Spirochetes

Question 1

What are the spirochetes we care about?

Answer 1

Treponema, Borrelia, and Leptospira interrogans.

Question 2

Where is leptospira interrogans found?

Answer 2

In water contaminated with animal urine

Question 3

How is the presentation of leptospirosis?

Answer 3

Flu-like sx, calf myalgias, jaundice, photophobia with “conjunctival suffusion” –> erythema without exudate.

Question 4

Where is leptospira endemic?

Answer 4

In the tropics and among surfers (ie Hawaii)

Question 5

What is weil disease?

Answer 5

Icterohemorrhagic leptospirosis: severe form w/ jaundice and azotemia from liver and kidney dysfunction, fever, hemorrhage and anemia.

Question 6

What is the natural reservoir of Borrelia burgdorferi?

Answer 6

The mouse.

Question 7

What is the vector of borrelia burgdorferi?

Answer 7

Ixodes deer tick.

Question 8

Where is Borrelia burgdorferi endemic?

Answer 8

Northeastern US.

Question 9

What are the initial sx of lyme disease?

Answer 9

erythema migrans (target rash), flu-like sx, +/- facial nerve palsy (typically bilateral)

Question 10

What are later sx of lyme disease?

Answer 10

Monoarthritis of large joints, migratory polyarthritis, AV nodal block (3rd degree), neurologic sx (meningitis, polyneuropathy, facial nerve palsy).

Question 11

What is the treatment for lyme disease?

Answer 11

Doxy/ceftriaxone.

Question 12

What is the presentation of primary syphilis? When does it present?

Answer 12

Painless chancre. – 3-6 weeks after contact

Question 13

How is treponema pallidum visualized?

Answer 13

Darkfield microscopy.

Question 14

What is the VDRL test?

Answer 14

Detects non-specific antibody that reacts with beef cardiolipin.

Question 15

What can cause VDRL false positive?

Answer 15

Viral infxn (mono, hepatitis)
Drugs
Rheumatic Fever
Lupus!!! and Leprosy!!

Question 16

What is the presentation of secondary syphilis? When does it present?

Answer 16

~6 weeks after resolution of chancre.

Disseminated dz with constitutional sx, maculopapular rash involving palms and soles, condyloma LATA.

Question 17

What are condyloma lata?

Answer 17

Smooth, moist, painless wart-like white lesions on genitals.

Question 18

How can syphilis be detected?

Answer 18

VDRL (non-specific), confirm w/ FTA-ABS (specific).

Question 19

What follows secondary syphilis?

Answer 19

Latent phase. 2/3 of patients will be latent & asx forever.

1/3 will progress to tertiary.

Question 20

What is the presentation of tertiary syphilis? When does it occur?

Answer 20

• Neurosyphilis (tabes dorsalis, general paresis
• Gummas (chronic granulomas)
• Aortitis due to vasa vasorum destruction
• Argyll Robertson pupil

Question 21

What is the Argyll Robertson’s pupil?

Answer 21

Constricts w/ accomodation but no reaction to light. “prostitutes pupil”.

Question 22

What tests can be done for neurosyphilis?

Answer 22

test CSF for VDRL and PCR.

Question 23

What are some telltale signs of tertiary syph?

Answer 23

Neurological: Broad-based ataxia, + romberg
MSK: Charcot joint
CV: Stroke w/out hypertension

Question 24

What is the presentation of congenital syphilis?

Answer 24

Facial abnormalities:
Rhagades (linear scars at angle of mouth)
Snuffles (nasal discharge)
Saddle nose
Notched hutchinson teeth
Mulberry molars
Short maxilla
Saber shins, CN VIII deafness.

Question 25

What is the treatment for syphilis?

Answer 25

Penicillin G.

Question 26

What is the Jarisch-Herxheimer reaction?

Answer 26

Flu-syndrome following abx for syphillis - due to killed bacteria releasing endotoxins.