Intestinal spirochetosis of the vermiform appendix

Area of Science:

• Microbiology
• Gastroenterology
• Pathology

Background:

• Spirochetes are spiral-shaped bacteria that can cause various infections.
• Appendicitis is a common surgical emergency.
• The role of spirochetes in appendiceal pathology is not well understood.

Purpose of the Study:

• To investigate the prevalence of spirochetes in surgically removed appendices.
• To determine if spirochetes are associated with acute appendicitis or other appendiceal conditions.
• To characterize the morphology of appendiceal spirochetes.

Main Methods:

• Histological examination of 681 surgically removed appendices.
• Microscopic detection of spirochetes.
• Ultrastructural analysis of spirochetes using negative staining and ultrathin sectioning.

Main Results:

• Spirochetes were detected in 12.3% of appendices with pseudoappendicitis (histologically normal but clinically suspected appendicitis).
• Spirochetes were found in only 0.7% of appendices with confirmed acute appendicitis (p < 0.05).
• Two cases (1.9%) of appendiceal spirochetosis were identified in appendices removed for other reasons (p < 0.05).
• The ultrastructure of the identified spirochetes was similar to Brachyspira aalborgi.

Conclusions:

• Spirochetes may play a role in pseudoappendicitis.
• The association between spirochetes and acute appendicitis appears weak.
• Appendiceal spirochetosis is a distinct entity that may require further study.