Colorectal Spirochetosis in a Child with Rectal Bleeding: Case Report and Literature Review

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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“…Spontaneous resolution of symptoms has also been reported [16,26]. One of our patients was treated with amoxicillin clavulanic acid.…”

Section: Discussionsupporting

confidence: 66%

Intestinal Spirochetosis: A Case Series and Review of the Literature

Lemmens

Devreker

Hauser

et al. 2019

Pediatr Gastroenterol Hepatol Nutr

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“…5 King et al showed it to be presenting as rectal bleed in a young child. 6 Histologically, it appears as a false brush border on the colonic mucosa epithelium. 7 Identification of spirochetes is done via the use of the hematoxylin and eosin (H and E stain) (Figure 1), while the most sensitive test for diagnosing it is polymerase chain reaction (PCR).…”

Section: Discussionmentioning

confidence: 99%

Intestinal Spirocheteosis in a Patient with Celiac Disease

Majid

Khalid

Khan

et al. 2019

J Coll Physicians Surg Pak

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A young girl presented to us with recurrent diarrhea along with a history of 5 kg weight loss in one year. On examination, she appeared pale, while her laboratory reports showed a low hemoglobin, mean corpuscular volume (MCV) and serum albumin. Her erythrocyte sedimentation rate (ESR) was slightly raised with her iron profile suggestive of iron deficiency anemia. Viral markers, human immunodeficiency virus (HIV) serology along with thyroid profile were all unremarkable. There was no history of tuberculosis, and purified protein derivative (PPD) skin test was also negative. Computed tomography (CT) abdomen showed thickening of the terminal ileum with multiple enlarged lymph nodes. An esophagogastroduodenoscopy (EGD) along with colonoscopy was done. Multiple biopsies were taken, which were suggestive of sprue along with intestinal spirochetosis. Her tissue transglutaminase (TTG) was negative while deamidated gliadin peptide (DGP) was positive. She was kept on gluten-free diet and started on tablet metronidazole. This case shows that intestinal spirochetosis should be kept in mind in patients belonging to lower socio-economic status, who present with chronic diarrhea symptoms.

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“…The most common presentation (Table 1) Table 1. Intestinal spirochetosis in children: A 20-year review of clinical data [3,7,8,[10][11][12][13][14] Case No. abnormal endoscopic exam, 5 had additional diagnoses that could explain the abnormal endoscopic findings.…”

Section: Discussionmentioning

confidence: 99%

“…A confirmatory silver stain (Warthin-Starry or Dieterle) is the preferred method for the visualization of the organisms as a picket fence along the brush border. The utility of less cumbersome stains, such as Giemsa (Diff-Quik) and periodic acid-Schiff stains, has been described in a few case reports [4,7,8]. Identification by anaerobic bacterial culture, molecular methods, and ultrastructural analysis are possible, but this identification is costly and time consuming [2,4,5].…”

Section: Introductionmentioning

confidence: 99%

Intestinal Spirochetosis in Children: Five New Cases and a 20-Year Review of the Literature

Carpentieri

Souza-Morones²,

Gardetto

et al. 2010

Pediatr Dev Pathol

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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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Colorectal Spirochetosis in a Child with Rectal Bleeding: Case Report and Literature Review

Cited by 9 publications

References 17 publications

Intestinal Spirochetosis: A Case Series and Review of the Literature

Intestinal Spirochetosis: A Case Series and Review of the Literature

Intestinal Spirocheteosis in a Patient with Celiac Disease

Intestinal Spirochetosis in Children: Five New Cases and a 20-Year Review of the Literature

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