Spirochetes Flashcards
Organisms who are poorly Gram stained / do not stain with Gram stain
MRCS
Mycoplasma
Rickettsia
Chlamydia
Spirochetes
Spirochetes includes
Treponema
Borrelia
Leptospira
Treponema shape and Motility
Very tight coils
Corkscrew motility
Shape of Borrelia
Loose coils
Leptospira shape
Hooked ends
Motile
Which organisms have Endoflagella
Spirochetes - in Periplasmic space
Classification of Treponema
STD
Non-STD
STD Treponema includes
Treponema Pallidum
Non STD Treponema includes
T. Endemicum
T. Pertenue
T. Carateum
T. Endemicum causes
Endemic Syphilis
Treponema Pallidum causes
Venereal Syphilis
T. Pertenue causes
Yaws
Transmission of Yaws, Endemic Syphilis and Pinta
Yaws and Pinta - Skin to skin
Endemic Syphilis - Kissing
T. Carateum Causes
Pinta
Age group affected in Yaws, endemic Syphilis and Pinta
Yaws and endemic Syphilis - Early childhood
Pinta - Late childhood
Features of Yaws, Endemic Syphilis and Pinta
Yaws - Ulcerative papilloma
Endemic - Rare
Pinta - Non ulcerative papule
Sites affected in Yaws, endemic Syphilis and Pinta
Yaws and Pinta - Extremities
Endemic - Oral
Relapses in Yaws, Endemic Syphilis and Pinta
Yaws - Common
Endemic - Uncommon
Pinta - No relapse
Incubation period of Treponema Pallidum infection
9-90 days
Stages of Venereal Syphilis
Primary
Secondary
Tertiary
Clinical features of Primary Syphilis
Hard chancre/Hunterian chancre( extremely indurated) - heals in 10-40 days (leaves scar or can progress to secondary syphilis)
Painless genital ulcer
Avascular and covered with thick glary exudate
Also Painless inguinal LN
Secondary syphilis occurs after how much time of Primary Syphilis
Occurs after 1-3 months of Primary Syphilis
Clinical features of Secondary Syphilis
Condylomata lata at mucocutaneous junction
Papular skin rashes on Palms and soles
Latent syphilis means
Spontaneous cure
Serology +ve
Clinical features absent
Tertiary Syphilis is divided into
Benign tertiary Syphilis
Cardiovascular Syphilis
Neurosyphilis
Clinical and Microscopic finding of Benign tertiary Syphilis
Gummas (Bone, skin)
M/E - Granuloma (abundant plasma cells)
Clinical features of Cardiovascular Syphilis
Obliterative Endarteritis of vasa vasorum
Ascending aorta and arch of aorta Aneurysms
Aortic valve
Clinical features of Neurosyphilis
Aseptic meningitis
Tabes dorsalis (Post column)
General paresis
Non venereal Syphilis can be seen in
Healthcare workers - primary chancre at extra genital sites
Blood Transfusion patients - no primary chancre
Congenital syphilis is transmitted and may manifest lately as
Transplacental
May manifest late as Osteoperiostitis (in children)
Specimen needed for diagnosis of Treponema Pallidum infection
Genital ulcers
Blood
CSF
Which Microscope is used to see Treponema Pallidum
Dark Field Microscope - thin organism
Movement shown by Treponema Pallidum
Forward and backward movement
Bending at right angles (90°)
Which Silver impregnation Method used to see solid tissue/films of Treponema Pallidum
Fontana’s method
Which Silver impregnation Method used to see liquid sample of Treponema Pallidum
Levaditi’s method
Non specific Serological Methods used for diagnosis of Treponema Pallidum
Wassermann test (Complement fixation technique)
Kahn test (tube precipitation test)
VDRL (Venereal disease research lab)
RPR (Rapid plasma Reagin)
Specific Serological Methods used for diagnosis of Treponema Pallidum
FTA-ABS (Fluorescent Treponemal Antibody Absorption)
TPI ( T. Pallidum immobilization)
TPHA ( T. Pallidum Hemagglutination assay)
TPPA (T. Pallidum Particulate Assay)
Antigen used in VDRL test
Cardiolipin antigen
VDRL Procedure
Heat inactivated serum + Cardiolipin antigen - mixed on slide - Rotated - On microscopy : Clumps
Best test to assess prognosis of Syphilis
VDRL
VDRL - False Positive seen in
V - Viral infections (Infectious mononucleosis)
D - Drugs (Procainamide)
R - Rheumatic fever
L - Lumps
L - Leprosy
False Positive - First trimester
Positive - of Pregnancy ( Early pregnancy)
Investigation of Choice in case of Neurosyphilis
VDRL
In VDRL antigen to be used within
24 hrs (Cardiolipin)
Most sensitive specific Serological test for Treponema Pallidum
FTA-ABS (Fluorescent Treponemal Antibody Absorption)
Most specific Serological Methods used for diagnosis of Treponema Pallidum
TPI»_space; TPPA
Most Sensitive Serological Methods in case of Congenital Syphilis
VDRL»_space; FTA-ABS
Drug of choice Primary, Secondary and latent stage of Syphilis
Benzathine Penicillin
Antibiotics used in case of Neurosyphilis
Pencillin G
Borrelia includes which organisms
B. Burdorgferi
B. Recurrentis
B. Vincenti
Motility shown by Borrelia species
Lashing motility - loose spirals
B. Burdorgferi causes
Lymes disease
Borrelia recurrentis is known to cause
Relapsing fever
Borrelia Vincenti is known to cause
Vincent’s angina
Most common vector borne infection in USA
Lyme disease
Lyme disease is transmitted by
Bite of Ixodid ticks (Hard ticks)
Incubation period of Lymes disease
3-30 days
Clinical features of Lymes disease are classified into
Localized infection
Disseminated infection
Persistent infection
Clinical features seen in localized infection of Lyme’s disease
Annular/Bulls eye or target rash (Erythema chronicum migrans)
Clinical features of Disseminated infection of Lyme’s disease
Satellite skin lesions smaller than ECM
CVS - Av block, Myocarditis
CNS - Facial nerve palsy
Joints
Persistent infection of Lyme’s disease can leads to
Lyme arthritis
Complications of Lyme’s disease
Bannwarth’s Syndrome (meningeal involvement) - Painful Radiculoneuritis
Stain used for diagnosis of Lyme’s disease
Warthin Stary silver stain (WSSS)
Relapsing fever is classified into
Epidemic louse borne Relapsing fever
Endemic tick borne Relapsing fever
Epidemic louse borne Relapsing fever is caused by
Borrelia recurrentis - Lice crashed on abraded skin
Endemic tick borne Relapsing fever is caused by
Borrelia duttoni - tick bite
Incubation period of Relapsing fever and fever pattern
2-10 days
Fever (3-5 days) - abundant organisms in blood
Afebrile for 4-10 days - No organism in blood
Relapsing fever - 3 to 10 relapses (organism reappears)
Microscopy used to see Borrelia species
Dark Field Microscope
Stain used for diagnosis of Relapsing fever
Giemsa/Leishman stain
Treatment of Relapsing fever
Tetracyclines
Chloramphenicol
No vaccine
Clinical features of Vincent’s angina
Ulcerative gingivostomatitis or oropharyngitis
Microscopy used for Diagnosis of Vincent’s angina
Dark Field Microscope
Fusospirochetosis includes
Symbiotic infection
Fusobacterium fusiform + B. Vincentii
Leptospira causes
Weil’s disease (Ictero hemorrhagic fever) AKA Hepato renal Syndrome
Pathogenesisof Leptospira
Zoonotic disease
Rat urine - Contaminated Rainy water - associated with Rice/Paddy field workers
Stages of Weil’s disease/ Ictero hemorrhagic fever
First stage/Septicemic phase
Second stage/Immune phase
Duration of Septicemic phase and immune phase in Weil’s disease
Septicemic - 3 to 10 days
Immune phase - 10 to 30 days
Clinical features of Weil’s disease (both phases)
High grade fever
Jaundice
Raised liver enzymes
Hemorrhage - Pulmonary, Skin, conjunctival
Renal - Raised creatinine
Sample taken in case of Septicemic phase and Immune phase of Weil’s disease
Septicemic phase - Blood, CSF
Immune phase - Urine
Serology findings IgM in Septicemic phase and immune phase in Weils disease
Septicemic phase - Igm absent
Immune phase - IgM present
Antibiotics used in Septicemic phase and immune phase of Weils disease
Septicemic phase - Doxycycline
Immune phase - Refractory Penicillin
Microscopy used and M/E findings in Leptospira infection
Dark field Microscopy - Hooked end
Culture media used in case of Leptospira infection
EMJH - Dingers ring
Fletcher
Korthoff
Serological examination done in Leptospira infection
Microscopic Agglutination test (MAT)
SAT MAT CAT
Brucella Leptospira Mycoplasma