Escherichia coli and appendicitis: phenotypic characteristics of E. coli isolates from inflamed and noninflamed appendices.

Two hundred four appendiceal isolates for Escherichia coli from 146 patients with either inflamed appendices (IA) (110 patients) or noninflamed appendices (NA) (36 patients) were characterized. Strains with P fimbriae were detected in 27% of IA and 31% of NA whereas type 1C-fimbriated strains were found only in IA (13%). Four serotypes, three with K5 antigens (O18:K5, O25:K5:H1, and O75:K5:H-) and one with K1 antigen (O75:K1:H7), were isolated only from IA (20 [18%] of 110); O25:K5:H1 was the most common serotype (isolated from 11 IA [10%]). Fecal isolates from the patients with IA resembled their corresponding appendiceal isolates rather than fecal isolates from patients with NA; this finding suggests that colonization of the gut by virulent E. coli--such as a hemolysin-producing, type 1C-fimbriated, P-fimbriated O25:K5:H1 serotype--may be a prerequisite for the development of appendicitis.