Human intestinal spirochetosis mimicking ulcerative colitis
Human intestinal spirochetosis mimicking ulcerative colitis
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DOI：
10.1007/s12328-017-0807-3
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发表时间：
2018-04-01
影响因子：
1
通讯作者：
Hokari, Ryota
中科院分区：
文献类型：
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作者：
Nishii, Shin;Higashiyama, Masaaki;Hokari, Ryota
人类肠道螺旋体病（HIS）是由短螺旋体属肠道螺旋体引起的结直肠感染，由于缺乏或症状轻微，其在人类中的致病性尚不清楚。我们监测了一名被诊断为HIS的妇女的5年临床病程，该妇女曾被怀疑患有溃疡性结肠炎（UC）。粪便潜血试验阳性后，她在当地诊所接受了结肠镜检查，在那里她被诊断为“右侧”UC伴偶然检测到的HIS，并被转诊到我院。结肠镜、组织病理学和细胞病理学检查显示升结肠和右横结肠中的局部糜烂性结肠炎，伴HIS类似UC的跳跃性病变。最初，我们选择了等待和观察的方法;然而，她逐渐出现了出血性腹泻。甲硝唑改善了她的腹部症状，以及她的结肠镜检查和组织病理学结果，表明HIS是她的结直肠炎症的原因。该病例揭示了（1）HIS可能的促炎作用，（2）在慢性直肠结肠炎中诊断HIS的困难，以及（3）可能将一些HIS病例纳入“UC”。HIS可模拟UC，并可纳入UC的鉴别诊断。在检测到HIS后，抗生素给药是必要的，特别是在表现出非典型UC表现的患者中。
Human intestinal spirochetosis (HIS) is a colorectal infection caused by the Brachyspira species of intestinal spirochetes, whose pathogenicity in humans remains unclear owing to the lack of or mild symptoms. We monitored the 5-year clinical course of a woman diagnosed with HIS in whom ulcerative colitis (UC) had been suspected. Following a positive fecal occult blood test, she underwent a colonoscopic examination at a local clinic where she was diagnosed with "right-sided" UC concomitant with incidentally detected HIS, and was referred to our hospital. Colonoscopic, histopathological, and cytological examination revealed localized erosive colitis in the ascending and the right transverse colon concomitant with HIS resembling skip lesions of UC. Initially, we chose the wait-and-watch approach; however, she gradually developed bloody diarrhea. Metronidazole improved her abdominal symptoms, as well as her colonoscopic and histopathological findings, suggesting that HIS was responsible for her colorectal inflammation. This case reveals (1) a possible pro-inflammatory role of HIS, (2) difficulties in diagnosing HIS in chronic proctocolitis, and (3) a possible inclusion of some HIS cases in "UC". HIS could mimic UC and might be included in differential diagnoses for UC. Antibiotic administration is necessary following the detection of HIS, particularly in patients demonstrating an atypical presentation of UC.