Zusammenfassung
Die sehr seltene intestinale Spirochätose wird immer dann diagnostiziert, wenn in den Biopsaten aus einer endoskopisch normalen kolorektalen Schleimhaut ein basophiler Saum zwischen den Mikrovilli des Deckepithels der kolorektalen Schleimhaut nachzuweisen ist. Die bakteriologische Klassifikation der in Spezialfärbungen (z. B. Warthin-Starry-Versilberung) und elektronenmikroskopisch nachweisbaren Bakterien ist immer noch unklar. Umstritten ist auch noch, ob es sich bei dieser Spirochätenbesiedlung um pathogene Keime handelt. Gegen die Pathogenität spricht, dass histologisch keine entzündliche Reaktion nachzuweisen ist. Auch die Symptomatik der Patienten mit intestinaler Spirochätose lässt keine Aussage zu der Frage zu, ob es sich um eine pathogene oder apathogene Kolonisation der kolorektalen Schleimhaut handelt. Einige Studien scheinen aber zu belegen, dass die Spirochätose Ursache für Symptome wie Diarrhöen, Obstipation und abdominale Schmerzen sein könnten. Für diese pathogene Bedeutung spricht auch, dass diese Symptome nach erfolgreicher Therapie mit Metronidazol verschwinden können. Die histologische Diagnose ist leicht zu stellen, wenn man bei scheinbar normalem histologischen Befund der kolorektalen Schleimhaut an die Möglichkeit der Spirochätose denkt und gezielt nach dem basophilen Saum im Deckepithel der kolorektalen Schleimhaut sucht.
Abstract
Whenever biopsy material obtained from endoscopically normal colorectal mucosa reveals the blue haematoxyphilic line between the microvilli of the covering epithelium, the rare condition of intestinal spirochetosis is diagnosed. The classification of the bacteria detected with the aid of special stains (e.g. the Warthin Starry silver stain) and in the electron microscope, continues to be something of a problem. A further point of contention is the question whether this spirochetal infection is of pathological significance or not. A point militating against pathogenicity is the fact that no histological signs of an inflammatory reaction are to be seen. Also, the symptoms of patients with intestinal spirochetosis are such that they provide no basis for a pronouncement on whether the infection is of a pathological or apathological nature. On the other hand, however, a number of studies do seem to indicate that the spirochetes might be the cause of such symptoms as diarrhoea, constipation and abdominal pain. A point that would appear to support this view is the fact that such symptoms may disappear after successful treatment with metronidazole. The histological diagnosis is easily established when, faced by an apparently normal histological appearance of the colorectal mucosa, the pathologist considers the possibility of spirochetosis, and undertakes a specific search for the blue haematoxyphilic line in the covering epithelium of the colorectal mucosa.
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Knopf, B., Bethke, B. & Stolte, M. Die intestinale Spirochätose des Menschen. Pathologe 24, 192–195 (2003). https://doi.org/10.1007/s00292-003-0609-x
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DOI: https://doi.org/10.1007/s00292-003-0609-x