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De Gea-Grela A, Maldonado-Barrueco A, Cabañuz C, Díaz-Almiron M, Rico A, Ruíz-Carrascoso G, Palacios ME, Martín-Arranz E, Escudero-Nieto R, Bernardino JI. Human intestinal spirochetosis: an entity associated with sexual transmitted infections. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:231-235. [PMID: 37248154 DOI: 10.1016/j.eimce.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/03/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Human intestinal spirochetosis (HIE) is a poorly studied clinical entity with variable clinical manifestations. However, in recent years it has gained special relevance because an increasing number of cases have been described in people living with HIV (PWH) and in patients with a history of sexually transmitted infections (STI) or immunosuppression. METHODS Retrospective review of all HIE cases identified in a tertiary level hospital (Hospital Universitario la Paz, Madrid) between 2014 and 2021. RESULTS 36 Cases of HIE were identified. Most cases corresponded to males (94%) with a median age of 45 years. 10 patients (29.4%) were PWH and 20 (56%) were men who had sex with men. Although the clinical manifestations were very heterogeneous, the most frequent was chronic diarrhea (47%), and up to 25% of the subjects had clinical proctitis. 39% percent of patients had been diagnosed with an STI in the previous two years, this characteristic being more frequent in PWH (90% vs. 28%; p < 0.01) than in patients without HIV infection. The STI most frequently associated with a diagnosis of HIE was syphilis (31%). CONCLUSION HIE is frequently diagnosed with other STIs and affects mostly men who have sex with men, which supports that this entity could be considered as a new STI.
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Affiliation(s)
- Alejandro De Gea-Grela
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | - Clara Cabañuz
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, Spain
| | - Mariana Díaz-Almiron
- Unidad de Bioestadística, Fundación para la Investigación Biomédica Hospital, Madrid, Spain
| | - Alicia Rico
- Servicio de Microbiología y Parasitología, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Raquel Escudero-Nieto
- Laboratorio de Referencia e Investigación en Patógenos Especiales, Centro Nacional de Microbiología, Majadahonda, Spain
| | - José I Bernardino
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER Enfermedades Infecciosas, CIBERINFEC, Madrid, Spain.
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2
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Matoba H, Iwaya M, Fujii C, Nakayama J. Identification of Terminal βGlcNAc on Brachyspira Species in Human Intestinal Spirochetosis. J Histochem Cytochem 2024; 72:71-78. [PMID: 38189179 PMCID: PMC10851879 DOI: 10.1369/00221554231222963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Human intestinal spirochetosis (HIS) is a colorectal bacterial infection caused by the Brachyspira species. Griffonia simplicifolia-II (GS-II) is a lectin specific to terminal α/βGlcNAc residues. Here, we investigated terminal βGlcNAc residues in the context of HIS infection using GS-II-horseradish peroxidase staining and HIK1083 immunostaining specific to terminal αGlcNAc residues. Fourteen of 15 HIS cases were GS-II-positive on the bacterial body. No cases showed HIK1083 positivity. The percentage of bacterial bodies staining positively for GS-II based on comparison with anti-Treponema immunostaining was ≤30% in seven cases, 30-70% in two, and >70% in six. Of 15 HIS cases analyzed, none were comorbid with tubular adenomas, and three were comorbid with sessile serrated lesions (SSLs). To determine the species of spirochete infected, the B. aalborgi-specific or B. pilosicoli-specific NADPH oxidase genes were amplified by PCR. After direct sequencing of the PCR products, all nine cases in which PCR products were observed were found to be infected with B. aalborgi alone. These results indicate that the HIS bacterial body, especially of B. aalborgi, is characterized by terminal βGlcNAc and also indicate that terminal βGlcNAc on the HIS bacterial body is associated with HIS preference for SSLs.
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Affiliation(s)
- Hisanori Matoba
- Department of Infection and Host Defense (HM); Department of Molecular Pathology (HM, CF, JN); Center for Medical Education and Clinical Training (CF), Shinshu University School of Medicine, Matsumoto, Japan; Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan (MI); Department of Biotechnology, Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, Matsumoto, Japan (CF); and Department of Pathology, North Alps Medical Center Azumi Hospital, Kitaazumi-gun, Japan (JN)
| | - Mai Iwaya
- Department of Infection and Host Defense (HM); Department of Molecular Pathology (HM, CF, JN); Center for Medical Education and Clinical Training (CF), Shinshu University School of Medicine, Matsumoto, Japan; Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan (MI); Department of Biotechnology, Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, Matsumoto, Japan (CF); and Department of Pathology, North Alps Medical Center Azumi Hospital, Kitaazumi-gun, Japan (JN)
| | - Chifumi Fujii
- Department of Infection and Host Defense (HM); Department of Molecular Pathology (HM, CF, JN); Center for Medical Education and Clinical Training (CF), Shinshu University School of Medicine, Matsumoto, Japan; Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan (MI); Department of Biotechnology, Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, Matsumoto, Japan (CF); and Department of Pathology, North Alps Medical Center Azumi Hospital, Kitaazumi-gun, Japan (JN)
| | - Jun Nakayama
- Department of Infection and Host Defense (HM); Department of Molecular Pathology (HM, CF, JN); Center for Medical Education and Clinical Training (CF), Shinshu University School of Medicine, Matsumoto, Japan; Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan (MI); Department of Biotechnology, Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, Matsumoto, Japan (CF); and Department of Pathology, North Alps Medical Center Azumi Hospital, Kitaazumi-gun, Japan (JN)
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3
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Ho K, Xu J, Katz S, Sarkar SA, Mujeeb Ullah A. Intestinal Spirochetosis: To Treat or Not to Treat. Cureus 2024; 16:e53248. [PMID: 38425640 PMCID: PMC10904080 DOI: 10.7759/cureus.53248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
Spirochete colonization of the gastrointestinal tract is a poorly understood phenomenon presenting with varying signs and symptoms. Due to the lack of a unified approach and its varying presentations, the management decision for intestinal spirochetosis (IS) has always been challenging. While metronidazole is the commonly preferred antimicrobial treatment, it remains unclear if therapeutic intervention is indicated for everyone, especially asymptomatic patients. We present three patients, diagnosed with IS. They presented with varying demographics, clinical presentations, and past medical histories and underwent different clinical managements. Our decisions for treatment not only included presenting symptoms but also factors like history of pre-existing gastrointestinal diseases, age, and immune status.
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Affiliation(s)
- Kimberly Ho
- Department of Pathology, New York University (NYU) Langone Health, Mineola, USA
| | - Joseph Xu
- Department of Internal Medicine, University of California Davis, Sacramento, USA
| | - Seymour Katz
- Department of Internal Medicine, New York University (NYU) Langone Health, Mineola, USA
| | - Suparna A Sarkar
- Department of Pathology and Laboratory Medicine, New York University (NYU) Langone Health, Mineola, USA
| | - Ateeqa Mujeeb Ullah
- Department of Pathology and Laboratory Medicine, New York University (NYU) Langone Health, Mineola, USA
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4
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Eslick GD, Fan K, Nair PM, Burns GL, Hoedt EC, Keely S, Talley NJ. Clinical and Pathologic Factors Associated With Colonic Spirochete (Brachyspira pilosicoli and Brachyspira aalborgi) Infection: A Comprehensive Systematic Review and Pooled Analysis. Am J Clin Pathol 2023; 160:335-340. [PMID: 37289435 PMCID: PMC10682506 DOI: 10.1093/ajcp/aqad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES This study aims to determine what pathologic and clinical factors differentiate Brachyspira species that may be useful to clinicians and pathologists. METHODS We identified 21 studies of Brachyspira infection with individual patient information (n = 113) and conducted a pooled analysis comparing each species. RESULTS There were differences in the pathologic and clinical profiles of each Brachyspira species. Patients infected with Brachyspira pilosicoli infection were more likely to have diarrhea, fever, HIV, and immunocompromised conditions. Those patients infected with Brachyspira aalborgi were more likely to have lamina propria inflammation. CONCLUSIONS Our novel data provide potential insights into the pathogenic mechanism(s) and the specific risk factor profile of Brachyspira species. This may be clinically useful when assessing and managing patients.
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Affiliation(s)
- Guy D Eslick
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
| | - Kening Fan
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
| | - Prema M Nair
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
| | - Grace L Burns
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
| | - Emily C Hoedt
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
| | - Simon Keely
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
| | - Nicholas J Talley
- NHMRC Centre for Research Excellence in Digestive Health, The University of Newcastle, Hunter Medical Research Institute (HMRI), Callaghan, Australia
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5
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Pérez-Tanoira R, Tamarit MDP, Montaña AMV, Carmena D, Köster P, Górgolas M, Fortes Alen JR, Cabello-Úbeda A, Prieto-Pérez L. Increased Prevalence of Symptomatic Human Intestinal Spirochetosis in MSM with High-Risk Sexual Behavior in a Cohort of 165 Individuals. Trop Med Infect Dis 2023; 8:tropicalmed8050250. [PMID: 37235298 DOI: 10.3390/tropicalmed8050250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Human intestinal spirochetosis (HIS) can cause gastrointestinal symptoms, although asymptomatic infections have been described. Individuals from low-income countries, people living with HIV, and men who have sex with men (MSM) show increased risk. A retrospective review of all patients diagnosed with HIS (n = 165) between January 2013 and October 2020 at a tertiary hospital in Madrid, Spain, was performed to assess risk factors for symptomatic HIS, symptoms, and response to treatment. Most patients were male (n = 156; 94.5%), 86.7% were MSM, and 23.5% practiced chemsex, of whom most were symptomatic (p = 0.039). Most patients (78.4%) reported unprotected oral-anal intercourse. A total of 124 (81.1%) were symptomatic; diarrhea was the most common complaint (68.3%). Multivariable regression showed increased odds of symptoms associated with age under 41 (odds ratio 5.44, 95% CI 1.87-15.88; p = 0.002). Colonoscopy was normal in 153 (92.7%). Furthermore, 66.7% presented previous or concomitant sexually transmitted diseases (STDs). Among the patients, 102 underwent testing for other gastrointestinal pathogens, with positive results in 20 (19.6%). All symptomatic patients without concomitant gastrointestinal infection presenting improvement on follow-up (42 of 53) had received either metronidazole or doxycycline (p = 0.049). HIS should be considered as a cause of chronic diarrhea in MSM with high-risk sexual behavior after other causes have been ruled out; treatment with metronidazole is recommended. Coinfection with other STDs is common.
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Affiliation(s)
- Ramón Pérez-Tanoira
- Department of Microbiology, Príncipe de Asturias University Hospital, 28805 Alcalá de Henares, Spain
- Department of Biomedicine and Biotechnology, University of Alcalá, 28040 Madrid, Spain
| | | | | | - David Carmena
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, 28040 Madrid, Spain
| | - Pamela Köster
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, 28040 Madrid, Spain
| | - Miguel Górgolas
- Department of Infectious Diseases, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - José R Fortes Alen
- Department of Pathology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
| | | | - Laura Prieto-Pérez
- Department of Infectious Diseases, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
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6
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Muacevic A, Adler JR, Fenster M, Correa J, Bansal R. Ulcerative Proctitis: An Unusual Case of Intestinal Spirochetosis. Cureus 2022; 14:e33046. [PMID: 36721604 PMCID: PMC9881603 DOI: 10.7759/cureus.33046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Human intestinal spirochetosis (HIS) is an uncommon disease characterized by the colonization of spirochetes in the colorectal mucosa and is most often found in individuals who are positive for human immunodeficiency virus (HIV) and in homosexual men. Although HIV is known to cause a variety of infectious colitis, the prevalence has significantly declined with antiretroviral therapy. Intestinal spirochetosis, however, remains meaningful as it can be an infectious cause of colonic ulcerations even with well-controlled HIV. Spirochetosis rarely causes macroscopic changes in the colorectal mucosa and reports of an ulcerated rectum are exceedingly scarce. Here, we report a case of a homosexual man with HIV who is compliant with antiretroviral therapy with high CD4 counts who presented with a six-week history of bloody diarrhea and was found to have multiple ulcerations in the rectosigmoid junction and rectum infected with non-treponemal spirochetes as confirmed on biopsy. To our knowledge, there have not been any reports of multiple rectal ulcerations caused by non-treponemal spirochetes. The patient was treated with metronidazole 500 mg four times daily for 10 days with complete resolution of symptoms. This case is notable as it alerts clinicians to consider intestinal spirochetosis as a differential diagnosis in the workup for bloody stool in the presence of colorectal ulcerations.
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7
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Novotny S, Mizrahi J, Yee EU, Clores MJ. Incidental diagnosis of intestinal spirochetosis in a patient with chronic hepatitis B: A case report. World J Clin Infect Dis 2022; 12:69-75. [DOI: 10.5495/wjcid.v12.i2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/01/2022] [Accepted: 08/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intestinal spirochetosis (IS) is caused by Brachyspira colonization of the gastrointestinal tract. Some patients are asymptomatic, while others present with gastrointestinal complaints such as abdominal pain, diarrhea, or gastrointestinal bleeding. However, the clinical significance of asymptomatic IS is unclear, and guidelines are lacking regarding decision to treat.
CASE SUMMARY A 73-year-old male with peptic ulcer disease and gastroesophageal reflux was evaluated for elevated liver enzymes. He was diagnosed with chronic hepatitis B virus and prescribed entecavir. Additionally, he was leukopenic and had stage 4 liver fibrosis on transient elastography. After 5 mo, the patient returned for esophagogastroduodenoscopy and screening colonoscopy. He denied any gastrointestinal symptoms at that time. Findings included grade I distal esophageal varices, mild portal hypertensive gastropathy, and patchy nodular gastric antral mucosa. On colonoscopy, several polyps were removed. Hematoxylin and eosin stain of mucosa adjacent to the polyps revealed a “false brush border,” and Steiner stain identified spirochetes adherent to the mucosa. These pathology findings confirmed the diagnosis of IS. He was managed conservatively with careful observation and without antibiotic therapy via a multidisciplinary approach between gastroenterology and infectious disease. He remained asymptomatic at the 7-wk follow-up.
CONCLUSION This case reports the finding of incidental, asymptomatic IS in a leukopenic patient with hepatitis B virus. Conservative management was appropriate.
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Affiliation(s)
- Samantha Novotny
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, United States
| | - Joseph Mizrahi
- Division of Gastroenterology and Hepatology, Stony Brook Medicine, Stony Brook, NY 11794, United States
| | - Eric U Yee
- Department of Pathology, Stony Brook Medicine, Stony Brook, NY 11794, United States
| | - Michael J Clores
- Division of Gastroenterology and Hepatology, Stony Brook Medicine, Stony Brook, NY 11794, United States
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8
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Xu J, Chu T, Yu T, Li N, Wang C, Li C, Zhang Y, Meng H, Nie G. Design of Diselenide-Bridged Hyaluronic Acid Nano-antioxidant for Efficient ROS Scavenging to Relieve Colitis. ACS NANO 2022; 16:13037-13048. [PMID: 35861614 DOI: 10.1021/acsnano.2c05558] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Overproduction of reactive oxygen species (ROS), a key characteristic of inflammatory bowel disease (IBD), is responsible for dysregulation of signal transduction, inflammatory response, and DNA damage, which ultimately leads to disease progression and deterioration. Thus, ROS scavenging has become a promising strategy to navigate IBD. Inspired by the targeting capability of hyaluronic acid (HA) to CD44-overexpressed inflammatory cells together with the redox regulation capacity of diselenide compounds, we developed an oral nanoformulation, i.e., diselenide-bridged hyaluronic acid nanogel (SeNG), with a view to treat colitis through a ROS scavenging mechanism. Our data demonstrated that SeNG specifically accumulated in colitis tissue that was mediated by highly efficient CD44-HA interaction. This has allowed us to demonstrate a significant anti-inflammatory effect in an acute colitis mouse model induced by dextran sulfate sodium and trinitrobenzenesulfonic acid. Mechanistically, we continued to show SeNG reduced the ROS level via both direct elimination and up-regulation of the Nrf2/HO-1 signal pathway. Collectively, our work provides proof-of-principle evidence for a SeNG-mediated nano-antioxidant strategy, by which colitis could be effectively managed.
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Affiliation(s)
- Jiaqi Xu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Zhongguancun Beiyitiao 11, Beijing 100190, China
| | - Tianjiao Chu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Zhongguancun Beiyitiao 11, Beijing 100190, China
- College of Pharmaceutical Science, Jilin University, Changchun 130021, China
| | - Tingting Yu
- Department of Orthodontics, Peking University School & Hospital of Stomatology, Zhongguancun South Avenue 22, Beijing 100081, China
| | - Naishi Li
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Zhongguancun Beiyitiao 11, Beijing 100190, China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Chunling Wang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Zhongguancun Beiyitiao 11, Beijing 100190, China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Chen Li
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Zhongguancun Beiyitiao 11, Beijing 100190, China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yinlong Zhang
- School of Nanoscience and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Huan Meng
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Zhongguancun Beiyitiao 11, Beijing 100190, China
| | - Guangjun Nie
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Zhongguancun Beiyitiao 11, Beijing 100190, China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
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9
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Fan K, Eslick GD, Nair PM, Burns GL, Walker MM, Hoedt EC, Keely S, Talley NJ. Human intestinal spirochetosis, irritable bowel syndrome, and colonic polyps: A systematic review and meta-analysis. J Gastroenterol Hepatol 2022; 37:1222-1234. [PMID: 35385602 PMCID: PMC9545717 DOI: 10.1111/jgh.15851] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/24/2022] [Indexed: 12/09/2022]
Abstract
Human colonic spirochetosis (CS) is usually due toBrachyspira pilosicolior Brachyspira aalborgiinfection. While traditionally considered to be commensal bacteria, there are scattered case reports and case series of gastrointestinal (GI) symptoms in CS and reports of colonic polyps with adherent spirochetes. We performed a systematic review and meta-analysis investigating the association between CS and GI symptoms and conditions including the irritable bowel syndrome (IBS) and colonic polyps. Following PRISMA 2020 guidelines, a systematic search of Medline, CINAHL, EMBASE, and Web of Science was performed using specific keywords for CS and GI disease. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Of 75 studies identified in the search, 8 case-control studies met the inclusion criteria for meta-analysis and 67 case series studies met the inclusion criteria for pooled prevalence analysis. CS was significantly associated with diarrhea (n = 141/127, cases/controls, OR: 4.19, 95% CI: 1.72-10.21, P = 0.002) and abdominal pain (n = 64/65, OR: 3.66, 95% CI: 1.43-9.35, P = 0.007). CS cases were significantly more likely to have Rome III-diagnosed IBS (n = 79/48, OR: 3.84, 95% CI: 1.44-10.20, P = 0.007), but not colonic polyps (n = 127/843, OR: 8.78, 95% CI: 0.75-103.36, P = 0.084). In conclusion, we found evidence of associations between CS and both diarrhea and IBS, but not colonic polyps. CS is likely underestimated due to suboptimal diagnostic methods and may be an overlooked risk factor for a subset of IBS patients with diarrhea.
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Affiliation(s)
- Kening Fan
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
| | - Guy D Eslick
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Prema M Nair
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
| | - Grace L Burns
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
| | - Marjorie M Walker
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Emily C Hoedt
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
| | - Nicholas J Talley
- Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
- NHMRC Centre for Research Excellence in Digestive Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- Australian Gastrointestinal Research Alliance (AGIRA)NewcastleNew South WalesAustralia
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
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10
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Iwamuro M, Urata H, Tanaka T, Okada H. Application of electron microscopy in gastroenterology. World J Gastrointest Pathophysiol 2022; 13:41-49. [PMID: 35433095 PMCID: PMC8976235 DOI: 10.4291/wjgp.v13.i2.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/26/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
Electron microscopy has long been used in research in the fields of life sciences and materials sciences. Transmission and scanning electron microscopy and energy-dispersive X-ray spectroscopy (EDX) analyses have also been performed in the field of gastroenterology. Electron microscopy and EDX enable (1) Observation of ultrastructural differences in esophageal epithelial cells in patients with gastroesophageal reflux and eosinophilic esophagitis; (2) Detection of lanthanum deposition in the stomach and duodenum; (3) Ultrastructural and elemental analyses of enteroliths and bezoars; (4) Detection and characterization of microorganisms in the gastrointestinal tract; (5) Diagnosis of gastrointestinal tumors with neuroendocrine differentiation; and (6) Analysis of gold nanoparticles potentially used in endoscopic photodynamic therapy. This review aims to foster a better understanding of electron microscopy applications by reviewing relevant clinical studies, basic research findings, and the state of current research carried out in gastroenterology science.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Haruo Urata
- Central Research Laboratory, Okayama University Medical School, Okayama 700-8558, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
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11
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Chichón Sánchez M, López Brasal L, Losa García JE. Intestinal spirochetosis in a Spanish hospital. Med Clin (Barc) 2020; 156:521-522. [PMID: 32624258 DOI: 10.1016/j.medcli.2020.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 04/04/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Marta Chichón Sánchez
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - Laura López Brasal
- Servicio de Anatomía Patológica, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Juan Emilio Losa García
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Lemmens R, Devreker T, Hauser B, Degreef E, Goossens A, Vandenplas Y. Intestinal Spirochetosis: A Case Series and Review of the Literature. Pediatr Gastroenterol Hepatol Nutr 2019; 22:193-200. [PMID: 30899696 PMCID: PMC6416382 DOI: 10.5223/pghn.2019.22.2.193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/17/2018] [Accepted: 05/16/2018] [Indexed: 11/21/2022] Open
Abstract
A clinical suspicion of intestinal spirochetosis is required when patients have long lasting complaints of abdominal pain, diarrhea, rectal bleeding, weight loss, and nausea. An endoscopy with biopsies needs to be performed to confirm the diagnosis of intestinal spirochetosis. The diagnosis of intestinal spirochetosis is based on histological appearance. Intestinal spirochetosis can also be associated with other intestinal infections and juvenile polyps (JPs). JPs seem to be more frequent in patients with intestinal spirochetosis than in patients without intestinal spirochetosis. Intestinal spirochetosis in children should be treated with antibiotics. Metronidazole is the preferred option. In this article, we describe 4 cases of intestinal spirochetosis in a pediatric population and provide a review of the literature over the last 20 years. Intestinal spirochetosis is a rare infection that can cause a variety of severe symptom. It is diagnosed based on histological appearance.
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Affiliation(s)
- Roel Lemmens
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Pathology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thierry Devreker
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bruno Hauser
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Elisabeth Degreef
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Annieta Goossens
- Department of Pathology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yvan Vandenplas
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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14
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Green KR, Harris C, Shuja A, Malespin M, De Melo SW. Intestinal Spirochetosis: An Obscure Cause of Lower Gastrointestinal Bleeding. Cureus 2018; 10:e2970. [PMID: 30221098 PMCID: PMC6136888 DOI: 10.7759/cureus.2970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Adherence of spirochetes to the apical membrane of the colonic epithelium has been well-described in the literature, but the exact pathogenesis leading to symptomatic clinical manifestations is poorly understood. Most cases are found incidentally on the pathological evaluation of colonic biopsies taken during diagnostic or therapeutic colonoscopies. However, whether the colonization of the intestinal mucosa can be attributed to clinical symptoms is a matter of debate. Here, we present a case of intermittent hematochezia attributed to the overwhelming invasion of the colonic mucosa by intestinal spirochetes.
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Affiliation(s)
- Kevin R Green
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | - Ciel Harris
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | - Asim Shuja
- Division of Gastroenterology, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | - Miguel Malespin
- Division of Gastroenterology, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | - Silvio W De Melo
- Division of Gastroenterology, Oregon Health and Science University, Portland, USA
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Delahoy MJ, Wodnik B, McAliley L, Penakalapati G, Swarthout J, Freeman MC, Levy K. Pathogens transmitted in animal feces in low- and middle-income countries. Int J Hyg Environ Health 2018; 221:661-676. [PMID: 29729998 PMCID: PMC6013280 DOI: 10.1016/j.ijheh.2018.03.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/20/2018] [Accepted: 03/14/2018] [Indexed: 02/04/2023]
Abstract
Animals found in close proximity to humans in low-and middle-income countries (LMICs) harbor many pathogens capable of infecting humans, transmissible via their feces. Contact with animal feces poses a currently unquantified-though likely substantial-risk to human health. In LMIC settings, human exposure to animal feces may explain some of the limited success of recent water, sanitation, and hygiene interventions that have focused on limiting exposure to human excreta, with less attention to containing animal feces. We conducted a review to identify pathogens that may substantially contribute to the global burden of disease in humans through their spread in animal feces in the domestic environment in LMICs. Of the 65 potentially pathogenic organisms considered, 15 were deemed relevant, based on burden of disease and potential for zoonotic transmission. Of these, five were considered of highest concern based on a substantial burden of disease for which transmission in animal feces is potentially important: Campylobacter, non-typhoidal Salmonella (NTS), Lassa virus, Cryptosporidium, and Toxoplasma gondii. Most of these have a wide range of animal hosts, except Lassa virus, which is spread through the feces of rats indigenous to sub-Saharan Africa. Combined, these five pathogens cause close to one million deaths annually. More than half of these deaths are attributed to invasive NTS. We do not estimate an overall burden of disease from improperly managed animal feces in LMICs, because it is unknown what proportion of illnesses caused by these pathogens can be attributed to contact with animal feces. Typical water quantity, water quality, and handwashing interventions promoted in public health and development address transmission routes for both human and animal feces; however, sanitation interventions typically focus on containing human waste, often neglecting the residual burden of disease from pathogens transmitted via animal feces. This review compiles evidence on which pathogens may contribute to the burden of disease through transmission in animal feces; these data will help prioritize intervention types and regions that could most benefit from interventions aimed at reducing human contact with animal feces.
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Affiliation(s)
- Miranda J Delahoy
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Breanna Wodnik
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Lydia McAliley
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Gauthami Penakalapati
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Jenna Swarthout
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Matthew C Freeman
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Karen Levy
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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17
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Nishii S, Higashiyama M, Ogata S, Komoto S, Ito S, Mizoguchi A, Terada H, Furuhashi H, Takajo T, Shirakabe K, Watanabe C, Tomita K, Nagao S, Miura S, Hokari R. Human intestinal spirochetosis mimicking ulcerative colitis. Clin J Gastroenterol 2017; 11:145-149. [PMID: 29204849 DOI: 10.1007/s12328-017-0807-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/25/2017] [Indexed: 10/18/2022]
Abstract
Human intestinal spirochetosis (HIS) is a colorectal infection caused by the Brachyspira species of intestinal spirochetes, whose pathogenicity in humans remains unclear owing to the lack of or mild symptoms. We monitored the 5-year clinical course of a woman diagnosed with HIS in whom ulcerative colitis (UC) had been suspected. Following a positive fecal occult blood test, she underwent a colonoscopic examination at a local clinic where she was diagnosed with "right-sided" UC concomitant with incidentally detected HIS, and was referred to our hospital. Colonoscopic, histopathological, and cytological examination revealed localized erosive colitis in the ascending and the right transverse colon concomitant with HIS resembling skip lesions of UC. Initially, we chose the wait-and-watch approach; however, she gradually developed bloody diarrhea. Metronidazole improved her abdominal symptoms, as well as her colonoscopic and histopathological findings, suggesting that HIS was responsible for her colorectal inflammation. This case reveals (1) a possible pro-inflammatory role of HIS, (2) difficulties in diagnosing HIS in chronic proctocolitis, and (3) a possible inclusion of some HIS cases in "UC". HIS could mimic UC and might be included in differential diagnoses for UC. Antibiotic administration is necessary following the detection of HIS, particularly in patients demonstrating an atypical presentation of UC.
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Affiliation(s)
- Shin Nishii
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Masaaki Higashiyama
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Sho Ogata
- Department of Laboratory Medicine, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Shunsuke Komoto
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Suguru Ito
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Akinori Mizoguchi
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hisato Terada
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hirotaka Furuhashi
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Takeshi Takajo
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Kazuhiko Shirakabe
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Chikako Watanabe
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Kengo Tomita
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Shigeaki Nagao
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Soichiro Miura
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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Kohli DR, Lippman HR, Shah TU. An Unusual Appearance of the Colon Wall. Gastroenterology 2017; 152:1293-1294. [PMID: 28376322 DOI: 10.1053/j.gastro.2016.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology & Hepatology, Department of Medicine, Virginia Commonwealth University, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - H Robert Lippman
- Department of Pathology, Hunter Holmes McGuire VA medical center, Richmond, Virginia
| | - Tilak U Shah
- Division of Gastroenterology & Hepatology, Department of Medicine, Virginia Commonwealth University, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
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Rojas P, Petrich A, Schulze J, Wiessner A, Loddenkemper C, Epple HJ, Sterlacci W, Vieth M, Kikhney J, Moter A. Distribution and phylogeny of Brachyspira spp. in human intestinal spirochetosis revealed by FISH and 16S rRNA-gene analysis. Anaerobe 2017; 47:25-32. [PMID: 28300642 DOI: 10.1016/j.anaerobe.2017.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 01/01/2023]
Abstract
During six years as German National Consultant Laboratory for Spirochetes we investigated 149 intestinal biopsies from 91 patients, which were histopathologically diagnosed with human intestinal spirochetosis (HIS), using fluorescence in situ hybridization (FISH) combined with 16S rRNA gene PCR and sequencing. Aim of this study was to complement histopathological findings with FISH and PCR for definite diagnosis and species identification of the causative pathogens. HIS is characterized by colonization of the colonic mucosa of the human distal intestinal tract by Brachyspira spp. Microbiological diagnosis of HIS is not performed, because of the fastidious nature and slow growth of Brachyspira spp. in culture. In clinical practice, diagnosis of HIS relies solely on histopathology without differentiation of the spirochetes. We used a previously described FISH probe to detect and identify Brachyspira spp. in histological gut biopsies. FISH allowed rapid visualization and identification of Brachyspira spp. in 77 patients. In most cases, the bright FISH signal already allowed rapid localization of Brachyspira spp. at 400× magnification. By sequencing, 53 cases could be assigned to the B. aalborgi lineage including "B. ibaraki" and "B. hominis", and 23 cases to B. pilosicoli. One case showed mixed colonization. The cases reported here reaffirm all major HIS Brachyspira spp. clusters already described. However, the phylogenetic diversity seems to be even greater than previously reported. In 14 cases, we could not confirm HIS by either FISH or PCR, but found colonization of the epithelium by rods and cocci, indicating misdiagnosis by histopathology. FISH in combination with molecular identification by 16S rRNA gene sequencing has proved to be a valuable addition to histopathology. It provides definite diagnosis of HIS and allows insights into phylogeny and distribution of Brachyspira spp. HIS should be considered as a differential diagnosis in diarrhea of unknown origin, particularly in patients from risk groups (e.g. patients with colonic adenomas, inflammatory polyps, inflammatory bowel disease or HIV infection and in men who have sex with men).
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Affiliation(s)
- Pablo Rojas
- Institute for Microbiology and Hygiene, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Annett Petrich
- Institute for Microbiology and Hygiene, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Schulze
- Biofilmcenter, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | | | - Hans-Jörg Epple
- Medical Clinic I, Gastroenterology, Rheumatology, Infectiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Judith Kikhney
- Institute for Microbiology and Hygiene, Charité - Universitätsmedizin Berlin, Berlin, Germany; Biofilmcenter, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Annette Moter
- Biofilmcenter, Deutsches Herzzentrum Berlin, Berlin, Germany; Former German Consultant Laboratory for Treponema Identification, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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20
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Yuki M, Emoto Y, Yoshizawa K, Yuri T, Tsubura A. Intestinal Bacterial Infection Diagnosed by Histological Examination of Endoscopic Biopsy Specimens. Case Rep Gastroenterol 2016; 10:629-632. [PMID: 27920653 PMCID: PMC5121558 DOI: 10.1159/000452212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022] Open
Abstract
Intestinal spirochetosis (IS) in humans is characterized by spirochetal microorganisms attached to the luminal surface of the colonic epithelium. In the present case, attached organisms appeared as 3- to 4 μm-thick (average thickness, 3.4 μm) basophilic fringes or haze in HE-stained endoscopic biopsy specimens. The basophilic fringes were clearly labeled by Treponema pallidum antiserum. Because IS is relatively rare in developed countries, thin basophilic fringes characteristic of IS are readily overlooked. Thus, the recognition of histological characteristics of this disease is important for its diagnosis.
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Affiliation(s)
- Michiko Yuki
- Department of Pathology II, Kansai Medical University, Hirakata, Japan
| | - Yuko Emoto
- Department of Pathology II, Kansai Medical University, Hirakata, Japan
| | | | - Takashi Yuri
- Department of Pathology II, Kansai Medical University, Hirakata, Japan
| | - Airo Tsubura
- Department of Pathology II, Kansai Medical University, Hirakata, Japan
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21
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Ngwa T, Peng JL, Choi E, Tayarachakul S, Liangpunsakul S. Colonic Spirochetosis in a 60-Year-Old Immunocompetent Patient: Case Report and Review. J Investig Med High Impact Case Rep 2016; 4:2324709616662671. [PMID: 27570780 PMCID: PMC4984321 DOI: 10.1177/2324709616662671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/02/2016] [Indexed: 01/03/2023] Open
Abstract
Spirochetes, a genetically and morphologically distinct group of bacteria, are thin, spiral-shaped, and highly motile. They are known causes of several human diseases such as syphilis, Lyme disease, relapsing fever, and leptospirosis. We report a case of colonic spirochetosis in a healthy patient presenting for surveillance colonoscopy. The diagnosis of intestinal spirochetosis was made accidentally during the histological examination of colonic polyps, which were removed during colonoscopy. We also performed an extensive review on intestinal spirochetosis with a focus on clinical presentation and outcomes of reported cases from the past two decades.
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Affiliation(s)
- Taiwo Ngwa
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jennifer L Peng
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Euna Choi
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sucharat Tayarachakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Suthat Liangpunsakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
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Walker MM, Talley NJ, Inganäs L, Engstrand L, Jones MP, Nyhlin H, Agréus L, Kjellstrom L, Öst Å, Andreasson A. Colonic spirochetosis is associated with colonic eosinophilia and irritable bowel syndrome in a general population in Sweden. Hum Pathol 2015; 46:277-83. [DOI: 10.1016/j.humpath.2014.10.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 10/26/2014] [Accepted: 10/27/2014] [Indexed: 12/21/2022]
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Tateishi Y, Takahashi M, Horiguchi SI, Funata N, Koizumi K, Okudela K, Hishima T, Ohashi K. Clinicopathologic study of intestinal spirochetosis in Japan with special reference to human immunodeficiency virus infection status and species types: analysis of 5265 consecutive colorectal biopsies. BMC Infect Dis 2015; 15:13. [PMID: 25582884 PMCID: PMC4300994 DOI: 10.1186/s12879-014-0736-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/22/2014] [Indexed: 01/03/2023] Open
Abstract
Background Previous studies reported that the incidence of intestinal spirochetosis was high in homosexual men, especially those with Human Immunodeficiency Virus infection. The aim of the present study was to clarify the clinicopathological features of intestinal spirochetosis in Japan with special reference to Human Immunodeficiency Virus infection status and species types. Methods A pathology database search for intestinal spirochetosis was performed at Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital between January 2008 and October 2011, and included 5265 consecutive colorectal biopsies from 4254 patients. After patient identification, a retrospective review of endoscopic records and clinical information was performed. All pathology slides were reviewed by two pathologists. The length of the spirochetes was measured using a digital microscope. Causative species were identified by polymerase chain reaction. Results Intestinal spirochetosis was diagnosed in 3 out of 55 Human Immunodeficiency Virus-positive patients (5.5%). The mean length of intestinal spirochetes was 8.5 μm (range 7–11). Brachyspira pilosicoli was detected by polymerase chain reaction in all 3 patients. Intestinal spirochetosis was also diagnosed in 73 out of 4199 Human Immunodeficiency Virus-negative patients (1.7%). The mean length of intestinal spirochetes was 3.5 μm (range 2–8). The species of intestinal spirochetosis was identified by polymerase chain reaction in 31 Human Immunodeficiency Virus-negative patients. Brachyspira aalborgi was detected in 24 cases (78%) and Brachyspira pilosicoli in 6 cases (19%). Both Brachyspira aalborgi and Brachyspira pilosicoli were detected in only one Human Immunodeficiency Virus-negative patient (3%). The mean length of Brachyspira aalborgi was 3.8 μm, while that of Brachyspira pilosicoli was 5.5 μm. The length of Brachyspira pilosicoli was significantly longer than that of Brachyspira aalborgi (p < 0.01). The lengths of intestinal spirochetes were significantly longer in Human Immunodeficiency Virus-positive patients than in Human Immunodeficiency Virus-negative patients (p < 0.05). Conclusions The incidence of intestinal spirochetosis was slightly higher in Human Immunodeficiency Virus-positive patients than in Human Immunodeficiency Virus-negative patients. However, no relationship was found between the Human Immunodeficiency Virus status and intestinal spirochetosis in Japan. Brachyspira pilosicoli infection may be more common in Human Immunodeficiency Virus-positive patients with intestinal spirochetosis than in Human Immunodeficiency Virus-negative patients with intestinal spirochetosis.
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Affiliation(s)
- Yoko Tateishi
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. .,Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
| | - Masae Takahashi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
| | - Shin-ichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
| | - Nobuaki Funata
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
| | - Koichi Koizumi
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
| | - Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
| | - Kenichi Ohashi
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
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Akiyama S, Kikuchi D, Mitani T, Fujii T, Yamada A, Matsui A, Ogawa O, Iizuka T, Hoteya S, Kaise M. A case of mucinous adenocarcinoma in the setting of chronic colitis associated with intestinal spirochetosis and intestinal stricture. Medicine (Baltimore) 2015; 94:e493. [PMID: 25634199 PMCID: PMC4602947 DOI: 10.1097/md.0000000000000493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Mucinous adenocarcinoma (MC) is a unique pathological type of colorectal cancer (CRC). The development of MC is often associated with intestinal inflammation and/or microsatellite instability (MSI). Moreover, MC has clinicopathological characteristics that render making the correct diagnosis difficult such as extramural progression. Meanwhile, intestinal spirochetosis (IS) is a condition in which colonic epithelial cells are colonized and/or infected by spirochetes. Intestinal inflammation due to IS occurs by the destruction of colonic microvilli and induces chronic diarrhea. Recently, it was reported that the prevalence of IS tended to be high in patients with sessile serrated adenomas/polyps, the precursor of MSI-high CRC including MC. This study presents a case of MC in the setting of intestinal inflammation due to IS and tries to clarify the cause of MC development by performing immunohistochemical stain of resected specimen for DNA mismatch repair (MMR) proteins. This patient is a 63-year-old man with no symptoms who had a positive fecal occult blood test. Subsequent endoscopic findings and biopsy results revealed intestinal stricture of the transverse colon and chronic infective colitis associated with IS. Metronidazole therapy was initiated but was not effective. Although follow-up colonoscopy was performed repeatedly, intestinal perforation occurred 20 months later. Subtotal colectomy and ileostomy were performed. Pathological examination of resected specimens revealed MC with normal expression of MMR proteins, including MLH1, MSH2, MSH6, and PMS2. The histopathological classification was Union for International Cancer Control (UICC) IIIB and adjuvant chemotherapy was initiated. This is an interesting case of MC developing in the setting of chronic colitis associated with IS. It seemed that the cause of MC development was not MSI but intestinal inflammation. Besides, endoscopic diagnosis of MC in this case was difficult because of the extramural progression and lack of obvious atypical colonic glands in biopsy specimens. This report provides evidence for an association between neoplasm and IS-induced intestinal inflammation. Moreover, we suggest that making the diagnosis of MC could be difficult because of its unique clinicopathological characteristics.
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Affiliation(s)
- Shintaro Akiyama
- From the Department of Gastroenterology (SA, DK, TM, AY, AM, OO, TI, SH, MK); and Department of Pathology (TF), Toranomon Hospital, Tokyo, Japan
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Omori S, Mabe K, Hatanaka K, Ono M, Matsumoto M, Takahashi M, Yoshida T, Ono S, Shimizu Y, Sugai N, Suzuki A, Katsuki S, Fujii T, Kato M, Asaka M, Sakamoto N. Human intestinal spirochetosis is significantly associated with sessile serrated adenomas/polyps. Pathol Res Pract 2014; 210:440-3. [PMID: 24767254 DOI: 10.1016/j.prp.2014.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 02/25/2014] [Accepted: 03/05/2014] [Indexed: 01/03/2023]
Abstract
It remains unclear whether or not human intestinal spirochetosis (HIS) has any associated symptoms or lesions. In this study, we assessed the prevalence of HIS in sessile serrated adenomas/polyps (SSA/Ps) and their possible association. Following identification of early cecal cancer with SSA/P accompanied by a colonization of HIS, we went on to conduct a retrospective case-control study using endoscopically resected SSA/P specimens to examine the frequency of HIS infection in SSA/Ps. Nineteen SSA/P cases and 172 controls were obtained. The rate of HIS infection was significantly higher at 52.6% (10/19) in the SSA/P cases compared to the controls at 8.1% (14/172). Our SSA/P series were associated with a remarkably higher rate of HIS than controls or than previously reported. This is the first report to provide evidence for potential association between HIS and SSA/Ps.
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Affiliation(s)
- Saori Omori
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Katsuhiro Mabe
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
| | - Kanako Hatanaka
- Division of Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Masayoshi Ono
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Mio Matsumoto
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Masakazu Takahashi
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Yoshida
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Shoko Ono
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Yuichi Shimizu
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Nozomi Sugai
- Division of Gastroenterology, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan
| | - Akira Suzuki
- Division of Pathology, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan
| | - Shinichi Katsuki
- Center of Gastroenterology, Otaru Ekisaikai Hospital, Otaru, Hokkaido, Japan
| | | | - Mototsugu Kato
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Masahiro Asaka
- Department of Cancer Preventive Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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Iwamoto J, Ogata S, Honda A, Saito Y, Murakami M, Ikegami T, Adachi Y, Matsuzaki Y. Human intestinal spirochaetosis in two ulcerative colitis patients. Intern Med 2014; 53:2067-71. [PMID: 25224189 DOI: 10.2169/internalmedicine.53.2386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A histological examination of colonic biopsies of the longitudinal and irregularly-shaped ulcerative lesions of a 37-year-old man and 61-year-old man with ulcerative colitis showed so-called "fringe formation," a typical finding of Brachyspira infection. The antibody titer to Brachyspira aalborgi showed marked elevation in both cases, and the patients were each treated with 1,000 mg of metronidazole for 14 days. Colonoscopy performed after treatment showed an improvement in the ulcerative lesions in both patients. These results indicate the possibility that intestinal spirochaetosis infection should be considered as an infectious complication in patients with ulcerative colitis receiving long-term steroid therapy.
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Affiliation(s)
- Junichi Iwamoto
- Department of Gastroenterology, Tokyo Medical University Ibaraki Medical Center, Japan
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27
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Omori S, Mabe K, Ono M, Suzuki M, Takahashi M, Ono S, Simizu Y, Kato M, Hatanaka K, Sakamoto N. [Case report: focal adenocarcinoma arising from sessile serrated adenoma/polyp with intestinal spirochetosis, report of a case]. ACTA ACUST UNITED AC 2013; 102:2046-9. [PMID: 24167865 DOI: 10.2169/naika.102.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Saori Omori
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Japan
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Abstract
Brachyspira species have been implicated as a potential cause of gastroenteritis in humans; this is, however, controversial. In 733 gastroenteritis cases and 464 controls, we found 29 samples positive for Brachyspira species (2.3% of cases and 2.6% of controls; P = 0.77). Brachyspira species were not associated with gastroenteritis in humans.
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Anthony NE, Blackwell J, Ahrens W, Lovell R, Scobey MW. Intestinal spirochetosis: an enigmatic disease. Dig Dis Sci 2013; 58:202-8. [PMID: 22851039 DOI: 10.1007/s10620-012-2305-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 06/25/2012] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Intestinal spirochetosis (IS) is a condition in which colonic and appendiceal epithelial cells are colonized by one of two anaerobic spirochetes, either the Brachyspira aalborgi or Brachyspira pilosicoli. There is much debate in the literature as to whether IS is a pathogen or a commensal inhabitant. A recent case of IS at our institution prompted a retrospective database search and review of the literature. METHODS A pathology database search for IS was performed at Carolinas Medical Center from 2003 through 2007. After patient identification, a retrospective review of the endoscopic record and the pathology report was performed. Pathology slides were reviewed for accuracy and special silver stains and/or immunostains were performed if needed. The following data were collected for each patient when available: age, gender, nationality, HIV status, and other co-morbid conditions when noted. We attempted to determine whether patients were treated for spirochetosis and if so, the treatment regimen used as well as the results. RESULTS The database search detected 29 patients with biopsies showing IS. Three patients were subsequently removed due to incorrect identification. A total of 26 patients with an average age of 45 years were reviewed. The most common symptoms were abdominal pain, diarrhea, and rectal bleeding. Most patients did not exhibit inflammatory changes despite the presence of spirochetosis. Pathologic examination revealed a relative increase in intra-epithelial lymphocytes in a subset of cases, a non-specific finding. Acute colitis or architectural distortion was not seen in any of the study cases. We were only able to obtain follow-up of two patients after treatment with metronidazole and both responded to therapy. CONCLUSIONS To date, our study is the largest case series that includes both endoscopic and pathologic descriptions and confirms the "bland" nature of the condition. In <20 % of our patients inflammation was present microscopically and it did not correlate well with endoscopic appearance. Symptoms reported by our patients were similar to those reported in previous studies, although our lack of endoscopic changes was different from one previous paper. There is no established standard of care for the treatment of IS and our study, reflects the enigmatic nature of IS as a disease process. In the absence of rigorous literature, physicians will need to use a logical and pragmatic approach to the evaluation and treatment of IS.
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Affiliation(s)
- Nicholas E Anthony
- Department of Internal Medicine, Carolinas Medical Center, 1000 Blythe Blvd., Charlotte, NC 28203, USA.
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Helbling R, Osterheld MC, Vaudaux B, Jaton K, Nydegger A. Intestinal spirochetosis mimicking inflammatory bowel disease in children. BMC Pediatr 2012; 12:163. [PMID: 23066991 PMCID: PMC3480841 DOI: 10.1186/1471-2431-12-163] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 10/08/2012] [Indexed: 11/30/2022] Open
Abstract
Background Intestinal spirochetosis is an unusual infection in children and its clinical significance in humans is uncertain. The presence of these microorganisms in humans is well-known since the late 1800’s and was first described in 1967 by Harland and Lee by electron microscopy. Case presentation This article reports the findings of one pediatric case, review of the current literature, and an overview of therapeutic options. Conclusion A high degree of suspicion is required in cases presenting with abdominal pain, chronic diarrhoea and/or hematochezia associated with a normal endoscopic examination, thus emphasizing the importance of multiple biopsies throughout the colon.
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Affiliation(s)
- Rossana Helbling
- Pediatric Gastroenterology Unit, Department of Pediatrics, University of Lausanne, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
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Intestinal spirochaetosis associated with hyperplastic and adenomatous colonic polyps. Pathol Res Pract 2012; 208:177-80. [PMID: 22277793 DOI: 10.1016/j.prp.2011.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 11/15/2011] [Accepted: 12/16/2011] [Indexed: 01/03/2023]
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Takezawa T, Hayashi S, Adachi Y, Sunada K, Hayashi Y, Nishimura N, Yano T, Miyata T, Yamamoto H, Hirai Y, Sugano K. Human intestinal spirochetosis in an immunocompromised host: evaluation of eradication therapy by endoscopy, histopathology and bacteriology. Clin J Gastroenterol 2011; 5:69-73. [DOI: 10.1007/s12328-011-0265-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 10/13/2011] [Indexed: 01/03/2023]
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Bloodstream infection due to Brachyspira pilosicoli in a patient with multiorgan failure. J Clin Microbiol 2011; 49:3697-9. [PMID: 21832021 DOI: 10.1128/jcm.00680-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Brachyspira pilosicoli is an etiological agent of human intestinal spirochetosis. Bloodstream infection due to this microorganism is rare. We report a case of B. pilosicoli bacteremia in a 70-year-old patient who presented with multiorgan failure.
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Carpentieri DF, Souza-Morones S, Gardetto JS, Ross HM, Downey K, Ingebo K, Siaw E. Intestinal spirochetosis in children: five new cases and a 20-year review of the literature. Pediatr Dev Pathol 2010; 13:471-5. [PMID: 20331366 DOI: 10.2350/09-10-0725-cr.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Intestinal spirochetosis (IS) is an unusual infection in children, one with no standard therapeutic options. This article reports the findings on 5 new cases in conjunction with a 20-year review of the pediatric literature. The diagnosis of IS in children requires a high degree of suspicion by the physician, as many cases present with abdominal pain, chronic diarrhea, and/or hematochezia associated with a normal endoscopic examination. Silver stains (Dieterle or Whartin-Starry) are the preferred confirmatory stains on tissue sections. Giemsa (Diff-Quik) and periodic acid-Schiff stains may also be of value. Current literature favors the use of metronidazole in adult patients with IS, yet little information is available regarding treatment options in pediatric cases. This review indicates that a macrolide antibiotic with or without metronidazole may represent the best therapeutic choice for children. Further investigations are needed to determine the correlation between IS and coexisting gastrointestinal diseases and/or immunodeficiencies.
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Sato H, Nakamura SI, Habano W, Wakabayashi G, Adachi Y. Human intestinal spirochaetosis in northern Japan. J Med Microbiol 2010; 59:791-796. [PMID: 20378723 DOI: 10.1099/jmm.0.017376-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A histological diagnosis of human intestinal spirochaetosis (HIS) was made in 114 patients during the period 1994-2007. All patients lived in three prefectures in the northern part of Honshu, Japan. Most patients were elderly and male. Twenty-nine patients complained of abdominal pain, bloody stools, diarrhoea or bowel symptoms, but most patients showed no direct symptoms of bowel disease, and occult faecal blood detected at medical check-up was the main reason for colonoscopic examination. There were no homosexual patients and no immunosuppressed patients. HIS was evenly distributed throughout the whole colorectum. PCR analysis of Brachyspira aalborgi and Brachyspira pilosicoli revealed that more patients were infected with B. aalborgi. Follow-up PCR studies confirmed that infestation with B. aalborgi could be repeatedly detected over a 6 year period. This study, involving over 100 patients, identified the characteristic features of HIS in northern Japan. The results suggest that these spirochaetes may be harmless commensals that cause no obvious pathological alterations in infected individuals.
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Affiliation(s)
- Hajime Sato
- Department of Surgery, Iwate Prefectural Ninohe Hospital, Ninohe, Japan
| | | | - Wataru Habano
- Department of Pharmacodynamics and Molecular Genetics, School of Pharmacy, Iwate Medical University, Morioka, Japan
| | - Go Wakabayashi
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Yoshikazu Adachi
- Animal Health Laboratory, School of Agriculture, Ibaraki University, Ibaraki, Japan
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36
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Lauwers G, Mino-Kenudson M, Kradin RL. Infections of the Gastrointestinal Tract. DIAGNOSTIC PATHOLOGY OF INFECTIOUS DISEASE 2010. [PMCID: PMC7152102 DOI: 10.1016/b978-1-4160-3429-2.00009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Diarrea de larga evolución y etiología infecciosa controvertida en paciente homosexual infectado por el VIH. Enferm Infecc Microbiol Clin 2009; 27:53-5. [DOI: 10.1016/j.eimc.2008.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 04/24/2008] [Indexed: 11/18/2022]
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Carr NJ, Mahajan H, Tan KL, Sharma R. The histological features of intestinal spirochetosis in a series of 113 patients. Int J Surg Pathol 2008; 18:144-8. [PMID: 19117973 DOI: 10.1177/1066896908330203] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A multicenter retrospective review of cases diagnosed as spirochetosis was performed to determine the presenting symptoms and histological changes. A total of 113 cases were retrieved from the archives, consisting of 97 colorectal specimens and 16 appendices. In only 25 cases was the presenting symptom recorded as diarrhea. Of the colorectal specimens, 87 (90%) showed no mucosal abnormality (apart from the spirochetes); the other 10 showed mucosal inflammation but 6 of them had a diagnosis of another inflammatory disease process accounting for the inflammatory changes. Five appendices showed acute appendicitis; the other 11 were unremarkable. It is concluded that spirochetosis in an unselected general population is unlikely to be of pathological significance. Furthermore, if spirochetosis is observed in an inflamed biopsy, it is most likely to be an incidental finding.
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Affiliation(s)
- Norman J Carr
- Graduate School of Medicine, University of Wollongong, New South Wales, Australia.
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Calderaro A, Gorrini C, Peruzzi S, Piccolo G, Dettori G, Chezzi C. Occurrence of human intestinal spirochetosis in comparison with infections by other enteropathogenic agents in an area of the Northern Italy. Diagn Microbiol Infect Dis 2007; 59:157-63. [PMID: 17662556 DOI: 10.1016/j.diagmicrobio.2007.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 04/27/2007] [Accepted: 05/03/2007] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate the occurrence of human intestinal spirochetosis (IS) by a 16S rRNA restriction fragment length polymorphism polymerase chain reaction (RFLP-PCR) in a selected group (234) of patients with gastrointestinal complaints and/or potential risk factors for IS in comparison with the occurrence of infections by other enteropathogenic agents. By using 16S rRNA RFLP-PCR, 16 patients (6.8%) with IS were found (11 infected by Brachyspira aalborgi, 3 by Brachyspira pilosicoli, and 2 by both species); moreover, 10 patients with gastroenteric viruses (4.2%), 13 with enteropathogenic bacteria other than intestinal spirochetes (5.5%), and 24 with intestinal parasites (10.2%) were found. This study provides an enhancement of the knowledge about the distribution of IS, suggesting that it may be more frequent than suspected and that clinicians should consider IS when patients present with long-standing diarrhea. Moreover, 16S rRNA RFLP-PCR might be a powerful tool not only for diagnostic purpose but also to investigate the occurrence of IS just on fecal samples, not requiring invasive diagnostic techniques.
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Affiliation(s)
- Adriana Calderaro
- Department of Pathology and Laboratory Medicine, Section of Microbiology, University of Parma, 43100 Parma, Italy.
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