Abstract
BackgroundHuman intestinal spirochetosis (IS) has been recognized for decades, but whether it represents commensalism or a pathogenic process remains controversial. IS is diagnosed on routine stains with confirmation by silver stains but these stains are labor intensive and slow to read. We evaluated the Treponema pallidum immunostain as a diagnostic adjunct for IS.MethodsWe retrieved biopsies from 33 patients with IS for this study. Each case was tested by Warthin-Starry (WS) and T. pallidum immunohistochemistry (IHC). Species specific genotyping was performed in 3 cases.ResultsPatients with IS ranged from 22 to 82 years without gender predilection. IS involved normal (n = 15), and inflamed (n = 5) mucosa and colonic polyps (n = 13). Warthin-Starry and T. pallidum IHC were positive in all cases including both species of Brachyspira. Six (18%) symptomatic patients were treated for IS, and experienced resolution. In patients diagnosed with incidental IS on cancer screening (n = 5), follow up biopsies, without therapy, were negative for IS. T. pallidum IHC required 75 min less hands-on time than WS for performance and was faster to interpret.ConclusionsT. pallidum IHC can be used to confirm the diagnosis of IS and is easier to perform and faster to interpret than WS.
Highlights
Human intestinal spirochetosis (IS) has been recognized for decades, but whether it represents commensalism or a pathogenic process remains controversial
Some of these data were presented at the 105th United States and Canadian Academy of Pathology Annual Meeting in Seattle, WA and have been published in abstract form [1]
Authors have suggested that IS is often incidentally discovered and has no apparent clinical consequence but in some cases there is a diarrheal illness which resolves after metronidazole treatment and may be associated with an immunocompromised state [5, 7, 8]
Summary
Human intestinal spirochetosis (IS) has been recognized for decades, but whether it represents commensalism or a pathogenic process remains controversial. Intestinal spirochetosis (IS) is diagnosed on routine sections with identification of a thick band of basophilia at the apical aspect of the intestinal mucosa on low magnification. On high magnification, this basophilic band can be resolved as linearly arranged spiral organisms attached to the apical aspect of the colonocytes at the mucosal surface. The Treponema pallidum immunostain has been shown to be positive in cases of intestinal spirochetosis in a prior study [8] but this was not the main focus of that study. We evaluated the Graham et al Diagnostic Pathology (2018) 13:7
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