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Unique pathology of colonic spirochaetosis characterised by mucosal eosinophilia is linked to diarrhoea and IBS
  1. Thomas M Goodsall1,
  2. Nicholas J Talley2,
  3. Loui Rassam3,
  4. Nicola K Wood4,
  5. Alkesh Zala5,
  6. Mike Jones6,
  7. Marjorie M Walker7
  1. 1Medical and Interventional Services, John Hunter Hospital, New Lambton, New South Wales, Australia
  2. 2Department of Health, University of Newcastle, Callaghan, New South Wales, Australia
  3. 3Department of Pathology North-Hunter, John Hunter Hospital, New Lambton, New South Wales, Australia
  4. 4Department of Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
  5. 5Medical and Interventional Services, John Hunter Hospital, New Lambton, New South Wales, Australia
  6. 6Department of Psychology, Macquarie University, Ryde, New South Wales, Australia
  7. 7Department of Anatomical Pathology, University of Newcastle, Newcastle, New South Wales, Australia
  1. Correspondence to Dr Thomas Goodsall, Medical and Interventional Services, John Hunter Hospital, Lookout Road, New Lambton, NSW 2305, Australia; tomgoodsall{at}

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Dear Sir,

We read with interest the commentary of Raes1 on the growing clinical role of microbiome-based companion diagnostics. We agree that the future of microbiome in medical practice will be in using markers for diagnosis as well as predicting and personalising treatment. We report here new observations on a colonic bacteria that, while traditionally considered a commensal, may be important in chronic diarrhoea and IBS.

Colonisation of the colon by Brachyspira aalborgi and B. pilosicoli is characterised by the histological finding of extensive, densely packed, end-on attachment of spirochaetes to the mucosal wall, which is visible on H&E stain as a hazy mucosal border; bacterial colonisation is dramatically demonstrated by Warthin-Starry staining like Helicobacter pylori (figure 1).2 ,3 The significance of this finding and its role in human disease has been debated in the literature and generally colonic spirochaetosis (CS) is considered to be a …

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