- Borrelia burgdorferi - gram (-) spirochete

- Ixodes (deer) tick in spring and summer

- Rickettsia ricketsii - spread by Dermacentor variabilis/andersoni (dog/wood tick)

Spirochetes Flashcards by Allison Moen

What dz’s are caused by spirochetes?

Lyme
Rockey Mountain Spotted Fever (RMSF)
Syphilis

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What causes lyme?

Borrelia burgdorferi

- gram (-) spirochete

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How is lyme spread?

Ixodes (deer) tick in spring and summer

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What is the most common vector borne illness in US?

Lyme

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What are the stages of Lyme?

primary or localized
early disseminated
chronic

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What are the signs and symptoms of primary or localized lyme?

erythema migrans

- non specific viral syndrome sx (fatigue, myalgias, arthralgias, headache, fever, chills, & neck stiffness)

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Describe erythema migrans in association with lyme

expanding, warm annular erythematous rash

- central “bullseye”

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When is the onset of primary or localized lyme?

w/in 30 d of tick bite

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When does the erythema migrans occur in primary or localized lyme?

7-10d after tick bite

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What are the signs and symptoms of early disseminated lyme?

musculoskeletal and neurologic sx MC (arthralgias & bells palsy)
weeks to months after bite

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What are the signs and symptoms of chronic lyme?

persistent musculoskeletal and neurologic sx

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T/F: Lyme can present with heart block.

true

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What is the workup for lyme?

erythema migrans = you win the dx w/o testing
culture
two tier immunoglobulin testint
CSF

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What is the oral v. IV rx therpy for lyme?

oral: doxy in pts >8y/o, amoxicilin

- IV: ceftriaxone

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How long is oral tx for lyme?

14-21 d

- 28 d w/ arthritis

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T/F: There is no prophylaxis tx for lyme.

false

- doxy w/in 72 hrs of tick removal

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What causes RMSF?

Rickettsia ricketsii

- spread by Dermacentor variabilis/andersoni (dog/wood tick)

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What is the most common rickettsial infx?

RMSF

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What are the signs and symptoms of RMSF?

petechial rash that does not blanch beginning on the palms/soles
febrile
H/A
myalgias
encephalitis
bradycardia
arrhythmias
N/V
insomnia/ photophobia

What are the lab findings for RMSF?

leukopenia
thrombocytopenia
anemia + elevated BUN + abnormal LFTs

What are the tests for RMSF?

serology
blood culture
LP

What is the tx for RMSF?

everyone gets doxy

- chloramphenicol is 2nd line

What causes syphilis?

Treponema pallidum

What is “The Great Imposter/Intimidator”?

syphilis

How is syphilis transmitted?

- sexual contact - mother to fetus in utero - blood product transfusion - breaks in the skin

What is the pathophys of syphilis?

- penetrates intact mucous membranes or microscopic dermal abrasions

Describe primary syphils

- painless chancre at the site of transmission - punched-out base and rolled edges - highly infectious

Describe primary syphilis healing

- w/ or w/o tx, healing occurs w/in 3-12w w/considerable residual fibrosis

What are the stages of syphilis?

- primary - secondary - latent - tertiary

Describe primary syphilis healing

- w/ or w/o tx, healing occurs w/in 3-12w w/considerable residual fibrosis

What are the signs and symptoms of secondary syphilis?

- 4-10w s/p primary lesions appear - malaise, fever, myalgias, arthralgias, LAD - *maculopapular rash, palms/soles common, that blanches* - condylomata lata

What are condylomata lata?

- painless, highly infectious, grey-white lesions | - develop in warm, moist areas

What is latent syphilis?

- secondary syphilis sx have resolved but pt remains seroreactive

T/F: 2/3 of untreated latent syphilis pts go on to develop tertiary syphilis.

- false, 1/3

What are the types of tertiary syphilis?

- cardiovascular - neurosyphilis - gummatous

Describe gummatous syphilis

- gummas with center of necrotic tissue w/ rubbery texture; breakdown and form ulcers - liver, bone, & testes

Describe cardiovasular syphilis

- destruction of vasa vasorum --> aortic valve insufficiency

Describe neurosyphilis

- syphilitic meningitis - meningovascular - parenchymal (tabes dorsalis, general paresis) - Argyll-Roberston pupil

Describe Argyll-Roberston pupil

like a prostitute | - does not react but accomodates

What are the signs and symptoms of congenital syphilis?

- widespread condylomata lata and rash - saddle nose - saber chins - Cluttons joints - Hutchinson's teeth - mulberry molars - tabes dorsalis and general paresis

T/F: T. pallidum cannot survive outside host on drying surface or on exposure to disinfectants.

- true

What is the workup for syphilis?

- serologic testing | - notreponemal test must be followed with teponemal test

What is the treatment for syphilis?

- PCN

What is a risk of treating syphilis?

- procaine toxicity | - Jarish-Herxherimer reaction

Define Jarish-Herxherimer reaction

- dying treponemes release inlam response