Intestinal Spirochetosis: A Case Series and Review of the Literature / 대한소아소화기영양학회지

A clinical suspicion of intestinal spirochetosis is required when patients have long lasting complaints of abdominal pain, diarrhea, rectal bleeding, weight loss, and nausea. An endoscopy with biopsies needs to be performed to confirm the diagnosis of intestinal spirochetosis. The diagnosis of intestinal spirochetosis is based on histological appearance. Intestinal spirochetosis can also be associated with other intestinal infections and juvenile polyps (JPs). JPs seem to be more frequent in patients with intestinal spirochetosis than in patients without intestinal spirochetosis. Intestinal spirochetosis in children should be treated with antibiotics. Metronidazole is the preferred option. In this article, we describe 4 cases of intestinal spirochetosis in a pediatric population and provide a review of the literature over the last 20 years. Intestinal spirochetosis is a rare infection that can cause a variety of severe symptom. It is diagnosed based on histological appearance.

Alterações bioquímicas, anatômicas e histopatológicas em fígado de Gallus gallus Linnaeus, 1758 experimentalmente infectados por Borrelia anserina Sakharoff, 1891 / Biochemical, anatomical and histopathological changes in the liver of Gallus gallus Linnaeus, 1758 experimentally infected by Borrelia anserine Sakharoff, 1891

A espiroquetose aviária é uma enfermidade septicêmica de curso agudo, cosmopolita, que acomete diversas espécies aviárias, causada por Borrelia anserina e transmitida pelo carrapato Argas miniatus. O experimento teve como objetivos avaliar as alterações bioquímicas e anátomo-histopatológicas no fígado de Gallus gallus, causadas pela infecção experimental por B. anserina. Quarenta aves da espécie G. gallus foram divididas em quatro grupos inteiramente casualizados com 10 animais cada: G1 - inoculado com soro infectado com B. anserina; G2 - inoculado com soro fisiológico a 0,9%; G3 - exposto a ninfas de terceiro ínstar de A. miniatus infectados por B. anserina; G4 - exposto a ninfas de terceiro ínstar de A. miniatus livres de B. anserina. As aves dos Grupos 1 e 3 manifestaram no 3º e 6º dias pós-inoculação (DPI) respectivamente, sintomatologia característica da doença como inapetência, perda de peso, sonolência, diarreia esverdeada, mucosas hipocoradas, penas arrepiadas e hipertermia. Os níveis de ALT do Grupo 1 mostraram-se significativamente mais elevados apenas no 12ºDPI e 24ºDPI em relação ao seu grupo controle (Grupo 2) e no Grupo 3 esses níveis se mantiveram elevados até o 20º DPI em comparação ao seu grupo controle (Grupo 4). Os níveis da enzima AST pouco oscilaram nos grupos experimentais, embora tenham sido encontradas elevações no 12ºDPI nos Grupos 1 e 3. Os fígados das aves dos Grupos 1 e 3 apresentaram à necropsia, moderada hepatomegalia, congestão, superfície irregular e coloração vermelha a cianótica; constataram-se ainda pequenos pontos esbranquiçados na superfície. A histopatologia do fígado revelou congestão, infiltrados inflamatórios mononucleares, focos de necrose fibrinoide, dilatação dos sinusoides e vacuolização de hepatócitos. A coloração de Warthin-Starry revelou, nos fígados das aves dos Grupos 1 e 3, a presença de espiroquetas compatíveis com B. anserina, frequentemente no interior de vasos sanguíneos.(AU)

Spirochetosis avian is a septicemic disease of acute course and cosmopolitan can affect various avian species, caused by Borrelia anserina and transmitted by Argas miniatus. The experiment aimed to evaluate the biochemical, anatomical and histopathological changes in the liver of Gallus gallus caused by experimental infection with B. anserina. A total of 40 fowls of the species G. gallus were divided into four randomized groups of ten fowls each: G1 - inoculated with serum infected with B. anserina; G2 - inoculated with 0.9% saline; G3 - exposed to nymphs of 3rd instar of A. miniatus infected with B. anserina; G4 - exposed to ticks nymphs of 3rd instar of A. miniatus free of B. anserina. The fowls of Groups 1 and 3 expressed at 3 and 6 days post-inoculation (DAI) respectively , symptoms characteristic of the disease as lack of appetite , weight loss , drowsiness, greenish diarrhea, pale mucous membranes , ruffled feathers and hyperthermia. ALT of group 1 levels were significantly higher only at the 12º and 24º day after inoculation (DAI) compared with its control group (group 2), and in group 3 these levels remained high until the 20º DAI as compared with its control group (group 4). AST enzyme fluctuated little in the experimental groups, although elevations at 12ºDAI has been found in group 1 and 3. The liver of fowls in groups 1 and 3, presented at necropsy moderate hepatomegaly, congestion, irregular surface and red color to cyanotic. If found even small whitish spots on the surface. The histopathology revealed congestion, mononuclear inflammatory infiltrates, fibrinoid necrotic foci, dilatation of sinusoids, and vacuolation of hepatocytes. The Warthin-Starry staining revealed in the liver of fowls in groups 1 and 3 the presence of spirochetes compatible with B. anserina, often within blood vessels.(AU)

Intestinal colonization of different Brachyspira spp. in laying hens

Avian intestinal spirochetosis [AIS] is caused by spiral-shaped Gram-negative Brachyspira spp. in poultry. It is known as a cause of diarrhea, low egg production, and increased occurrence of dirty eggs in layer hens. In this study, the presence of some Brachyspira spp. was investigated in laying hens. A total of 100 cloacal swab samples were individually collected from 20 laying hen flocks showing fecal egg staining in northeast of Iran. Using culture and morphologic examination, 41 samples [41%] from 20 flocks were positive; however, by using genus-specific PCR, only 37 [37%] samples were confirmed as Brachyspira spp. Using species-specific primers, single colonization was identified in 18 samples associated with B. pilosicoli [48.6%], while single colonization with B. intermedia was found in only two samples [5.4%]. Simultaneous colonization by B. intermedia and B. murdochii was detected in 3 samples [8.1%]. B. pilosicoli was the most prevalent species in concurrent colonization in 11 cases [29.7%]. Finally, cocolonization by B. intermedia and B. innocens was identified in 3 samples [8.1%]. The results of this study showed the colonization of different species of Brachyspira with dominance of B. pilosicoli in layer hens

Intestinal spirochetosis

The intestinal spirochetosis (IS) is a histologically defined by the presence of spirochetal microorganisms connected to the apical cell membrane of the colorectal epithelium. The disease is caused by a heterogeneous group of bacteria. In humans, Brachyspira aalborgi and Brachyspira pilosicoli are prevalent. The incidence ranges from 1% in developed countries to 34% in poorer areas. It affects 62.5% of colonized areas, as well as men who have intercourse with men (MSM) and those with the human immunodeficiency virus (HIV) infected. Clinical significance of such colonization is still not clear. Most infected people are asymptomatic. At the presence of gastrointestinal symptoms, treatment with metronidazole is effective. Due to unknown reasons, MSM and HIV-positive men are more likely to be symptomatic. Treponema pallidum infection must be excluded, since this agent may cause serious and permanent complications, and because the treatment is different. (AU)

A espiroquetose intestinal está definida histologicamente como a presença de micro-organismos da família spirochetaceae ligadas ao ápice das células do epitélio cólico. A doença pode ser provocada por um grupo heterogêneo de bactérias. Em humanos, a Brachyspira aalborgi e a Brachyspira pilosicoli predominam. A incidência varia desde 1%, nos países desenvolvidos, até 34% nas áreas mais pobres, atingindo taxas de colonização de 62,5%, em homens que fazem sexo com homens (HSH) e vírus da imunodeficiência humana (HIV) positivo. O significado clínico dessa colonização ainda é incerto e a maioria dos infectados permanece assintomática. Quando há sintomas gastrointestinais, o tratamento com metronidazol é efetivo. Por razões desconhecidas, HSH positivos para o HIV, apresentam mais infestação sintomática. A infecção pelo Treponema pallidum dever ser excluída, pois os tratamentos são diferentes e as complicações por essa última são mais graves e definitivas. (AU)

Report on the unusual presence of latent microorganisms in animals: a risk to research and health of employees / Relato inusitado de micro-organismos latentes em animais: riscos à pesquisa e à saúde dos funcionários

Relata-se inusitado achado de micro-organismos, semelhantes às espiroquetas, móveis e de diferentes morfologias e tamanhos, identificados pela microscopia de campo escuro, no sangue de animais do Centro de Bioterismo da Faculdade de Medicina da USP. As bactérias não crescem em meios habituais de cultivo, são pouco coradas pelo Giemsa e derivados da prata, e as provas sorológicas e moleculares foram negativas para Borrelia e Leptospira. A microscopia eletrônica revelou presença de micro-organismos com morfologia de Mycoplasma e, devido à sua mobilidade, sugeriu-se a presença de Mollicutes do gênero Spiroplasma. Visualizaram-se micro-organismos com mesmas características em 15 dos 26 funcionários (57,6 por cento) do Centro de Bioterismo da FMUSP; contudo, exames clínicos e laboratoriais indicaram que os indivíduos estavam saudáveis. Estudos adicionais desenvolvidos na Disciplina de Reumatologia da FMUSP mostraram que, aproximadamente, 94 por cento dos pacientes com Síndrome Baggio-Yoshinari (SBY) e 20 por cento dos indivíduos normais também exibiam as mesmas estruturas identificadas no Centro de Bioterismo. A microscopia eletrônica realizada com amostras de pacientes com SBY mostrou bactérias que apresentam semelhanças com Mycoplasma, Chlamydia e Bacteroides. Visto que as sorologias e os testes moleculares foram negativos para estes contaminantes e com base em publicações da literatura médica, sugeriu-se que estes agentes infecciosos latentes fossem bactérias na sua apresentação L, que são definidas como bactérias despojadas de parede celular, assumindo, assim, morfologia de Mycoplasma, sendo, na maioria dos casos, inofensivas aos hospedeiros. Concluímos que os "espiroquetídeos" visualizados em animais e funcionários do Centro de Bioterismo seriam bactérias na forma L, não patogênicas, provenientes de contaminantes do meio ambiente, infecções regulares habituais ou oriundos de micro-organismos endógenos da flora saprofítica normal. Ao contrário, os...

We report the unusual finding of mobile spirochetal microorganisms with different morphologies and sizes, on dark-field microscopy of the blood of animals from the Vivarium of the Medical School of USP. The bacteria did not grow in common culture media, shows faint staining to Giemsa and silver-derived stains, and serologies and molecular tests were negative for Borrelia and Leptospira. Electron microscopy revealed the presence of microorganisms with Mycoplasma-like morphology and, due to its mobility, it was suggested that they represented Mollicutes of the genus Spiroplasma. Microorganisms with the same morphology were also observed in 15 out of 26 employees (57.6 percent) of the Vivarium of FMUSP; however, clinical and laboratorial exams indicated that those individuals were healthy. Additional studies undertaken at the Rheumatology Department of FMUSP demonstrated the presence of the same structures identified at the Vivarium in approximately 94 percent of the patients with Baggio-Yoshinary syndrome (BYS) and 20 percent of healthy individuals. Electron microscopy of the blood of BYS patients showed bacteria that shared similarities with Mycoplasma, Chlamydia, and Bacteroides. Since serologies and molecular tests were negative for those contaminants, and based on publications in the medical literature, it was suggested that those latent infectious agents were L-form bacteria, defined as cell wall deficient bacteria, assuming, therefore, Mycoplasma morphology and they are, for the most part, harmless to the host. We concluded that spirochetal microorganisms visualized in animals and employees of the Vivarium were non-pathogenic L-form bacteria from contaminants in the environment, regular infections, or endogenous microorganism from the normal saprophytic flora. On the other hand, spirochetal organisms identified in BYS, by preserving the capacity to invade cells in vitro, are potentially pathogenic and related to the etiology of BYS. We consider BYS as a ...

Alterações nos parâmetros hematológicos de Gallus gallus domesticus experimentalmente infectados por Borrelia anserina / Alterations in hematological parameters of Gallus gallus domesticus experimentally infected with Borrelia anserina

Borreliose aviária é uma doença septicêmica aguda, cosmopolita, que acomete diferentes espécies aviárias, sendo causada por Borrelia anserina Sakharoff, 1891. O objetivo do presente trabalho foi avaliar as alterações hematológicas em Gallus gallus domesticus experimentalmente infectados por B. anserina via vetor Argas (Persicargas) miniatus. Um total de 27 aves da espécie G. g. domesticus com 67 dias de vida, foram divididas em três grupos inteiramente casualizados contendo nove animais cada. Um grupo foi exposto a carrapatos infectados por B. anserina (Grupo 1); outro a carrapatos livres deste agente (Grupo 2); além de um grupo não exposto aos carrapatos (Grupo 3). Realizaram-se esfregaços sangüíneos diariamente, a partir do primeiro dia de exposição ao vetor, até o 25º dia pós-exposição (DPE). Amostras de sangue foram coletadas 3 dias antes da exposição aos carrapatos, e 3, 8 e 18 dias pós-exposição (DPE), para a realização dos hemogramas. O exame dos esfregaços das aves do Grupo 1 revelou grande número de espiroquetas. Os esfregaços sangüíneos dos Grupos 2 e 3 mantiveram-se negativos durante todo o período experimental. De acordo com os resultados das avaliações hematológicas, as aves do Grupo 1 apresentaram um quadro de anemia normocítica normocrômica em oito DPE, além de leucocitose com heterofilia e monocitose que cursaram paralelamente ao período de espiroquetemia. Concluiu-se que a infecção por B. anserina determinou nas aves do Grupo 1 alterações hematológicas compatíveis com uma infecção bacteriana de moderada gravidade, evoluindo para auto-cura, nas condições experimentais estabelecidas neste trabalho.(AU)

Avian spirochaetosis is a cosmopolite acute septicemic disease of many avian species, caused by Borrelia anserina Sakharoff, 1891. The present study assesses the estimate of the hematological alterations of Gallus gallus domesticus experimentally infected with B. anserina by vector Argas (Persicargas) miniatus. Twenty-seven fowls of the species G. g. domesticus, 67 days old, were randomly allocated into three groups composed by nine animals each. One group was exposed to B. anserina infected ticks (Group 1), other one to ticks free of this agent (Group 2), and another group not exposed to ticks (Group 3). Blood smears of the fowls were taken daily, since the first day the fowls were exposed to the ticks, up to the 25th day after exposure (DAE). Blood samples were collected three days before exposure, and three, eight and 18 DAE, for hematologic tests. The examination of Group 1 smears revealed large number of spirochaetes. Group 2 and 3 blood smears were negative during the whole period under exam. In agreement with the hematological evaluation results, the fowls exposed to infected ticks showed a normocytic normochromic anemia in eight DAE, leucocytosis with heterophilia and monocytosis concomitant with the spirochaetemia. We concluded that B. anserina infection determined on fowls of Group 1 hematological alterations compatible with bacterial infection of moderate gravity, developing to self-cure, in the experimental conditions established in this study.(AU)

Cloranfenicol: un aliado olvidado, revisión bibliográfica / Chloramphenicol: a forgotten ally, bibliographic review

El cloranfenicol es un antimicrobiano cuyo mecanismo de acción radica en la inhibición de la síntesis proteica bacteriana y posee un amplio espectro de acción. La dosificación en adultos y niños está dada no sólo por peso en kilos sino por la edad cronológica, en especial en estos últimos. Su uso actualmente está limitado a la salmonellosis tífica; pero tiene otras aplicaciones como en la meningitis por meningococo, en especial en los pacientes alérgicos a los betalactámicos. Sus reacciones adversas como la aplasia medular y el síndrome del niño gris, se presentan en 1 por 30.000 y l por 70.000 pacientes respectivamente; siendo causadas por idiosincrasia y por el uso de dosis superiores a los rangos terapéuticos.

Chloramphenicol is a bacterostatic agent it inhibits bacterial protein synthesis and it has a wide spectrum activity. The dosage in adults and children depends not only on weight but on chronological age. Its use is limited to salmonella typi but can also be used for Meningococcal Meningitis in patients who are allergic to beta lactamics. The adverse reaction are bone marrow depression and the Gray Baby Syndrome present in 1/ 30.000 and 1 / 70.000 respectively which have idiosyncratic cause and also from use of high doses.

The 23S rRNA gene PCR-RFLP used for characterization of porcine intestinal spirochete isolates

Using three reference strains of Brachyspira hyodysenteriae (B204, B234, B169), one B. pilosicoli (P43/6/78), one B. murdochii (56-150), one B. intermedia (PWS/A), one B. innocens (B256) and ten Korean isolates, PCR-RFLP analysis of DNA encoding 23S rRNA was performed to establish a rapid and accurate method for characterizing porcine intestinal spirochetes. Consequently, B. hyodysenteriae and B. pilosicoli revealed different restriction patterns; however, the other three species shared the same pattern. These findings are not consistent with a prior report. Differences in 23S rRNA gene sequences, between two B. murdochii strains, 56-150 and 155-20, were observed. These results indicate that 23S rRNA PCR-RFLP could be used as an identification method for pathogenic Brachyspira spp. (B. hyodysenteriae and B. pilosicoli) as well as an epidemiological tool for characterizing spirochetes isolated from swine.

Intestinal spirochetosis and colon diverticulosis

Um caso de espiroquetose intestinal é relatado em um homem branco de 62 anos. A condição foi caracterizada por flatulência crônica e episódios de hemorragia intestinal, além da evidência de doença diverticular hipotônica dos cólons, com numerosos organismos filamentosos no epitélio e nas criptas do cólon. Os espiroquetas foram demonstrados pela coloração de Whartin-Starry. Os testes sorológicos para sífilis e HIV foram positivos. A espiroquetose foi tratada com penicilina G e o paciente permanece sem queixas intestinais após 20 meses.

Prevalence of Lawsonia intracellularis, Brachyspira hyodysenteriae and Salmonella in swine herds

The prevalence of Lawsonia intracellularis, Brachyspira hyodysenteriae and Salmonella spp. were investigated by multiplex PCR using fecal samples of pigs with diarrhea or a history of diarrhea. The overall herd prevalence of L. intracellularis, B. hyodysenteriae and Salmonella spp. were 46.5%, 37.2% and 51.1%, respectively. Also, the prevalence of L. intracellularis, B. hyodysenteriae and Salmonella spp. among all sampled pigs were 19.9%, 10.8% and 17.7%, respectively. Seventeen of 43 herds were positive with 2 enteric organisms, and 2 herds were positive with L. intracellularis, B. hyodysenteriae and Salmonella spp. simultaneously. It was notable that 11 of 12 herds with more than 2, 000 pigs were affected with Salmonella spp., and that only 2 of 12 the herds were affected with B. hyodysenteriae. This study suggested that herds positive for L. intracellularis, B. hyodysenteriae and Salmonella spp. were distributed throughout Korea, although the relationship among other pathogens such as viral or parasitic ones and/or with metabolic disorders was not determined.

Characterization of Brachyspira hyodysenteriae isolates from Korea

This study was done to characterize diversity in 10 Brachyspira hyodysenteriae isolates in Korea. The isolates were compared with 14 well-characterized non-Korean strains of various Brachyspira species. All Korean isolates showed strong beta haemolysis and had blunt cell ends with 7~14 periplasmic flagella. They produced indole, and did not ferment fructose. They were alpha-glucosidase positive and alpha-galatosidase negative using the APIZYM kit. Using polyclonal antisera raised in rabbits against recognized serotypes, all isolates showed a strong reaction to B. hyodysenteriae antisera E, A and B. Using multilocus enzyme electrophoresis (MLEE) with 15 enzymes and 5 buffer systems, the Korean and non-Korean isolates were divided into 22 electrophoretic types (ETs) and 5 divisions (A, B, C, D and E). Division A corresponded to B. hyodysenteriae, B to B. innocens, C to B. intermedia, D to B. murdochii and E to B. pilosicoli. The 10 Korean isolates of B. hyodysenteriae were relatively diverse, being divided into 9 ETs within MLEE division A. They were all distinct from the non-Korean strains.

Simultaneous detection of Lawsonia intracellularis, Brachyspira hyodysenteriae and Salmonella spp. in swine intestinal specimens by multiplex polymerase chain reaction

A multiplex PCR assay was developed for the simultaneous detection of the etiologic agents associated with porcine proliferative enteropathies (PPE), swine dysentery (SD)and porcine salmonellosis (PS)in a single reaction using DNA from swine intestinal samples. Single and multiplex PCR amplification of DNA from Lawsonia intracellularis, Salmonella typhimurium and Brachyspira hyodysenteriae with each primer set produced fragments of the predicted size without any nonspecific amplification, 210-bp, 298-bp and 403-bp bands, respectively. The single PCR assay could detect as little as 100 pg of purified DNA of S. typhimurium and L. intracellularis, and 50 pg of B.hyodysenteriae, respectively. However, multiplex PCR turned out to be 10 times lower sensitivity with S. typhimurium compared with single PCR. With 23 swine intestinal specimens suspected of having PPE, SD and/or PS, the multiplex PCR assay showed identical results with conventional methods except one. In conclusion, this multiplex PCR is a feasible alternative to standard diagnostic methods for detection of L. intracellularis, B. hyodysenteriae and Salmonella spp. from swine intestinal specimens.

The changes of subgingival microbials during periodontal maintenance in patients with gingivitic and wearing fixed orthodontic appliances / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the microbiological changes of subgingival microbials in patients with gingivitis and wearing fixed orthodontic appliances.</p><p><b>METHODS</b>48 subjects (10 to 17 years old) with gingivitis, and wearing fixed orthodontic appliances, were divided randomly into three groups (placebo, NS and CH). Placebo group had normal saline mouthrinse; only and no oral hygiene instruction (OHI). The NS group had OHI and normal saline mouthrinse; The CH group had OHI and 0.12% chlorhexidine gluconate mouthrinse. Bacterial examinations were carried out on baseline, one week, one month and three months after scaling. The bacterial examination was carried out. The percentage of coccus, bacillus and spirochete was calculated.</p><p><b>RESULTS</b>In placebo group and NS group, the percentage of coccus increased up to the third examination then dropped down. The spirochete's percentage changed inversely. CH group maintained an increasing trend in coccus' percentage and decreasing trend in spirochete's percentage. The percentage changes of coccus and bacillus between placebo group and CH group are statistically significant (P < 0.05).</p><p><b>CONCLUSIONS</b>During the three-month examination, the CH group had better microbiologic change than the other two groups.</p>

Enfermedad de Lyme: Un caso comprobado en Colombia / Lyme disease: A proven case in Colombia

La enfermedad de Lyme es un desorden inflamatorio multisistémico, producido por una espiroqueta, Borrelia Burgdorferi (B.b) la cual es transmitida el hombre por la picadura de una garrapata. Fue descrita inicialmente por Steere y colaboradores en 1975 – 1977 en un grupo de niños con artritis epidémica en Lyme, Connecticut. El agente infeccioso responsable fue identificado cuando Burgdorfer aisló y cultivo la espiroqueta Borrelia burgdorferi en 1982; desde entonces, múltiples casos han sido reportados en Estados Unidos y muchos países de Europa, África y Australia en Latinoamérica, algunos casos aislados han sido reportados de Brasil. Nosotros describimos el primer caso de enfermedad de Lyme diagnosticado en Colombia, el cual se presentó con el marcador cutáneo de esta enfermedad, el eritema migratorio crónico y una prueba serológica especifica positiva.

Sífilis congênita: uma apresentação cutânea incomum

Embora seja doença passível de prevenção, diagnóstico e tratamento adequados e geralmente acessíveis, a sífilis congênita ainda constitui significativo problema de saúde pública. Os autores apresentam um caso de sífilis congênita recente e fazem uma revisão do assunto. Trata-se de uma criança que nasceu com baixo peso, prematura e com manifestações clínicas em vários sistemas e aparelhos (insuficiência respiratória aguda, hepatoesplenomegalia, instabilidade hemodinêmica, icterícia, hipoglicemia, plaquetopenia, leucocitose com desvio para esquerda, hematúria e osteocondrite). Do ponto de vista dermatológico apresentava quadro cutâneo incomum (dermatite esfoliativa com presença de lesões ceratóticas)