spirochete cases

Question 1

Patient presents to your clinic with nuchal rigidity and splenomegaly. Chest xray shows pulmonary infiltrates, and an ophthalmic exam shows conjunctival hemorrhages. The patient was seen a week ago for fever an muscle pain, but sent home with suspected flu. What could be the cause, what’s the long term threat, and how would you test for it?

Answer 1

Leptospirosis: leptospiacae

Primary infection is through accidental exposure via soil. Lepto is the smallest spirochete with “ice tong” tail. It’s initial infection includes a fever and severe muscle pain for about a week. The secondary form, which this patient has, does not always present, but if it does it can include meningitis, conjunctiva hemorrhage, splenomegaly, and pulmonary infiltrates. Long term, this may cause Weil’s disease which affects the kidneys, liver, and causes a change in consciousness. Weil’s may be fatal.

Check CSF. Most spirochetes are not visible to culture or microscope.

Question 2

Child is brought to the clinic in southeast asia with lesions on her extremities that are starting to erode. Mom says other kids at school have the same thing. What is it and what are the long term consequences if untreated?

Answer 2

Treponema Pallidum Pertenue: Yaws

South EAST asia and Africa spirochete.
Caused by direct skin contact.
Primary infection: extremity lesions which erode
Late phase: osteitis of fingers and possible facial deformity, hyperkeratosis of palms and feet, gummatous lesions.

Question 3

A child is brought to the clinic with musosal patches, lymphadenopathy, and is having diffuse pain throughout body. What might be causing this?

Answer 3

Treponema Pallidum Endemica: Bejel

WEST asia and Africa spirochete.
Caused by sharing eating utensils. 
Primary: oral lesion, usually missed
Secondary: mucosal patches, adenopathy, periostitis
Late: gummatous lesions

Question 4

A child is brought to the clinic in southern Mexico with small red papules all over his neck, chest and face. Mom says he has had these nodules for months and nothing has helped them. What might he have and how will it progress?

Answer 4

Treponema Carateum: Pinta

Southern Mexico and central America. direct skin contact.
Primary: small red papules on face, neck and chest which cn last for years
Secondary: blue grey or brown patches
Late: depigmentation of ankles, elbows and wrists which look painted on
“Red, Blue and White”

Question 5

Patient presents in the united states complaining of reoccurring fevers that have come and gone. She also has a trunkal rash and sensitivity to light. Exam shows a tender abdomen, eye redness and petechiae. What might be the problem, what spread it, and what is her prognosis if untreated? How would you test?

Answer 5

Borrelia Recurrentis: relapsing fever

May be transferred by:
1. tick = global, multiple relapses
2. Lice = south Africa south America, one relapse
You may only test for this successfully when the patient is febrile. This is the only spirochete visible on microscope. Symptoms tend to decrease with each relapse.
However, long term, this may cause myocarditis, CNS hemorrhage and liver failure.

Question 6

Patient presents to clinic in the Midwest with a bull’s eye rash. He heard online that it could be Lyme disease. How would you test for this, and what symptoms might he have had if you didn’t treat it right away?

Answer 6

Borrelia Burgdoferi: Lyme

Transferred via the white tailed deer and white footed mouse on the Ixode tick. Common in the Midwest.
Primary: “erythema migrans”, bulls eye
Secondary: dissemination to joints, nervous system (possible meningitis and palsy), heart (possible heart block) and skin.
Late: Persistent, chronic, latent infection

Culture the skin lesions. You should find increased IgG.