Exam 3 Spirochetes Flashcards
Spirochetes are structurually ___ like, but are not visualized by ____
Gram-negative like; Gram stain
Spirochetes should be visualized using:
- dark field microscopy
- silver stain
Spirochetes are shaped like a:
Corkscrew
Spirochete movement
Rotation locomotion via endoflagellum that wraps around the cell
Treponema is aerobic or anaerobic?
Anaerobic
Disease caused by Treponema
Syphilis
Oral treponemes are implicated in:
- periodontal disease
- acute necrotizing ulcerative gingivitis (ANUG)
ANUG stands for
Acute necrotizing ulcerative gingivitis
___ is vector borne
Borrelia
Leptospira is aerobic or anaerobic?
Aerobic
Relapsing fever and Lyme disease are caused by what species?
Borrelia
Third most common bacterial STD
Syphilis
What group of people have the highest rates of syphilis cases?
- American Indian or Alaska native
- Black/African American
___ account for the most cases of syphilis
Men
Vast majority of syphilis cases occur among:
Men who have sex with men (MSM)
Syphilis often occurs in patients with ____; important facilitator of ____
other STDs; HIV
Treponema pallidum looks like:
long, thin, spiral
True or false: Treponema pallidum can be cultured on medium
False - limited growth in tissue culture, rapidly dies on drying
Treponema pallidum has limited ____ capacity; it is an _____
metabolic (missing TCA cycle); obligate internal parasite
Treponema pallidum lack what two virulence factors?
- no catalase
- no superoxide dismutase
Treponema pallidum virulence factors
- immune avoidance (few surface antigens)
- surface adhesins to bind fibronectin
- hyaluronidase facilitates infiltration
Syphilis - modes of transmission
- Sexual contact
- Transplacental
- Close contact with active lesion (also perinatal)
- Blood transfusion
- Accidental direct inoculation
Patient with syphilis is most infectious during:
Early disease stages
Syphilis patient is considered not infectious after ____ years due to ____
4; low bacterial load
What are the clinical stages of syphilis?
- Primary
- Secondary
- Latent
- Tertiary
- Congenital
What happens during primary syphilis?
- primary lesion formed is a chancre
- infiltrated with lymphocytes and plasma cells
- heals after 14 days
The chancre formed during primary syphilis is:
- painless
- highly infectious
How long are you seropositive for syphilis once contracted?
For life
Primary syphilis incubation period
3-4 weeks
Where can primary syphilis chancres occur?
- lip
- tongue
- on hand (infected cut)
- genitals
A high increase of plasma cells in tissues, exudates, or blood is indicative of:
Some kind of infection (could be syphilis)
When does secondary syphilis occur?
2-10 weeks after primary syphilis
Secondary syphilis occurs in ____ of those with untreated primary syphilis
25%
What happens during secondary syphilis?
- Wide dissemination of T. pallidum (highly infectious)
- causes skin rashes, mucous patches, condylomata lata
Condylomata lata
Wart-like growths
Syphilis skin rashes are:
- widespread (palms, soles)
- macular/papular
Secondary syphilis mucous patches can occur on:
- tonsil
- soft palate
- palms and soles
- scalp (alopecia)
Latent syphilis is characterized as being:
Seropositive with no symptoms
Latent syphilis occurs in ____ of patients with untreated secondary syphilis
15%
How long can latent syphilis last?
Several years to decades
____ is more infectious than late latent stage, including transmission to fetus
Early latent
Those with HIV experience ____ if they have syphilis
Shortened latency
Tertiary syphilis is not common anymore due to _____
Antibiotics
In the beginning of a syphilis infection, bacterial load is ____. Towards the end of the infection (tertiary syphilis), bacterial load is ___
high; low
Tertiary syphilis occurs ____ after the primary infection
Several months to 30 years
In _____ syphilis, 50% develop gumma
Tertiary
Is gumma contagious?
No
Gumma is highly ____ but often painless
Destructive
What does a gumma look like?
- white-grey
- rubbery
- single or multiple
- tiny to tumor like sizes
Tertiary syphilis is associated with ____ involvement. Organisms ____
Multisystem; spread to other body parts
Where can a gumma occur?
- skin
- oral cavity
- bone
- joints
- cardiovascular system
- nervous system
can occur in most organs
A ____ is a soft tumor-like inflammation
Gumma
A gumma in the oral cavity can lead to:
Perforated palate (can bore holes in the tissue)
Gumma in the joints can lead to:
Charcot’s joints (neuropathic)
Gumma in the cardiovascular system can lead to:
Aortic aneurism (abnormal bulge that occurs in the wall of the aorta)
caused by syphilitic aortitis
_____ can lead to collapse of midfoot arch
Charcot’s foot (joint) - tertiary syphilis
Aortic aneurism (definition)
Abnormal bulge that occurs in the wall of the aorta
When does neurosyphilis occur?
At any stage of syphilis
True or false: neurosyphilis is symptomatic
False - can be asymptomatic
Early neurosyphilis occurs:
A few months to a few years after infection
Acute syphilitic meningitis and ocular involvement occur during what stage of neurosyphilis?
Early neurosyphilis
Late neurosyphilis occurs during what stage of syphilis?
Tertiary syphilis
Late neurosyphilis can lead to:
- general paresis
- tabes dorsalis
General paresis
Brain cortex degeneration
Tabes dorsalis
- damage to dorsal root ganglia
- ataxia, wide based gait, foot slap
- loss of sensation
Ataxia
without coordination (tabes dorsalis, late neurosyphilis)
Recently, syphilis cases have been:
Increasing
Those who use ____ are at higher risk of contracting syphilis
Methamphetamine; injection drugs
Congenital syphilis cases must be reported within:
24 hours
40% of syphilis pregnancies result in:
- miscarriage
- stillbirth
- infant death
If a baby survives with congenital syphilis, they may develop:
- developmental delays, seizures (due to meningitis)
- craniofacial anomalies
A newborn with congenital syphilis is:
Infectious (fluid is contagious - syphilistic rhinitis snuffles)
How is congenital syphilis prevented?
Antibiotic treatment of mother
What craniofacial anomalies can result from congenital syphilis?
- Hutchinson’s teeth
- Mulberry (Moon’s) molars
- mucous patches
- perforated palate
- saddle nose
- keratitis
Hutchinson’s teeth affects:
Permanent incisors
Describe Hutchinson’s teeth phenotype
- incisor crown wider in cervical portion than incisal edge
- incisal edge has crescent shaped notch
- incisors can also have triangular shaped deformity
Mulberry (Moon’s) molars can affect:
First permanent molars
What do Mulberry molars look like?
Occlusal surface is composed of an aggregate of enamel nodules
Syphilis diagnosis involves:
2-tiered serology: non-treponemal and treponemal
Non-treponemal serology is ____ to treponemes
Non-specific
Non-treponemal serology tests for:
- cellular damage
- antibodies to cardiolipin
Examples of non-treponemal tests
- Wassermann test
- VDRL (Venereal disease research laboratory)
- RPR (rapid plasma reagin)
Wassermann test tests for
Complement fixation
VDRL tests for:
Neurosyphilis in CSF
Non-treponemal serology can show _____ for other diseases
False positive results
Which non-treponemal serology tests are agglutination assays?
- VDRL
- RPR
For RPR, mix ____ with patient’s blood. They will agglutinate bith blood ____
cardiolipin antigen; Reagin (antibodies to materials released by damaged cells)
Treponemal serology is for
Syphilis disease confirmation
Treponemal tests (Identification of T. pallidum)
- PCR
- FTA-ABS (fluorescent treponemal antibody absorption)
- TPPA (Treponema pallidum particle agglutination)
- MHA-TP (micro hemagglutination to T. pallidum)
TPPA allows for clotting of:
Ab:Ag
Treponemal serology - Antibodies in spinal fluid is highly suggestive of:
Active neurosyphilis
2-tiered syphilis testing - which test is first?
Either can be first (non-treponemal or treponemal)
If non-treponemal test is first:
- RPR or VDRL first
- then confirmatory TT (TPHA or TPPA)
2 tiered syphilis testing - it is less expensive but has high rates of false negatives to do which test first?
Non-treponemal
When first test is treponemal test:
- first TT immunoassay
- then NTT (RPR or VDRL) if there is previous history of treatment
Syphilis DOC
Penicillin - single dose intramuscular
Treatment of late latent syphilis or latent syphilis of unknown duration; or pregnant women
Three doses of penicillin recommended
Possible complication of Syphilis antibiotics therapy
Jarisch-Herxheimer reaction - similar to endotoxic shock; Allergic reaction from rapid release of treponemal antigen from cell wall
All patients with syphilis must be tested for
HIV
Other treponemes
- Yaws (skin disease in Africa)
- Pinta (skin disease in South america)
- Normal oral flora (Treponema denticola): associated with periodontal disease, ANUG
Borrelia is ___ than treponemes
Larger
Some Borrelia sp are visualized by:
Giemsa staining
What causes Lyme disease?
Borrelia burgdorferi
Borrelia species that causes epidemic relapsing fever
Borrelia recurrentis
What is relapsing fever?
- febrile illness that goes away and comes back
Borrelia hermsii is endemic in:
Western US
tick vector, rodent reservoir
Borrelia miyamotoi is endemic in
NE uS
deer tick vector, rodent reservoir
Relapsing fever DOC
Tetracyclines
B. burgdorferi reservoir
White tailed deer
B. burgdorferi vector
Tick (can transfer pathogen to others)
Eastern US - Ixodid deer tick
Western US - black legged ticks
Is the nymph or adult tick responsible for majority of Lyme disease cases?
Nymph
Early infection of lyme disease involves localized ____
Erythema migrans (bulls eye rash)
Patients with untreated Lyme disease can progress to early disseminated stage, which involves:
arthritis, neurologic manifestations (Bell’s palsy), cardiac dysfunction
Late Lyme disease involves:
- arthritis
- chronic skin involvement
- carditis
Muscle weakness on one side can be due to
Bell’s palsy caused by untreated Lyme disease
Lyme disease - what does rash look like
Bulls-eye
Diagnosis of Lyme Disease
Serology 2-tiered
- ELISA or immunofluorescence
- Western blot to confirm
Early stage Lyme disease treatment
Tetracycline
Disseminated/late stage Lyme disease treatment
IV ceftriaxone
Acrodermatitis chronica atrophicans
Skin rash/fibrosis that can occur during late disseminated Lyme disease
Leptospira interrogans is a:
Human pathogen
Leptospira sp. is an ____ spirochete with ____
aerobic; hooked ends
Leptospira interrogans causes what disease
Leptospirosis
Tx for Leptospirosis
Doxycycline
How can you get infected by Leptospira?
- Rodent urine can contaminate water/soil/food and becomes more of an issue after natural disaster
- infects eyes, ingestion, wound contamination