Invasive Colitis and Hepatitis Due to Previously Uncharacterized Spirochetes in Patients with Advanced Human Immunodeficiency Virus Infection

Abstract

We describe three patients with advanced human immunodeficiency virus (HIV) infection, two with colitis and one with cholestatic hepatitis, for whom results of detailed endoscopic and histologic studies were suggestive of invasive spirochetosis. In the two patients with colitis, colonoscopic evaluation revealed either diffuse ulcerations or pustules; in both cases, there was histologic evidence of extensive superficial cell necrosis and infiltration of the mucosa and lamina propria with acute inflammatory cells. Spirochetes in the mucosa and crypts were visualized by Warthin-Starry silver staining. Morphologically similar spirochetes throughout the liver specimen from the patient with cholestatic hepatitis were demonstrated by Warthin-Starry silver staining. Analysis with electron microscopy revealed these organisms to be loosely coiled spirochetes. Despite extensive evaluation, no other pathogens were identified. Invasive spirochetal infection, as defined by the results of Warthin-Starry silver staining of involved tissues, should be considered in the differential diagnosis of patients with HIV infection who have otherwise unexplained colitis or cholestatic hepatitis.

Population genetic analysis of Serpulina pilosicoli and its molecular epidemiology in villages in the Eastern Highlands of Papua New Guinea

“…In certain immunocompromised or debilitated humans, spirochaetes resembling S . pilosicoli have been isolated from regions of the body beyond the large intestine, including the liver (Kostman et al, 1995), and S. pilosicoli has been isolated from the bloodstream (Fournik-Amazouz et al, 1995 ;Trott et al, 1997a). S .…”

In Vitro Antimicrobial Susceptibility of Brachyspira pilosicoli Isolates from Humans

“…In humans, B. pilosicoli is one cause of intestinal spirochetosis, a condition characterized by end-on attachment of the organism to colorectal epithelial cells (9,16,21). In several reports, intestinal spirochetosis was the only abnormal finding for patients with abdominal pain, rectal bleeding, and diarrhea, and many of these symptoms were long-term or recurrent (4,12,16).B. pilosicoli has been isolated at a prevalence of 10 to 30% from the feces of a range of different human population groups, including Aboriginal Australians (3, 15), individuals from developing countries (2, 3, 23), homosexual males, and human immunodeficiency virus-positive individuals (21).…”

“…In humans, B. pilosicoli is one cause of intestinal spirochetosis, a condition characterized by end-on attachment of the organism to colorectal epithelial cells (9,16,21). In several reports, intestinal spirochetosis was the only abnormal finding for patients with abdominal pain, rectal bleeding, and diarrhea, and many of these symptoms were long-term or recurrent (4,12,16).…”

The Spirochete Brachyspira pilosicoli, Enteric Pathogen of Animals and Humans

“…In another study, spirochetal invasion was observed in two HIV ϩ patients where there was an extension of IS into the crypts of Lieberkühn, with spirochetal invasion of the colonic mucosa, and a marked inflammatory response that involved macrophages in the underlying lamina propria (127). Spirochetes that are presumed to have been B. pilosicoli also have been observed in the livers of immunocompromised human patients who had invasive colitis (128). There also has been a report of aborted fetuses from young women showing nontreponemal spirochetes in the lumen and mucosa of the intestine, as well as, less commonly, in other organs (129).…”