Lecture 30 Spirochetes Flashcards
Can T. pallidum be spread via fomites?
No
Definitive Clinical Criteria for Lyme Disease…
Erythema Migrans (rash)
At least 1 manifestation (i.e. arthritis) AND positive Lab Confirmation
Lab criteria:
- Isolation of borellia burgdorferi
- Diagnostic levels of IgM/IgG Ab’s
- Significant increase between acute and convalescent Ab titers
Describe early congenital syphilis caused by T. pallidum:
Early or late disease can cause stillbirth
Early congenital syphilis:
Symptoms manifest from birth –> 2 years, Extensive cutaneous lesions,
“snuffles” = mucopurulent rhinitis which is highly infectious,
osteochondritis of long bones
Describe late congenital syphilis caused by T. pallidum:
Cutaneous gummas, interstitial keratitis, 8th cranial nerve deafness Hutchinson teeth: raspberry molars, saber shins: saddle nose:
Describe the “rule of thirds” in syphilis…
A third of people will move on from primary to secondary…
Of those who make it to secondary only a third move to tertiary.
Describe the clinical symptoms of Relapsing Fever…
Fluctuating stages of fever, chills, then sweats.
Flu-like symptoms lasting 2-7d, then…
Drenching sweats and weakness, lasts 7d (4-14)
Second attack starts with chills and fever again, 3-10 relapses, severity diminishes with each relapse.
Diagnosis of Leptospirosis is done by …
Serology:
MAT - Microscopic agglutination test, serum samples agglutinate live leptospires, only used in reference labs.
Diagnosis of Lyme Disease
Hx of Tick Bite
CDC RECOMMENDS: Ab decection titer followed by immunoblot
Diagnosis of T. pallidum can be done by…
Microscopy
- darkfield microscopy of lesions
- fluorescet-labeled T. pallidum Ab’s. (SPECIFIC)
Serology
- Routinely used, 2 types (Nontreponemal and Treponemal), both are screening tools for T. pallidum “in a way”.
Geography for Lyme Disease?
CT, DE, ME, MD
MA, MN, NJ
NH, NY, PA
VA, WI
Infection of T. pallidum is caused mainly through ______ _______?
Sexual contact
But also blood contact and congenital transfer.
Leptospira interrogans causes… It is found almost 50% in ____ (state), ______ are the reservoir host.
Transmission?
Leptospirosis, Hawaii, Rodents,
Shed in urine, Transmitted via contaminated water/food.
*** Think… Hawaii –> Mice –> Pee –> Waterskiier
Leptospirosis symptoms… Causes _____ Disease.
Flu-like illness as the organism spreads through blood
Second phase: is headache, myalgia, chills, abdominal pain
Weil Disease - Renal failure, hepatic symptoms with jaundice. Can be fatal.
List the symptoms found in LATE (TERTIARY) PHASE T. pallidum infection:
Destruction of specific tissue; can affect specific organs i.e. heart and brain. Can be fatal. 3wks to 3mo’s after secondary.
Neurosyphilis - descruction of brain parenchyma causing dementia or dorsal roots of spinal cord causing Tabes dorsalis (demyleination)
Cardiovascular Syphilis - thoarcis aortic aneurysm, aortic endocarditis
Gummas - in bone, skin, tissues, (destructive granulomatous lesions - no bac’s in the lesions)
List the symptoms found in PRIMARY PHASE T. pallidum infection:
Painless ulcer with raised borders at the site of infection that began as a papule.
Heals on its own by 2 mo’s.
List the symptoms found in SECONDARY PHASE T. pallidum infection:
Begins as flu-like syndrome, appears 4-10 weeks after initial ulcer.
“Copper colored” rash over entire body. Rash can be varied and is highly infectious.
Patchy alopecia - moth eaten appearance
Condylomata lata - soft fleshy papules
List the three phases of T. pallidum infection…
Primary phase
Secondary phase
Late (tertiary) phase
Name the three major spirochetes’ genuses covered in Lecture 30 that are pathogenic to humans:
Treponemes
Borellia
Leptospira
Name the two important Borrelia species and what they cause?
Borellia burgdorferi - Lyme disease
Borellia recurrentis - Relapsing fever
Name the two types of Nontreponemal tests?
VDRL - Venereal disease research laboratory
RPR - Rapid plasma reagin
Positive for syphilis but also for something like malaria or mononucleosis too… This just helps you SUSPECT something.
Name the two types of Tick-borne relapsing fever? (Borrelia recurrentis)
Louse-borne (more severe, not in US).
Tick-borne
Nontreponemal Tests act by… They are (specific/nonspecific)?
Measure IgG and IgM Ab’s (reagininc Ab’s)
Nonspecific
This works because Pt makes Abs against lipids released from damaged cells, cardiolipin is the Ag used in the test from beef heart!
Relapsing Fever: Diagnosis is by…
Dark field microscopy… Only seen in febrile period
Serology not useful due to antigenic variation
How do you test for syphilis using nontrep/trep tests?
Screen with a nontrep test… unfortunately positive reactions develop late in the first stage of syphilis.
Definitive diagnosis can be had with trep tests with 98% specificty. Resolved via western blot.
Spirochetes are ______-shaped, Gram____ and (do/do not) have LPS?
Spiral
Negative
DO NOT have LPS
Spirochetes are motile via a ______ _______-like motion and have a __________ flagella? What does that mean about the flagella and what implications does it have for culturing?
Cork Screw-Like
Periplasmic flagella
It means it’s inside the membrane
It means they are difficult to culture!
T. carateum causes… Where? Symptoms?
Pinta
C/S America
Small pruritic papules on skin,
Hypopigmented lesions –> Scarring/disfigurement
NO GRANULOMAS
T. pallidum causes the ____ most common STD in the US?
Third (syphilis)
T. pallidum subspecies endemicum causes… Where? What syptoms?
Bejel
Africa, Asia, Australia
Person-to-person spread via contaminating utensils
Initial oral lesions, gummas in bones skin nasopharynx
T. pertenue causes… Where is it found? What symptoms does it cause?
Yaws
S. America, Africa, Asia
Granulomatous disease:
Early skin lesions, late destructive lesions, spread by direct skin-lesion contact
Tick-borne relapsing fever (Borrelia recurrentis) is caused by _____ ticks and the buzzword for this is that it is found in ______ _______ (State: ___)
Soft
Rustic Cabins
CO
Treponema pallidum is pathenogenic by…
No specific VF/toxin,
More or less tissue destruction and lesions of syphilis due to host immune response.
Treponemal test examples are… (Specific for syphilis only)
FTA-ABS - Fluorescent treponemal antibody-absorption
TP-PA - T. pallidum particle agglutination
EIA - Enzyme immunoassays
What are the clinical manifestations of STAGE 1 lyme disease?
Bulls-eye Rash at site of tick bite 3-30d after bite
1/3 of pts have no further manifestations (only 75% have a rash).
What are the clinical manifestations of STAGE 2 lyme disease?
~6 mo’s later…
Intermittent arthritis
Severe malaise
Fatigue
What are the clinical manifestations of STAGE 3 lyme disease?
Prolonged arthritis Chronic encephalitis Myelitis Fibromyalgia-like symptoms Skin involvement Unilateral Facial palsy
What are the three stages of clinical manifestation of Lyme Disease?
Localized, disseminated, persistent (chronic)
What are the two major pathogenic species of Treponemes?
What do they cause?
Treponema pallidum - Syphilis
Treponema carateum - Pinta
What are the two subsets of T. pallidum and what do they cause? (These ones aren’t found in the US)
T. pallidum endemicum - endemic syphilis (bejel)
T. pallidum pertenue - yaws
What is the main pathenogenic factor for Relapsing Fever (Borrelia recurrentis)?
Antigenic variation of spirochetes changes during infections… which prevents the existing Ab’s from binding to them.
Relapse occurs due to multiplication of new variants of their OUTER MEMBRANE PROTEIN.
What is the main trasmitter/reservoir for Lyme Disease and what is it caused by?
Black-legged tick (Ixodes scapularis)
–> on rodents and deer
Caused by Borellia burgdorferi
What kind of flagella does Borellia have?
Periplasmic, outer envelope surrounding it.
