Medical Articles

Not your average diarrhoea

Patient LF

• 40 year old male
• Progressive watery diarrhoea, 8-10 episodes per day for 6 months
• No associated symptoms
• No mucus or blood in stool
• No weight loss

Further history

• No history of travel
• Strong alcohol history (Stopped 3 years ago)
• No past medical or surgical history
• No previous chronic diarrhoea
• No other family members affected

Investigations

• FBC, LFT, Alb, TFT, CRP normal
• HIV negative
• Faecal elastase normal
• Stool MCS normal
• Colonoscopy normal – random biopsies taken

Histology

• Histology revealed spirochetosis

Therapy

• Flagyl 400mg three times daily for 14 days
• Excellent response with normalisation of stool frequency within 7 days

Spirochetosis: An overview

• Borrelia eurygyrata, Brachyspira aalborgi, or Serpulina pilosicoli.
• Genetically unrelated to nonintestinal spirochetes, such as Treponema pallidum.
• Patients may be asymptomatic or present with watery diarrhoea, weight loss, abdominal pain and rectal bleeding.
• Treatment is with Flagyl 400mg tds x14 days