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Intestinal spirochetosis in eight pediatric patients from Southern Sweden: A clinical, histopathological and ultrastructural study

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Marthinsen L, Willén R, Carlén B, Lindberg E, Värendh G. Intestinal spirochetosis in eight pediatric patients from Southern Sweden. A clinical, histopathological and ultrastructural study. APMIS 2002;110:571–9.

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 μm-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.
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Keywords: Intestinal spirochetosis; electron microscopy; histopathology; pediatrics

Document Type: Research Article

Affiliations: 1: Department of Pediatrics, County Hospital, Halmstad 2: Department of Pathology, University Hospital, Lund 3: Department of Pediatrics, University Hospital, Örebro 4: Department of Pediatrics, Ystad Hospital, Ystad, Sweden

Publication date: 2002-08-01

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