Spirochetes

Question 1

Leptospira interrogans

how to ppl get i?

what does it cause?

Tip off?

Rare complication?

Diagnosis:

Treatment:

Classic case:

Answer 1

mice urinating in place where ppl swim

Disease ranges asymptomatic → severe

Flu-like illness: fever, rigors, myalgias, headache

Tip off: Conjunctival suffusion (red eyes)

Aseptic meningitis

Weil’s disease (rare complication) • Liver damage (jaundice), renal failure, and bleeding

Diagnosis: • Usually from classic history/exam • Serology (antibody) tests available

Treatment: Doxycycline or Azithromycin

Classic case: • Surfer or swimmer in Tropics • Flu-like illness • Conjunctival suffusion • Jaundice

Question 2

3 Stages of Lyme Disease:

Answer 2

Stage 1: Erythema chronicum migrans • Classic finding: expanding “Bulls-eye” rash • Flu-like symptoms

Stage 2: Neurologic and cardiac • Facial nerve palsy • AV block

Stage 3: • Arthritis (often knees) • Neuropathy (pain, paresthesias) • Encephalopathy (mild cognitive disturbance) • Rash: Blue-red discoloration • Acrodermatitis Chronica Atrophicans • More common in European Lyme

Treatment: Doxycycline or Ceftriaxone

Question 3

non burgdorferi borelia cause _ due to:

Answer 3

Relapsing Fever

Antigenic variation causes recurrent fevers, Spirochetes change major antigens on surface which evades immune response • Growth occurs • Fever returns

Question 4

Treponema pallidum causes:

Answer 4

Causes syphilis • Sexually transmitted disease • Can see spirochete by dark field microscopy • Disease: 1o , 2o , 3o stages

Question 5

3 stages of syphilis:

Answer 5

1: 2-3 wks after exposure • Painless chancre (ulcer) • Classically on the penis • Usually 1-2cm • Raised

2 :Rash • Classically maculopapular rash • Covers all extremities including palms/soles • Flu-like symptoms • Fever, headache, malaise, sore throat, myalgias • Condyloma lata • Large, raised, gray to white lesions • Moist areas: inside mouth, perineum • Often close to chancre; may reflect direct spread (Treponema loaded in condyloma and chancre → visualize with dark-field microscopy)

3: Gummas • Form of granuloma • Mass lesions that can appear anywhere: skin, liver • Often mistaken for tumors • Aortitis • Vasa vasorum inflammation • Risk of aortic dissection • Neurosyphilis • Many, many symptoms • Meningitis, dementia, nerve palsies

Question 6

Most maculopapular rashes spare palms/soles but Three that don’t are:

Answer 6

Syphilis • Rock Mountain Spotted Fever • Coxsackie virus (hand, foot, mouth)

Question 7

2 special manifestation of neurosyphilis:

Answer 7

Argyll Robertson pupil

Small pupils • Constrict to accommodation • Do not constrict to light

Tabes Dorsalis

Demyelination of posterior columns • Wide-based gate • Ataxia (falls, loss of balance)

Question 8

Syphilis Diagnosis

Answer 8

Start with two general specific tests:

VDRL • Venereal Disease Research Laboratory • “Non treponemal” test • Serum reacted with cardiolipin antigen (nonspecific)

RPR • Rapid Plasma Reagin • Syphilis patients’ serum (antibodies) will react • Positive VDRL/RPR

[For neurosyphilis need to test CSF]

FTA-ABS • Fluorescent treponemal antibody absorption • Test result: “Reactive” “Non-reactive”

Question 9

Congenital Syphilis Early Findings

Answer 9

Hepatomegaly

Runny nose

Maculopapular rash • Small, red or pink spots • Often on back, buttocks, posterior thighs, and soles

Abnormal long-bone radiographs

Question 10

Congenital Syphilis Late Findings

Answer 10

Ears/nose • Saddle nose (no nasal bridge) • Hearing loss/deafness

Teeth • Hutchinson teeth (notched, peg-shaped teeth) • Mulberry molars (maldevelopment of the molars)

Legs • Saber shins (bowed legs)

Question 11

normal, classic reaction to Syphilis Treatment:

Answer 11

Jarisch-Herxheimer reaction

Flu-like syndrome after starting antibiotics • Killed bacteria cause immune response • Self-limited