Invasive intestinal spirochetosis: A report of three cases

Padmanabhan, Vijayalakshmi; Dahlstrom, Jane E.; Maxwell, Lesley; Kaye, Graham; Clarke, Anthony; Barratt, P J

doi:10.1080/00313029600169174

Cited by 38 publications

(45 citation statements)

References 17 publications

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“…However, recent studies have demonstrated invasive spirochetes penetrating into epithelial cells, lamina propria, macrophages, and even Schwann cells. [17][18][19] Furthermore, marked increase of IgE-producing plasma cells in lamina propria and intraepithelial mast cells has been reported, suggesting close association of immediate-type immune reaction of the host. 20 Kö rner et al 21 postulate that invasive human intestinal spirochetosis with marked inflammatory reaction is related to clinical symptoms.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2008

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Human intestinal spirochetosis is a common condition in Western countries, but is not well recognized in Japan. To demonstrate the incidence and clinicopathologic findings of human intestinal spirochetosis in Japan, we retrospectively investigated biopsy, and endoscopically or surgically resected specimens of the large intestine. Among a series of 2556 samples, 11 cases of human intestinal spirochetosis were detected (0.4%). Together with additional nine cases sporadically found, 20 cases of human intestinal spirochetosis were subjected to molecular detection of two strains of spirochetes (Brachyspira aalborgi and Brachyspira pilosicoli) by amplifying species-specific portion of 16S ribosomal RNA and NADH oxydase gene by polymerase chain reaction. B. aalborgi was detected in all cases examined, three of which revealed dual infection of both species. Our results suggest that human intestinal spirochetosis infection is relatively rare, and B. aalborgi is the most prevalent species in Japan. Most of human intestinal spirochetosis were asymptomatic, although symptomatic in exceptional cases. In addition, we emphasize a usefulness of immunostaining with anti-Treponema pallidum and anti-Mycobacterium bovis polyclonal antibodies for detecting the spirochetes.

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Section: Discussionmentioning

confidence: 97%

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

et al. 2008

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“…Ultrastructurally, spirochetes are attached perpendicular to the epithelial membrane between the microvilli, which appear shorter or depleted (11,17,23,36). However, more severe lesions with spirochetal invasion of the epithelium and the adjacent lamina propria together with purulent discharge may occur (15,27,30,42). HIS is a morphological description based on microscopic examination of biopsy samples.…”

mentioning

confidence: 99%

Diagnostic Examination of Human Intestinal Spirochetosis by Fluorescent In Situ Hybridization for Brachyspira aalborgi , Brachyspira pilosicoli , and Other Species of the Genus Brachyspira ( Serpulina )

Jensen¹,

Boye²,

Ahrens³

et al. 2001

J Clin Microbiol

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Human intestinal spirochetosis, characterized by end-on attachment of densely packed spirochetes to the epithelial surface of the large intestines as a fringe has been associated with the weakly beta-hemolytic spirochetes Brachyspira aalborgi and Brachyspira (Serpulina) pilosicoli. In this study, fluorescent in situ hybridization with oligonucleotide probes targeting 16S or 23S rRNA of B. aalborgi, B. pilosicoli, and the genus Brachyspira was applied to 40 sections of formalin-fixed, paraffin-embedded intestinal biopsy specimens from 23 Danish and 15 Norwegian patients with histologic evidence of intestinal spirochetosis. Five biopsy specimens from patients without intestinal spirochetosis and three samples from pigs with experimental B. pilosicoli colitis were examined as well. In addition, the 16S ribosomal DNAs of two clinical isolates of B. aalborgi were sequenced, and a PCR procedure was developed for the identification of B. aalborgi in cultures. The genotypic characteristics of the two clinical isolates showed very high (99.5%) similarity with two existing isolates, the type strain of B. aalborgi and a Swedish isolate. Hybridization with the Brachyspira genus-specific probe revealed a brightly fluorescing fringe of spirochetes on the epithelia of 39 biopsy specimens, whereas 1 biopsy specimen was hybridization negative. The spirochetes in biopsy specimens from 13 Danish and 8 Norwegian patients (55.3%) were identified as B. aalborgi. The spirochetes in the biopsy specimens from the other 17 patients hybridized only with the Brachyspira probe, possibly demonstrating the involvement of as-yet-uncharacterized Brachyspira spirochetes in human intestinal spirochetosis.Human intestinal spirochetosis (HIS) is a condition of the large intestinal mucosa microscopically characterized by colonization and extensive end-on attachment of densely packed spirochetes to the epithelial surface (16). The spirochetes are easily demonstrated in hematoxylin-eosin-stained biopsy sections as a diffuse blue fringe 3 to 6 m thick. The colonization is usually associated with no or only minor morphologic and inflammatory reactions in the mucosa (16,17,23,36). Ultrastructurally, spirochetes are attached perpendicular to the epithelial membrane between the microvilli, which appear shorter or depleted (11,17,23,36). However, more severe lesions with spirochetal invasion of the epithelium and the adjacent lamina propria together with purulent discharge may occur (15,27,30,42). HIS is a morphological description based on microscopic examination of biopsy samples. Hence, most reports have outlined histologic and electron microscopic findings, whereas there have been only a few reports of concurrent culturing of spirochetes from the same individuals (11,15,17,36), and two species, Brachyspira aalborgi and Brachyspira (Serpulina) pilosicoli, have been identified (17,36).Recently, the phylogeny of intestinal spirochetes has been studied by multilocus enzyme electrophoresis (20, 21), polyacrylamide gel electrophoresis (7), pulsed-field gel el...

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“…In chickens, the cytoplasm of enterocytes may appear damaged, with vacuolation, condensation, and fragmentation of the chromatin (59). In an immunocompetent heterosexual man with histological HIS, electron microscopy identified stunting of the microvilli together with spirochetes invading colonic epithelial cells, goblet cells, macrophages, and Schwann cells (125). In another patient, who had Crohn's disease and ankylosing spondylitis, spirochetes were found on the luminal surface of absorptive and goblet cells but also within the cytoplasm, in occasional macrophages within the lamina propria, and again within the occasional Schwann cell (126).…”

Section: Observations In Natural and Experimental Infectionsmentioning

confidence: 99%

The Spirochete Brachyspira pilosicoli, Enteric Pathogen of Animals and Humans

Hampson

2018

Clin Microbiol Rev

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SUMMARY Brachyspira pilosicoli is a slow-growing anaerobic spirochete that colonizes the large intestine. Colonization occurs commonly in pigs and adult chickens, causing colitis/typhlitis, diarrhea, poor growth rates, and reduced production. Colonization of humans also is common in some populations (individuals living in village and peri-urban settings in developing countries, recent immigrants from developing countries, homosexual males, and HIV-positive patients), but the spirochete rarely is investigated as a potential human enteric pathogen. In part this is due to its slow growth and specialized growth requirements, meaning that it is not detectable in human fecal samples using routine diagnostic methods. Nevertheless, it has been identified histologically attached to the colon and rectum in patients with conditions such as chronic diarrhea, rectal bleeding, and/or nonspecific abdominal discomfort, and one survey of Australian Aboriginal children showed that colonization was significantly associated with failure to thrive. B. pilosicoli has been detected in the bloodstream of elderly patients or individuals with chronic conditions such as alcoholism and malignancies. This review describes the spirochete and associated diseases. It aims to encourage clinicians and clinical microbiologists to consider B. pilosicoli in their differential diagnoses and to develop and use appropriate diagnostic protocols to identify the spirochete in clinical specimens.

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Invasive intestinal spirochetosis: A report of three cases

Cited by 38 publications

References 17 publications

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

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

Diagnostic Examination of Human Intestinal Spirochetosis by Fluorescent In Situ Hybridization for Brachyspira aalborgi , Brachyspira pilosicoli , and Other Species of the Genus Brachyspira ( Serpulina )

The Spirochete Brachyspira pilosicoli, Enteric Pathogen of Animals and Humans

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