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Intestinal Bacterial Infection Diagnosed by Histological Examination of Endoscopic Biopsy Specimens

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ABSTRACT

Intestinal spirochetosis (IS) in humans is characterized by spirochetal microorganisms attached to the luminal surface of the colonic epithelium. In the present case, attached organisms appeared as 3- to 4 μm-thick (average thickness, 3.4 μm) basophilic fringes or haze in HE-stained endoscopic biopsy specimens. The basophilic fringes were clearly labeled by Treponema pallidum antiserum. Because IS is relatively rare in developed countries, thin basophilic fringes characteristic of IS are readily overlooked. Thus, the recognition of histological characteristics of this disease is important for its diagnosis.

No MeSH data available.


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Intestinal spirochetosis. a Basophilic fringes (average thickness, 3.4 μm) reflecting a group of spirochetes are seen on the luminal surface of sigmoid colon mucosa by HE staining. b Immunostaining with T. pallidum antiserum highlights the fringes. Scale bars, 25 μm.
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Figure 1: Intestinal spirochetosis. a Basophilic fringes (average thickness, 3.4 μm) reflecting a group of spirochetes are seen on the luminal surface of sigmoid colon mucosa by HE staining. b Immunostaining with T. pallidum antiserum highlights the fringes. Scale bars, 25 μm.

Mentions: Biopsy specimens during endoscopy were taken from the ileum end, ascending colon, and sigmoid colon. In HE-stained sections, all specimens showed marked but nonspecific inflammatory cell infiltration in the mucosal layer. The histology did not support a diagnosis of inflammatory bowel disease, such as Crohn's disease or ulcerative colitis. Moreover, PAS-stained sections did not label trophozoites, so amebic colitis was excluded. However, specimens from the sigmoid colon displayed characteristic morphology, so-called basophilic fringes, haze, or false brush border on the luminal surface and in the crypts of the nonneoplastic epithelium, suggestive of IS (Fig 1a). Invasion of the microorganism beyond the surface epithelium was not seen in biopsy specimens. The IS infection was confirmed by immunostaining with antiserum against Treponema pallidum (rabbit polyclonal antibody; Biocare Medical, Concord, CA, USA), performed according to the manufacturer's instructions (Fig 1b). This antiserum clearly labels Brachyspiraceae [3]. Therefore, infective colitis associated with IS was the diagnosis.


Intestinal Bacterial Infection Diagnosed by Histological Examination of Endoscopic Biopsy Specimens
Intestinal spirochetosis. a Basophilic fringes (average thickness, 3.4 μm) reflecting a group of spirochetes are seen on the luminal surface of sigmoid colon mucosa by HE staining. b Immunostaining with T. pallidum antiserum highlights the fringes. Scale bars, 25 μm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121558&req=5

Figure 1: Intestinal spirochetosis. a Basophilic fringes (average thickness, 3.4 μm) reflecting a group of spirochetes are seen on the luminal surface of sigmoid colon mucosa by HE staining. b Immunostaining with T. pallidum antiserum highlights the fringes. Scale bars, 25 μm.
Mentions: Biopsy specimens during endoscopy were taken from the ileum end, ascending colon, and sigmoid colon. In HE-stained sections, all specimens showed marked but nonspecific inflammatory cell infiltration in the mucosal layer. The histology did not support a diagnosis of inflammatory bowel disease, such as Crohn's disease or ulcerative colitis. Moreover, PAS-stained sections did not label trophozoites, so amebic colitis was excluded. However, specimens from the sigmoid colon displayed characteristic morphology, so-called basophilic fringes, haze, or false brush border on the luminal surface and in the crypts of the nonneoplastic epithelium, suggestive of IS (Fig 1a). Invasion of the microorganism beyond the surface epithelium was not seen in biopsy specimens. The IS infection was confirmed by immunostaining with antiserum against Treponema pallidum (rabbit polyclonal antibody; Biocare Medical, Concord, CA, USA), performed according to the manufacturer's instructions (Fig 1b). This antiserum clearly labels Brachyspiraceae [3]. Therefore, infective colitis associated with IS was the diagnosis.

View Article: PubMed Central - PubMed

ABSTRACT

Intestinal spirochetosis (IS) in humans is characterized by spirochetal microorganisms attached to the luminal surface of the colonic epithelium. In the present case, attached organisms appeared as 3- to 4 μm-thick (average thickness, 3.4 μm) basophilic fringes or haze in HE-stained endoscopic biopsy specimens. The basophilic fringes were clearly labeled by Treponema pallidum antiserum. Because IS is relatively rare in developed countries, thin basophilic fringes characteristic of IS are readily overlooked. Thus, the recognition of histological characteristics of this disease is important for its diagnosis.

No MeSH data available.


Related in: MedlinePlus