Intestinal spirochetosis

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Intestinal spirochetosis, also known as intestinal spirochetes, in an uncommon intestinal infection.

Intestinal spirochetosis
Diagnosis in short

Intestinal spirochetosis. H&E stain.

LM hyperchromatic fuzz on luminal aspect of epithelial cells - at brush border; spirochetes
Stains silver stains, e.g. Warthin-Starry stain
Site intestine - colon

Signs watery diarrhea +/-blood per rectum
Symptoms abdominal pain
Prevalence uncommon
Endoscopy often normal
Prognosis benign
Clin. DDx other causes of diarrhea
Treatment antibiotics

It is usually in the colon; thus, also known as colonic spirochetes and colonic spirochetosis.


  • Caused by spirochetes[1][2] - specifically Brachyspira piloicoli[3] (previously Serpulina pilosicoli[4]) and Brachyspira aalborgi.
  • Very rare cause of diarrhea, associated with male homosexual behaviour.


  • Watery diarrhea, abdominal pain, +/-blood per rectum.


  • Metronidazole.


  • Typically normal appearance.


  • Anatomical distribution in large intestine varies - may be absent in rectum.[6]



  • Hyperchromatic fuzz on luminal aspect of epithelial cells; at brush border.




Special stains


Sign out

Rectum, Biopsy:
     - Colonic-type mucosa with spirochetes, otherwise within normal limits.

The presence of spirochetes was confirmed with a Warthin-Starry stain.

See also


  1. Amat Villegas I, Borobio Aguilar E, Beloqui Perez R, de Llano Varela P, Oquiñena Legaz S, Martínez-Peñuela Virseda JM (January 2004). "[Colonic spirochetes: an infrequent cause of adult diarrhea]" (in Spanish; Castilian). Gastroenterol Hepatol 27 (1): 21–3. PMID 14718105.
  2. 2.0 2.1 URL: Accessed on: 25 April 2011.
  3. Margawani, KR.; Robertson, ID.; Hampson, DJ. (Feb 2009). "Isolation of the anaerobic intestinal spirochaete Brachyspira pilosicoli from long-term residents and Indonesian visitors to Perth, Western Australia.". J Med Microbiol 58 (Pt 2): 248-52. doi:10.1099/jmm.0.004770-0. PMID 19141744.
  4. URL: Accessed on: 28 June 2011.
  5. Calderaro A, Bommezzadri S, Gorrini C, et al. (November 2007). "Infective colitis associated with human intestinal spirochetosis". J. Gastroenterol. Hepatol. 22 (11): 1772–9. doi:10.1111/j.1440-1746.2006.04606.x. PMID 17914949.
  6. Walker MM, Talley NJ, Inganäs L, Engstrand L, Jones MP, Nyhlin H, Agréus L, Kjellstrom L, Öst Å, Andreasson A (February 2015). "Colonic spirochetosis is associated with colonic eosinophilia and irritable bowel syndrome in a general population in Sweden". Hum Pathol 46 (2): 277–83. doi:10.1016/j.humpath.2014.10.026. PMID 25540866.
  7. Tsinganou, E.; Gebbers, JO. (Jan 2010). "Human intestinal spirochetosis--a review.". Ger Med Sci 8: Doc01. doi:10.3205/000090. PMID 20200654.