Spirochetosis Research Articles

Coexistence of Intestinal Spirochetosis and Colorectal Cancer: Could the Coil be Carcinogenic?

ABSTRACT Intestinal spirochetosis (IS) is an infectious gastrointestinal disease caused by Brachyspira bacteria. We detail an exceedingly rare case of IS with concomitant invasive colorectal adenocarcinoma (CRC) in a 58-year-old man presenting with abdominal discomfort and fever. Colonoscopic evaluation revealed abnormal-appearing, nodular cecal mucosa and a 35 mm rectosigmoid mass. Histopathology confirmed IS infection and CRC. Our case report is the first to detail IS diagnosed concurrently with colorectal cancer. It highlights the necessity of a high index of suspicion for IS in patients presenting with abdominal discomfort and endoscopic evidence of irregular nodular mucosa, particularly in the setting of suspected CRC. It further details potential pathophysiologic links between IS and colorectal malignancy.

S2782 Symptomatic Colonic Spirochetosis in a Patient With Newly Diagnosed HIV

S2782 Symptomatic Colonic Spirochetosis in a Patient With Newly Diagnosed HIV

BPP43_05035 is a Brachyspira pilosicoli cell surface adhesin that weakens the integrity of the epithelial barrier during infection

ABSTRACT The anaerobic spirochete Brachyspira causes intestinal spirochetosis, characterized by the intimate attachment of bacterial cells to the colonic mucosa, potentially leading to symptoms such as diarrhea, abdominal pain, and weight loss. Despite the clinical significance of Brachyspira infections, the mechanism of the interaction between Brachyspira and the colon epithelium is not known. We characterized the molecular mechanism of the B. pilosicoli-epithelium interaction and its impact on the epithelial barrier during infection. Through a proteomics approach, we identified BPP43_05035 as a candidate B. pilosicoli surface protein that mediates bacterial attachment to cultured human colonic epithelial cells. The crystal structure of BPP43_05035 revealed a globular lipoprotein with a six-bladed beta-propeller domain. Blocking the native BPP43_05035 on B. pilosicoli, either with a specific antibody or via competitive inhibition, abrogated its binding to epithelial cells, which required cell surface-exposed N-glycans. Proximity labeling and interaction assays revealed that BPP43_05035 bound to tight junctions, thereby increasing the permeability of the epithelial monolayer. Extending our investigation to humans, we discovered a downregulation of tight junction and brush border genes in B. pilosicoli-infected patients carrying detectable levels of epithelium-bound BPP43_05035. Collectively, our findings identify BPP43_05035 as a B. pilosicoli adhesin that weakens the colonic epithelial barrier during infection.

Chronic diarrhea secondary to intestinal spirochetosis, should we think about it?

Abstract Human intestinal spirochetosis (HIS) is defined as a colonization of the apical membrane of the colonic mucosa and the appendix by spirochetes. It is a very rare finding, being more common in some populations (individuals living in villages and peri-urban environments in developing countries, recent immigrants from developing countries, men who have sex with other men and HIV positive patients), but the spirochete rarely is investigated as human enteric potential microorganism. It is a slow-growing microorganism and has specialized growth requirements, which is why it is not detectable in human fecal samples using routine diagnostic methods. However, it has been histologically identified attached to the colon and rectum in patients with conditions such as chronic diarrhea, rectal bleeding, and/or nonspecific abdominal discomfort. In this article we present the case of a patient with chronic diarrhea secondary to intestinal spirochetosis, highlighting the importance of considering this etiology in the differential diagnosis.

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

BackgroundBrachyspira (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.ResultsThe 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.ConclusionsShedding 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.

Identification of Terminal βGlcNAc 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/βGlcNAc residues. Here, we investigated terminal βGlcNAc 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 βGlcNAc and also indicate that terminal βGlcNAc on the HIS bacterial body is associated with HIS preference for SSLs.

S2265 A Tale of Two 'Chetes: Varying Presentations of Intestinal Spirochetosis

S2265 A Tale of Two 'Chetes: Varying Presentations of Intestinal Spirochetosis

S2604 Intestinal Spirochetosis in Rural Oklahoma Mimicking Colorectal Polyps on Screening Colonoscopy

S2604 Intestinal Spirochetosis in Rural Oklahoma Mimicking Colorectal Polyps on Screening Colonoscopy

Unusual Behavior of Intestinal Spirochetosis: A Case Report

Abstract Human intestinal spirochetosis is a rare clinicopathological condition characterized by the presence of spirochetal microorganisms on the surface of the colorectal mucosa and, in some cases, by their invasion into the lamina propria. The most frequent cause of this infection is immunocompromised status. Our case report describes a patient with relevant symptoms and endoscopic alterations, but limited invasion by spirochetes, as shown by histological analysis of ileal and colonic specimens. After histological examination, metronidazole was initiated. This resulted in rapid and complete resolution of the symptoms, which demonstrated an infectious etiology. The peculiarity of our case is that the clinical and endoscopic appearances were typical of the aggressive behavior of the disease, but histological samples showed only superficial colonization of the colonic epithelium without clear invasion of deeper layers. This case report emphasizes that the virulence of spirochetes is not strictly related to intestinal mucosal invasion.

Human intestinal spirochetosis: an entity associated with sexual transmitted infections

IntroductionHuman 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. MethodsRetrospective review of all HIE cases identified in a tertiary level hospital (Hospital Universitario la Paz, Madrid) between 2014 and 2021. Results36 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%). ConclusionHIE 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.

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.

Espiroquetosis intestinal humana como entidad asociada a infecciones de transmisión sexual

IntroductionHuman 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. Methodsretrospective review of all HIE cases identified in a tertiary level hospital (Hospital Universitario la Paz, Madrid) between 2014-2021. Results36 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%). ConclusiónHIE 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.

Pneumatosis cystoides coli associated with intestinal spirochetosis.

A 61-year-old asymptomatic man underwent colonoscopy during a medical check-up, which revealed multiple translucent submucosal tumor-like lesions along the ascending and transverse colon along with erythematous areas (Fig. 1A). Computed tomography (CT) colonography revealed multiple air-containing cysts within the walls of the colon (Fig. 1B, C). Clostridioides difficile toxin was not detected in stools. We performed biopsies of the cystic lesions. Histopathological examination revealed edematous and mild non-specific inflammatory cell infiltration (Fig. 2A).

Cecal Reduction of Brachyspira and Lesion Severity in Laying Hens Supplemented with Fermented Defatted ‘Alperujo’

Antimicrobial resistance demands the development of therapeutic alternatives such as prebiotics, probiotics, and nutraceuticals. The aim of this study was to assess the antimicrobial proprieties of the nutraceutical fermented defatted “alperujo”, derived from olive oil production, in a laying hen farm (n = 122,250) endemic with avian intestinal spirochetosis (Brachyspira spp.). Part of the batch (n = 1440) was divided into six groups of 240 hens each that included 80 or 108-week-old laying hens, supplemented with 0%, 2%, or 6% fermented defatted ‘alperujo’ for a month. At the end of the experiment, eight hens from each group were autopsied and cecal content was subjected to (i) Brachyspira culture and species identification by PCRs, and (ii) direct DNA extraction and Brachyspira qPCR. Furthermore, the ceca were processed for histopathology. Microbiological isolation revealed B. pilosicoli and B. hyodysenteriae co-infection in all groups. The 80-week-old hen group 2% supplemented showed a reduction in the cecal Brachyspira content (qPCR) compared with non-supplemented hens. Cecal histopathology showed a diffuse mild infiltration of lymphocytes, plasma cells, and heterophils; and hyperplasia of the gut-associated lymphoid tissue hyperplasia which decreased in severity in 80-week-old supplemented hens. The reduction in Brachyspira colonization and the severity of the lesions observed in supplemented hens highlights a potential protective function against avian intestinal spirochetosis.

S2199 A Rare Case of Intestinal Spirochetosis in an Asymptomatic Immunocompetent Patient

Introduction: Human Intestinal spirochetosis is defined as presence of spirochetes attached to the surface of the intestinal mucosa. Intestinal spirochetes comprise of a heterogeneous group of bacteria. In humans, Brachyspira aalborgi and Brachyspira pilosicoli predominate. Intestinal spirochetosis is primarily reported in developing countries and rare in places with high living standards. Immunocompromised patients and homosexuals are at higher risk for colonization and invasive human intestinal spirochetosis. Patients can be asymptomatic or present with diarrhea, abdominal pain, hematochezia and lower GI bleeding. We present a rare case of asymptomatic human intestinal spirochetosis with no risk factors. Case Description/Methods: A 66-year-old White heterosexual male with past medical history of nicotine use disorder, alcohol dependence, and hypertension was referred to the gastroenterology clinic for persistently elevated liver enzymes and abnormal abdominal imaging results. He denied having any gastrointestinal or systemic symptoms except occasional diarrhea and was sexually active with only one female partner for last 40 years. CT scan of the abdomen & pelvis showed hepatic steatosis, sigmoid diverticulosis with sigmoid wall thickening and a fistulous communication between the sigmoid colon and bladder dome. An active open fistula between bowel and bladder was considered. Further evaluation with colonoscopy showed a total of 2 large polyps and multiple sigmoid diverticula but no evidence of fistula. Histopathology of biopsies showed hyperplastic, adenomatous polyps and spirochetes. Warthin-Starry stain was positive for Barchyspira spirochetes from all the tissue specimens. Patient was referred to an infectious disease specialist. HIV and Rapid Plasma Regain (RPR) were negative. The decision was made to monitor the clinical condition and avoid antibiotics for time being, given the absence of symptoms and concurrent alcohol use. A surgical evaluation was planned to look into a possible colo-vesical fistula, but patient was lost to follow-up (Figure). Discussion: Intestinal spirochetosis is known to cause havoc in veterinary medicine, especially in the swine population (Our patient lived in a trailer park and worked with goats, chickens, dogs, and cats). Intestinal spirochetosis in humans and its clinical significance in an asymptomatic immunocompetent patient is poorly understood. Antibiotics are not recommended unless the patient is symptomatic. If recommended metronidazole is the choice of treatment.Figure 1.: Intestinal Spirochetosis.

S2145 The Great Imitator Hiding in Plain Sight

Introduction: Lower gastrointestinal syphilis is a rare manifestation of early syphilis transmitted through anal contact. It usually occurs in men and transwomen who have sex with men. It can present with symptoms of proctitis including hematochezia, mucous discharge, and tenesmus, and can mimic inflammatory bowel disease (IBD). We present a case of intestinal syphilis in an HIV patient who presented with fevers and bloody diarrhea found to have intestinal spirochetosis. This case report adds to the importance of including STI colitis in the differential when presented with high-risk patients with lower gastrointestinal features. Case Description/Methods: A 32-year-old male with a history of untreated HIV, untreated hepatitis C, and IV drug use presented to the emergency department with a one-month history of worsening sharp and diffuse abdominal pain, subjective fevers, and blood-tinged mucoid bowel movements. He was diagnosed with rectal gonorrhea and chlamydia infection a few days prior to presentation and was treated with intramuscular ceftriaxone. He was discharged on doxycycline, which he failed to take. The patient’s social history is significant for being a sex worker and having sex with males. On physical exam, he was cachectic appearing with a diffusely tender abdomen. A rectal exam revealed palpable nodules and anal condylomas. He was treated with HAART and doxycycline for a presumed lymphogranuloma venereum infection. Computed Tomography (CT) of the abdomen pelvis showed an irregular and thick-walled rectum with perirectal soft-tissue stranding and necrotic nodes in the left perirectal region, the largest measuring 1.7 x 1.7 cm. Given continuous bloody bowel movements and a family history of colorectal cancer, a colonoscopy was obtained and showed scattered and patchy severe edema, erythema, and friability with shallow and deep rectal ulcerations. His labs revealed late latent syphilis infection (1:128 titer) and he was started on penicillin (PCN). Pathology of the colon later revealed intestinal syphilis as depicted in the Figure. Discussion: In recent years, there has been an increase in the number of reported cases of syphilis, especially in men and transwomen who have sex with men. Given this rare manifestation of syphilis, it is important to recognize and effectively treat to reduce patient morbidity and minimize community spread. Our case demonstrated the importance of maintaining a high level of suspicion for high-risk individuals presenting with lower gastrointestinal symptoms.Figure 1.: Right colon (Specimen A), left colon (Specimen B), and rectum (Specimen C).

S2238 An Uncommon Cause for Common Symptoms of Abdominal Pain and Diarrhea: A Case Report of Human Intestinal Spirochetosis in an Immune-Competent Patient

S2238 An Uncommon Cause for Common Symptoms of Abdominal Pain and Diarrhea: A Case Report of Human Intestinal Spirochetosis in an Immune-Competent Patient

Incidental diagnosis of intestinal spirochetosis in a patient with chronic hepatitis B: A case report

Incidental diagnosis of intestinal spirochetosis in a patient with chronic hepatitis B: A case report

Acute intestinal spirochetosis presenting as an IBD mimicker

25-year-old male with a history of polysubstance abuse (cocaine and crystal meth) and risky sexual behavior, who presented with a 1-month history of intermittent hematochezia, loose stools and lower abdominal pain. ROS revealed subjective fevers, night sweats, and chills for the preceding 4 days. He used intra-rectal cocaine and crystal meth injection with a needleless syringe.

Mucosal Immune Characterization of Colonic Spirochetosis

Mucosal Immune Characterization of Colonic Spirochetosis