antibiotics for appendicitis.

[msf]

http://www.nytimes.com/2015/05/19/h...as-alternative-to-removing-appendix.html?_r=0

What, doctors being wrong about the cause of an illness, and wrong about antibiotics having no effect on it? Surely not!

More seriously, I wonder what percentage of those cases did not actually have appendicitis (whatever that turns out to be) but pseudo-appendicitis. I know Yersinia Enterocolitica can cause this (because I've experienced it) but I wouldn't be surprised if other pathogens can have a similar effect.

 

[Hutan]

Interesting @msf.

My family's ME/CFS started with abdominal pain. My daughter was admitted to hospital with suspected appendicitis. Her official diagnosis upon discharge was possible epiploic appendagitis which seems to be the trendy diagnosis when it's not appendicitis but no one is sure what it is.

When I said to the consultant, 'well, it's good my daughter doesn't need an operation', the consultant (with his posse of students around him) said 'ah well, not so good for us, we were all hoping for an operation'. It was a joke, of course.

 

[msf]

Your family's ME? You mean you have more than one case in your family? Did your daughter have any of the other symptoms of Yersinia, i.e. exudative pharyngitis or mesenteric lymphadenitis? Does she have any Reactive Arthritis-like symptoms, such as pain in the entheses or the sacral-iliac joint?

Yeah, I think operations such as these are often more popular with the doctors than with the patients.

 

[Hutan]

Yes, @msf, my daughter, my son and I all became ill at the same time.

We all had sore throats but nothing exuding as far as I know. I don't recall anything about mesenteric lymphadenitis. We all have had joint pain, mainly ankles, knees and hips (yes, that sacral-iliac joint). It was particularly bad in my son. After a month or so he could hardly walk but he's mobile now.

I know of another teenager whose ME/CFS illness started with severe abdominal pain. His appendix was taken out and found to be healthy.

Yersinia is interesting. I'll look in to a test for past exposure. It doesn't persist?

 

[Hutan]

I see it does.

Infection. 1988 Mar-Apr;16(2):81-5.
Persistence of Yersinia enterocolitica in man.
http://www.ncbi.nlm.nih.gov/pubmed/3286508

 

[msf]

Yep, the evidence is increasingly (I would say overwhelmingly, but the chronic infection doubters on PR would contest this) in favour of persistence. It has been shown to persist in mice, in which it also causes arthritis, pigs, and several other animals. The problem with showing it persists in humans is that you are not allowed to sacrifice them in order to find the Yersinia, but even so there is good evidence (such as in the article you found) for persistence in humans. If you want to get tested for it (and it sounds to me like you should) then you need to get either a western blot with both IgG and IgA (IgA is thought to show current infection) or the LTT-ELISPOT. I have had both and am positive on both. The agglutinating antibodies test is almost useless in cases of chronic infection, which makes it a shame that it countries like the UK it is the only test available. The stool test (culture) is also very insensitive, although when positive it does show beyond doubt that you are infected).

Have you been tested for the other causes of Reactive Arthitis, such as Salmonella and Chylamydia? I would think Cpn is more likely than Ctr in the case of your family, but from the gut symptoms it sounds like it was probably the enteric kind.

The exudative in pharyngitis merely means that there was some phlegm, not that much in my case (not like having bronchitis or something like that). Mesenteric lymphadenitis is when you have pain in the abdominal lining - I had it all over my abdomen.

Lastly, have any of your family ever had Erythema Nodosom? This is another tell-tale symptom of a Yersiniosis.

 

[Hutan]

Thanks msf. I'll add a Yersinia test to the list of things to do, and look in to salmonella and chylamydia.

We all did have generalised abdominal pain as well as more specific pain. I still have mild generalised abdominal pain (ie on pressing).

No, we have not had erythema nodosom.

 

[snowathlete]

My wife had appendicitus a few years ago, it "walled itself off" we were told, which meant they couldn't opperate safely on it. Their solution: pump her full of antibiotics. Seems to have worked.

 

[msf]

Hi Hutan, if you can you might want to get a campylobacter test too.

Is the pain in the right lower quadrant, i.e. where the appendix is?

 

[msf]

Hi Snowathelete, looks like she was ahead of the trend then! The article mentions numerous occasions where antibiotics had to be used, apparently without any adverse results!

 

[Hutan]

@msf. Thanks. sorry, I have this thread watched but thought I'd get alerts for new posts. Just found the watched threads tab.

Campylobacter added to my increasing large spreadsheet of things to follow up. Abdominal pain now is generalised. During the acute stage my daughter's abdominal pain was in the lower right quadrant. I can't remember where the pain was for me and my son.

 

[msf]

No problem. I think from the symptoms you have described, it is unlikely that Chlamydia Pneumoniae was the trigger, but if you have the money I would get checked for this anyway, and Lyme, since these are often present in patients with Yersinia infections.