Spirochetes Flashcards
What are the spirochetes we care about?
Treponema, Borrelia, and Leptospira interrogans.
Where is leptospira interrogans found?
In water contaminated with animal urine
How is the presentation of leptospirosis?
Flu-like sx, calf myalgias, jaundice, photophobia with “conjunctival suffusion” –> erythema without exudate.
Where is leptospira endemic?
In the tropics and among surfers (ie Hawaii)
What is weil disease?
Icterohemorrhagic leptospirosis: severe form w/ jaundice and azotemia from liver and kidney dysfunction, fever, hemorrhage and anemia.
What is the natural reservoir of Borrelia burgdorferi?
The mouse.
What is the vector of borrelia burgdorferi?
Ixodes deer tick.
Where is Borrelia burgdorferi endemic?
Northeastern US.
What are the initial sx of lyme disease?
erythema migrans (target rash), flu-like sx, +/- facial nerve palsy (typically bilateral)
What are later sx of lyme disease?
Monoarthritis of large joints, migratory polyarthritis, AV nodal block (3rd degree), neurologic sx (meningitis, polyneuropathy, facial nerve palsy).
What is the treatment for lyme disease?
Doxy/ceftriaxone.
What is the presentation of primary syphilis? When does it present?
Painless chancre. – 3-6 weeks after contact
How is treponema pallidum visualized?
Darkfield microscopy.
What is the VDRL test?
Detects non-specific antibody that reacts with beef cardiolipin.
What can cause VDRL false positive?
Viral infxn (mono, hepatitis)
Drugs
Rheumatic Fever
Lupus!!! and Leprosy!!
What is the presentation of secondary syphilis? When does it present?
~6 weeks after resolution of chancre.
Disseminated dz with constitutional sx, maculopapular rash involving palms and soles, condyloma LATA.
What are condyloma lata?
Smooth, moist, painless wart-like white lesions on genitals.
How can syphilis be detected?
VDRL (non-specific), confirm w/ FTA-ABS (specific).
What follows secondary syphilis?
Latent phase. 2/3 of patients will be latent & asx forever.
1/3 will progress to tertiary.
What is the presentation of tertiary syphilis? When does it occur?
- Neurosyphilis (tabes dorsalis, general paresis
- Gummas (chronic granulomas)
- Aortitis due to vasa vasorum destruction
- Argyll Robertson pupil
What is the Argyll Robertson’s pupil?
Constricts w/ accomodation but no reaction to light. “prostitutes pupil”.
What tests can be done for neurosyphilis?
test CSF for VDRL and PCR.
What are some telltale signs of tertiary syph?
Neurological: Broad-based ataxia, + romberg
MSK: Charcot joint
CV: Stroke w/out hypertension
What is the presentation of congenital syphilis?
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.
What is the treatment for syphilis?
Penicillin G.
What is the Jarisch-Herxheimer reaction?
Flu-syndrome following abx for syphillis - due to killed bacteria releasing endotoxins.
