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Clinical food and microbiology > 8. Syphilis > Flashcards

8. Syphilis Flashcards

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1
Q

What microorganism causes syphilis?

A

Treponema pallidum

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2
Q

What is syphilis?

A
  • chronic potentially fatal infection
  • spread through sex, intravenous drugs and is congenital
  • origin is controversial
  • Columbian, Pre-Columbian and Evolutionary theory
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3
Q

What microorganism causes the Pinta disease?

A
  • Treponema carateum
  • spread by direct skin contact (CEntra; -South America)
  • manifestations; skin lesions, scarring, disfigurement
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4
Q

What microorganism causes the Bejel disease?

A
  • Treponema pallidum Subsp. endemicum
  • spread by; contaminated eating utensils (Africa/ Asia)
  • manifestations; oral lesions
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5
Q

What microorganism causes the Yaws disease?

A
  • Treponema pallidum Subsp. pertenue
  • spread by direct skin contact; (S. America/ Asia/ Africa)
  • manifestations; skin lesions destruction of lymph nodes/ bones
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6
Q

What microorganism causes the Syphilis disease?

A
  • Treponema pallidum Subsp. pallidum
  • spread; sexual/ congenital
  • manifestations; primary - tertiary syphilis
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7
Q

What is the epidemiology of syphilis?

A

steady increases:
- behavioural changes; alcohol, drugs, promiscuity, MSM (78.4%)
- Associated with large outbreaks
- unprotected oral sex
- social venues/ networks

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8
Q

What is primary syphilis?

A
  • infectious dose; 50-100
  • 3 weeks (10-90 days); single painless ulcer (chancre); highly infectious
  • widespread dissemination
  • lymphadenopathy
  • often inconspicuous (MSM)
  • chancres heal spontaneously (2-6 weeks)
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9
Q

What are clinical manifestations of primary syphilis?

A
  • incubation period; 10-90 days post contact
  • genital chancre; painless sore
  • lymphadenopathy
  • spontaneous healing - 2-6 weeks
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10
Q

What is secondary syphilis?

A
  • widespread dissemination
  • symptoms appear in approx 3 months
  • non-specific and specific presentation
  • specific; disseminated mucocutaneous rash; alopecia; condyloma late (infectious lesions)
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11
Q

What are the clinical manifestations of secondary syphilis?

A
  • incubation period; 6weeks-6months post contact
  • non-specific
  • specific symptoms; mucocutaneous rash, lymphadenopathy, alopecia, condyloma lata
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12
Q

What is tertiary syphilis?

A
  • 20-40 years after initial exposure
  • widespread progressive/ chronic inflammation leading to:
  • gumma (nodular-like lesions)
  • cardiovascular syphilis (aortic aneurysm)
  • Neurosyphilis, tabes dorsalis
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13
Q

What are the clinical manifestations of tertiary syphilis?

A
  • most destructive form of syphilis
  • granulomatous lesions
  • cardiovascular syphilis
  • neurosyphilis; paresis, tabes dorsalis
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14
Q

What is congenital syphilis?

A

early onset (2-10 weeks post-delivery);
- sniffles
- skin lesions
- pulmonary haemorrhage/ hepatitis

late onset (>2 years);
- Hutchinson’s teeth - central incisors notched
- saddle nose

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15
Q

What is the physiology and structure of Treponema pallidum?

A
  • 0.1micrometres - 6-15micrometres
  • 3 periplasmic flagella; corkscrew motility
  • limited metabolic capacity; glycolysis, but no TCA - host-derived: difficult to grow
  • unculturable on artificial media
  • slow doubling time (30h)
  • sensitive
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16
Q

What are the virulence factors?

A
  • attachment;
    Tp0115 binds to matrix fibrinogen
    Tp0483 binds to both matrix and soluble fibronectin
  • invasion;
    hyaluronidase production / molecular mimicry
  • motility; corkscrew motion
  • chemotaxis; Methyl-accepting chemotactic proteins/ Cytoplasmic chemotactic proteins
17
Q

What is the clinical diagnosis of syphilis?

A

complicated
- chancre often inconspicuous
- syphilis; ‘great imitator’

18
Q

What is the laboratory diagnosis of syphilis?

A
  • conforms/disproves clinical suspicion (patient history required)
  • Treponema; non-culturable on artificial media
  • usage of direct microscopy and serological assays
19
Q

How can syphilis be diagnosed via clinical samples?

A
  • painless/ asymptomatic
  • exudate from penile chancre (primary) or condylama lata (secondary)
20
Q

How can syphilis be diagnosed via dark-ground microscopy?

A
  • DGM: paraboloid condenser
  • light scattered by motile treponemes
  • bright treponemes against a dark backgroung; slow, corkscrew- like motility
21
Q

How can syphilis be diagnosed via results interpretation?

A
  • positive result; primary/secondary syphilis
  • negative result; does not rule out syphilis
22
Q

How can serological assays be used for diagnosis of syphilis?

A
  • estimation of IgM/ IgG antibodies
  • non-specific and specific antibodies produced in syphilis infection; both exploited in serological analysis

a) non - specific (reagin) antibodies:
cardiolipin/ cholesterol

b) specific antibodies:
flagella proteins, surface lipids

23
Q

What clinical samples can be used for serological analysis?

A

serum
CSF: neurosyphilis
Foetal blood cord: congenital syphilis

24
Q

What is a non-specific serological assay?

A

VDRL test - venereal disease reference laboratory

  • detects non-specific antibody to cardiolipin/ cholesterol/ lecithin agent

sensitivity: primary (78%), secondary (100%), tertiary (71%)
specificity: 98%

BFPs: autoimmune disease, connective tissue disorders, viral infection, coronary artery disease

25
Q

What is a specific serological assay? (TPHA )

A

TPHA - Treponema pallidum Haemagglutination assay

-Treponema pallidum antigen coated on RBC
- Antibodies in serum = haemagglutination of RBC

positive- haemagglutinatiom
negative- buttoning of RBC

sensitivity; 84%
specificity; 96%

26
Q

What is a specific serological assay? (FTA-Abs)

A

FTA-Abs - fluorescent treponemal antibody absorption test

  • acetone fixed T.pallidum
  • incubated with patients serum
  • incubated with anti-human antibody conjugate FITC
  • qualitative/ quantitative

sensitivity; 84%
specificity; 97%

27
Q

What is the treatment for syphilis?

A
  • syphilis <2 years: benzathine penicillin IM, single dose; oral doxycycline 10-14 days
  • syphilis >2 years: 3x benzathine penicillin IM, single dose; oral doxycycline 28 days
28
Q

How is syphilis controlled?

A
  • screening for syphilis (pregnancy / GUM clinics)
  • contact tracing and treatment
  • no vaccine; safe sex

Clinical food and microbiology (12 decks)

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