Table 1

Description of 25 cases of pediatric intestinal spirochetosis (IS)
Ref. Age (y) Sex Signs and Symptoms Endoscopic findings Histologic findings Treatment Comments
[5] 6 F Rectal bleeding, abdominal pain, pruritus ani Normal IS and mild inflammation Piperazine Improvement
2 M Intermittent bloody diarrhoea Distal colitis IS and mild to moderate infiltration with inflammatory cells Mebendazole (Ascaris in stool) Improvement
13 M Recurrent fever, abdominal pain, joint pain, mouth and penile ulcers Normal IS and mild patchy inflammation No treatment No follow-up information
[6] 7.5 M Periumbilical pain, frequent bloody stools, urgency, poor appetite and weight loss Mild rectal granularity IS 1) Metronidazole Persistence of diarrhea; eradication on endoscopicfollow-up at 6 months
2) Neomycine
8 F Acute abdominal pain, vomiting and fever Not done IS in resected appendix No treatment Improvement
[7] 12 M Intermittent vomiting, diarrhoea, weight loss, headaches and fatigue Normal IS and mild focal colitis Metronidazole and Amoxicillin (7 days) Improvement
12 M Recurrent abdominal pain Normal IS and mild focal cryptitis in the caecum 1) Penicillin V and Metronidazole (7 days) Persistence of symptoms and IS; after second course of Metronidazole eradication and improvement
2) Metrodidazole (800mg 3x/d for 7 days)
16 F Recurrent colicky right upper quadrant pain Normal IS Metronidazole and Amoxicillin (10 days) Improvement
9 F Intermittent diarrhoea and rectal bleeding Normal IS Metronidazole and Amoxicillin (10 days) Improvement
[8] 5 F Abdominal pain, diarrhoea and rectal bleeding Rectal oedema and enterobiasis IS Erythromycin (40mg/kg/d for 10 days) Rectal bleeding ceased but abdominal pain recurred, no follow-up
7 M Abdominal pain and diarrhoea Slight proctitis IS Doxycycline (200mg day1, then 100mg/d for 8 days ) Persistence of abdominal pain despite endoscopic eradication
4 F Mucus and bloody stools Proctitis, juvenile polyp IS Clarithromycin (50mg/kg/d for 10 days) Improvement
10 F Diarrhoea and rectal bleeding Rectal hyperaemic membranes IS Clarithromycin Improvement
13 M Abdominal pain, nausea and weight loss Slight inflammation of rectum IS and HP- positive gastritis 1) Clarithromycin and Amoxicillin Persistence of IS, eradication after Clarithromycin and Metronidazole
2) Clarithromycin and Metronidazole (500mg 2x/d and 400mg 3x/d 7 days)
8 M Recurrent abdominal pain Juvenile polyp IS and low-grade chronic inflammation 1) Penicillin V Improvement after Erythromycin
2) Erythromycin (40-50mg/kg/d for 10 days)
15 F Abdominal pain and rectal bleeding Normal IS Clarithromycin (500mg 2x/d for 14 days) Improvement but persistence of rectal bleeding; absence of IS on follow-up rectoscopy
14 F Abdominal pain Normal IS Metronidazole (400mg 3x/d for 10 days) No improvement; absence of IS on follow-up colonoscopy
[9] 9 M Recurrent abdominal pain, diarrhea and rectal bleeding Mild erythema of rectal mucosa IS and hypereosinophilia Erythromycin (40mg/kg/d for 10 days) Improvement
[10] 9 M Rectal bleeding, diarrhea, tenesmus, flatulence and weight loss Normal IS and mild epithelial reactive changes No treatment Improvement
[11] 4 F Abdominal discomfort, rectal bleeding and weight loss Mucosal erosions, hyperemia, 2 juvenile polyps IS and inflammatory infiltrate Metronidazole Improvement
[12] 11 F Intermittent abdominal pain and rectal bleeding Normal IS 1)Metronidazole (250mg 3x/d) No improvement, additional course of Metronidazole and Vancomycin with persistence of IS, no follow-up information
2) Metronidazole (1000mg/d for 2 months and 750 mg/d for 14 days)
3) Vancomycin (7 days)
6 M Stomach cramps, rectal bleeding, intermittent diarrhea, rectal prolapse Normal IS Metronidazole (250mg 2x/d) Improvement, but alternating constipation with watery diarrhea and rectal prolapse
17 F Recurrent abdominal pain, nausea, vomiting Normal IS and mild eosinophilic inflammatory infiltrate No treatment No follow-up information
11 F Right lower quadrant pain Not done Appendicitis and IS in resected appendix Cefoxitin (30mg/kg/dose, 4 doses) No follow-up information
10 M Periumbilical and epigastric pain, nausea, fever Not done Appendicitis and IS in resected appendix No treatment No follow-up information

Helbling et al.

Helbling et al. BMC Pediatrics 2012 12:163   doi:10.1186/1471-2431-12-163

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