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Intestinal spirochetosis in eight pediatric patients from Southern Sweden
Lars Marthinsen1, Roger Willén, Birgitta Carlén
1Department of Pediatrics, County Hospital, Halmstad, Sweden.
Insights
Intestinal spirochetosis, a condition affecting children, may cause colorectal disease. This study observed spirochetes adhering to intestinal cells, with some cases showing inflammation and symptom improvement after treatment.
Area of Science:
- Gastroenterology
- Microbiology
- Pediatric Medicine
Background:
- Intestinal spirochetes have been known for over a century, but their role as commensals or pathogens in colorectal disease remains debated.
- Most existing literature focuses on adult cases, with limited information available on pediatric intestinal spirochetosis.
Observation:
- A retrospective study identified eight pediatric cases of intestinal spirochetosis.
- Microscopic examination revealed a thick layer of spirochetes on the luminal surface of enterocytes and within gland openings in all patients.
- Electron microscopy suggested intracytoplasmic spirochetes in one case and demonstrated adherence to enterocyte membranes despite microvilli damage.
Findings:
- Five of the eight pediatric patients exhibited inflammatory cell reactions.
- Treatment correlated with symptom relief in three children, partial improvement in four, and no change in one.
- The study presents clinical and pathological findings, including light and electron microscopy data.
Implications:
- Intestinal spirochetes may be a causative agent of colorectal disease in children.
- Further research into pathogenic mechanisms of pediatric intestinal spirochetosis is warranted.
- This study highlights the need to consider intestinal spirochetosis in the differential diagnosis of pediatric gastrointestinal disorders.
Abstract:
Intestinal spirochetes in humans have been recognized for more than a century, but it is still a matter of debate whether they are just commensal organisms or whether they cause colorectal disease. Most descriptions to date are of adult patients, while reports in the pediatric literature have been scarce. In a retrospective study we found eight children with intestinal spirochetosis. The findings, clinical as well as pathological, with light- and electron microscopy, are presented. In all patients, a 3 microm-thick layer of spirochetes was visualised on the luminal aspect of the epithelial cells covering the enterocytes and part of the gland openings. In five of the eight cases an inflammatory cell reaction was seen by light microscopy and in one patient a picture suggesting intracytoplasmatically located spirochetes was seen by electron microscopy. Despite partial or complete destruction of microvilli, spirochetes were still able to adhere to the enterocyte membranes. In three children there was a clear correlation between treatment and relief of symptoms. In four there was partial improvement and in one child no change in bowel-related symptoms. We believe that intestinal spirochetes may cause colorectal disease in children. Possible pathogenic mechanisms are discussed.