Spirochetal Diseases

Question 1

Lyme DZ:

Answer 1

1. Multisystem dz- Borrelia burgdorferi- ticks ixodes genus
2. 3 stages-
   • 1)Localized infxn- erythema migrans w/in 7-14d removal tick…
   • 2) early disseminated- wks-mos. MC MSK/ Neuro sx…
   • 3) chronic lyme mos- yrs- MC MSK/ Neuro sxs
3. SX: systemic, cutaneous, neuro, cardiac, jts, ocular
4. If typical EM- no labs
5. Cx, IgM, IgG, CSF Ab
6. TX: tick bite – no sx- no tx, adults/ child >8 doxycycline if all of these
   a. Tick recgnz’d/ attached >36hrs
   b. Prophylaxis w/in 72 hr
   c. Bacterial infxn 20%
   d. No doxy CI

Question 2

Rocky Mountain Spotted Fever:

Answer 2

1. Rickettsia Rickettsii- tick borne
2. HALLMARK**- petechial rash begins palms, soles ft
3. Tick needs to be attchd x 6-10hrs
4. MC sx: fever >102 w/in 3d of bite, severe HA, myalgias
5. Labs: CBC,PLTS, H/H, ALT, AST, NA+, BILI, CSF, BUN, SCR, CK, Serology- BC, LP
6. Tx: doxy, corticosteroids, protect against tick bites!!!

Question 3

Syphilis:

Answer 3

1. VD- Treponema Pallidum- sex, mother-baby, blood products, skin break
2. Acquired- few hrs after entering bld/lymph = systemic infxn
3. HALLMARK** endarteritis, plasma cell rich infiltrate
4. Primary syph: painless chancre- highly infxs!!!
5. Secondary syph: 4-10wks after 1st lesion- spirochetes mult→ spread body- systemic manifests= lesions body, palms, soles, oral
6. Latent syph: secondary sx resolve, pt remains seroactive x 2-3 wks
7. Labs: serologic- RPR VDRL, ICE syph
8. TX: benzathine PCN G
9. Alt : tetra, erythro
10. Jarisch Herxheimer rxn- myalgias, fever, HA, tachy