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MHD Block 3: Spirochetes > Borrelia & Leptospirosis > Flashcards

Borrelia & Leptospirosis Flashcards

1
Q

Describe Borrelia

A

Large spirochetes
Can see on blood smear as they are ciruclating in blood
Serologic test for specific dx
Plasmids code for outer membrane protein antigens

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2
Q

What is the characteristic diseases associated with Borrelia species?

A

Relapsing fever- B.recurrentis

Lyme Borreliosis- B.Burgdoferis

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3
Q

How does B.Recurrentis avoid the immune system?

A

Antigenic diversity of their structures using genes on plasmid -> leads ot relapsing fever

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4
Q

When is relapsing fever seen epidemically? endemically?

A

Epidemic: catastrophe like war/famine
Endemic: Tick borne relapsing fever in mountainous regions in western US

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5
Q

How does the transmission and cycle of relapsing borrelia differ between B.REcurrentis and other Borrelia species?

A

B.Recurrentis: Louse borne -> suck blood -> crush louse- > transmit infection

Borrelia Species: Tick borne -> feed on rodent -> transovarial passage in ticks -> humans are accidental host here

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6
Q

What are the clinical presentaitons of relapsing fever?

A 
Fever
Chills
Muscle Pain
HA
Relapse: resolves 3-5 days, remits after 7-9 days with decreasing severity with each relapse
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7
Q

How is relapsing fever treated

A

Tetracycline, Erythromycin

J-H reactions commonly seen

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8
Q

How is relapsing fever diagnosed?

A

Blood smear

Serology

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9
Q

What is lyme borreliosis?

A

Systemic spirochetal disease that resembles syphilis

Prominently involves skin and CNS

B.Burgdoferi

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10
Q

What are hte primary reservoirs of B.Burgdoferi?

A

Deer and mouse

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11
Q

How is B.Burgdoferi spread?

A

Ixodes Ticks (nymph form in spring/summer)

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12
Q

Where in the US is lyme disease most prominent?

A

Northeast

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13
Q

Describe the pathogenesis of Lyme Borreliosis

A

Tick bite -> B.Burgdoferi -> multiply locally -> enter lymph/blood -> dissemination

Antibody leads to disappearance of spirochetes -> immune pathogenesis in late stage

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14
Q

What is the characteristic of Early Stage Lyme Disease?

A

Erythema Migrans: expanding erythematous lesion at site of tick bite with flu like illness

Bull’s Eye lesion

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15
Q

What is the presentation of early disseminated lyme disease?

A

Occurs days-weeks after primary infection
Fatigue, HA, fever, malaise
Multiple skin lesions

Neuro: ISOLATED FACIAL NERVE PARALYSIS, Meningitis

Cardiac: Heart Block, myocarditis

Arthritis: occurs in 60% untreated much later

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16
Q

What happens in late stage lyme disease?

A

Arthritis: recurrent pain and swelling in large joints esp KNEE

Encephalopathy: maybe?

Skin: Acrodermatitis Chronic Atrophicans (flat, fragile scar on skin)

17
Q

How is Lyme Borreliosis diagnosed?

A

Can’t use culture
ELISA mostly now -> if positive-> confirm with Western Blot

PCR

18
Q

How is hte positive serologic test related to infection stage of lyme disease?

A

Acute EM: 30-40%
Convalescent: 60-70%
4-6 weeks post infection: 90%

If clinical findings sufficient-> treat before positive testing results

19
Q

How is Lyme Borreliosis treated?

A

Early: Doxycycline, Amoxicillin, Cefuroxime Oral

Late: Oral same as early or IV PEN-G or Ceftriaxone

20
Q

How can Lyme borreliosis be prevented?

A

Repellants

Tick checks

21
Q

How long do ticks have to be attached for intfection to be transmitted for lyme borreliosis?

A

24 hours

22
Q

How long does hte tick need to cause relapsing fever in B.recurrentis infeciton?

A

Just a few minutes

23
Q

What is leptospirosis?

A

Zoonosis spirochete
Variety of animal reservoirs
Humans get via contact with infected animal urine usually contaminated water

24
Q

How does leptospirosis look structurally?

A

Thin spirochete wiht hook on one or both ends

25
Q

How is leptospirosis transmitted?

A

Ingestion/contact with food or water contaminated with infected animal urine

26
Q

Describe the pathogenesis of leptospirosis

A

Infection -> spirochetes invade bloodstream -> affect endothelial integrity -> vasculitis in organs

Immune complexes found in kidney

Excreted in urine long time after infection

27
Q

How does leptospirosis present clinically in the first stage?

A

1st Stage: Bacteremia

Fever, HA, myalgia, abd pain

28
Q

How does leptospirosis present clinically in the second stage?

A

2nd Stage; Immune

Aseptic meningitis, generalized illness, myalgia, HA, rash

29
Q

How does leptospirosis present clinically in its severe stage?

A

Prominent hepatitis
renal failure
Hemorrhage
Mortality 5-10%

Most patients don’t develop this form

30
Q

How is leptospirosis best diagnosed?

A

Serology:
MAT: Microscopic Agglutination test =after first week
ELISA/IHA tests

Culture:
blood/CSF early
Urine late

PCR- but not readily available

31
Q

How is leptospirosis treated?

A

Penicillin

Doxycycline

MHD Block 3: Spirochetes (3 decks)

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