Calderaro Adriana, Villanacci Vincenzo, Bommezzadri Simona, Gorrini Chiara, Piccolo Giovanna, Aquilano Maria Costanza, Incaprera Marina, Viviani Giovanni, Dettori Giuseppe, Chezzi Carlo
Department of Pathology and Laboratory Medicine, Section of Microbiology, University of Parma, Parma, Italy.
J Gastroenterol Hepatol. 2007 Jan;22(1):64-7. doi: 10.1111/j.1440-1746.2006.04396.x.
The present study reports on a prompt diagnosis of colonic amoebiasis with colonic spirochetosis by Brachyspira aalborgi and B. pilosicoli; such diagnosis allowed exclusion of other diseases and resolution of the case after specific treatment.
A 37-year-old Italian man with a history of several months' mucosal diarrhea travelled to Greece, Romania and Tunisia. After his last trip he presented with an increase of up to 3-5 discharges daily, associated with bloody diarrhea, supporting the clinical suspect of inflammatory bowel disease. Colonoscopy revealed erosions from the cecum to the rectum, and ulcers both in the descending and sigmoid colon. Structures resembling amoebic trophozoites and sinusoidal microorganisms were observed in the colonic biopsies at histopathology and electron microscopy. Entamoeba histolytica DNA was detected by small-subunit rDNA polymerase chain reaction (PCR) from feces, rectal biopsies and isolated trophozoites. Spirochetes were identified from feces, colonic biopsies and cultures using a 16S rDNA restriction fragment length polymorphism-PCR specific for the detection of B. aalborgi and B. pilosicoli. After therapy, the patient was restored to health.
The rapid identification of E. histolytica, B. aalborgi and B. pilosicoli using traditional and specific and sensitive molecular methods permitted an accurate diagnosis and a specific therapy. It is suggested that mixed infection by parasites and spirochetes might occur more frequently than expected: it would be of extreme interest and importance to intensify clinical findings, and one infection should not prompt the pathologist/clinician to stop looking.
本研究报告了一例由奥尔堡短螺旋体和柔毛短螺旋体引起的合并结肠螺旋体病的结肠阿米巴病的快速诊断；这种诊断排除了其他疾病，并在经过特异性治疗后使病例得到解决。
一名37岁有数月黏膜腹泻病史的意大利男子前往希腊、罗马尼亚和突尼斯旅行。最后一次旅行后，他出现每日排便次数增加至3 - 5次，并伴有血性腹泻，支持了炎症性肠病的临床怀疑。结肠镜检查显示从盲肠到直肠有糜烂，降结肠和乙状结肠有溃疡。在组织病理学和电子显微镜检查的结肠活检中观察到类似阿米巴滋养体和正弦形微生物的结构。通过小亚基rDNA聚合酶链反应（PCR）从粪便、直肠活检组织和分离的滋养体中检测到溶组织内阿米巴DNA。使用针对检测奥尔堡短螺旋体和柔毛短螺旋体的16S rDNA限制性片段长度多态性-PCR从粪便、结肠活检组织和培养物中鉴定出螺旋体。治疗后，患者恢复健康。
使用传统以及特异性和敏感性分子方法快速鉴定溶组织内阿米巴、奥尔堡短螺旋体和柔毛短螺旋体，实现了准确诊断和特异性治疗。建议寄生虫和螺旋体的混合感染可能比预期更频繁地发生：加强临床检查结果将极具意义和重要性，不应因一种感染而使病理学家/临床医生停止进一步检查。
