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Table 1 Description of 25 cases of pediatric intestinal spirochetosis (IS)

From: Intestinal Spirochetosis mimicking inflammatory bowel disease in children

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