1/4. Spirochaetosis of the human rectum associated with an intraepithelial mast cell and IgE plasma cell response.In two patients presenting with mild intestinal symptoms, rectal spirochaetosis was the only morphological abnormality diagnosed by light microscopy. A re-evaluation of the morphological changes using electron microscopy and immunohistochemistry showed certain unusual features: the microorganisms were observed within epithelial cells and in subepithelial macrophages; there were numerous partially degranulated intraepithelial mast cells; and there was a marked increase in the proportion of IgE plasma cells within the lamina propria. Mucosal penetration by the organisms may be responsible for the unusual immune response. In one patient, treatment with antibiotics eliminated the spirochaetes and resulted in a clinical improvement. Spirochaetes should not always be considered as harmless commensals in the colon.- - - - - - - - - - ranking = 1keywords = lamina propria, propria, lamina (Clic here for more details about this article) |
2/4. Intestinal spirochaetosis: an electron microscopic study of an unusual case.An unusual case of intestinal spirochaetosis is described. The rectum of a 34-year-old male, suffering from Crohn's disease and ankylosing spondylitis, was heavily infested by spirochaetes. Both absorptive and goblet cells were colonized. Spirochaetes were found not only on the luminal surface of these cells, but also within the cytoplasm, in occasional macrophages within the lamina propria and, even more surprisingly, within the occasional Schwann cell. The significance of these findings is discussed.- - - - - - - - - - ranking = 1keywords = lamina propria, propria, lamina (Clic here for more details about this article) |
3/4. Intestinal spirochetosis and acquired immunodeficiency syndrome: ultrastructural studies of two cases.Two cases of intestinal spirochetosis (IS) with acquired immunodeficiency syndrome are reported. In case 1, a 48-year-old homosexual black man presented with a 1-month history of alternating watery diarrhea and constipation, which dissipated following the removal of two colonic hyperplastic polyps containing IS. In case 2, a 26-year-old homosexual black man presented with a 3-month history of persistent bloody diarrhea and was found to have chronic shigellosis and IS. Pathologic findings of IS were similar in both cases. Basophilic fringes typical of IS covered the surfacing colonic epithelium and consisted of dense growths of spirochetes adherent to and oriented perpendicular to the plasma membranes of the surfacing epithelium. The spirochetes measured 3 to 5 microns in length and 0.2 micron in width, contained four to eight axial fibrils, and closely resembled brachyspira aalborgi ultrastructurally. These cases are notable because the histopathologic changes of IS were more extensive than generally described. There was involvement of both the right colon and rectum by IS in case 2, and in both cases there was extension of the IS down into the crypts of Lieberkuhn, spirochetal invasion of the colonic mucosa, and a conspicuous inflammatory response by macrophages in the underlying lamina propria.- - - - - - - - - - ranking = 1keywords = lamina propria, propria, lamina (Clic here for more details about this article) |
4/4. Invasive colitis and hepatitis due to previously uncharacterized spirochetes in patients with advanced human immunodeficiency virus infection.We describe three patients with advanced human immunodeficiency virus (hiv) infection, two with colitis and one with cholestatic hepatitis, for whom results of detailed endoscopic and histologic studies were suggestive of invasive spirochetosis. In the two patients with colitis, colonoscopic evaluation revealed either diffuse ulcerations or pustules; in both cases, there was histologic evidence of extensive superficial cell necrosis and infiltration of the mucosa and lamina propria with acute inflammatory cells. Spirochetes in the mucosa and crypts were visualized by Warthin-Starry silver staining. Morphologically similar spirochetes throughout the liver specimen from the patient with cholestatic hepatitis were demonstrated by Warthin-Starry silver staining. Analysis with electron microscopy revealed these organisms to be loosely coiled spirochetes. Despite extensive evaluation, no other pathogens were identified. Invasive spirochetal infection, as defined by the results of Warthin-Starry silver staining of involved tissues, should be considered in the differential diagnosis of patients with hiv infection who have otherwise unexplained colitis or cholestatic hepatitis.- - - - - - - - - - ranking = 1keywords = lamina propria, propria, lamina (Clic here for more details about this article) |