Chapter 1.14 Spirchetes Flashcards
What are the cell characteristics of spirochetes?
tiny gram-negative organisms that look like corkscrews
have axial filaments from cell wall
Why are spirochetes difficult to culture?
can’t be cultured in ordinary media
too small to be seen with a microscope
need to use darkfield microscopy, immunofluorescence and silver stains
What are the 3 genera of Spirochetes?
Treponema, Borrelia, and Leptospira
What are the characteristics of Treponema?
produce no toxins or tissue destructive enzymes
disease manifestations are from host response
What bacteria causes STD syphilis?
Treponema pallidum
How does treponema pallidum enter the body?
penetrating intact mucous membranes or invading epithelial abrasions
What occurs during primary syphilis?
painless chancre that erupts
3-6 weeks after initial contact
What occurs during secondary syphilis?
bacteremic stage*
systemic: bacteria multiply and spread via blood
widespread rash, generalized lymphadenopathy, and many organ involvement
What is the clinical presentation of the rash of secondary syphilis?
small red macular (flat) lesions
symmetrically distributed over body
*specifically palms, soles, and mucous membrane of oral cavity
When does condyloma latum occur in syphilis?
secondary syphilis
What is condyloma latum?
skin finding
painless, wartlike lesion at warm, moist sites
*vulva or scrotum
ulcerates and is very contagious
How is hair growth affected in secondary syphilis?
patchy bald spots and loss of eyebrows
When does the latent phase of syphilis occur?
after 6 weeks of the secondary syphilis stage
What is the patient presentation during the latent phase of syphilis?
asymptomatic
*usually lasts about 4 years and the patient is then noncontagious
When does tertiary syphilis occur?
6-40 years
What are the 3 general groups of tertiary syphilis?
- gummatous syphilis
- cardiovascular syphilis
- neurosyphilis
When does gummatous syphilis occur?
3-10 years after primary infection
What is the clinical presentation of gummatous syphilis?
localized granulomatous lesions that necrose and become fibrotic
*found on skin (painless) and bones (painful)
When does cardiovascular syphilis occur?
10 years after primary infection
What is the clinical presentation of cardiovascular syphilis?
aneurysm forms in ascending aorta or aortic arch
What are the 5 most common presentations of neurosyphilis?
- asymptomatic neurosyphilis
- subacute meningitis
- meningovascular syphilis
- tabes dorsalis- ataxia
- general paresis- psychotic symptoms
What is the rule of 6s associated with syphilis?
Six-Sexual trasmission
6 axial filaments
6 week incubation
6 weeks for ulcer to heal
6 weeks after ulcer heals, secondary syphilis develops
6 weeks for secondary syphilis to resolve
66% of latent stage patients have resolution
6 years to develop tertiary symptoms (at the least)
Who does congenital syphilis affect?
fetus of an infected pregnant woman
What occurs during early congenital syphilis?
widespread rash and condyloma latum "snuffles"- runny nose lymph node, liver and spleen enlargement bone infection *occurs within 2 years
What occurs during late congenital syphilis?
similar to adult syphilis without cardiovascular involvement
- neurosyphilis
- bone and teeth involvement
- eye disease
What is the clinical presentation of the nose, tibia, and teeth in late congenital syphilis?
Saddle nose- sunken appearance of nose from destroyed cartilage
Saber shins- inflammation of tibia
Hutchinson’s teeth- upper central incisors are widely spaced
Mulberry molars- molars have to many cusps
What are the 2 serologic screen tests for syphilis?
nonspecific and specific
What is nonspecific treponemal tests?
measure the titer of antibodies that bind to specific lipids
What are the 2 most common tests of nonspecific treponemal testing?
Venereal Disease Research Laboratory test (VDRL) and Rapid Plasma Reagin (RPR) test
What is a specific treponemal test?
measure antibodies against the spirochete itself
What is the most commonly used specific treponemal test?
Indirect immunofluorescent treponemal antibody-absorption test (FTA-ABS)
What is Jarisch-Herxheimer phenomenon?
patients with spirochetes who develop acute worsening of symptoms immediately after antibiotics started
What are the symptoms of Jarish-Herxheimer phnenomenon?
mild fever, chills, malaise, headache, and muscle aches
What are the 3 subspecies of Treponema pallidum?
endemicum, pertenue, and carateum
What are nonvenereal diseases caused by the 3 subspecies of Treponema pallidum?
endemic, syphilis, yaws and pinta
What symptoms do all 3 subspecies of Treponema pallidum cause?
skin ulcers (all 3) gummas of the skin and bones in children (NOT carateum)
What is the difference between the subspecies of treponema pallidum and the pure treponema pallidum?
the subspecies do not cause the sexually transmitted disease syphilis
What clinical presentation of the subspecies of treponema pallidum is different from pure treponema pallidum?
the tertiary stages of the nonvenereal treponemes do not involve the heart of central nervous system
What are the antibodies produces by nonvenereal treponemes?
postive VDRL and FTA-ABS
Where does Treponema palldium subspecies endemicum occur?
desert zones of Aftrics and Middle East
*called Endemic syphilis
How is Treponema pallidum subspecies endemicum transmitted?
sharing drinking and eating utensils
What is the clinical presentation of endemic syphilis?
skin lesions in oral mucosa
gummas of the skin and bone
What disease is caused by Treponema pallidum subspecies pertenue?
Yaws
Where is Yaws most common?
disease of the moist tropics
How does Yaws spread?
from person to person by contact with open ulcers
What are the clinical symptoms of Yaws?
Initial site: papule that becomes wartlike- called the “mother yaw”
Secondary lesions appear on exposed parts of the body
Years later- teritary gummas develop on skin and long bones
What is the mneumonic used for symptoms of the tertiary lesions of yaws?
imagine JAWs taking a bite out a person’s face– this disfiguring lesions on the face caused by the spirochetes destroys bone, cartilage, and skin – called gangosa
*Gang of J(Y)aws!
What disease is caused by Treponema pallidum subspecies carateum?
Pinta
What is pinta?
skin disease limited to rural Latin america
How is Pinta transmitted?
direct contact
What is the clinical presentation of a person with Pinta?
papule develops that slowly expands
secondary eruption of numerous red lesions that turn blue in the sun
within a year the lesions are dispigmented turning white
What is the cell type for Borrelia?
corkscrew-shaped, larger that treponema and can be viewed under microscope using Giemsa or Wright stains
What diseases does Borrelia cause?
Lyme Disease and relaspsing fever
*transmitted by insect vectors
What bacteria causes Lyme disease?
Borrelia burgdorferi
What is the tick involved in Lyme disease?
Ixodes tick that can transfer Lyme disease
What is the difference between Lyme disease and syphilis?
lyme disease is NOT a sexually transmitted disease
What are the similarities between Lyme disease and syphilis?
caused by spirochetes
primary stage involves single, painless skin lesion at site of inoculation
spirochetes then spread over whole body and invade organs, especially skin
both cause chronic problems later in life
What occurs during the Early Localized Stage of Lyme disease?
begins 10 days after tick bite
skin lesion at site of tick bite- erythema chronicum migrans
flu-like symptoms
regional lymphadenopathy
What is the clinical presentation of erythema chronicum migrans?
starts of as red flat, round rash
spreads out over time
outer border remains bright red
center turns blue or necrosed
What 4 organs are involved in the early disseminated stage of lyme disease?
skin, nervous system, heart, and joints
What is most common cardiac abnormality involved in early disseminated stage of Lyme Disease
atrioventricular nodal block
What symptoms can occur 6 months after infection with lyme disease?
arthritis of large joints (knee) become hot, swollen and painful
What occurs during the late stage of lyme disease?
arthritis of 1 or 2 large peripheral joints
can cause chronic neurologic damage
encephalopathy can develop causing memory impairment, irritability, and somnolence
What bacteria causes Relapsing Fever?
Borrelia recurrentis
What is unique about Borrelia recurrentis?
it is the only Borrelia that is transmitted to humans via body louse (insect)
What is the clinical presentation of a patient with Relapsing Fever?
high fever, chills, headaches, muscle aches
*resolves after 3-6 days
patient relapses developing similar features
How to diagnose Borrelia recurrentis?
drawing blood cultures during febrile periods revealing the spirochete between RBCs
What are Leptospira?
long, thin, aerobic spirochetes
What is the difference between Leptospira interrogans and Leptospira interrogans haemorrhagiae?
Leptospira interrogans- causes human disease through urine contamination
Leptospire interrogans haemorrhagiae- cause Weil’s disease (infectious jaundice)
What are the 2 phases of Leptospira interrogans?
- bacteria invade blood and CSF
2. appearance of IgM antibodies
What is the clinical presentation of patient in first phase of Leptospira interrogans?
abrupt onset of high spiking temperature, headache, malaise, severe muscle ache in thighs and lower back
*conjunctiva are red
What is the clinical presentation of a patient in the second phase of Leptospira interrogans?
meningismus, CSF exam with elevated white cell count
What is involved in Weil’s disease?
renal failure, hepatitis wit jaundice, mental status change, hemorrhaging of many organs
