spirochetes Flashcards
main characteristics of spirochetes
-coiled shaped
-most don’t gram stain
-none culturable on routine media
what is needed for spirochetes
good patient history and diagnosed serologically
syphilis
3rd/4th most common STD
organism responsible to syphilis
treponema pallidum
(need to differentiate between normal flora or pathogen)
where is normal flora treponema pallidum found
oral and urogenital region
transmission stage
gets in through breaks in skin
-transmitted gential, anal or oral region
primary stage incubation period
10-60 days before any symptoms
primary stage- syhphillis
development of chancre at site of entry
shanker- hard ulcer lesion
-may last 1-5 weeks if not treated (infectious)
small amounts of people will heal spontaneously
early stage of syphilis will be serology
negative
only way to diagnose
dark field microscope
when do people serolgoically convert
late primary stage or secondary stage
majority of people will be antibody
+ for life (does not mean active infection)
secondary stage- syhphillis
rash all over body- on palms of hands and soles of feet
lesions contains spirochetes and makes it contagious
latent syphilis
no outwardly symptoms, sero +, contagious, pass mother to baby
not everyone goes into
some people revert back to seconday stage or go to teritary stage
people can be latent for life
if more than 4 years will become non contagious
teritary
can be
secondary- teriatry
or
secondary- latent- tertiary
happens if not treated
years after primary
spread to other parts fo body
how is tertiary diagnosed
gummas- ulcer lesions that break down and become ulcerated
what is congenital syphilis
mother has syphilis and passes it onto the baby
-can happen at any stage of syphilis
-but typically not passed until 4th month of preg
what is associated with congenital syphilis
hutchinson’s diease
malformation of long bones
molar moons
what is specifically seen in hutchison’s disease
deep grove in teeth and deafness
as soon as baby is detected to have congenital syphilis
treatment should start immediately
-can prevent major outcomes
if mother is diagnosed with syphilis during pregnancy
baby will be treated immediately after birth
why is congenital syphilis not always easy to diagnose
first 6 months of baby life is IgG from mother
so if truly want to diagnose need IgM , but doesn’t get very high because immune system not fully developed
2 treatment– diagnosis
treponemal test or non-treponemal test
non-treponemal
used a a screen because rapid and easy to perform
less specific, but more sensitive
does not detect any antibodies to treponema
what does non treponemal detect
reagin
3 characteristics of reagin
-APR
-antibody like substance
-seen in many acute illnesses
finding of reagin means you have syphilis
NOW
2 non-treponemal tests are
RPR and VDRL
RPR- rapid plasma reagin
-most common; used on plasma or serum
-fibrinogen in plasma makes difficult to read
-never done on CSF
antigen in RPR
lecithin, cholesterol cardiolipin antigen (can’t dilute)
contains charcoal (makes macroscopic) and choline chloride (inactivates complement)
how long is antigen viable for in RPR
90 days once opened or date of expiration
what is in the premade antigen for RPR
non beveled silicone coated needle to disperse 60 +/- 2 mL drops on cards
how does test for RPR work
1) Drop 50 mL into each well (can do 10 patients)
2) Add drop of antigen into each
3) Stir in circle
4) Rotate 100 RPM for 8 min on rotor
5) Look macroscopically and report out reactive or non reactive
a) Reactive = flocculation technique (looks like agglutination) - lipid antigen looser aggregation
b) Weak reactive= not as large clumps
c) Non reactive= smooth
VDRL- venereal disease research lab
-looks for reagin
only used for CSF
flocculation technique
what is the antigen for VDRL
Antigen is a lecithin, cholesterol cardiolipin antigen
NO CHARCOAL – read microscopically
NO CHOLINE CHLORIDE- physically have to activate complement (no inactivating bc not enough crossed BBB)
antigen for VDRL dilution becuase
dilute to prevent post zone (too much antigen)
how often is antigen made for VDRL
everyday- good for 24 hrs
for VDRL if highest level is weakly reactive what do you report
weakly reactive
to confirm syphilis you need a
treponemal test
FTA
fluorscent treponemal antibody test
what is coacted on FTA to make it indirect fluorescent
T. pallidum (antigen)- means we are looking for antibody
FTA test steps
- Slide coated with antigen (T. pallidum)
2. Add serum (ANTIBODY)
3. INCUBATION- need the antibody, antigen complex to form
4. Wash - remove any unbound antibody
5. Add anti-antibody (conjugate) tagged with FITC
6. Incubate
i. Look for antigen-antibody- anti-antibody sandwich
7. Wash
8. Read
in FTA we are looking for antibodies to
Nichols strain of T. pallidum - pathogenic strain
normal flora non-pathogenic called
Reiter’s strain of trep
don’t want to find this
in FTA test a reagent added called ______; gets added to every patient because
sorbant; absorbs out any non specific antibody to the reiter’s strain
controls for FTA
IgG antibodies
reactive - positive??
maddie notes for non-specific
treponemal can be _____ forever
positive
non treponemal is only positive if you have it
now
TP-PA stands for
treponema pallidum particle agglutination
what does the TP-PA test use
sensitive sheep, turkey, or chicken RBCs with killed T. pallidum
if you have antibodies to T. pallidum you will have
even distribution on plate
if you have no antibodies to T. pallidum
fall to the bottom and little clumping
RPR +
Treponemal -
FTA or TPPA
False Positive Syphilis
RPR-
Treponemal +
Past syphilis
RPR +
Treponemal +
Syphilis now! (acute)
RPR-
Treponemal -
no syphilis ever
borrelia borgdorferi transmitted
via tick
seen in the midwest; summer
seen in higher concentration after a mild winter, because larvae not killed off in winter
most common arthropod disease in US
lyme disease
real name of lyme disease
borrelia borgdorferi
longer it takes to diagnose lyme disease
the more damage done to the host
-does not always have overt symptoms, so can go undetected for years
initial stage of lyme disease
-enlargement of lymph nodes near site of infection
-bull’s eye shaped ring near infection
-spirochetes active at skin lesions
name of characteristic bull’s eye shaped ring near the shape of infection
erythramigrenties
stage 2 of lyme disease
spirochetes now in the bloodstream
-if get into bone= joint pain
can be seen in spinal fluid
FLU-like symptoms
stage 3 of lyme disease - chronic
can happen years after infection
-see neurological symptoms
ex. dizziness, foggy brain, etc
diagnosis of lyme disease
hard to detect
1)product varying antibody response to lyme disease
IgM- best acute
IgG- can wan over years
2)a lot of tests are not always sensitive
people can be ____ ______ for long periods of time and be undiagnosed from lyme disease
sero negative
most accurate way to diagnose lyme disease
western blot
-more accurate and most useful 6-12 weeks after infection to confirm
another option for diagnosis lyme disease
PCR- not sensitive for blood and spinal fluid
recommended direct biopsy at site of lesion- but this means you need to have a lesion
name for relapsing fever
borrelia recurrentis
relapsing fever characteristics and transmission
can be seen light microscopy
transmitted via body lice - so poor sanitation areas
flu like symptoms
can get in blood stream and affect organs
why is it called relapsing fever
has period of wellness and then relapse if not treated
happens because undergo antigenic structure
symptoms get milder after this
diagnosis of relapsing fever
can see in blood: GOLD STANDARD
can be cultures on: modified Kelly’s medium
serologically
what disease if you contract you become a dead end host
leptosporosis
-no transmission to anyone
reservoirs for leptosporosis
rats
raccoons
beavers
cattle
foxes
how is Leptosporosis contracted
coming in contact with infected urine from infected animal
ex. swimming in waters or near infected soil
what state is Leptosporosis most seen
hawaii
biphasic illness general info
abrupt onset
symptoms
muscle aches
high fever
nausea
eye pain
go into asymptomatic or immune phase
what happens in biphasic illness immune phase
if you develop anitbodies= don’t need treatment
if you do not have an immune response– get very sick
how is biphasic illness diagnosis
serology
not seen in brightfield
what media does biphasic grow on
fletcher’s media
what organism causes rocky mountain spotted fever
rickettsia
how does rickettsia live
in arthropod– this is how we contract
can’t survive outside the host -intercellular
not a spirochete
how is rickettsia diagnosed
serology
how is Rickettsia transmitted
tick bite
isolated in rocky mountains
can jump cell to cell in human host and infect organs
physical signs of Rickettsia
rash
starts at ankle and wrists and migrates upward
can see on soles of hands
not seen on face
test for Rickettsia
weil-felix test
-depends on reaction with proteus vulgaris
-cross with subtypes
reaction seen with weil-felix test for Rickettsia
4+ OX-19
2+ OX-2
0- OX- K
how is Rickettsia treated
tetracycline
what organism causes Q fever/ query fever
Coxiella burnetti
agent of bioterriost
Coxiella burnetti
-rare and may never suspect
incubation period ranges from weeks to years
how to contract Coxiella burnetti
infected birthing products of animal
-seen in people who raise farm animals
-normal intestinal flora
aerosolized
how is Coxiella burnetti detected
serology
small obligate intercellular organism
NO CELL WALL
mycoplasma pneumoniae
mycoplasma pneumoniae also known as
walking pneumonia
-people don’t know they have it and can live normal life
-by the time diagnosed it is almost gone
mycoplasma pneumoniae can produce
cold agglutinates
produce IgM which will attach to I antigen on RBC
-mild form hemolytic anemia
how do we test for mycoplasma pneumoniae
indirectly for cold agg.
draw serum and keep warm until cells and serum separate
add O RBCs, put in cold
pull out and read for agg
why does mycoplasma pneumoniae serum need to be kept warm
if cold IgM antibodies will attach to RBC and won’t be able to find in the serum anymore
how titer will detect mycoplasma pneumoniae presence
1/64
to check put in incubator and see if reaction becomes negative
can also do indirect antibody florescent
treatment for mycoplasma pneumoniae
tetracycline
CAN’t use penicillin because acts on cell wall and this organism has no cell wall
seen in cases of newborns where nothing grows but pin point colonies
mycoplasma hominis
-can cause preterm delivery
another cause of infertility
mycoplasma genitalia
urea plasma characteristics
associated infertility
genital infection
urease enzyme
urea + on slant
chlamydia general
intercellular- obligate
cell wall
chlamydia infection
elementary body goes into the cell
-invade columnar epi cells
metabolic active body (reform in elementary body and get released by to cell to infect others)
infectious chlamydia
elementary body
metabolic active chlamydia
reticulate body
what chlamydia causes conjuctivitis
chlamydia trichomonas
-leads to blindness
eyelids turn inward and scratch the cornea and scar
NON STD
how to chlamydia trichomonas get transmitted
hands, clothing, flies
children will carry as normal flora in respiratory tract
cold contimating STD
positive for chlamydia and another STD
worlds most leading cause of preventable blindness
chlamydia trichomonas
most common cause of bacteria transmitted STD
sexually transmitted chlamydia
-breaks in gential area
STD chlamydia women
asymptomatic
cause endometriosis, ectopic preg
10% women become infertile after 1 episode
can be passed mother to baby during pregnancy
-put eye drops in once born
STD chlamydia men
symptomatic
painful discharge
lymphoma granuloma vinerium
chlamydia LGV
-sexual
-more serious in male
elephant titis in genitals
rectal fistulas
how is chlamydia diagnosed
PCR gold standard
1 specimen can test for chlamydia and neisseria
sensitive
yolk sac
ask maddie
passed from parrots to humans
chlamydia psittasci
-pneumonia like illness
associated with cat scratch fever
bartinella henselae
-can’t be grown in vitro
how is Bartinella Henselae transmitted
bite of flea
cause of fever of unknown origin in children
how to ID Bartinella Henselae
○ Patient history and symptoms, enlarged lymph nodes
○ Antibody testing - no one will have antibodies unless u actually have it
○ Take a scraping from enlarged lymph nodes and stain with Warthin starry stain
what stain used in Bartinella Henselae for lymph nodes
warthin starry stain
Bartinella Quintana
transmitted lice
cause of endocarditis, bacilli angiomatosis
black and blue marks
world war 1
what is bacilli angiomatosis
bacterial infection invades the vascular system
seen in AIDS patients
rat bite fever
sporellia minor
-more in ASIA
cause: sodoku
symptoms of sporellia minor
3 weeks after bitten
fever
rash at bite
headache
joint pain
will not grow on media
another cause of rat bite fever
Streptobacillus Moniliformis
-brainabscess : endocarditis
how to diagnose Streptobacillus Moniliformis
antibody titers
gram stain Streptobacillus Moniliformis
gram -
need carboyl fusion to counterstain
