A Case Study: Incidental Finding of Human Intestinal Spirochetosis in Screening Colonoscopy.

Human intestinal spirochetosis (HIS) is a rare occurrence. We present an interesting case study on an asymptomatic over-60-year-old male who was incidentally discovered to have HIS following a colonoscopy that was conducted for his positive fecal occult blood test (FOBT). Histopathology of the colonic biopsy proved the presence of human intestinal spirochetosis; however, as he was asymptomatic, treatment was not initiated in his case. We discuss here the prevalence, presentation, diagnostic methods, and treatment of colonic HIS.

Brachyspira in dogs: risk factors of shedding in central Germany and longitudinal study of an infected kennel.

BACKGROUND: Brachyspira (B.) pilosicoli is a zoonotic pathogen, able to infect different animal species such as pigs, poultry, and rodents, causing intestinal spirochetosis. An association of gastrointestinal clinical signs, such as diarrhea, with the isolation of B. pilosicoli from fecal samples or rectal swabs has not been proven in dogs. Other Brachyspira species commonly isolated from dogs, such as "B. canis" and "B. pulli", are considered commensals. This study investigated the occurrence of different Brachyspira species in rectal swabs and fecal samples in an independent canine cohort in central Germany. These included samples from shelter dogs, hunting dogs, and dogs presenting at regional small animal practices with various clinical signs. Data about the dogs, including potential risk factors for Brachyspira isolation, were obtained using a standardized questionnaire. The study also longitudinally investigated a colony of Beagle dogs for Brachyspira over 5 years. RESULTS: The rate of Brachyspira spp. isolation was 11% and included different Brachyspira species ("B. canis", "B. pulli", and B. pilosicoli). "B. canis" was detected in 18 dogs, whereas B. pilosicoli was only isolated from 1 dog in the independent cohort (not including the Beagle colony). Risk factors for shedding Brachyspira and "B. canis" were being less than 1 year of age and shelter origin. Gastrointestinal signs were not associated with the shedding of Brachyspira. B. pilosicoli and "B. canis" were isolated from several dogs of the same Beagle colony in 2017 and again in 2022, while Brachyspira was not isolated at multiple sampling time points in 2021. CONCLUSIONS: Shedding of B. pilosicoli in dogs appears to be uncommon in central Germany, suggesting a low risk of zoonotic transmission from dogs. Commensal status of "B. canis" and "B. pulli" is supported by the results of this study. Findings from the longitudinal investigation of the Beagle colony agree with an asymptomatic long-term colonization of dogs with "B. canis" and B. pilosicoli and suggest that introducing new animals in a pack can trigger an increased shedding of B. pilosicoli.

Intestinal Spirochetosis: To Treat or Not to Treat.

Spirochete colonization of the gastrointestinal tract is a poorly understood phenomenon presenting with varying signs and symptoms. Due to the lack of a unified approach and its varying presentations, the management decision for intestinal spirochetosis (IS) has always been challenging. While metronidazole is the commonly preferred antimicrobial treatment, it remains unclear if therapeutic intervention is indicated for everyone, especially asymptomatic patients. We present three patients, diagnosed with IS. They presented with varying demographics, clinical presentations, and past medical histories and underwent different clinical managements. Our decisions for treatment not only included presenting symptoms but also factors like history of pre-existing gastrointestinal diseases, age, and immune status.

Identification of Terminal ßGlcNAc on Brachyspira Species in Human Intestinal Spirochetosis.

Human intestinal spirochetosis (HIS) is a colorectal bacterial infection caused by the Brachyspira species. Griffonia simplicifolia-II (GS-II) is a lectin specific to terminal α/ßGlcNAc residues. Here, we investigated terminal ßGlcNAc residues in the context of HIS infection using GS-II-horseradish peroxidase staining and HIK1083 immunostaining specific to terminal αGlcNAc residues. Fourteen of 15 HIS cases were GS-II-positive on the bacterial body. No cases showed HIK1083 positivity. The percentage of bacterial bodies staining positively for GS-II based on comparison with anti-Treponema immunostaining was ≤30% in seven cases, 30-70% in two, and >70% in six. Of 15 HIS cases analyzed, none were comorbid with tubular adenomas, and three were comorbid with sessile serrated lesions (SSLs). To determine the species of spirochete infected, the B. aalborgi-specific or B. pilosicoli-specific NADPH oxidase genes were amplified by PCR. After direct sequencing of the PCR products, all nine cases in which PCR products were observed were found to be infected with B. aalborgi alone. These results indicate that the HIS bacterial body, especially of B. aalborgi, is characterized by terminal ßGlcNAc and also indicate that terminal ßGlcNAc on the HIS bacterial body is associated with HIS preference for SSLs.

Spirochetosis Mimicking Acute Appendicitis: Clinical Report and Review of the Literature.

Introduction: Intestinal spirochetosis is sometimes found by chance in histological specimen of routine endoscopies. There are only a few cases described in the literature that spirochetosis of the appendix was mimicking acute appendicitis. We present a case of pseudoappendicitis with the histological finding of spirochetes and review the current literature. Case Presentation: A 72-year-old woman presented with pain of the lower right abdomen and previous systemic corticoid therapy. In clinical examination, there was a tenderness and pain in the right lower quadrant, and inflammation values were elevated. An abdominal computed tomography scan revealed no obvious inflammation of the appendix. A diagnostic laparoscopy was performed and revealed a macroscopically uninflamed appendix which was removed. Histology revealed spirochetosis of the appendix but no typical signs of appendicitis. The patient was treated with antibiotics for 5 days and was discharged without abdominal pain. In a clinical control 6 weeks later, the abdominal pain had disappeared and the patient was in good clinical condition. Discussion: Intestinal spirochetosis is randomly found in histological specimen during routine endoscopies, even in asymptomatic patients. There are only a few cases described with spirochetosis of the appendix causing pain and mimicking appendicitis; hence, this entity is an important differential diagnosis of pain in the right lower quadrant of the abdomen.

A Rare Cause of Diarrhea: Intestinal Spirochetosis in an HIV-Positive Patient.

Intestinal spirochetosis (IS) is a rare gastrointestinal infection with vague presenting symptoms. Diagnosis is confirmed histopathologically. Risk factors include homosexuality and HIV. Antibiotic treatment with metronidazole usually leads to resolution of symptoms. We present the case of a 56-year-old HIV-positive man with chronic, watery diarrhea who was diagnosed with IS. This case highlights the importance of considering IS in the differential in HIV-positive patients with nonspecific gastrointestinal symptoms after more common etiologies have been ruled out.

Intestinal Spirochetosis and Chronic Diarrhea: A Case Report and Literature Review.

Spirochetosis is a rare condition characterized by the presence of spirochetes in the gastrointestinal tract. It is typically associated with immunodeficiency. We present a case of chronic watery diarrhea in a 48-year-old housewife who had a 12-week history of variable-volume bowel movements without blood or mucus, accompanied by a sense of urgency. Chronic diarrhea led to weight loss and fatigue, significantly impacting her quality of life. Despite the absence of known risk factors, a comprehensive clinical evaluation and exclusion of other potential causes prompted a rectosigmoid biopsy, which revealed distinctive histological findings of spirochetosis. This case underscores the significance of considering spirochetosis as a differential diagnosis in cases of chronic watery diarrhea, even in the absence of immunodeficiency. The utilization of rectosigmoid biopsy and careful histopathological examination played a pivotal role in establishing an accurate diagnosis.

Clinical and Pathologic Factors Associated With Colonic Spirochete (Brachyspira pilosicoli and Brachyspira aalborgi) Infection: A Comprehensive Systematic Review and Pooled Analysis.

OBJECTIVES: This study aims to determine what pathologic and clinical factors differentiate Brachyspira species that may be useful to clinicians and pathologists. METHODS: We identified 21 studies of Brachyspira infection with individual patient information (n = 113) and conducted a pooled analysis comparing each species. RESULTS: There were differences in the pathologic and clinical profiles of each Brachyspira species. Patients infected with Brachyspira pilosicoli infection were more likely to have diarrhea, fever, HIV, and immunocompromised conditions. Those patients infected with Brachyspira aalborgi were more likely to have lamina propria inflammation. CONCLUSIONS: Our novel data provide potential insights into the pathogenic mechanism(s) and the specific risk factor profile of Brachyspira species. This may be clinically useful when assessing and managing patients.

Modeling and analysis of the transmission of avian spirochetosis with non-singular and non-local kernel.

An acute bacterial infection called avian spirochetosis is spread by ticks to a variety of birds. Clinical symptoms can vary greatly and are frequently non-specific. To diagnose a condition, the infectious spirochete must be detected. Here, we structure an epidemic model for the transmission of avian spirochetosis to visualize the interaction between tick and bird populations. The recommended dynamics of avian spirochetosis is illustrated with the help of fractional framework. We inspected the steady-states of the system of the avian spirochetosis for the stability analysis. The next-generation technique is used to evaluate the model's reproduction parameter R0. The infection-free and endemic steady-state of avian spirochetosis were shown to be locally asymptotically stable under the specified conditions. Through mathematical skills, the positivity of solutions is determined. Additionally, evidence supporting the existence and uniqueness of the avian spirochetosis framework solution has been shown. We conduct modified simulations of the suggested avian spirochetosis system with different input factors to study the complex phenomena of avian spirochetosis under the effect of numerous input parameters. Our outcomes illustrate the significance and plausibility of fractional parameter, and they also suggest that this input parameter may adequately account for these kinds of observations.

Increased Prevalence of Symptomatic Human Intestinal Spirochetosis in MSM with High-Risk Sexual Behavior in a Cohort of 165 Individuals.

Human intestinal spirochetosis (HIS) can cause gastrointestinal symptoms, although asymptomatic infections have been described. Individuals from low-income countries, people living with HIV, and men who have sex with men (MSM) show increased risk. A retrospective review of all patients diagnosed with HIS (n = 165) between January 2013 and October 2020 at a tertiary hospital in Madrid, Spain, was performed to assess risk factors for symptomatic HIS, symptoms, and response to treatment. Most patients were male (n = 156; 94.5%), 86.7% were MSM, and 23.5% practiced chemsex, of whom most were symptomatic (p = 0.039). Most patients (78.4%) reported unprotected oral-anal intercourse. A total of 124 (81.1%) were symptomatic; diarrhea was the most common complaint (68.3%). Multivariable regression showed increased odds of symptoms associated with age under 41 (odds ratio 5.44, 95% CI 1.87-15.88; p = 0.002). Colonoscopy was normal in 153 (92.7%). Furthermore, 66.7% presented previous or concomitant sexually transmitted diseases (STDs). Among the patients, 102 underwent testing for other gastrointestinal pathogens, with positive results in 20 (19.6%). All symptomatic patients without concomitant gastrointestinal infection presenting improvement on follow-up (42 of 53) had received either metronidazole or doxycycline (p = 0.049). HIS should be considered as a cause of chronic diarrhea in MSM with high-risk sexual behavior after other causes have been ruled out; treatment with metronidazole is recommended. Coinfection with other STDs is common.

Human intestinal spirochetosis: an entity associated with sexual transmitted infections.

INTRODUCTION: Human intestinal spirochetosis (HIE) is a poorly studied clinical entity with variable clinical manifestations. However, in recent years it has gained special relevance because an increasing number of cases have been described in people living with HIV (PWH) and in patients with a history of sexually transmitted infections (STI) or immunosuppression. METHODS: Retrospective review of all HIE cases identified in a tertiary level hospital (Hospital Universitario la Paz, Madrid) between 2014 and 2021. RESULTS: 36 Cases of HIE were identified. Most cases corresponded to males (94%) with a median age of 45 years. 10 patients (29.4%) were PWH and 20 (56%) were men who had sex with men. Although the clinical manifestations were very heterogeneous, the most frequent was chronic diarrhea (47%), and up to 25% of the subjects had clinical proctitis. 39% percent of patients had been diagnosed with an STI in the previous two years, this characteristic being more frequent in PWH (90% vs. 28%; p < 0.01) than in patients without HIV infection. The STI most frequently associated with a diagnosis of HIE was syphilis (31%). CONCLUSION: HIE is frequently diagnosed with other STIs and affects mostly men who have sex with men, which supports that this entity could be considered as a new STI.

Human intestinal spirochetosis, histological finding associated with diarrhea with poor clinical evolution

Human intestinal spirochetosis was described by Harland and Lee in 1971, after observing colonization of the apical membrane of the intestinal mucosa by spirochetes. The clinical importance of these findings is not clear, since it is unknown whether the presence of these microorganisms is pathogenic or commensal. The clinical presentation is variable. It can be asymptomatic or manifest with abdominal pain, changes in intestinal rhythm and rectal bleeding. The prevalence of intestinal spirochaetosis is notably higher in developing countries than in developed countries, with the most likely route of transmission being fecal-oral, although sexual transmission has also been suggested as it is more prevalent in homosexual men. We present the case of a 42-year-old man, in treatment for 3 years with Tenofovir, with an HIV-positive partner, who went to the hospital for persistent diarrhea associated with eating a hamburger. (AU)

Intestinal Spirochetes Associated With Asymptomatic COVID-19 Infection.

A 60-year-old, human immunodeficiency virus (HIV)-negative, homosexual male presented to our colorectal clinic with abdominal pain for three weeks followed by persistent watery diarrhea refractory to loperamide. He had no history of recent travel, no known infectious contacts, and his last colonoscopy nine years prior was within normal limits. After one episode of hematochezia, computed tomography of the abdomen/pelvis was performed demonstrating colitis and coronavirus disease 2019 (COVID-19)-related changes to the lung bases. Testing confirmed COVID-19 infection which was self-limited. The initial workup for infectious colitis was negative. Colonoscopy revealed no evidence of gross colitis. Histopathology demonstrated microscopic colitis with spirochete colonization of the intestinal epithelium. A course of metronidazole led to the resolution of the patient's symptoms. Intestinal spirochetosis has been described as a rare source of colitis caused by the organism Brachyspira pilosicoli in an immunocompromised population (HIV-positive, organ transplant). It is associated with abdominal pain and refractory diarrhea. This report details the unique case of intestinal spirochetosis in an HIV-negative, COVID-19-positive patient with no other risk factors for immunosuppression. Further review is necessary to establish a true association; however, this case suggests that intestinal spirochetosis should be considered during the workup of chronic diarrhea (more than two weeks) in COVID-19-positive patients.

Human Intestinal Spirochetosis: A Rare Case of Intermittent Bloating and Hematochezia.

Human intestinal spirochetosis (HIS) is a condition where spirochetes, a group of spiral-shaped bacteria, attach to the apical membrane of the human colorectal epithelium. Although most findings of HIS are simply incidental discoveries found during screening colonoscopies, the ability to mimic the presentation of inflammatory bowel diseases should prompt consideration of this condition as part of a working differential diagnosis. Herein, we present the case of a 57-year-old bisexual, African American male with a medical history of Human Immunodeficiency Virus (HIV) on antiretroviral therapy (ART) with an undetectable viral load that presented for an elective, outpatient colonoscopy after experiencing four months of intermittent bloating and hematochezia. Histologic examination of colonic biopsies confirmed a diagnosis of HIS. The nonspecific clinical presentation in the setting of well-controlled HIV makes HIS a formidable diagnostic challenge that requires increased awareness.

Human Intestinal Spirochetosis Incompatible With Dysplastic Adenomatous Epithelium.

Human intestinal spirochetosis (HIS) refers to the colonization of spirochetal bacteria in the human intestinal tract. HIS caused by Brachyspira spp. has been recognized for decades, but their pathological and clinical significance is largely unclear. The coincidence of dysplasia in adenoma or adenocarcinoma and HIS is very rare, and whether spirochetes can colonize on dysplastic epithelium remains controversial. Here, we report a case that showed abrupt abolition of mucosal surface fringe formation on a tubular adenoma (TA) and increased cytoplasmic MUC1 expression in the dysplastic epithelial cells compared with adjacent nondysplastic colonocytes. The findings support the hypothesis that the epithelial colonization of spirochetes is significantly reduced by dysplasia likely due to loss of microvilli, and an increase of epithelial MUC1 expression might contribute to reduced spirochetal colonization in colonic mucosa.

Intestinal Spirochaetosis-A case series from the developing world.

Spirochaetes comprise a heterogenous group of gram negative, motile, spiral shaped bacteria. Some of these pathogens are known to cause numerous human diseases such as Lyme disease, relapsing fever, syphilis and leptospirosis. However, intestinal spirochetosis is a rare condition. Patients frequently present with long-term complaints of loose stools, abdominal pain and weight loss and rectal bleeding. Hence to establish a diagnosis an endoscopy with biopsy is required. In this article, we describe four such cases, having different ages and socio- economic background, successfully treated with a short course of metronidazole.

Ulcerative Proctitis: An Unusual Case of Intestinal Spirochetosis.

Human intestinal spirochetosis (HIS) is an uncommon disease characterized by the colonization of spirochetes in the colorectal mucosa and is most often found in individuals who are positive for human immunodeficiency virus (HIV) and in homosexual men. Although HIV is known to cause a variety of infectious colitis, the prevalence has significantly declined with antiretroviral therapy. Intestinal spirochetosis, however, remains meaningful as it can be an infectious cause of colonic ulcerations even with well-controlled HIV. Spirochetosis rarely causes macroscopic changes in the colorectal mucosa and reports of an ulcerated rectum are exceedingly scarce. Here, we report a case of a homosexual man with HIV who is compliant with antiretroviral therapy with high CD4 counts who presented with a six-week history of bloody diarrhea and was found to have multiple ulcerations in the rectosigmoid junction and rectum infected with non-treponemal spirochetes as confirmed on biopsy. To our knowledge, there have not been any reports of multiple rectal ulcerations caused by non-treponemal spirochetes. The patient was treated with metronidazole 500 mg four times daily for 10 days with complete resolution of symptoms. This case is notable as it alerts clinicians to consider intestinal spirochetosis as a differential diagnosis in the workup for bloody stool in the presence of colorectal ulcerations.

Unusual intra-rectal "laterally spreading tumour" in immunosuppressed patient with ulcerative colitis.

Condyloma acuminatum (CA) is a manifestation of Human Papillomavirus (HPV) infection which usually occurs in genital and perianal regions. We report a 46-year-old man with an ulcerative proctitis diagnosed four years earlier, asymptomatic for a long time under azathioprine but without any follow-up for three years. A colonoscopy was performed prior to potential immunosuppressive treatment discontinuation and showed a circumferential "laterally spreading tumour" in the rectum. Surprisingly biopsies revealed a CA with a very focally high-grade intra-epithelial lesion. Azathioprine was stopped and a transanal surgical resection was performed. At guided anamnesis, patient confirmed to be a former active "men who have sex with men". No recurrence of proctitis occurred despite azathioprine discontinuation. A retrospective review of the histological sections suggests that it was, in fact, an intestinal spirochetosis misdiagnosed as inflammatory bowel disease. Involvement of the rectal mucosa by HPV is a rare condition and this may have been promoted by inappropriate immunosuppressive treatment.