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Clinical Micro > Spirochetes > Flashcards

Spirochetes Flashcards

1
Q

What kind of morphology/motility do spirochetes have?

A
  1. Gram negative and anerobic
  2. Helically coiled body (spiral shaped)
  3. Motile - corkscrew movement
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2
Q

Where is the flagella located for spirochetes?

A

in the periplasm

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3
Q

Are all spirochetes pathogenic?

A

no

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4
Q

What are the 3 species/genera of spirochetes that cause human disease?

A
  1. Leptospira species
  2. Treponema pallidum (subspecies pallidum)
  3. Borrelia burgdorferi
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5
Q

What disease do leptospira cause?

A

Leptosporosis

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6
Q

What is an example of a pathogenic leptospira and a non-pathogenic one?

A

Pathogenic: L. interrogans

Non-pathogenic: L.biflexa

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7
Q

What is the natural habitat for Leptospira sp.?

A

stagnant fresh water

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8
Q

What growth conditions do Leptospira favour?

A

higher temperatures

- see it more in the summer months

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9
Q

What is the geographical/time distribution of Leptospirosis cases?

A

usually occur in tropical areas

outside of tropical areas, the distribution of cases is seasonal (usually)
- typically occurring in Aug-Sep

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10
Q

Leptospirosis is a zoonotic disease. What is the primary host? what are humans?

A

Primary host: rodents

Humans: accidental hosts

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11
Q

What other animals can be infected with Leptospirosis?

A

trick question! pretty much any animal, wild or domestic

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12
Q

How do humans become infected with Leptospirosis?

A

ingestion or contact with water/soil contaminated by animal urine
- through breaks in the skin or mucous membranes

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13
Q

Why is the diagnosis of leptospirosis often missed?

A

Because there can be a wide range of symptoms

  • flu like symptoms
  • can also mimic other diseases as it progresses
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14
Q

What 3 antibiotics can be used to treat leptospirosis?

A
  1. Aminoglycosides
  2. Doxycycline
  3. ß-lactams
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15
Q

What is the timeline of where the spirochetes can be found in the body for leptospirosis?

A
  1. First 7-10 days they can be found in the blood
    - leptospiremia
  2. After this they move to the kidneys and are found in the urine
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16
Q

Why is culture not really used to diagnose leptospirosis in the lab?

A

Because you need a very special media and it takes about 3 months to generate a positive/negative results

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17
Q

What is the go to lab method used to diagnose leptospirosis?

A

Serology - looking for IgM and IgG responses

Sometimes will also do PCR on blood or urine depending on the timing

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18
Q

In the treponema genus, how many are human pathogens?

A

4

19
Q

Which species of treponema causes syphilis?

A

T. pallidum subsp. pallidum

20
Q

What are the 4 stages of syphilis? what is a characteristic symptom of each?

A
  1. Primary - chancre and lymphadenopathy
  2. Secondary - rash
  3. Latent - asymptomatic
  4. Tertiary - cardiovascular, neurological issues or gumma
21
Q

What is the chancre like? is it infectious?

A

painless ulcer with sharp borders and clean base

contact leads to infection in >50% of cases

22
Q

What is the presentation of the rash like in syphilis? What is distinctive?

A

Can present variably - diffuse, maculopapular, pustular

23
Q

What is the lab-diagnosis definition of latent syphilis?

A

having serological proof of infection without symptoms of disease

24
Q

What is the differentiation between early and late latent syphilis?

A
  1. Early latent: less than a year after secondary syphilis

2. Late latent: greater than 1 year after secondary syphilis

25
Q

What are the 3 potential presentations of tertiary syphilis?

A
  1. Gummatous syphilis
    - soft, tumour-like balls of inflammation in the skin, bone liver etc.
  2. Neurosyphilis
  3. Cardiovascular syphilis
26
Q

What are the 2 days that syphilis can be transmitted?

A
  1. Sexual contact

2. Vertical transmission

27
Q

Vertical transmission of syphilis often results in?

A

miscarriage and stillbirth

28
Q

What are some early vs. late symptoms of congenital syphilis?

A

Early: kind of looks like an RTI at birth
- rash, fever, pneumonitis, hepatosplenomegaly

Late: if untreated
- saddle nose, clutton’s joints, saber shin, hutchinson teeth

29
Q

What is the treatment for syphilis?

A

IM or IV penicillin

  • not the typical kind
  • Benzathine (IM)
  • PenG (IV)
30
Q

When is IV PenG given?

A

for neurosyphilis

31
Q

What can be given as an alternate drug treatment for syphilis if the patient is allergic to penicillin?

A

Doxycycline

32
Q

Can you culture syphilis?

A

Not on artificial media

Used to use a rabbit infectivity test (RIT)

33
Q

What is the main diagnostic tool used for syphilis?

A

serology

34
Q

What are the two types of serological tests used for syphilis?

A

non-treponemal and treponemal

35
Q

What is another name for non-treponemal tests?

A

flocculation test

36
Q

How do non-treponemal tests work? what type of test are they

A

Agglutination type test

  1. Treponemes induce damage to host cell
  2. Body then produces anti-cardiolipin antibodies
  3. These interact with lecithin-cholesterol-cardiolipin
37
Q

What are 2 examples of non-treponemal tests?

A
  1. Rapid Plasma Reagin (RPR)

2. Venereal Disease Research Lab test (VDRL)

38
Q

What are the disadvantages of non-treponemal tests?

A
  1. Insensitive early and late in disease
  2. False positive reactions can occur so you always need to do a confirmatory test
    - ex: in an area with other endemic treponemes, endocarditis, pregnant…
39
Q

Non-treponemal rests are the most sensitive at detecting which stage of syphilis?

A

secondary stage

40
Q

What are 2 advantages to non-treponemal serological testing?

A
  1. Rapid, inexpensive, and easy to perform
    - qualitative
  2. Quantitative in that it can be used to measure response to therapy
41
Q

What are treponemal tests measuring?

A

Measure antibody directed against T. pallidum antigens

42
Q

What are 4 examples of treponemal tests? Which one would you use first?

A
  1. EIA
    - would probably use this first because of IgM capture but you can get false positives
  2. Fluorescent treponemal antibody absorbed (FTA-ABS)
  3. T.pallidum particle agglutination (TPPA)
  4. Recombination immunoblot
43
Q

What are some disadvantaged to treponemal testing?

A
  1. People are reactive for life, even after treatment
    - can’t use it to monitor treatment
  2. False positives can still occur
  3. False negatives can also occur
44
Q

What is the current testing algorithm for syphilis?

A
  1. Do an EIA IgM screening (treponemal test)
    - if negative = no syphilis
  2. If EIA +, do a second treponemal test (TPPA)
    - if this one was negative it indicates:
  3. had it but have been treated successfully
  4. early of late latent stage
  5. False positive EIA
    - would then do an immunoblot/FTA-ABS
  6. If + for both the EIA and the TPPA, move on to doing a non-treponemal RPR titre test

Clinical Micro (28 decks)

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