Intestinal Spirochetosis: A Case Series and Review of the Literature

Abstract

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.

Keywords: Antibiotics; Co-infection; Endoscopy; Polyps; Spirochete infections.

Fig. 1. Diffuse blue fringe seen on hematoxylin-eosin staining. It is approximately 3 to 6 µm thick along the border of the intercryptal epithelial layer, suggesting the diagnosis of spirochetosis.

Fig. 2. The diffuse fringe is referred to as “false brush border”. It can be more clearly seen in a silver Warthin-Starry staining.