Intestinal spirochetosis: epidemiology, microbiology, and clinical significance

First recognized in humans in the late 1800s, intestinal spirochetes are still poorly understood in their capacity to cause human disease. Though more commonly seen in developing than developed countries, the prevalence of intestinal spirochetosis appears to be growing in the Western world, particularly in the homosexual male and human immunodeficiency virus-infected populations. This change may also reflect increased recognition, as opposed to increased prevalence. Reported symptoms have ranged from asymptomatic colonization to watery, chronic diarrhea, abdominal pain, and fever, to the rare cases of fulminant hepatic failure and sepsis. The characteristic histological findings of a false brush border are distinctly unique, and while other methods of detection are being examined experimentally, they are not yet readily available. No specific guidelines for treatment exist. Although metronidazole is the most commonly employed means of therapy, cases of symptomatic remission have also been reported with penicillin, clindamycin, and erythromycin.