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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. Enferm Infecc Microbiol Clin (Engl 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Prieto Pérez L, Górgolas Hernández-Mora M. An approach to the correct interpretation of intestinal spirochaetosis. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:229-230. [PMID: 38704192 DOI: 10.1016/j.eimce.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Laura Prieto Pérez
- División de Enfermedades Infecciosas, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Departamento de Medicina, Universidad Autónoma de Madrid, Spain
| | - Miguel Górgolas Hernández-Mora
- División de Enfermedades Infecciosas, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Departamento de Medicina, Universidad Autónoma de Madrid, Spain.
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Català A, Hernández DG. AEDV Expert Recommendations on the Management of Suppurative Sexually Transmitted Infections. Actas Dermosifiliogr 2024:S0001-7310(24)00340-5. [PMID: 38663731 DOI: 10.1016/j.ad.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024] Open
Abstract
The incidence of sexually transmitted infections (STIs) is increasing in Spain. Suppurative STIs are one of the most frequent reasons for consultation in specialized centers. The reason for suppurative STIs is multiple and their empirical treatment varies with the currently growing problem of antimicrobial resistance. Dermatologists are trained and prepared to treat these diseases, but their correct management requires active knowledge of national and international guidelines. The present document updates, reviews and summarizes the main expert recommendations on the management and treatment of these STIs.
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Affiliation(s)
- A Català
- Servicio de Dermatología y Venereología, Grupo Español de Investigación en ITS y VIH de la Academia Española de Dermatología y Venereología, España; Programa de Salud Sexual, Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Barcelona, España; Grupo Español de Investigación en ITS y VIH de la Academia Española de Dermatología y Venereología,spaña.
| | - D García Hernández
- Programa de Salud Sexual, Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Barcelona, España; Grupo Español de Investigación en ITS y VIH de la Academia Española de Dermatología y Venereología,spaña
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Tidwell J, Fusco J, Nguyen MTT, Nam GH, Goldenberg S. Colonizing the Unlikely: Brachyspira in an Immunocompetent Patient. ACG Case Rep J 2024; 11:e01338. [PMID: 38638197 PMCID: PMC11025710 DOI: 10.14309/crj.0000000000001338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Chronic diarrhea is a common condition that medical professionals often encounter. We present an unusual case of chronic diarrhea in a relatively young, immunocompetent man that was attributed to Brachyspira. The patient's clinical presentation was not specific, and he underwent workup for common infectious, inflammatory, and autoimmune causes, all unrevealing. During colonoscopy, no abnormalities were detected; however, histopathology revealed the presence of Brachyspira. Following a course of metronidazole, the patient showed marked improvement in his diarrhea. It is worth noting that the patient's social history did not align with the established risk factors mentioned in the existing literature.
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Affiliation(s)
- Jasmine Tidwell
- Department of Internal Medicine, UConn John Dempsey Hospital, Farmington, CT
| | - Jennifer Fusco
- School of Medicine, University of Connecticut, Farmington, CT
| | - Minh Thu T. Nguyen
- Department of Gastroenterology and Hepatology, University of Connecticut, Farmington, CT
| | - Ga Hie Nam
- Department of Pathology and Laboratory Medicine, University of Connecticut, Farmington, CT
| | - Steven Goldenberg
- Department of Gastroenterology and Hepatology, University of Connecticut, Farmington, CT
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Ramanathan B, Ramachandran V, Rana A, McDonald C. A Case Study: Incidental Finding of Human Intestinal Spirochetosis in Screening Colonoscopy. Cureus 2024; 16:e55422. [PMID: 38567235 PMCID: PMC10985559 DOI: 10.7759/cureus.55422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/04/2024] Open
Abstract
Human intestinal spirochetosis (HIS) is a rare occurrence. We present an interesting case study on an asymptomatic over-60-year-old male who was incidentally discovered to have HIS following a colonoscopy that was conducted for his positive fecal occult blood test (FOBT). Histopathology of the colonic biopsy proved the presence of human intestinal spirochetosis; however, as he was asymptomatic, treatment was not initiated in his case. We discuss here the prevalence, presentation, diagnostic methods, and treatment of colonic HIS.
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Affiliation(s)
| | | | - Abdul Rana
- Surgery, Lyell Mcewin Hospital, Adelaide, AUS
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lüthy M, Käser SA, Wagener C, Fahrner R. Spirochetosis Mimicking Acute Appendicitis: Clinical Report and Review of the Literature. Inflamm Intest Dis 2023; 8:128-132. [PMID: 38098494 PMCID: PMC10718576 DOI: 10.1159/000531961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/30/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Intestinal spirochetosis is sometimes found by chance in histological specimen of routine endoscopies. There are only a few cases described in the literature that spirochetosis of the appendix was mimicking acute appendicitis. We present a case of pseudoappendicitis with the histological finding of spirochetes and review the current literature. Case Presentation A 72-year-old woman presented with pain of the lower right abdomen and previous systemic corticoid therapy. In clinical examination, there was a tenderness and pain in the right lower quadrant, and inflammation values were elevated. An abdominal computed tomography scan revealed no obvious inflammation of the appendix. A diagnostic laparoscopy was performed and revealed a macroscopically uninflamed appendix which was removed. Histology revealed spirochetosis of the appendix but no typical signs of appendicitis. The patient was treated with antibiotics for 5 days and was discharged without abdominal pain. In a clinical control 6 weeks later, the abdominal pain had disappeared and the patient was in good clinical condition. Discussion Intestinal spirochetosis is randomly found in histological specimen during routine endoscopies, even in asymptomatic patients. There are only a few cases described with spirochetosis of the appendix causing pain and mimicking appendicitis; hence, this entity is an important differential diagnosis of pain in the right lower quadrant of the abdomen.
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Affiliation(s)
- Magdalena Lüthy
- Department of Surgery, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Samuel A. Käser
- Department of Surgery, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Carolin Wagener
- Institute of Pathology, Pathology Länggasse, Bern, Switzerland
| | - René Fahrner
- Department of Surgery, Bürgerspital Solothurn, Solothurn, Switzerland
- Department of Surgery, Spital Thun, Thun, Switzerland
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8
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Vega-González J, Pérez-Alonso P, Sanz G, Fernández-Aceñero MJ. Anal cytology: Diagnosis of intestinal spirochaetosis. Cytopathology 2023; 34:630-633. [PMID: 37485960 DOI: 10.1111/cyt.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE A case of intestinal spirochaetosis diagnosed in anal cytology is presented. METHODS An anal liquid-based cytology was performed and stained with Papanicolau and Warthin-Starry stains. RESULTS An apical filamentous "fringe" was identified in columnar cells groups. CONCLUSION Anal cytology is a potential tool for intestinal spirochaetosis diagnosis.
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Affiliation(s)
- Jesús Vega-González
- Department of Pathology, Hospital Universitario Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
- Department of Surgery, Hospital Universitario Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo Pérez-Alonso
- Department of Pathology, Hospital Universitario Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
- Department of Surgery, Hospital Universitario Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Gonzalo Sanz
- Department of Pathology, Hospital Universitario Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
- Department of Surgery, Hospital Universitario Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - María Jesús Fernández-Aceñero
- Department of Pathology, Hospital Universitario Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
- Department of Surgery, Hospital Universitario Clínico San Carlos, Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Duncanson K, Tikhe D, Williams GM, Talley NJ. Irritable bowel syndrome - controversies in diagnosis and management. Expert Rev Gastroenterol Hepatol 2023; 17:649-663. [PMID: 37317843 DOI: 10.1080/17474124.2023.2223975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The irritable bowel syndrome (IBS) is the best-recognized disorder of gut brain interactions (DGBI). However, it is controversial if the Rome IV criteria iteration for IBS diagnosis is fit for purpose. AREAS COVERED This review critically evaluates Rome IV criteria for diagnosis of IBS and addresses clinical considerations in IBS treatment and management, including dietary factors, biomarkers, disease mimics, symptom severity, and subtypes. The role of diet in IBS is critically reviewed along with the influence of the microbiota, including small intestinal bacterial overgrowth. EXPERT OPINION Emerging data suggest the Rome IV criteria are more suitable for identifying severe IBS and least useful for sub-diagnostic patients who are still likely to benefit from IBS treatment. Despite convincing evidence that IBS symptoms are diet-driven and often postprandial, a relationship to eating is not a Rome IV diagnostic criterion. Few IBS biomarkers have been identified, suggesting the syndrome is too heterogeneous to be measured by a single marker, and combined biomarker, clinical, dietary, and microbial profiling may be needed for objective characterization. With many organic diseases mimicking and overlapping with IBS, it's important clinicians are knowledgable about this to mitigate the risk of missing comorbid organic intestinal disease and to optimally treat IBS symptoms.
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Affiliation(s)
- Kerith Duncanson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Centre of Research Excellence in Digestive Health, The University of Newcastle, New Lambton Heights, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Dhanashree Tikhe
- Centre of Research Excellence in Digestive Health, The University of Newcastle, New Lambton Heights, NSW, Australia
- Department of Gastroenterology, John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW, Australia
| | - Georgina M Williams
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Centre of Research Excellence in Digestive Health, The University of Newcastle, New Lambton Heights, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Nicholas J Talley
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Centre of Research Excellence in Digestive Health, The University of Newcastle, New Lambton Heights, NSW, Australia
- Immune Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Department of Gastroenterology, John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW, Australia
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Novick SD, Berhanu M, Negassi YG, Demissie SW, Hussain Kazmi SA, Holder SS. Intestinal Spirochetosis and Chronic Diarrhea: A Case Report and Literature Review. Cureus 2023; 15:e40276. [PMID: 37448403 PMCID: PMC10336368 DOI: 10.7759/cureus.40276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Spirochetosis is a rare condition characterized by the presence of spirochetes in the gastrointestinal tract. It is typically associated with immunodeficiency. We present a case of chronic watery diarrhea in a 48-year-old housewife who had a 12-week history of variable-volume bowel movements without blood or mucus, accompanied by a sense of urgency. Chronic diarrhea led to weight loss and fatigue, significantly impacting her quality of life. Despite the absence of known risk factors, a comprehensive clinical evaluation and exclusion of other potential causes prompted a rectosigmoid biopsy, which revealed distinctive histological findings of spirochetosis. This case underscores the significance of considering spirochetosis as a differential diagnosis in cases of chronic watery diarrhea, even in the absence of immunodeficiency. The utilization of rectosigmoid biopsy and careful histopathological examination played a pivotal role in establishing an accurate diagnosis.
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Affiliation(s)
- Samuel D Novick
- General Surgery, Nassau University Medical Center, East Meadow, USA
- Medical School, University of Nicosia Medical School, Nicosia, CYP
| | - Mefthe Berhanu
- Health Science, University of Texas Health Science Center at Houston, Houston, USA
| | - Yordanos G Negassi
- Internal Medicine, Learn and Live Wholestic Health Services Clinic, Alexandria, USA
| | | | | | - Shaniah S Holder
- Medicine, American University of Barbados School of Medicine, Bridgetown, BRB
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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