Espiroquetosis intestinal, una causa extraordinariamente rara de diarrea crónica.

espanolLa prevalencia de la espiroquetosis intestinal es muy elevada en paises en vias de desarrollo (11,4-64,3%) y notablemente inferior en paises desarrollados (1,1-5%). Se ha descrito una prevalencia aumentada en diversos subgrupos, tales como: hombres que practican sexo con hombres, pacientes portadores de VIH, zonas de pobreza, pacientes criticos con fallo organico multiple, y coexistencia con infeccion gonococica, entre otros, dependiendo de la region estudiada. Las manifestaciones clinicas son amplias e inespecificas, siendo el estandar oro para el diagnostico la deteccion de microorganismos en el examen histologico. Presentamos el caso de un paciente con diarrea cronica en la que tras descartar otras causas de diarrea, identificamos en las muestras aleatorias tomadas en la colonoscopia, espiroquetas intestinales como posible causa de la misma. Tras su erradicacion con Metronidazol, el paciente experimento por primera vez mejoria en muchos meses. Queremos destacar la importancia de sospechar la espiroquetosis intestinal en pacientes con los factores predisponentes referidos, incluyendose dentro del algoritmo habitual d EnglishThe prevalence of intestinal spirochetosis is very high in developing countries (11.4-64.3%) and notably lower in developed countries (1.1-5%). An increased prevalence has been described in various subgroups, such as: men who have sex with men, patients with HIV, areas of poverty, critical patients with multiple organ failure, and coexistence with gonococcal infection, among others, depending on the region studied. The clinical manifestations are broad and non-specific, being the gold standard for diagnosis the detection of microorganisms in the histological examination. We present the case of a patient with chronic diarrhea in whom after ruling out other causes of diarrhea, we identified in the random samples taken in the colonoscopy, intestinal spirochetes as the cause of it. After its eradication with Metronidazole, the patient experienced improvement for the first time in many months. We would like to highlight the importance of suspecting intestinal spirochetosis in patients with the predisposing factors referred to, including it within the usual algorithm of chronic diarrhea in these cas