July 2020 — Gastroenterology: Case 1

6-Year-old male presented with dysphagia and hoarseness of voice for 3 months. Physical examination and laboratory work up were normal. Esophagram and esophagogastroduodenoscopy were performed and ruled out any anatomic abnormalities. Tissue biopsy showed normal esophagus, moderate chronic gastritis and mild chronic inflammation of the duodenum. Representative images are shown below.

What is the most likely organism?

  • Campylobacter jejuni
  • Helicobacter heilmannii
  • Helicobacter hepaticus
  • Helicobacter pylori

The correct answer is...

The correct answer is Helicobacter heilmannii.

Helicobacter heilmannii is a gram negative rod, characterized by its large size (5–9 μm) and tightly coiled corkscrew appearance, unlike the smaller (3.5 μm) comma or slight spiral shape of H. pylori. In contrast to the low prevalence in humans, H. heilmannii infection is very common in dogs, cats, pigs, and nonhuman primates. Gastric biopsies from infected patients demonstrate chronic gastritis but generally less severe than in H. pylori gastritis. In clinical practice the typical morphologic features of the organisms on H&E are sufficient to establish a diagnosis of H. heilmannii chronic gastritis. Immunohistochemical stains of H. pylori can cross react with H. heilmannii further revealing its corkscrew-shaped appearance, larger size, and greater distance from the surface epithelium compared with H. pylori.

The importance of Helicobacter hepaticus to humans is not yet completely known. The bacterium is motile and gram negative, 0.2 to 0.3 µm in diameter, 1.5 to 5.0 µm long, and curved to spiral in shape. It colonizes the lower gastrointestinal tract, including the cecum, colon, and hepatobiliary system of mice. It has bipolar sheathed flagella (one at each end) but lacks the periplasmic fibers that envelope the bacterial cells in other Helicobacter species.

Campylobacter jejuni is a gram negative bacterium, comma or S shaped (with polar flagella), oxidase positive, and grows at 42°C. It is the major cause of bloody diarrhea, especially in children. Other clinical manifestations include fever, abdominal pain, and vomiting. Diagnosis of Campylobacter infection is usually established by stool culture.


1. APA Singhal, Anuradha V MD; Sepulveda, Antonia R MD, PhD Helicobacter Heilmannii Gastritis, The American Journal of Surgical Pathology: November 2005 - Volume 29 - Issue 11 - p 1537-1539 doi: 10.1097/01.pas.0000169499.96658.6e

2. Roehrl, Michael H A; Hernandez, Marier; Yang, Shi; Christensen, Thomas G; Morera, Claudio; Wang, Julia YHelicobacter heilmannii gastritis in a young patient with a pet: Gastrointestinal endoscopy, ISSN: 1097-6779, Vol: 76, Issue: 2, Page: 421-2 Publication Year: 2012

3. Fox JG, Dewhirst FE, Tully JG, Paster BJ, Yan L, Taylor NS, Yan N, Tayla NS, Collins MJ Jr, Govelick PL, Ward JM. Helicobacter hepaticus sp. nov., a microaerophilic bacterium isolated from livers and intestinal mucosal scrapings from mice. J Clin Microbiol 1994;32:1238–45.

4. Kaakoush NO, Castaño-Rodríguez N, Mitchell HM, Man SM. Global Epidemiology of Campylobacter Infection. Clin Microbiol Rev. 2015;28(3):687‐720. doi:10.1128/CMR.00006-15

Photo of Mazen Osman, M.B., B.Ch. Mazen Osman, M.B., B.Ch.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
Photo of Lizhi Zhang, M.D. Lizhi Zhang, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science

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