Intestinal spirochetosis: first cases reported in Brazil and the use of immunohistochemistry as an aid in histopathological diagnosis

Abstract

Colonization of the colon and rectum by intestinal spirochetes is detected for the first time in Brazil in 4 of 282 (1.41%) patients who had undergone sigmoidoscopy and/or colonoscopy with a histopathological diagnosis of chronic non specific-colitis. This frequency is probably understimated, since surgically obtained specimens were not considered in the present study. Histopathological diagnosis was performed using routine stains like hematoxylin-eosin which showed the typical, of 3-µm thick hematoxyphilic fringe on the brush border of the surface epithelium, and by silver stains like the Warthin-Starry stain. Immunohistochemical procedures using two, polyclonal, primary antibodies, one against Treponema pallidum and the other against Leptospira interrogans serovar copenhageni serogroup Icterohaemorrhagiae cross-reacted with spirochetal antigen/s producing a marked contrast of the fringe over the colonic epithelium, preserving the spiral-shaped morphology of the parasite. In one case with marked diarrhea, immunohistochemistry detected spirochetal antigen/s within a cell in an intestinal crypt, thus demonstrating that the infection can be more widely disseminated than suspected using routine stains. Immunohistochemical procedures, thus, greatly facilitate the histological diagnosis of intestinal spirochetosis and may contribute to a better understanding of the pathogenesis of the disease. Transmission and scanning electron microscopy performed in one case showed that the spirochete closely resembled the species designated as Brachyspira aalborgi.

Cross-reactivity of Anti-Treponema Immunohistochemistry With Non-Treponema Spirochetes: A Simple Call for Caution

“…These findings are supportive of those described by De Brito and colleagues, 4 who described the cross-reactivity of the spirochetes of intestinal spirochetosis with both anti-T pallidum and antiLeptospira interrogans antibodies. …”

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

“…The cross reaction between intestinal spirochetes and T. pallidum was first described by De Brito et al in 1996. 7 In addition, anti-M. bovis antibody has been reported to be a promising screening tool for the detection of microorganism especially in the field of dermatopathology because of its cross reactivity with many bacteria and fungi. 8 Thus, we considered to apply both anti-T. pallidum and anti-M. bovis immunostaining to the detection of intestinal spirochetes.…”

The Spirochete Brachyspira pilosicoli, Enteric Pathogen of Animals and Humans

“…The majority of patients who have been described with histologically defined HIS have been from developed westernized countries, although rectal biopsy specimens showing false brush borders of spirochetes also have been recorded in rural patients from southern India (84) and from Brazil (85). Individuals with biopsy samples showing evidence of HIS may have one or another of a range of nonspecific symptoms attributable to an underlying chronic intestinal complaint for which other potential etiological factors have been excluded.…”

“…The application of antiserum to Treponema pallidum or Leptospira interrogans to histological sections can be used to assist with identifying the presence of attached spirochetes (85,117,163,196). An alternative novel approach has been the use of in vivo confocal endomicroscopy on fresh tissue, with specific fluorescent staining used to identify areas of spirochete attachment (197).…”