Intestinal spirochetosis

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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

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

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.