Mucosal eosinophilic infiltration may be a characteristic of human intestinal spirochetosis

Abstract

Background Human intestinal spirochetosis (HIS) is an infectious disease of large intestines caused by Brachyspira species, and most HIS cases are asymptomatic or exhibit mild intestinal symptoms. The host reaction to HIS remains unclear, and we examined HIS-related mucosal inflammatory features histologically. Methods From the archival HIS cases in a single medical center, 24 endoscopically taken specimens from 14 HIS cases (male:female = 10:4; 28–73 yrs) were selected as not containing polypoid or neoplastic lesions. Stromal neutrophils, eosinophils, and mast cells, and intraepithelial neutrophils and eosinophils, (sNeu, sEo, sMast, iNeu, and iEo, respectively) were counted, and the presence or absence of lymphoid follicles/aggregates (LFs) was also examined. Association of the above inflammation parameters and spirochetal infection parameters (such as degrees of characteristic fringe distribution, of spirochetal cryptal invasion, and of spirochetal intraepithelial invasion) were also analysed. Results iNeu was observed in 29.2%, iEo in 58.3%, and LFs in 50.0% of the specimens. Maximal counts of sNeu, sEo, sMast, iNeu, and iEo averaged 8.4, 21.5, 6.0, 0.5 and 1.5, respectively. Strong correlation between the maximum counts of iNeu and iEo (p < 0.001, r = 0.81), and correlations between those of iEo and sNeu (p = 0.0012, r = 0.62) and between those of iEo and sEo (p = 0.026, r = 0.45) were observed. iNeu was influenced by fringe formation (p < 0.05) and spirochetal crypt involvement (p < 0.05). Conclusions HIS was accompanied by inflammatory reactions, and among these, mucosal eosinophilic infiltration may be a central indicator and host reaction of HIS.

Human intestinal spirochetosis: A challenging condition

“…1-6 Diagnosis confirmation depends on histopathology features including the classical presence of the agents in epithelial surface appearing as thread-like structures mimicking a palisade (“blue fringe”). 1-6 Metronidazole, clindamycin, macrolides, and penicillin G are utilized to treat symptomatic patients. 1-6…”

“…Human intestinal spirochetosis (HIS) is an uncommon entity often evolving unsuspected and may be incidentally detected in male patients who underwent colonoscopy with biopsy evaluations. 1-6 The major predisposing factors are male homosexuality and immunocompromised health conditions; the patients may be asymptomatic or have abdominal pain and chronic watery or bloody diarrhea. 1-6 The agents are from the Brachyspiraceae family ( Brachyspira aalborgi and Brachyspira pilosicoli ), and intestinal changes as polyps, diverticula, tubular adenoma, and aphthous ulcers are described.…”

“…1-6 The major predisposing factors are male homosexuality and immunocompromised health conditions; the patients may be asymptomatic or have abdominal pain and chronic watery or bloody diarrhea. 1-6 The agents are from the Brachyspiraceae family ( Brachyspira aalborgi and Brachyspira pilosicoli ), and intestinal changes as polyps, diverticula, tubular adenoma, and aphthous ulcers are described. 1-6 Diagnosis confirmation depends on histopathology features including the classical presence of the agents in epithelial surface appearing as thread-like structures mimicking a palisade (“blue fringe”).…”

“…1-6 The agents are from the Brachyspiraceae family ( Brachyspira aalborgi and Brachyspira pilosicoli ), and intestinal changes as polyps, diverticula, tubular adenoma, and aphthous ulcers are described. 1-6 Diagnosis confirmation depends on histopathology features including the classical presence of the agents in epithelial surface appearing as thread-like structures mimicking a palisade (“blue fringe”). 1-6 Metronidazole, clindamycin, macrolides, and penicillin G are utilized to treat symptomatic patients.…”

“…1-6 Metronidazole, clindamycin, macrolides, and penicillin G are utilized to treat symptomatic patients. 1-6…”