Anna M. Catinis, BA1, Catherine T. Hudson, MD, MPH2, Jason R. Stibbe, MD, MS2, Daniel Raines, MD, FACG2
1Louisiana State University School of Medicine, River Ridge, LA; 2Louisiana State University Health Sciences Center, New Orleans, LA
Introduction: Both the origin and commensal or pathogenic nature of intestinal spirochetes (IS) in humans are poorly understood. Colonization is predominantly found in homosexual males and in HIV patients.1 Homosexual males have shown colonization rates up to 20.6-62.5% leading scientists to hypothesize that IS could be sexually transmitted.2 Colonization can be associated with severe clinical symptoms like persistent diarrhea and rectal bleeding, especially in children.3 Therefore, a greater understanding of clinical presentation and risk factors is needed.
Case Description/Methods: A 51-year-old asymptomatic male with compensated alcoholic cirrhosis presented for a screening colonoscopy. He denied NSAID use and a personal or family history of inflammatory bowel disease. Colonoscopy revealed multiple clean-based ulcers in the cecum and ascending colon. Histologic examination of the specimens on H&E stain revealed colonic mucosa with focal, acute inflammation and microorganisms consistent with spirochetes. No granulomas, crypt architectural distortion, or dysplasia were identified. The fuzzy, basophilic fringe-like microorganisms were positive for GMS and PAS stains and negative for FITE stain. The findings were consistent with IS and the patient was treated with metronidazole.
Discussion: The clinical significance of IS in humans is not well defined. Presentation may vary from asymptomatic to causing chronic diarrhea, rectal bleeding, abdominal pain, and weight loss. IS can be associated with immunodeficiency, alcoholism and drug abuse, poor hygiene, sexual practices, and concomitant bowel content stasis. Pathology reveals presence of spirochetes in the brush border. Transmission electron microscopy reveals spirochetes attached to enterocytes with associated shortened or depleted microvilli. Often endoscopy in IS-infected patients is normal, but in this rare presentation of intestinal spirochetosis, ulcerations of colonic mucosa were noted. Metronidazole is an effective treatment.4-5
- Tsinganou E, Gebbers JO. Human intestinal spirochetosis--a review. 2010 Jan 7.
- Surawicz CM et al. Intestinal spirochetosis in homosexual men. 1987; 587–592.
- White J, Roche D, Chan YF, Mitchell EA. Intestinal spirochetosis in children: report of two cases. 1994; 191–199.
- Ogata S1, Shimizu K2, Nakanishi K3. Human intestinal spirochetosis: right-side preference in the large intestine. 2015 Dec; 414-7.
- Calderaro A et al. Infective colitis associated with human intestinal spirochetosis. 2007 Nov; 1772-9.
Citation: Anna M. Catinis, BA; Catherine T. Hudson, MD, MPH; Jason R. Stibbe, MD, MS; Daniel Raines, MD, FACG. P1969 - ASYMPTOMATIC INTESTINAL SPIROCHETOSIS WITH COLONIC ULCERATIONS. Program No. P1969. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.