[Human intestinal spirochetosis].
A characteristic feature of human intestinal spirochetosis (IS) is the colonization of the mucosa of the large intestine with intestinal spirochetes of the genus Brachyspira. The joining of the brachyspirae with the apical cellular membrane of enterocytes resembles in histological slides a false brush border of the intestinal mucosa. Various symptoms related to the involvement of the large gut were found with invasive IS. From the cultures of these cases were isolated Brachyspira aalborgii and B. pilosicoli. The frequency of the incidence of brachyspirae depended on the socio-economic living conditions of people. Colonization of the mucosa of the large gut was found more often in human populations in the developing countries; it was fairly rare in countries with high hygienic standards. An exception were men of homosexual orienation and patients presenting with a HIV infection. Isolation of brachyspirae from the faeces and biopsy of the mucosa of the large gut are fairly demanding jobs, especially with B. aalborgii. Most documented IS cases of this aetiology were diagnosed using immunohistochemical methods and amplification of the genus-specific region of the gene 16S rRNA. Isolation of B. pilosicoli tends to be simpler, it requires anaerobic incubation on selective blood agars for a period of 3-6 days at 37 degrees C. When manual haemoculture systems were used, patients in a critical state presented a translocation of brachyspirae into blood circulation, while automatic systems don't necessarily diagnose spirochetaemia. In the management of described cases of invasive IS particularly successful proved metronidazole and beta-lactam antibiotics. In isolated B. pilosicoli, in vitro tests confirmed sensitivity to metronidazole, ceftriaxone, meropenem, tetracycline, moxifloxacine and chloramphenicol. A varying frequency of resistance was found with clindamycin and amoxicillin, which how ever was efficacious in combination with clavulanic acid.
Cízek
Alois
A
Institute of Microbiology and Immunology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, 61242 Brno, Czech Republic. cizeka@vfu.cz
Lobová
Dana
D
D005243:Feces / Q000382:microbiology; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D013143:Spirochaetaceae / Q000187:drug effects / Q000302:isolation & purification; D013145:Spirochaetales Infections / Q000175:diagnosis / Q000382:microbiology / Q000635:transmission