Infections of the NS/ spirochaetes

Question 1

Diseases of the NS associated with spirocheates

Answer 1

• Lyme disease (borrelia burgoferi)
• Syphilis (treponema pallidum)
• Leptospirosis

Question 2

Stages in Lyme disease

Answer 2

Stage 1

1-30 day
Early localised infection
Sign: skin rash at the sign of the tick (erythema migrans) + flu like symptoms

Stage 2

Weeks to months
Disseminated infection: Haematological/lymphatic spread leads to one or more organs being involved( most common are neurological/musculoskeletal)

Stage 3

Months to years

Question 3

Common neurological symptoms in stage 2 of Lyme disease

Answer 3

• Myelitis
• Meningo-encephalitis
• Mononeuropathy
• Painful Radiculoneuropathy
• Cranial neuropathy

Question 4

Common neurological symptoms in stage 3 of Lyme disease

Answer 4

• subacute encephalopathy

- encephalomyelitis

Question 5

Investigations for Lyme disease

Answer 5

• CSF lymphocytosis
• serum tests
• MRI of the brain
• Nerve conduction studies

Question 6

Treatment of Lyme disease

Answer 6

prolonged antibiotics:

• Oral doxycycline
• IV CEFTRIAZONE

Question 7

Neurosyphilis investigation and treatment

Answer 7

CSF lymphocytes will be raised
Treponema and non-treponema (type)

Treat with high dose penicillin