Intestinal Spirochetosis in an Immunocompetent Patient

Abstract

Intestinal spirochetosis (IS) is an infestation defined by the presence of spirochetes on the surface of the colonic mucosa. The implicated organisms can be Brachyspira aalborgior Brachyspira pilosicoli.We present the case of a 66-year-old man with a past medical history of diabetes mellitus, hypertension, morbid obesity, and gastroesophageal reflux. The patient was sent to the gastroenterology clinic for a screening colonoscopy due to a prior history of colonic polyps. The patient was completely asymptomatic as he denies any abdominal pain, diarrhea, melena, or hematochezia. A colonoscopy was done showing colitis in the cecum and at the ileocecal valve, for which random biopsies were taken in the terminal ileum, cecum, and ascending colon. The histopathology result was positive for spirochetosis. Due to this finding, the patient was referred to the infectious diseases clinic, where a rapid plasma reagin (RPR) and human immunodeficiency virus (HIV) tests were found to be negative. Since the patient was immunocompetent and asymptomatic, it was decided to monitor and not initiate antibiotic treatment.Human IS are not related to non-intestinal spirochetes like Treponema pallidum. An infection of T. pallidum leads to a malignant picture called syphilitic proctitis and appears in the setting of an immunocompromised patient. The treatment of IS is based on the clinical presentation, severity of symptoms, and immune status. The purpose of this case is to emphasize the correct antibiotic indication in patients with IS.

An Unusual Case of Subacute Appendicitis and Intestinal Spirochetosis

“…Spirochetosis has been previously suggested to occur in immunocompromised individuals infected with HIV; however, spirochetosis's prevalence is increasing in the general population [6]. IS masked by systemic or local bowel disease has been previously discussed [2]. Our patient presented with atypical symptoms of IS, masking the diagnosis of appendicitis.…”

“…Moreover, diagnostic procedures are often inconclusive. Colonoscopy may aid in the diagnosis, but findings are non-specific to IS, such as erythematous lesions, polypoid lesions, or normal findings in the majority of the mucosa, as seen in our patient [2]. Histopathology can vary from patient to patient, although a "fuzzy brush border" appearance seems to be the common characteristic [2].…”

“…Colonoscopy may aid in the diagnosis, but findings are non-specific to IS, such as erythematous lesions, polypoid lesions, or normal findings in the majority of the mucosa, as seen in our patient [2]. Histopathology can vary from patient to patient, although a "fuzzy brush border" appearance seems to be the common characteristic [2]. Treatment depends on the presentation and severity of symptoms as well as any other underlying conditions or factors [1].…”

“…Spirochetes are found in the digestive tracts of many species, including humans [1]. Additionally, the clinical presentation of the infection is usually vague and can be similar to other gastrointestinal infections and conditions, such as appendicitis, irritable bowel syndrome and inflammatory bowel disease [2]. The vague nature and presentation of IS highlight the clinical importance of recognizing the disease.…”

A Case of Human Intestinal Spirochetosis Diagnosed During Screening Colonoscopy

“…In most cases, the patient is monitored without prescribing any medication. When the disease is causing severe symptoms, Metronidazole 500 mg four times a day for 10 days can be used to treat patients [19]. Moreover, some patients did not show improvement in symptoms despite the use of antibiotics which questions the clinical significance of the disease [5].…”