Google Scholar]
  5. Borriello S. P., Hudson M. J., Hill M. J. 1978; Investigation of the gastrointestinal bacterial flora.. Clinics in Gastroenterology 7:329–349
     [Google Scholar]
  6. Brandt L. J., Bernstein L. H., Boley S. J., Frank M. S. 1982; Metronidazole therapy for perineal Crohn’s disease: a follow-up study.. Gastroenterology 83:383–387
     [Google Scholar]
  7. Brandtzaeg P., Baklien K. 1976; Immunohistochemical studies of the formation and epithelial transport of immunoglobulins in normal and diseased human intestinal mucosa.. Scandinavian Journal of Gastroenterology ll: Suppl 361–45
     [Google Scholar]
  8. Brown W. R., Lee E. 1974; Radioimmunological measurements of bacterial antibodies: II. Human serum antibodies reactive with Bacteroides fragilis and enterococcus in gastrointestinal and immunological disorders.. Gastroenterology 66:1145–1153
     [Google Scholar]
  9. Cowan S. T. 1974; Cowan and Steel’s manual for the identification of medical bacteria. 2nd edn Cambridge University Press; Cambridge:
     [Google Scholar]
  10. Croucher S. C., Houston A. P., Bayliss C. E., Turner R. J. 1983; Bacterial populations associated with different regions of the human colon wall.. Applied and Environmental Microbiology 45:1025–1033
     [Google Scholar]
  11. Crowther J. S. 1971; Transport and storage of faeces for bacteriological examination.. Journal of Applied Bacteriology 34:477–483
     [Google Scholar]
  12. Donnelly L. S., Hartman P. A. 1978; Gentamicin-based medium for the isolation of Group D streptococci and application of the medium to water analysis.. Applied and Environmental Microbiology 35:576–581
     [Google Scholar]
  13. Dowell V. R., Lombard G. L., Thompson F. S., Armfield A. Y. 1977; Media for the isolation, characterization and identification of obligately anaerobic bacteria. US Department of Health, Education and Welfare, Center for Disease Control; Atlanta, GA:
     [Google Scholar]
  14. Drasar B. 1974; The isolation and identification of non-sporing anaerobes. In Phillips I., Sussman M. (eds) Infection with non-sporing anaerobic bacteria Churchill-Livingstone; Edinburgh: pp 20–36
     [Google Scholar]
  15. Edmiston C. E., Avant G. R., Wilson F. A. 1982; Anaerobic bacterial populations on normal and diseased human biopsy tissue obtained at colonoscopy.. Applied and Environmental Microbiology 43:1173–1181
     [Google Scholar]
  16. Gargan R. A., Phillips I. 1978; Performance of converted pressure cookers and two conventional jars for anaerobic bacterial culture.. Journal of Clinical Pathology 31:426–429
     [Google Scholar]
  17. Gorbach S. L., Nahas L., Plaut A. G., Weinstein L., Patterson J. F., Leviton R. 1968; Studies of intestinal microflora. V. Fecal microbial ecology in ulcerative colitis and regional enteritis: relationship to severity of disease and chemotherapy.. Gastroenterology 54:575–587
     [Google Scholar]
  18. Gump D., Caul E., Eade O., Greenberg H., Kapikian A., Macpherson B., Mitchell P., Parent K., Richmond S., Beeken W. 1981; Lymphocytotoxic and microbial antibodies in Crohn’s disease and matched controls.. Antonie van Leeuwenhoek 47:455–464
     [Google Scholar]
  19. Hartley C. L., Neumann C. S., Richmond M. H. 1979; Adhesion of commensal bacteria to the large intestine wall in humans.. Infection and Immunity 23:128–132
     [Google Scholar]
  20. Helphingstine C. J., Hentges D. J., Campbell B. J., Butt J., Barrett J. T. 1979; Antibodies detectable by counterimmunoelectrophoresis against Bacteroides antigens in serum of patients with inflammatory bowel disease.. Journal of Clinical Microbiology 9:373–378
     [Google Scholar]
  21. Holdeman L. V., Cato E. P., Moore W. E. C. 1977; Anaerobe laboratory manual. 4th edn Virginia Polytechnic Institute and State University; Blacksburg, VA:
     [Google Scholar]
  22. Kasper H., Sommer H., Kuhn H. A. 1979; Therapy of Crohn’s disease with metronidazole—an uncontrolled trial.. Acta Hepato-gastroenterology 26:217–221
     [Google Scholar]
  23. Keighley M. R. B., Arabi Y., Dimock F., Burdon D. W., Allan R. N., Alexander-Williams J. 1978; Influence of inflammatory bowel disease on intestinal microflora.. Gut 19:1099–1104
     [Google Scholar]
  24. Koransky J. R., Allen S. D., Dowell V. R. 1978; Use of ethanol for selective isolation of sporeforming microorganisms.. Applied and Environmental Microbiology 35:762–765
     [Google Scholar]
  25. Krook A. 1981; Effect of metronidazole and sulfasalazine on the normal human fecal flora.. Scandinavian Journal of Gastroenterology 16:587–592
     [Google Scholar]
  26. Krook A., Danielsson D., Kjellander J., Jarnerot G. 1981a; The effect of metronidazole and sulfasalazine on the fecal flora in patients with Crohn’s disease.. Scandinavian Journal of Gastroenterology 16:183–192
     [Google Scholar]
  27. Krook A., Jarnerot G., Danielsson D. 1981b; Clinical effect of metronidazole and sulfasalazine on Crohn’s disease in relation to changes in the fecal flora.. Scandinavian Journal of Gastroenterology 16:569–575
     [Google Scholar]
  28. Lennard-Jones J. E., Ritchie J. K., Zohrab W. J. 1976; Proctocolitis and Crohn’s disease of the colon: a comparison of the clinical course.. Gut 17:477–482
     [Google Scholar]
  29. Marks C. G., Hawley P. R., Peach S. L., Drasar B. S., Hill M. J. 1979; The effects of phthalylsulphathiazole on the bacteria of the colonic mucosa and intestinal contents as revealed by the examination of surgical samples.. Scandinavian Journal of Gastroenter ology 14:891–896
     [Google Scholar]
  30. Matthews N., Mayberry J. F., Rhodes J., Neale L., Munro J., Wensinck F., Lawson G. H. K., Rowland A. C., Berkhoff G. A., Barthold S. W. 1980; Agglutinins to bacteria in Crohn’s disease.. Gut 21:376–380
     [Google Scholar]
  31. MeijerC J. L. M., Bosman F. T., Lindeman J. 1979; Evidence for a predominant involvement of the B-cell system in the inflammatory process in Crohn’s disease.. Scandinavian Journal of Gastroenterology 14:21–32
     [Google Scholar]
  32. Miles A. A., Misra S. S., Irwin J. O. 1938; The estimation of the bactericidal power of the blood.. Journal of Hygiene 38:732–749
     [Google Scholar]
  33. Moss A. A., Carbone J. V., Kressel H. Y. 1978; Radiologic and clinical assessment of broad-spectrum antibiotic therapy in Crohn’s disease.. American Journal of Roentgenology 131:787–790
     [Google Scholar]
  34. Peach S. L., Lock M. R., Katz D., Todd I. P., Tabaqchali S. 1978; Mucosal-associated bacterial flora of the intestine in patients with Crohn’s disease and in a control group.. Gut 19:1034–1042
     [Google Scholar]
  35. Persson S., Danielsson D. 1979; On the occurrence of serum antibodies to Bacteroides fragilis and serogroups of Escherichia coli in patients with Crohn’s disease.. Scandinavian Journal of Infectious Disease Supplement 19:61–67
     [Google Scholar]
  36. Preston N. W., Morrell A. 1962; Reproducible results with the Gram stain.. Journal of Pathology and Bacteriology 84:241–243
     [Google Scholar]
  37. Rogosa M. 1956; A selective medium for the isolation and enumeration of the veillonella from the oral cavity.. Journal of Bacteriology 72:533–536
     [Google Scholar]
  38. Rosen A., Ursing B., Aim T., Barany F., Bergelin I., Norlin K., Hoevels J., Huitfeldt B., Jarnerot G., Krause U., Krook A., Lindstrom B., Nordle O. 1982; A comparative study of metronidazole and sulfasalazine for active Crohn’s disease: the cooperative Crohns’ disease study in Sweden. I. Design and Methodologic considerations. Gastroenterology 83:541–549
     [Google Scholar]
  39. Ruseler-vanEmbden J. G. H., Patoir H. C. 1983; Anaerobic gram-negative faecal flora in patients with Crohn’s disease and healthy subjects.. Antonie van Leeuwenhoek 49:125–132
     [Google Scholar]
  40. Sutter V. L., Citron D. M., Finegold S. M. 1980; Wadsworth anaerobic bacteriology manual. 3rd edn C V Mosby Co.; St Louis:
     [Google Scholar]
  41. Tabaqchali S., Donoghue D. P., Bettelheim K. A. 1978; Escherichia coli antibodies in patients with inflammatory bowel disease.. Gut 19:108–113
     [Google Scholar]
  42. Ursing B., Kamme C. 1975; Metronidazole for Crohn’s disease.. Lancet 1:775–777
     [Google Scholar]
  43. Ursing B., Aim T., Barany F., Bergelin I., Norlin K., Hoevels J., Huitfeldt B., Nordle O., Rosen A. 1982; A comparative study of metronidazole and sulfasalazine for active Crohn’s disease: the co-operative Crohn’s disease study in Sweden. II. Result.. Gastroenterology 83:550–562
     [Google Scholar]
  44. Vince A., Dyer N. H., Grady F. W., Dawson A. M. 1972; Bacteriological studies in Crohn’s disease.. Journal of Medical Microbiology 5:219–229
     [Google Scholar]
  45. Wensinck F. 1975; The faecal flora of patients with Crohn’s disease.. Antonie van Leeuwenhoek 41:214–215
     [Google Scholar]
  46. Wensinck F., VanLieshout L. M. C., Kustermans P. A. J., Schroder A. M. 1981; The faecal flora of patients with Crohn’s disease.. Journal of Hygiene 87:1–12
     [Google Scholar]
  47. Wensinck F., de Merwe J. P. 1981; Serum agglutinins to Eubacterium and Peptostreptococcus species in Crohn’s and other diseases.. Journal of Hygiene 87:13–24
     [Google Scholar]
  48. West B., Lendrum R., Hill M. J., Walker G. 1974; Effects of sulphasalazine (Salazopyrin) on faecal flora in patients with inflammatory bowel disease.. Gut 15:960–965
     [Google Scholar]
  49. Willis A. T., Hobbs G. 1959; Some new media for the isolation and identification of Clostridia.. Journal of Pathology and Bacteriology 77:511–521
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/00222615-18-3-335
Loading
The Microbial Flora of the Rectal Mucosa and Faeces of Patients with Crohn’s Disease Before and During Antimicrobial Chemotherapy
J. Med. Microbiol. 18, 335 (1984); https://doi.org/10.1099/00222615-18-3-335
/content/journal/jmm/10.1099/00222615-18-3-335
/content/journal/jmm/10.1099/00222615-18-3-335
Loading

Data & Media loading...

Most cited this month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error