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Indian Journal of Pathology and Microbiology
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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 902-903
Intestinal spirochaetosis


1 Department of Gastroenterology, Medical Trust Hospital, Kochi, India
2 Department of Pathology, Medical Trust Hospital, Kochi, India

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Panackel C, Sebastian B, Mathai S, Thomas R. Intestinal spirochaetosis. Indian J Pathol Microbiol 2010;53:902-3

How to cite this URL:
Panackel C, Sebastian B, Mathai S, Thomas R. Intestinal spirochaetosis. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Aug 13];53:902-3. Available from: http://www.ijpmonline.org/text.asp?2010/53/4/902/72063


Sir,

A 60 year old male patient presented with history of crampy lower abdominal pain and loose stools of three months duration. The diarrhea was small volume, watery and there was no blood in stool. There was no weight loss, steatorrhea, bloating, borborygmi or vomiting. There was no significant past history. There was no history of high-risk sexual activity. General examination and systemic examination was normal. Hematologic and biochemical work up were normal. His HIV Elisa was negative. Stool routine examination was negative for blood, parasites and ova. Colonoscopy showed mild erythema of cecum and ascending colon, rest of the colon was normal. Biopsy specimen from cecum and ascending colon showed a layer of basophilic organism covering the colonic epithelium forming a false brush border. There was no significant inflammation of mucosa or sub-mucosa [Figure 1]a. Giemsa and silver stain [Figure 1]b, c confirmed the organism to be spirochetes. Patient was diagnosed to have intestinal spirochetosis and treated with metrogyl 400 mg orally for 10 days. Patient had symptomatic improvement and repeat colonoscopy and biopsy after one month was negative for the organism.
Figure 1: (a) High-power view of colonic biopsy showing a densely packed layer of basophilic organism covering the luminal surface of colonic epithelia and forming a false brush border; there is no significant inflammation of lamina propria, (b) Silver stain highlighting the organism, (c) Giemsa stain highlighting the organism

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Intestinal spirochetosis is characterized by the presence of spirochetes attached to the apical cell membrane of colonic epithelium. It is a self-limiting disorder caused by gram-negative motile organisms belonging to family Spirochetaceae. [1] The members of family include, Brachyspira aalborgi and Brachyspira pilosicoli. The organisms are spiral, 10 μm in length, 0.2-0.5 μm in diameter and basophilic. [1] The prevalence of intestinal spirochetosis varies from 1 to 1.5% in developed countries to 11.4 to 64.3% in developing countries. [2] The incidence is higher in homosexual males (35%) and immunosuppressed (20.6-62.3%). [1],[2] The organism spread via feco-oral route and colonization depends on sanitation, diet, sexual practice and immune status of the patient. Chronic fecal stasis also favors bacterial multiplication and colonization.

Intestinal spirochetosis is usually asymptomatic and detected on routine colonic biopsy. Rarely patients present with watery diarrhea, weight loss, crampy abdominal pain and rectal bleeding. [3] Increased incidence of spirochetes has been found in appendicectomy specimens of patients who have typical symptoms and signs of appendicitis but no inflammation on biopsy specimen. [4] The goal standard for diagnosis of intestinal spirochetosis is colonic biopsy. Colonoscopic appearance varies from normal to mild edema, erythema, erosions or small ulcerations. On hematoxylin and eosin stain, the biopsy specimens show a densely packed layer of basophilic organism covering the luminal surface of colonic epithelia and forming a false brush border. Rarely organisms invade the lamina propria. The colonization is not associated any significant inflammation. The organisms can be highlighted using periodic acid Schiff, Giemsa, Grocotts and Silver stains. [2] Immunostaining using antibody against Treponema Pallidum that cross reacts with Brachyspira spp. has been used to identify the organism. PCR and FISH techniques detect the organism in feces and biopsy specimens. Recently, in vivo detection of spirochetes using confocal endomicroscopy has been described. [5] The clinical significance of intestinal spirochetosis is not known. Asymptomatic patients can be safely followed up. Symptomatic patients and immunosuppressed are treated with metronidazole 500 mg three times daily or clarithromycin 800 mg daily for ten days. [1] Most patients achieve clinical relief and recurrence is rare.

 
   References Top

1.Tsuzawa K, Fujisawa N, Sekino Y, Suzuki K, Saito K, Koyama S, et al. Education and Imaging: Gastrointestinal: Colonic spirochetosis. J.Gastroenterol Hepatol 2008;23:1160.  Back to cited text no. 1
    
2.Korner M, Gebbers JO. Clinical significance of human intestinal spirochetosis: A morphologic approach. Infection 2003;31:341-9.   Back to cited text no. 2
    
3.Alsaigh N, Fogt F. Intestinal spirochetosis: Clinicopathological features with review of the literature. Colorectal Dis 2002;4:97-100.  Back to cited text no. 3
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4.Henrik-Nielsen R, Lundbeck FA, Teglbjaerg PS, Ginnerup P, Hovind-Hougen K. Intestinal spirochetosis of the vermiform appendix. Gastroenterology 1985;88:971-7.  Back to cited text no. 4
[PUBMED]    
5.Gunther U, Epple HJ, Heller F, Loddenkemper C, Grunbaum M, Schneider T, et al. In vivo diagnosis of intestinal spirochaetosis by confocal endomicroscopy. Gut 2008;57:1331-3.  Back to cited text no. 5
    

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Correspondence Address:
Charles Panackel
Associate Consultant, Department of Gastroenterology, Medical Trust Hospital, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72063

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