Chapter 14: Spirochetes

Question 1

What are the two unique features of spirochetes compared to other gram-negative bacteria?

Answer 1

(1) surrounded by an additional phospholipid-rich outer membrane with few exposed proteins (make them stealth)
(2) Axial flagella come out of the ends of the cell wall but do not protrude out of the outer membrane. Instead, flagella run sideways along the spirochete under the outer membrane sheath (periplasmic flagella)

Question 2

How do spirochetes replicate?

Answer 2

transverse fission

Question 3

What is responsible for the sexually transmitted disease syphilis?

Answer 3

Treponema pallidum

Question 4

How does treponema pallidum enter the body?

Answer 4

by penetrating intact mucous membranes or invading through epithelial abrasions. skin contact with an ulcer can result in infection

Question 5

What are the stages of syphilis?

Answer 5

Primary stage: painless ulcer 6 weeks after contact

Secondary stage: 6 wks after 1* chancre healed - Rash on palms and soles, condyloma latum, CNS, eyes, bones, kidneys and/or joints can be involved. Hair loss. Systemic - weight loss, fever, lymphadenopathy. lasts 6 weeks

Latent syphilis: 25% may relapse and develop secondary symptoms again - 4 years

Tertiary stage: gummas of skin and bone, cardiovascular- aneurysm, neurosyphillis

Condyloma latum: painless, wartlike lesion on vulva or scrotum

Question 6

What is gummatous syphilis?

Answer 6

occurs 3-10 years after primary infection of Treponema pallidum
Localized granulamatous lesions that eventually necrose and become fibrotic
Found mainly in skin(painless with sharp borders) and bones (deep gnawing pain)

Question 7

What are the 5 most common presentations of neurosyphilis?

Answer 7

Asymptomatic neurosyphilis: CSF tests positive
Subacute meningitis: fever, stiff neck, headache
Meningovascular syphilis: attack circle of Willis -> neurologic impairments
Tabes dorsalis: posterior column and dorsal roots affected –> ataxia and loss of reflexes, pain and temp sensations
General paresis (of the insane): progresive disease of nerve cells in brain

Question 8

What are the results of the CSF analysis in a pt infected with a bacteria that causes and acute meningitis? Subacute?

Answer 8

Most bacteria cause high neutrophil count, high protein, and low glucose

Trephonema pallidum and mycobacterium tuberculosis cause subacute meningitis with lymphocytes predominating

Question 9

What is Argyll-Robertson pupil?

Answer 9

midbrain lesion
Constricts during accommodation but does not react to light
Prostitute’s pupil
Pt usually has syphilis and may be present in both tabes dorsalis and general paresis

Question 10

Rule of sixes for syphilis

Answer 10

Six-Sexual transmission
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 pts have resolution
6 years to develop tertiary syphilis at the least

Question 11

Effects of syphilis in a fetus of an infected pregnant woman

Answer 11

high mortality rate (stillbirth, spontaneous abortion, neonatal death)
Those that survive will develop early or late congenital syphilis
Does not damage fetus until fourth month of gestation

Question 12

Early congenital syphilis

Answer 12

Treponema pallidum
Occurs w/i 2 years
like severe adult secondary syphilis
Invasion of nasal mucous membrane -> runny nose snuffles
Lymph node, liver, and spleen enlargement and bone infection (osteitis)

Question 13

Late congenital syphilis

Answer 13

Treponema pallidum
Similar to adult tertiary syphilis except cardiovascuar involvement rarely occurs

Neurosyphilis is the same, CN8 deafness
Bone and teeth frequently involved: saddle nose and saber shins, Hutchinson’s teeth, mulberry molars

Eye disease: corneal inflammation

Question 14

What can pts with syphilis develop immediately after antibiotics are started?

Answer 14

Jarisch-Herxheimer Phenomenon
Mild fever, chills, malaise, headache, and muscle aches
Killed organisms release pyrogen

Question 15

What do the 3 subspecies of Treponema pallidum general cause?

Answer 15

nonvenereal disease
Skin ulcers and gummas of skin and bones in CHILDREN (exception - carateum only causes skin discoloration)
Do not cause sexually transmitted disease syphyilis

Stages: 1* skin ulcer–>widespread skin lesions–>gummas of bone and skin but no heart of CNS involvement

Endemicum, pertenue, and carateum

Question 16

What does treponema pallidum subspecies endemicum cause?

Answer 16

endemic syphilis in desert zones of Africa and Middle east
Sharing drinking and eating utensils
Skin lesions in oral mucosa and are similar to condyloma lata of secondary syphilis
Gummas may develop later

Question 17

What does Treponema pallidum subspecies pertenue cause?

Answer 17

yaws - moist tropics
Person-person via open ulcers
papule grows over months becoming wartlike (mother yaw)
Secondary lesions appear on exposed parts of body
Gummas develop years later

Question 18

What does Treponema pallidum subspecies carateum cause?

Answer 18

Pinta - purely a skin disease limited to rural Latin America
Direct contact - initial papule slowly expands
Secondary eruption of numerous red lesions that turn blue in the sun!!!!
Lesons become depigmented/white in a year

Question 19

What causes Lyme disease and relapsing fever?

Answer 19

Borrelia transmitted by insects

Question 20

What nonspecific tests are used for syphilis? Specific tests?

Answer 20

non-specific treponemal tests VDRL; RPR

Specific treponemal test: FTA-ABS, MHA-TP

Question 21

What is the most commonly reported tick-borne illness in the U.S? What is it caused by?

Answer 21

Lyme disease
Northeast, Midwest and northwestern U.S
Borrelia burgdorferi

Question 22

Lyme disease and Syphyllis is caused by what type of bacteria?

Answer 22

Spirochetes

Question 23

What are the stages of Lyme disease?

Answer 23

(1) early localized stage: Erythema chronicum migrans
(2) Early disseminated stage: multiple smaller ECM, Neurologic and cardiac and joint involvement
(3) Late stage: chronic arthritis, encephalopathy

Question 24

What are a pts symptoms during the early localized stage of lyme disease?

Answer 24

10 days after tick bite
Skin lesion - ECM along with flu-like illness anf regional lymphadenopathy
ECM - flat round rash that spreads out over time that has a bright red outer border and the center will clear, turn blue or necrose
Last 4 weeks

Question 25

What are a pts symptoms during the Early disseminated stage of lyme disease?

Answer 25

stage can occur after or at the same time as first stage
Skin: multiple smaller ECM
Nervous system: aseptic meningitis, cranial nerve palsies, pheripheral neuropathies
Heart: AV nodal block most common, myocarditis (less common)
Joint: brief attacks of arthritis of large joints

Question 26

What are the pts symptoms during the Late stage lyme disease?

Answer 26

10% of untreated pts develop chronic arthritis that lasts for more than a year
1 or 2 of the large peripheral joints (knee)
B-cell allo antigens?
Can lead to neurologic damage - encephalopathy (memory impairment, irritability and somnolence)

Question 27

How is Lyme disease diagnosed?

Answer 27

leading edge of rash biopsied and cultured
CSF very difficult
Levels of anti-Borrelia burgdorferi abs often helpful (ELISA and Western blotting)

Question 28

What causes relapsing fever?

Answer 28

Borrelia recurrentis via body louse

Other Borrelia species via tick (Ornithodoros, western U.S)

Question 29

What are the symptoms of relapsing fever?

Answer 29

Once in the blood, high fever develops, with chills, headaches and muscle aches
Rash and meningeal involvement may follow
Drenching sweats, fever and symptoms resolve after a week
Afebrile for another week then it relapses

Question 30

What is the key to relapsing fever??

Answer 30

Abs form and bind specifically to the Borrelia surface proteins and remove it from the blood
But Borrelia rapidly changes surface proteins so Abs cant recognize
New set of Abs formed and Borrelia changes again

Question 31

How is relapsing fever diagnosed?

Answer 31

Drawing blood during febrile periods only

wright’s or Giemsa-stained smear

Question 32

What are Leptospira?

Answer 32

Long, thin aerobic spirochetes, tight coil with hook on one or both ends
Leptospira interrogans cause human disease: penetrate abraded skin or mucous membranes (swimmin in contaminated water)
Found all over the world in urine of dogs, rats, livestock and wild animals

Question 33

What are the two phases of Leptospira?

Answer 33

(1) Leptospiremic phase: invade the blood and CSF, abrupt onset of high spiking temperatures, headache, malaise, and sever muscle aches (thighs and lower back), conjunctive red and phtophobia; after 1 week short afebrile period then symptoms recur
(2) Immune phase: IgM antibodies, pts may develop meningismus, CSF reveals elevated white cell count in most pts

Question 34

What does Leptospira interrogans (serogroup icterohaemorrhagiae) cuase?

Answer 34

Weil’s disease - infectious jaundice

Renal failure, hepatitis with jaundice, mental status changes, hemorrhage in many organs

Question 35

How is Leptospira diagnosed?

Answer 35

Culturing (blood) and CSF during first febrile phase
Urine culture during second phase and later
ELISA, PCR