George Washington University School of Medicine and Health Sciences Washington, District of Columbia
Samuel Kallus, MD1, Praphopphat Adhatamsoontra, MD2, Vinay Rao, MD3, Katrina Naik, MD2, Jenny Dave, MD, MS2, Aslam Akhtar, PhD1, Marie L. Borum, MD, EdD, MPH1; 1George Washington University School of Medicine and Health Sciences, Washington, DC; 2George Washington University, Washington, DC; 3Thomas Jefferson University, Washington, DC
Introduction: Human intestinal spirochetosis can be a cause of diarrhea in immunocompromised patients and has uncertain significance in patients who are immunocompetent. The exact prevalence of the disease is unknown, but reports indicate that it may range from 0.4% to 12%. There have been increasing reports of asymptomatic individuals with colon biopsies revealing spirochetosis. The aim of this study is to identify risk factors associated with intestinal spirochetosis in an urban university medical center. Methods: A retrospective, IRB exempt, chart review between January 2016 and December 2019 was conducted to identify colonic biopsies with intestinal spirochetosis. Patient age, gender, self-identified race, sexual practices, HIV status, symptoms and socioeconomic status (based upon insurance) were obtained. A confidential database was created. Statistical analysis was conducted using Fisher exact test with significance set at p < 0.05. Results: Twenty-one cases of biopsy-confirmed intestinal spirochetosis were identified in patients with a mean age of 48. There was 1 (4.8%) female and 20 (95.2%) males, of whom 13 (62%) were men who have sex with men (MSM). Nine (43%) were HIV positive, 6 (29%) were HIV negative and 6 (29%) had unknown HIV status. Nine (43%) were White, 9 (43%) were Black, and 3 (14%) were Hispanic. Eleven patients (52%) had private insurance, 8 (38%) had Medicaid and 2 (10%) had Medicare. Eight (38%) were symptomatic. Men had significantly more spirochetosis than women (p = 0.0001). Individuals who were HIV positive were not more likely to be symptomatic than those who were HIV negative or those who had unknown HIV status (p = 0.67). There was no significant difference in the presence of intestinal spirochetosis based race (p = 0.08) or insurance status (p = 1.000). Discussion: This study characterized 21 cases of human intestinal spirochetosis in a diverse urban, U.S. population. Consistent with previously published data, the majority of cases were MSM, among which a large proportion of individuals were HIV positive. Differing from previous reports, this study revealed that individuals who were HIV positive were no more likely to have diarrhea than those who were HIV negative. While this study is limited based upon size and single institutional design, it offers a foundation for further research. Additional studies are necessary to understand risk factors, prevalence and presentation of intestinal spirochetosis.
Disclosures: Samuel Kallus indicated no relevant financial relationships. Praphopphat Adhatamsoontra indicated no relevant financial relationships. Vinay Rao indicated no relevant financial relationships. Katrina Naik indicated no relevant financial relationships. Jenny Dave indicated no relevant financial relationships. Aslam Akhtar indicated no relevant financial relationships. Marie Borum indicated no relevant financial relationships.