       Document 0998
 DOCN  M9650998
 TI    Invasive colitis and hepatitis due to previously uncharacterized
       spirochetes in patients with advanced human immunodeficiency virus
       infection.
 DT    9505
 AU    Kostman JR; Patel M; Catalano E; Camacho J; Hoffpauir J; DiNubile MJ;
       Department of Medicine, Cooper Hospital/University Medical; Center,
       University of Medicine and Dentistry of New Jersey/Robert; Wood Johnson
       Medical School, Camden, USA.
 SO    Clin Infect Dis. 1995 Nov;21(5):1159-65. Unique Identifier : AIDSLINE
       MED/96125997
 AB    We describe three patients with advanced human immunodeficiency virus
       (HIV) infection, two with colitis and one with cholestatic hepatitis,
       for whom results of detailed endoscopic and histologic studies were
       suggestive of invasive spirochetosis. In the two patients with colitis,
       colonoscopic evaluation revealed either diffuse ulcerations or pustules;
       in both cases, there was histologic evidence of extensive superficial
       cell necrosis and infiltration of the mucosa and lamina propria with
       acute inflammatory cells. Spirochetes in the mucosa and crypts were
       visualized by Warthin-Starry silver staining. Morphologically similar
       spirochetes throughout the liver specimen from the patient with
       cholestatic hepatitis were demonstrated by Warthin-Starry silver
       staining. Analysis with electron microscopy revealed these organisms to
       be loosely coiled spirochetes. Despite extensive evaluation, no other
       pathogens were identified. Invasive spirochetal infection, as defined by
       the results of Warthin-Starry silver staining of involved tissues,
       should be considered in the differential diagnosis of patients with HIV
       infection who have otherwise unexplained colitis or cholestatic
       hepatitis.
 DE    Adult  AIDS-Related Opportunistic Infections/*COMPLICATIONS/DIAGNOSIS/
       MICROBIOLOGY  Case Report
       Cholestasis/*COMPLICATIONS/DIAGNOSIS/MICROBIOLOGY
       Colitis/*COMPLICATIONS/DIAGNOSIS/MICROBIOLOGY  Diagnosis, Differential
       Female  Hepatitis/*COMPLICATIONS/DIAGNOSIS/MICROBIOLOGY  Human  Male
       Microscopy, Electron  Spirochaetales/ISOLATION & PURIF/ULTRASTRUCTURE
       Spirochaetales Infections/*COMPLICATIONS/DIAGNOSIS/MICROBIOLOGY  JOURNAL
       ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

