Spirochaetosis: a remediable cause of diarrhoea and rectal bleeding?

Abstract

Spirochaetes have been found in the alimentary tract and faeces of apparently healthy people.' In some animals similar infestation may cause an acute and often fatal diarrhoeal illness.2 A review of 100 consecutive rectal biopsy specimens obtained from patients with rectal bleeding or diarrhoea showed that 10 had spirochaetosis.3 In two of these patients no other underlying cause for the symptoms could be found and it was not clear whether these organisms were just commensals. The authors suggested that antibiotic treatment in such cases may provide an answer to this problem. We describe two patients with spirochaetosis who presented with diarrhoea and rectal bleeding. Both improved after treatment with metronidazole. Case reports CASE 1A 54-year-old man presented in October 1979. Since 1974 he had experienced self-limiting episodes of watery diarrhoea and rectal bleeding associated with the sigmoidoscopic and histological changes of active non-specific granular proctitis. He presented with a further episode of rectal discomfort and loose slimy diarrhoea of three weeks' duration. Physical examination was unremarkable, and stool culture and microscopy were negative. A double-contrast barium enema was normal. Sigmoidoscopy confirmed active proctitis with considerable rectal tenderness. A repeat rectal biopsy specimen showed chronic inflammatory changes. A haematoxyphilic fuzzy border typical of intestinal spirochaetosis was seen on the surface epithelium (figure). After metronidazole 1 g by suppository twice daily for five days his diarrhoea stopped and rectal discomfort diminished. Sigmoidoscopy two months later confirmed improvement in the proctitis. Histology again showed chronic inflammation but the fuzzy border had disappeared.During March 1980 his diarrhoea and rectal bleeding recurred. A further rectal biopsy specimen again showed a fuzzy brush border. Electron microscopy showed spiral organisms 3 /m in length and 0-2 jum diameter between the microvilli of the rectal epithelium. Transverse section on electron microscopy showed axial filaments with a rosette formation. He received a further seven-day course of metronidazole suppositories after which his symptoms disappeared. A repeat rectal biopsy specimen showed that the spirochaetal infestation had disappeared. CASE 2A 49-year-old man presented in September 1980 with a history of two weeks' watery diarrhoea that had started while he was on holiday abroad and one week's tenesmus and fresh rectal bleeding. Physical examination was satisfactory and stool culture and microscopy were negative. A doublecontrast barium enema was normal. On sigmoidoscopy the rectal mucosa appeared normal. A rectal biopsy specimen showed normal histology apart from a fuzzy blue brush border over the surface epithelium (figure). Electron microscopy showed spirochaetes identical with those in case 1. Metronidazole 400 mg four times a day by mouth for 10 days abolished his symptoms. A further biopsy specimen in December showed that the spirochaetes had disappeared. Comment

Colonization and risk factors for Brachyspira aalborgi and Brachyspira pilosicoli in humans and dogs on tea estates in Assam, India

“…Most faecal samples appeared loose compared to faeces collected from individuals in developed countries. It was unfortunate that water content was not recorded, since IS has been linked to chronic diarrhoea in humans [5,6,37,38], whilst B. pilosicoli infection in animals increases faecal water content directly, and exacerbates diarrhoea due to nutritional and other infectious causes [39,40]. Colorectal biopsies were not taken in this study, so it is not known whether any of the colonized individuals had colitis or histological evidence of IS.…”

“…Both species have been associated with a condition called intestinal spirochaetosis (IS), in which a fringe can be seen in histological sections of the colorectal epithelium, caused by end-on attachment of large numbers of spirochaetes. IS has been linked to a number of symptoms, including chronic diarrhoea, rectal bleeding, pseudo-appendicitis, and lower abdominal discomfort [4][5][6][7].…”

Comparison of prevalence and risk factors for faecal carriage of the intestinal spirochaetes Brachyspira aalborgi and Brachyspira pilosicoli in four Australian populations

“…Logistic regression identified diagnoses of 'possible worms', and chronic diarrhoea, FFT and being underweight as being significantly associated with the presence of B. pilosicoli. Chronic diarrhoea is a symptom that has been associated with IS in a number of human studies [22][23][24].…”

The prevalence of Serpulina pilosicoli in humans and domestic animals in the Eastern Highlands of Papua New Guinea

“…The clinical significance of HIS is unclear. Some consider it to be a cause of chronic diarrhoea and rectal bleeding [7][8][9][10][11][12][13][14], and others * Author for correspondence.…”