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  Table of Contents    
Year : 2021  |  Volume : 64  |  Issue : 5  |  Page : 97-99
Helicobacter heilmannii associated gastritis: Report of a rare case

1 Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

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Date of Submission30-May-2020
Date of Decision07-Jul-2020
Date of Acceptance14-Aug-2020
Date of Web Publication7-Jun-2021

How to cite this article:
Majumder R, Mishra P, Samal SC, Bhat SJ, Patra S. Helicobacter heilmannii associated gastritis: Report of a rare case. Indian J Pathol Microbiol 2021;64, Suppl S1:97-9

How to cite this URL:
Majumder R, Mishra P, Samal SC, Bhat SJ, Patra S. Helicobacter heilmannii associated gastritis: Report of a rare case. Indian J Pathol Microbiol [serial online] 2021 [cited 2022 Nov 28];64, Suppl S1:97-9. Available from:

Helicobacter pylori, is the most common bacterium causing chronic gastritis and gastroduodenal diseases in humans, with a prevalence rate of 20–50% in developed countries and up to 80% in developing countries.[1] Other bacteria from the same genus causing gastritis include Helicobacter bizzozeronii, Helicobacter felis, and Helicobacter heilmannii.[2] The incidence of H. heilmannii infection is significantly lower accounting for 1% of all Helicobacter infections among humans, but the frequency is higher in countries with poor socioeconomic status.[2] This bacterium is generally found in primates, dogs, cats and pigs, and infection in humans is acquired through a zoonotic transmission.[3] H. heilmannii, similar to H. pylori, not only causes chronic gastritis, but has also been implicated in the pathogenesis of peptic ulcer disease and neoplasms such as gastric cancer and mucosa associated lymphoid tissue (MALT) lymphoma.[4]

A 70-year-old male presented with complaints of dyspepsia, abdominal pain, and distension for 3 months. The physical examination, hematological, and biochemical tests of the patient were within normal range. In view of his clinical symptoms, upper gastrointestinal endoscopy [Figure 1] was suggested which revealed a mosaic-like pattern and nodularity in the proximal and distal body of the stomach. Biopsies were taken from proximal body. Microscopic examination showed body mucosa with focal mucin depletion and infestation of H. heilmannii in groups and singly on the surface epithelium and also within the foveolar pits. They are long, slender organism with a cork-screw appearance having 4-7 spirals [Figure 2]a,[Figure 2]b,[Figure 2]c. There were moderate atrophy of fundic glands replaced by intestinal and pseudopyloric metaplasia involving the glandular and surface epithelium without dysplasia along with prominent lymphoid follicles with germinal centers [Figure 2]d. Focal mild neutrophilic activity were also of note. However, typical lymphoepithelial lesion or any evidence of MALT lymphoma were not seen. There was no associated H. pylori infestation. Immunostain for H. pylori was positive with a terminal knob like pattern [Figure 2]e. Focal areas of metaplastic epithelium were also seen colonized by the organism which is not a feature of H. pylori [[Figure 2]e, inset]. Deeper tissue invasion by the organism was also noted [Figure 2]f and in the lumen [[Figure 2]f, inset]. Occasional intracellular positivity was also noted.
Figure 1: Videoendoscopic view (Olympus GIF-HQ 170) - Body and fundic mucosal nodularity with cobble stone appearance

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Figure 2: Photomicrograph showing spiral cork-screw shaped organisms (a – H and E, b – Giemsa stain, c – Warthin Starry stain). (d) - Pseudopyloric metaplasia (long arrow), intestinal metaplasia highlighted by AB-PAS (short arrow, inset), lymphoid aggregate (star). (e) - Immunohistochemistry for H. pylori showing positivity with knob-like pattern. (e, inset) - Metaplastic epithelium showing colonization by the bacteria. (f) - Deeper tissue invasion by the organism. (f, inset) - Organism within the lumen

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H. Heilmannii, was named after a German histopathologist, K. Heilmann.[5] H. Heilmannii is a spiral, gram negative bacterium measuring about 5 to 9 μm in length with four to eight tight spirals.[4],[6] About 1% of all Helicobacter infections in humans are caused by H. Heilmannii. In our institute, we have encountered only one case of H. heilamnnii out of 1214 endoscopic biopsies in the last one year in the department of Anatomical Pathology. Infection in humans occurs through zoonotic transmission and infected patients significantly report contact with animals[6] as observed in the present case, who has history of raising domestic animals. H. heilmannii infection in humans usually colonizes the gastric antrum with infestation of very few organisms,[6] commonly affecting children and causes a milder form of gastritis. In contrary to the usual clinicopathological features, our case is an elderly individual having a corpus predominant gastritis with moderate infestation of the organism. There were significant atrophy, intestinal metaplasia and lymphoid follicle formation. Focal mucin depletion was also observed in our case which is not a feature of H. heilmannii. An association between H. Heilmannii infection with gastric cancer and MALT lymphoma have been described in previous studies.[7] Though, there is no evidence of gastric carcinoma or MALT lymphoma in our case, acquisition of precursor lesion like MALT and intestinal metaplasia are seen. Immunohistochemical stain with commercially available antibodies against H. pylori highlights H. heilmannii demonstrating cross reactivity between the two organisms.[6] Other species of Helicobacter needs 16S rDNA sequencing or fluorescence in situ hybridization (FISH) with specific probes for their identification because of morphological similarity with H. heilmannii.[8] We experienced a rare case of H. heilmannii infection of stomach with morphological features of chronicity and deeper tissue invasion in an elderly individual. Because of its rarity, not much data is available to establish the role of H. heilmannii in human diseases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Telford JL, Ghiara P, Dell 'Orco M, Comanducci M, Burroni D, Bugnoli M, et al. Gene structure of the Helicobacter pylori cytotoxion and evidence of its key in role in gastric disease. J Exp Med 1994;179:1653-8.  Back to cited text no. 1
Vukojevic J, Nikolic I, Kukic B, Bogdanovic B, Nikin Z. Helicobacter heilmannii associated gastritis: Case report. Arch Oncol 2011;19:73-5.  Back to cited text no. 2
Stolte M, Wellens E, Bethke B, Ritter M, Eidt H. Helicobacter heilmannii (formerly Gastrospirillum hominis) gastritis: An infection transmitted by animals. Scand J Gastroenterol 1994;29:1061-4.  Back to cited text no. 3
Iwanczak B, Biernat M, Iwanczak F, Grabinska J, Matusiewicz K, Gosciniak G. The clinical aspects of Helicobacter heilmannii infection in children with dyspeptic symptoms. J Physiol Pharmacol 2012;63:133-6.  Back to cited text no. 4
Heilmann KL, Borchard F. Gastritis due to spiral shaped bacteria other than Helicobacter pylori: Clinical, histological, and ultrastructural findings. Gut 1991;32:137-40.  Back to cited text no. 5
Singhal AV, Sepulveda AR. Helicobacter heilmannii gastritis: A case study with review of literature. Am J Surg Pathol 2005;29:1537-9.  Back to cited text no. 6
Morgner A, Lehn N, Andersen LP, Thiede C, Bennedsen M, Trebesius K, et al. Helicobacter heilmannii-associated primary gastric low-grade MALT lymphoma: Complete remission after curing the infection. Gastroenterology 2000;118:821-8.  Back to cited text no. 7
Priestnall SL, Wiinberg B, Spohr A, Neuhaus B, Kuffer M, Wiedmann M, et al. Evaluation of “Helicobacter heilmannii” subtypes in the gastric mucosas of cats and dogs. J Clin Microbiol 2004;42:2144-51.  Back to cited text no. 8

Correspondence Address:
Susama Patra
Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, Odisha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJPM.IJPM_629_20

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