Intestinal spirochaetosis: an electron microscopic study of an unusual case

Antonakopoulos, G N; Newman, J.; Wilkinson, MarkL.

doi:10.1111/j.1365-2559.1982.tb02744.x

Cited by 47 publications

(32 citation statements)

References 23 publications

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“…However, recent studies have demonstrated invasive spirochetes penetrating into epithelial cells, lamina propria, macrophages, and even Schwann cells. [17][18][19] Furthermore, marked increase of IgE-producing plasma cells in lamina propria and intraepithelial mast cells has been reported, suggesting close association of immediate-type immune reaction of the host. 20 Kö rner et al 21 postulate that invasive human intestinal spirochetosis with marked inflammatory reaction is related to clinical symptoms.…”

Section: Discussionmentioning

confidence: 98%

Human intestinal spirochetosis in Japan; its incidence, clinicopathologic features, and genotypic identification

et al. 2008

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Human intestinal spirochetosis is a common condition in Western countries, but is not well recognized in Japan. To demonstrate the incidence and clinicopathologic findings of human intestinal spirochetosis in Japan, we retrospectively investigated biopsy, and endoscopically or surgically resected specimens of the large intestine. Among a series of 2556 samples, 11 cases of human intestinal spirochetosis were detected (0.4%). Together with additional nine cases sporadically found, 20 cases of human intestinal spirochetosis were subjected to molecular detection of two strains of spirochetes (Brachyspira aalborgi and Brachyspira pilosicoli) by amplifying species-specific portion of 16S ribosomal RNA and NADH oxydase gene by polymerase chain reaction. B. aalborgi was detected in all cases examined, three of which revealed dual infection of both species. Our results suggest that human intestinal spirochetosis infection is relatively rare, and B. aalborgi is the most prevalent species in Japan. Most of human intestinal spirochetosis were asymptomatic, although symptomatic in exceptional cases. In addition, we emphasize a usefulness of immunostaining with anti-Treponema pallidum and anti-Mycobacterium bovis polyclonal antibodies for detecting the spirochetes.

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Section: Discussionmentioning

confidence: 98%

Human intestinal spirochetosis in Japan; its incidence, clinicopathologic features, and genotypic identification

et al. 2008

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“…In addition, the tips of the spirochetes also penetrated the adjacent cell cytoplasm but did not go all the way to the lamina propria, as was demonstrated in two other reports. 8,9 This superficial penetration of the spirochetes in our case, apparently represents an anchoring mechanism rather than a sign of invasiveness.…”

Section: Discussionmentioning

confidence: 57%

“…3 Ultrastructural studies have shown variable results regarding the invasiveness of spirochetes. [7][8][9][10] The purpose of this paper is to present our light microscopic and ultrastructuralobservations in the first two cases of appendicealspirochetosis from Saudi Arabia.…”

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confidence: 99%

Appendiceal Spirochetosis: A Light and Electron Microscope Study of Two Cases

Haleem

Al‐Hindi

et al. 2003

Ann Saudi Med

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Intestinal spirochetosis is generally considered a saprophytic infestation of the large bowel mucosa. Since this term was introduced in 1967, 1 there have been many reports of colorectal spirochetosis, including one from Saudi Arabia.2 Appendicealspirochetosis, however, is less commonly reported. A Medline search of the English language literature yielded only four reports of appendicealspirochetosis describing 85 cases before 2001. 3-6The reported incidence of spirochetosis in otherwise normal appendices has varied between 3.7% 6 and 12.3%. 4 We reviewed 598 consecutive appendectomy specimens with intact surface epithelium and found only two cases of spirochetosis. Spirochetosis is generally considered a harmless infestation colonizing the large bowel epithelium.3 Ultrastructural studies have shown variable results regarding the invasiveness of spirochetes.7-10 The purpose of this paper is to present our light microscopic and ultrastructuralobservations in the first two cases of appendicealspirochetosis from Saudi Arabia. Patients and MethodsThis report is based on a retrospective study of 679 appendectomy specimens received during a period of two years in the Department of Histopathology at the Armed Forces Hospital, Riyadh, Saudi Arabia. Eighty-one cases that lacked an intact surface epithelium were excluded from the study. These included 65 cases of acute appendicitis and 16 cases of appendiceal fibrosis. For light microscopy, cross sections of the base and middle of an appendix and a longitudinal section of the tip were processed for paraffin embedding. Sections were routinely cut and stained with haematoxylin and eosin (H&E) stain. Sections with epithelial surfaces suspicious of spirochetal colonization on H&E were also stained with Warthin-Starry (WS) stain. Electron microscopy was carried out on one of the two appendices showing spirochetosis. One-millimeter slices were taken from the remaining formalin-fixed tissue. These were post-fixed in 3% glutaraldehyde and processed for electron microscopy using standard techniques. ResultsOf 598 appendectomy specimens with intact surface epithelium, a diagnosis of acute appendicitis was made in 473 appendices (79%) followed by 22 parasitic infestations (4%) and 6 tumors (1%) ( Table 1). Ninety-seven appendices (16%) were histologically normal except for neuromatous hyperplasia in 3 cases and spirochetosis in two cases. The incidence of spirochetosis was 0.3% of all the appendices and 2% of the normal looking ones. Both patients with spirochetosis were male, aged 18 and 25 years. Both presented with abdominal pain and were diagnosed with acute appendicitis on clinical grounds. Although their HIV status was not known, both appeared immunocompetent and had no other complaints. The excised appendices of these two patients appeared normal on gross examination.On light microscopy, both appendices showed a thick layer of spirochetes on the luminal side of the surface epithelium (Figure 1). They appeared as haematoxyphilic fibrillar material on H&E and were argyrophilic ...

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“…In an immunocompetent heterosexual man with histological HIS, electron microscopy identified stunting of the microvilli together with spirochetes invading colonic epithelial cells, goblet cells, macrophages, and Schwann cells (125). In another patient, who had Crohn's disease and ankylosing spondylitis, spirochetes were found on the luminal surface of absorptive and goblet cells but also within the cytoplasm, in occasional macrophages within the lamina propria, and again within the occasional Schwann cell (126). Potentially, interference with Schwann cell function could influence neuronal myelation and function at the level of the gut wall or in other regions where the spirochete might invade.…”

Section: Observations In Natural and Experimental Infectionsmentioning

confidence: 99%

The Spirochete Brachyspira pilosicoli, Enteric Pathogen of Animals and Humans

Hampson

2018

Clin Microbiol Rev

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SUMMARY Brachyspira pilosicoli is a slow-growing anaerobic spirochete that colonizes the large intestine. Colonization occurs commonly in pigs and adult chickens, causing colitis/typhlitis, diarrhea, poor growth rates, and reduced production. Colonization of humans also is common in some populations (individuals living in village and peri-urban settings in developing countries, recent immigrants from developing countries, homosexual males, and HIV-positive patients), but the spirochete rarely is investigated as a potential human enteric pathogen. In part this is due to its slow growth and specialized growth requirements, meaning that it is not detectable in human fecal samples using routine diagnostic methods. Nevertheless, it has been identified histologically attached to the colon and rectum in patients with conditions such as chronic diarrhea, rectal bleeding, and/or nonspecific abdominal discomfort, and one survey of Australian Aboriginal children showed that colonization was significantly associated with failure to thrive. B. pilosicoli has been detected in the bloodstream of elderly patients or individuals with chronic conditions such as alcoholism and malignancies. This review describes the spirochete and associated diseases. It aims to encourage clinicians and clinical microbiologists to consider B. pilosicoli in their differential diagnoses and to develop and use appropriate diagnostic protocols to identify the spirochete in clinical specimens.

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Intestinal spirochaetosis: an electron microscopic study of an unusual case

Cited by 47 publications

References 23 publications

Human intestinal spirochetosis in Japan; its incidence, clinicopathologic features, and genotypic identification

Human intestinal spirochetosis in Japan; its incidence, clinicopathologic features, and genotypic identification

Appendiceal Spirochetosis: A Light and Electron Microscope Study of Two Cases

The Spirochete Brachyspira pilosicoli, Enteric Pathogen of Animals and Humans

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