Intestinal spirochetosis and chronic watery diarrhea: Clinical and histological response to treatment and long‐term follow up

Esteve, María; Salas, Antonio; Fernández‐Bañares, Fernando; Lloreta, Josep; Mariné, Meritxell; González, Clara Isabel; Forné, Montserrat; Casalots, Jaume; Santaolalla, Rebeca; Espinós, Jorge C.; Munshi, M. Arif; Hampson, David J.; Viver, Josep Maria

doi:10.1111/j.1440-1746.2006.04150.x

Cited by 94 publications

(68 citation statements)

References 43 publications

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“…Furthermore, in several HIS case reports, edematous mucosa with multiple erythematous spots was detected in the ascending and proximal transverse colon, but not in the distal colon or rectum (13,14). The colonoscopic findings in HIS patients show either non-specific ulceration of the ileocecal valve or extensive areas of ischemic ulcers (15). In the present cases, HIS was found in irregularly-shaped ulcers or extensive longitudinal ulcers.…”

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confidence: 57%

Human Intestinal Spirochaetosis in Two Ulcerative Colitis Patients

et al. 2014

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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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confidence: 57%

Human Intestinal Spirochaetosis in Two Ulcerative Colitis Patients

et al. 2014

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“…However, diagnosis of HIS on the basis of HE staining requires experienced laboratory personnel and accurate interpretation, and silver staining is often needed to confirm the diagnosis (10). Therefore, a significant portion of cases may be missed, especially since B. pilosicoli might also colonize the epithelium without the characteristic end-on attachment, impeding identification by light microscopy at low magnification (24).…”

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confidence: 99%

Rapid and Accurate Diagnosis of Human Intestinal Spirochetosis by Fluorescence In Situ Hybridization

Schmiedel

Epple²,

Loddenkemper

et al. 2009

J Clin Microbiol

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Human intestinal spirochetosis (HIS) is associated with overgrowth of the large intestine by spirochetes of the genus Brachyspira. The microbiological diagnosis of HIS is hampered by the fastidious nature and slow growth of Brachyspira spp. In clinical practice, HIS is diagnosed histopathologically, and a significant portion of cases may be missed. Fluorescence in situ hybridization (FISH) is a molecular method that allows the visualization and identification of single bacteria within tissue sections. In this study, we analyzed intestinal biopsy samples from five patients with possible HIS. All specimens yielded positive results by histopathological techniques. PCR amplification and sequencing of the 16S rRNA gene were performed. Sequences of two isolates clustered in the group of Brachyspira aalborgi, whereas in three cases, the sequences were highly similar to that of Brachyspira pilosicoli. Three phylotypes showed mismatches at distinct nucleotide positions with Brachyspira sp. sequences published previously. In addition, culture for Brachyspira was successful in three cases. On the basis of these data, we designed and evaluated a Brachyspira genus-specific 16S rRNA-directed FISH probe that detects all of the Brachyspira spp. published to date. FISH of biopsy samples resulted in strong, unequivocal signals of brush-like formations at the crypt surfaces. This technique allowed simultaneous visualization of single spirochetes and their identification as Brachyspira spp. In conclusion, FISH provides a fast and accurate technique for the visualization and identification of intestinal spirochetes in tissue sections. It therefore represents a valuable tool for routine diagnosis of HIS.

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“…Colonization of the large intestine is usually followed by the attachment of spirochetes to the epithelial apical membrane, but penetration and cell damage are uncommon (5,17). The clinical significance of HIS is still controversial (6,15), since most cases are asymptomatic, though some individuals may present abdominal cramps, diarrhea, and rectal bleeding (15,17).…”

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confidence: 99%

“…While HIS is quite common in developing areas, in western countries it is mainly seen in men who have sex with men (13), HIV-infected individuals, and certain populations, such as Australian aborigines (3). HIS seems to be relatively uncommon in our area (Catalonia, Spain), according to a prospective 10-year study using specific PCR detection on colonic biopsy specimens from patients with chronic watery diarrhea (6). No stool cultures were taken to confirm spirochete fecal carriage in our patient since he did not display diarrhea and the possibility of HIS was not suspected at any point.…”

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confidence: 99%

Bloodstream Infection Due to Brachyspira pilosicoli in a Patient with Multiorgan Failure

et al. 2011

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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. CASE REPORTA 70-year-old Spanish man with a history of high blood pressure, concentric hypertrophy of the left ventricle, and chronic obstructive pulmonary disease (COPD) with emphysema was referred from a regional hospital to the intensive care unit (ICU) at our center for severe dyspnea. He arrived intubated and oxygen saturation was 75%. On examination he presented with multiorgan failure, hypothermia, tachycardia, and oliguria. Laboratory tests revealed a leukocyte count of 16.5 ϫ 10 9 /liter with 93.7% polymorphonuclear (PMN) cells. A chest X ray showed diffuse emphysema and an upper lobe image suggesting old tuberculosis. Blood and urine specimens for culture were collected on arrival. As respiratory infection was suspected to have exacerbated his COPD, empirical treatment with amoxicillin-clavulanic acid was started. Stool cultures were not performed as the patient had no previous or present signs of gastrointestinal disorders. Initial urine culture was negative. Culture of the bronchoalveolar lavage (BAL) fluid specimen collected on the second day revealed nonsignificant counts of Staphylococcus aureus and scarce colonies of Aspergillus fumigatus, initially considered colonization of the respiratory tract. The patient was hemodynamically unstable for several days due to persistence of rapid atrial fibrillation. Noradrenalin was administered for 3 days, and continuous hemodiafiltration was required. As the patient's condition remained critical, empirical amoxicillinclavulanic was changed to voriconazole and cloxacillin on the fifth day and continued for 10 days.The anaerobic bottle (SN anaerobic medium) from the blood culture set taken on arrival was positive after 6.5 days of incubation in a BacT/Alert automated system (bioMérieux). Gram staining revealed Gram-negative, spiral-shaped bacteria, initially suggesting either a member of the Campylobacter genus or a spirochete (Fig. 1). A subculture of the isolate on Schaedler agar plates (bioMérieux) supplemented with sheep blood (5%) at 37°C yielded growth as a thin, smooth, and beta-hemolytic film under anaerobic conditions only. Catalase, oxidase, and indole test results were negative while the result for hippurate hydrolysis was positive. The isolate was identified as Brachyspira pilosicoli by 16S rRNA gene sequencing and compared to sequences available from GenBank using BLAST (http://blast.ncbi.nlm .nih.gov/Blast.cgi). The nucleotide sequence of the isolate displayed 100% identity to B. pilosicoli strains ATCC 51139 T and P43/6/78 (GenBank accession numbers AY155458 and U14927, respectively).Antibiotic susceptibility of the strain was studied by Etest according to the manufacturer's instructions for anaerobes (AB Biodisk, Sweden). Susceptibility assays were performed on Schaedler agar plates and incubated at ...

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Intestinal spirochetosis and chronic watery diarrhea: Clinical and histological response to treatment and long‐term follow up

Cited by 94 publications

References 43 publications

Human Intestinal Spirochaetosis in Two Ulcerative Colitis Patients

Human Intestinal Spirochaetosis in Two Ulcerative Colitis Patients

Rapid and Accurate Diagnosis of Human Intestinal Spirochetosis by Fluorescence In Situ Hybridization

Bloodstream Infection Due to Brachyspira pilosicoli in a Patient with Multiorgan Failure

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