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© 1995 Oxford University Press

research-article

Clusters of Acute Appendicitis: Further Evidence for an Infectious Aetiology

ROLAND ANDERSSON*, ANDERS HUGANDER*, ANDERS THULIN*, PER OLOF NYSTRÖM{dagger} and GUNNAR OLAISON{dagger}

* Department of Surgery, Ryhov Hospital S-551 85 Jönköping, Sweden
{dagger} Department of Surgery, University Hospital Linköping, Sweden

BACKGROUND: The aetiology of appendicitis, the commonest cause of acute abdomen, is unknown. Infection has been proposed but the evidence has been unconvincing. The purpose of the present study was to investigate if temporo-spatial clustering and outbreaks, characteristics of infections diseases, could be found in appendicitis cases in a defined Swedish population.

METHODS: Temporo-spatial clustering among 1155 cases from three districts of Jönköping County in 1984–1990 was identified by Knox space-time cluster analysis. Outbreaks were identifled by retrospective study of temporal variations in 3590 consecutive cases of acute appendicitis from the city of Jönköping in 1969–1990.

RESULTS: Space-time clustering was found among patients with operations less than 60 days apart (observed/expected [O/E)-ratio 1.46, P = 0.016). Subset analysis revealed clustering to be commonest among patients from the same households (O/E-ratio 6.52, P= 0.012), among patients younger than 15 years (O/E-ratio 3.61, P = 0.004) and among females (O/E-ratio 2.28, P = 0.004). Three outbreaks with a significantly increased number of cases were observed during the 22-year study period (O/E-ratio 1.6–2.2, P = 0.001–0.049).

CONCLUSIONS: The finding of temporo-spatial interaction and outbreaks among appendicitis cases supports the concept that appendicitis may be caused by infectious agents.

Keywords appendicitis, epidemiology, cluster analysis, space-time cluster, disease outbreak

Revised 1 February 1995


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