Polycythaemia with leukoerythroblastosis.
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The aims of the study were to determine what microscopic changes occur in the rectal mucosa of men who have had anal intercourse and to correlate the sigmoidoscopic and microscopic appearances. Histological abnormalities were found in 29 of 100 men who attended consecutively a sexually-transmitted diseases clinic. The histopathology of rectal gonorrhoea, as observed in 18 patients, is described as are the microscopic findings in the rectal mucosa of 10 patients with early syphilis. Of 70 men without any detectable rectal infection, biopsies from 15 (21.4%) were abnormal. Intestinal spirochaetosis was observed in biopsies from 36 of these 100 men. With the use of strict criteria to describe the macroscopic appearance of the rectal mucosa, the sigmoidoscopic findings correlated well with the histology.
In two patients presenting with mild intestinal symptoms, rectal spirochaetosis was the only morphological abnormality diagnosed by light microscopy. A re-evaluation of the morphological changes using electron microscopy and immunohistochemistry showed certain unusual features: the microorganisms were observed within epithelial cells and in subepithelial macrophages; there were numerous partially degranulated intraepithelial mast cells; and there was a marked increase in the proportion of IgE plasma cells within the lamina propria. Mucosal penetration by the organisms may be responsible for the unusual immune response. In one patient, treatment with antibiotics eliminated the spirochaetes and resulted in a clinical improvement. Spirochaetes should not always be considered as harmless commensals in the colon.
Spirochaetes are organisms that can infect the colon of people with normal or compromised immune systems. Infected patients can present with a variety of gastrointestinal symptoms, including diarrhoea and rectal bleeding. However, some report a lack of association between specific symptoms and the presence of spirochaetes. It is therefore unclear whether the spirochaetes colonising the colon are true pathogens. Diagnosis is typically made by histological examination, with the biopsy specimen showing a band-like growth of spirochaetes adherent to the colonic luminal surface, giving an accentuated brush-border appearance. A course of metronidazole can eliminate the spirochaetes, but treatment might not lead to improvement of symptoms. Owing to the lack of a definite association between symptoms and the presence of spirochaetes, observation without specific antibiotic treatment can be pursued in most patients.
A case of congenital syphilis in an aborted fetus in the second trimester of pregnancy was documented by demonstration of spirochaetes in the fetal liver, despite the fact that diagnostic studies had not been performed on the mother. Suspicion was aroused by the gross and microscopic appearance of the placenta, which appeared identical with the described in proven cases of congenital syphilis. Although these changes have been alleged to be non-specific, the rarity with which such well-developed lesions are encountered in placentas in other circumstances dictates the necessity for further study when they are observed.
A retrospective light microscopic study of 310 consecutive endoscopic gastric biopsy specimens was performed. Spiral bacteria were found in 42% of cases and, apart from occasional organisms in parietal cell canaliculi, were confined to the surface of the glands and epithelium. Electron microscopic study of selected cases showed the bacteria to be approximately 6 micron maximum length and 0.7 micron diameter with a spiral periodicity of 1.2 micron. A significant association between the occurrence of spiral bacteria and gastritis was noted but not with carcinoma, peptic ulceration, or high pH of the gastric aspirate.
Faeces or rectal swabs from 1527 subjects were examined for the presence of intestinal spirochaetes by anaerobic culture on blood agar incorporating spectinomycin (400 mg/l). Twenty three specimens (1.5%) were positive, and only one of these came from a patient with diarrhoea. All positive specimens came from either Asians or known homosexuals. Comparative tests showed a close phenotypic similarity between the human isolates and non-pathogenic porcine intestinal spirochaetes. These organisms differ from Brachyspira aalborgi, a spirochaete isolated from subjects with histologically confirmed intestinal spirochaetosis.
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Two cases of intestinal spirochaetosis are described. The first case improved with treatment while the second case improved spontaneously without any intervention. Controversy over treatment and pathogenicity of intestinal spirochaetosis is discussed with review of previous publications.
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We report four cases of rectal spirochaetosis, one in an active male homosexual. One of the heterosexual patients was referred to the genitourinary clinic by a general surgeon after spirochaetes had been found on histopathological examination of a rectal biopsy specimen. We doubt that most of our cases represent sexual transmission of spirochaetosis, or that the condition causes disease in most people. Rectal spirochaetosis possibly occurs only when the normal flora of the gut are disturbed for other reasons. Most of our patients became asymptomatic after nonspecific treatment, although metronidazole appears to be specific.
Ulcerative balanoposthitis associated with non-syphilitic spirochaetal infection was found in 41 (12%) of 344 consecutive men with genital ulcer disease in two clinics in South Africa. All patients with non-syphilitic spirochaetal infection were uncircumcised. Non-syphilitic treponemes were seen in only two of 60 uncircumcised men who had urethritis without genital ulceration. In 14 patients with ulcerative balanoposthitis no cause of genital ulceration could be identified. Most patients presented with large, serpiginous, superficial, foul smelling, and tender ulcers, the base of which was purulent with undermined edges. Non-tender inguinal lymphadenopathy was present in seven of 14 patients. One female sexual partner of a patient with non-syphilitic spirochaetal infection had a vaginal infection with non-syphilitic spirochaetes.
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OBJECTIVE: To determine the prevalence of rectal spirochaetosis in homosexual men attending a sexually transmissible diseases clinic and investigate the association between their presence and sexual practices, HIV infection and enteric flora. DESIGN: The study included 144 male homosexual subjects who each completed a questionnaire, underwent physical examination, proctoscopy and investigations for STD and HIV screening, rectal biopsies and collection of faecal samples. SETTING: The Sexual Health Centre, Sydney Hospital, Sydney, Australia. RESULTS: Spirochaetes were detected in 39% of the rectal biopsies, using histological criteria. Logistic regression analysis showed that rectal spirochaetosis was significantly associated with: oral-anal contact. (P < 0.05, OR 3.45, 95% CI 1.48-8.05); detection of 3-5 different non-pathogenic protozoa in faeces (P < 0.01, OR 11.68, 95% C.I. 2.33-58) and a positive HIV antibody test (P < 0.01) OR 4.48, 95% C.I. 1.28-15.72). CONCLUSIONS: These findings indicate that rectal spirochaetosis is relatively common in homosexual men. The association with non-pathogenic protozoa is most likely attributable to the common mode of transmission viz oral-anal contact. However it is difficult to determine whether the association with HIV infection is cause or effect because of the limitations in the study design. Further information is required to determine the clinical significance of infection with these organisms.