Spirochetal Infections

Question 1

Syphilis (Treponema pallidum)

Answer 1

• Gram(-), highly motile. -granulomatous–taken up by macrophages
• Pyogenic STD with 3 characteristic stages
• Primary: Chancre (firm, painless) with luetic vasculitis, occasionally multiple lesions in immunecompromised.
• Secondary: (involves systemic spread) Maculopapular rash on palms and soles of the feet, follicular and numular syphilids-cutaneous + mucous membran lesions, condylomata lata (white plaques on perineum region), obliterative endarteritis.
• Latent stage: Asymptomatic
• Tertiary (3-15 yrs after infection): Gumma: soft, tumor-like balls of inflammation which may vary considerably in size–necrotic center with inflammed reddened surrounding–leads to cardiac and cerebral complications if present in heart, or brain. NeuroSyphilis - meningitis, seizure, dementia + tabes doralis (peripheral nerve demyelination) Cardiovascular syphilis- aortitis => aneurism.
• Congenital syphilis can cause snuffles, saddle nose, saber shins, and Hutchinson teeth in newborn

Question 2

Yaws (Treponema pallidum pertenue)

Answer 2

• Found in tropics, skin-to-skin transmission
• Pyogenic: neutrophilic Raspberrry-like papilloma lesion.
• Diffuse skin lesions, ones on the sole of feet can cause “Crab Yaw” walking
• hyperkeratosis-darkening of skin with infection
• After a latent period, re-emerges as face and upper airway lesions

Question 3

Bejel (endemic syphilis) (Treponema pallidum endemicum).

Answer 3

• gummas in skin, airways, bone
• transmission is mouth-to-mouth, breast-to-mouth, or utensil-to-mouth
• usually begins in childhood as a small mucous patch, often on the interior of the mouth, followed by the appearance of raised, eroding, Pyogenic lesions on the limbs and trunk. Periostitis (inflammation) of the leg bones is commonly seen, and gummas of the nose and soft palate develop in later stages.
• Mediterrenian/West Africa

Question 4

Pinta (Treponema carateum)

Answer 4

• spirochete, invade macrophages
• Skin-to-skin transmission
• Mexico, Central America
• Colored spots, scaly/flakey, disease limited to the skin; may leave behind areas of hyperpigmentation

Question 5

Lyme disease (Borrelia burgdorferi)

Answer 5

• Zoonotic spirochete, Transmitted by ticks, reservoir = mice, deer.
• Stage 1: erythema chronicum migrans (characteristic annular red lesions), fever, malaise
• Stage 2: muscle, heart, and nerve problems, including meningitis and facial nerve palsy
• Stage 3: more joint, skin, and nerve problems - mimics rheumatoid arthritis
• Late manifestations (years later): acrodermatits chronica atrophicans, patchy atrophy and sclerosis of skin
• Diagnosis usually established using antibody titers

Question 6

Leptospirosis

Answer 6

• Transmission: Water w/ animal urine contacts breaks in the skin.
• Usually mild and self-limited, sever forms cause hepatic and renal failure
• Leptospiremic phase: bacteremic: 1-2 weeks of nonspecific fever, shaking chills, headache, myalgia that resolve on their own (Gets in CSF, but not very virulent–does not cause severe disease by itself)
• Immune phase / Weil disease: 3 days after the leptospiremic phase, symptoms return with vasculitis, hemorrhage, meningitis (CNS pleocytosis), liver and kidney failure, shock and death.
• Mortality of Weil disease is 5-30%

Question 7

Relapsing Fever (Borrelia recurrentis)

Answer 7

• Epidemic fever disease from lice, caused by Borrelia recurrentis: high untreated mortality
• Endemic version is from ticks, many species
• General symptoms: fever, lethargy, arthralgia, headache, myalgia, petechiae -More specific symptoms: splenomegaly with miliary microabscesses, hemorhages, hepatomegaly because the spirochetes live in liver sinusoids → inflammation
• Sickness comes and goes abruptly in 1-2 week long waves, each time the duration is shorter and symptoms are milder.
• Spirochetes also change their antigenic coats in between each febrile period
• can be fatal

Question 8

Tropical Phagedenic Ulcer (Bacillus fusiformis and Treponema vincentii)

Answer 8

• a.k.a Tropical Foot, fusospirochetal infection
• Follows trauma (lesions) in the tropics, malnutrition is a factor.
• Painful leg legion with necrosis, sloughing of skin, and gray putrid exudate -May be complicated by tibial osteomyelitis and squamous cell carcinoma
• Deep wounds that persist for years, often need reconstructive surgery to fix

Question 9

Noma / gangrenous stomatits / cancrum oris

Answer 9

• A disfiguring, smelly facial necrosis that destroys both soft tissue and bones of mouth and face
• Often targets malnourished kids in and immune compromised in the tropics
• Common bacteria: T. vincentii, B. fusiformis (fusospirochetal), Bacteroides, Corynebacterium
• Underlying bone may be revealed.
• Usually need antibiotics and reconstructive surgery