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Infectious Disease > Spirochetes > Flashcards

Spirochetes Flashcards

1
Q

What are spirochetes

A
  • bacteria with long corkscrew shape
  • difficult to culture
  • usually used serology to Dx
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2
Q

Spirochetes to know

A

Leptospira (leptospirosis)

Borrelia (Lyme disease)

Treponema (Syphilis)

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3
Q

Leptospira interrogans

A

mouse peeing in a lake where people swim

  • Causes leptospirosis
  • lives in rodents -> shed in urine
  • illness commonly from contaminated water
  • Diseases range from asymptomatic->severe
  • Flu-like illness: fever, rigors, myalgias, headache
  • Conjunctival suffusion (red eyes)
  • Aseptic meningitis
  • Weil’s disease (rare complication)
    • liver damage (jaundice), renal failure and bleeding
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4
Q

Leptospira interrogans Dx

A
  • Usually from classic history/exam
  • serology available
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5
Q

Leptospira interrogans treatment

A

Doxycycline or Azithromycin

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6
Q

Classic case of Leptospira interrogans

A
  • Surfer or swimmer in tropics
  • Flu-like illness
  • Conjunctival suffusion
  • Jaundice
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7
Q

Borrelia burgdorferi

A
  • causes Lyme disease
  • Cause by tick bite (Ixodes scapularis)
    • tick larvae feed on mice (reservoir for Borrelia)
    • Infected adult ticks feed on deer
  • Ticks can bite humans -> infection with Borrelia
  • Tick must be attached ~48 hours to transmit bacteria
  • Common in Northeast US (Lyme, Connecticut)
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8
Q

Lyme disease

A
  • Caused by Borrelia burgdorferi
  • Caused by tick bite (Ixodes scapularis)
  • Stage 1: Erythema chronicum migrans
    • classic finding: expanding “bulls-eye” rash
    • Flu-like symptoms
  • Stage 2: Neurologic and cardiac
    • facial nerve palsy
    • AV block
  • Stage 3:
    • Arthritis (often knees)
    • Neuropathy (pain, paresthesias)
    • Encephalopathy (mild cognitive disturbance)
    • Rash
      • blue-red discoloration
      • Acrodermatitis chronica Atrophicans
        • more common in European Lyme
  • Treatment
    • Doxycycline or ceftriaxone
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9
Q

How are spirochetes usually Dxed?

A

They are difficult to grow and culture so antibody tests are usually used for diagnosis

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10
Q

Spirochetes to know

A
  • Leptospira
  • Borrelia
  • Treponema
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11
Q

What causes Leptospirosis?

A

Leptospira interrogans

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12
Q

What causes Lyme disease?

A

Borrelia burgdorferi

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13
Q

What causes Syphilis?

A

Treponema

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14
Q

Leptospirosis mechanism of transmission

A
  • lives in rodents -> shed in urine
  • usually get sick from swimming in contaminated water or lakes
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15
Q

Leptospirosis symptoms

A

flu-like illness

  • fever
  • Rigors
  • Myalgias
  • Headache
  • Conjunctival suffusion
  • Aseptic meningitis
  • Rare complication is Weil’s Disease
    • liver damage (jaundice)
    • renal failure
    • bleeding
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16
Q

Leptospirosis complications

A

Rare complication

Weil’s Disease

  • Liver damage (jaundice)
  • Renal failure
  • Bleeding
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17
Q

Diagnosis of Leptospirosis

A
  • Usually from classic history/exam
  • Serology (antibody) tests
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18
Q

Treatment of Leptospirosis

A
  • Doxycycline or Azithromycin
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19
Q

Classic history and exam of Leptospirosis

A
  • Surfer or swimmer in the tropics
  • Flu-like illness
  • Conjunctival suffusion (very red eyes)
  • Jaundice
20
Q

Mechanism of Transmission of Lyme Disease

A
  • Caused by tick bite (Ixodes scapularis)
    • Tick larvae feed on mice (reservoir for Borrelia)
    • Infected adult ticks feed on deer
    • Ticks can then bite humans -> infection with Borrelia
  • ***Ticks must be attached ~48 hours to transmit the bacteria***
21
Q

Lyme Disease region

A

Common in Northeast US (Lyme, Connecticut)

22
Q

Reservoir for Lyme Disease

A

Mice

23
Q

Clinical presentation of Lyme Disease

A

Lyme Disease has 3 stages

  • Stage 1: Erythema chronicum migrans
    • Classic finding: expanding “bulls-eye” rash
    • Flu-like symptoms
  • Stage 2: Neurologic and cardiac
    • Facial nerve palsy (1/2 of face)
    • AV block
  • Stage 3:
    • Arthritis (often knees)
    • Neuropathy (pain, paresthesias)
    • Encephalopathy (mild cognitive disturbance)
    • Rash: Blue-red discoloration
      • Acrodermatitis Chronica Atrophicans
      • More common in European Lyme
24
Q

Treatment of Lyme Disease

A

Doxycycline or Ceftriaxone

25
Q

What causes Relapsing Fever?

A
  • US
    • Transmitted by Tick bites
      • Borrelia hermsii
      • Borrelia turicatae
  • Developing world
    • Transmitted by louse (insect) can be spread from persont-to-person by the louse
      • Borrelia recurrentis
26
Q

Relapsing Fever clinical presentation

A
  • Relapsing fever (caused by antigenic variation (spirochetes change the major antigens on the surface evading the immune response)
    • growth occurs and fever returns then the immune system manages to contain the spirochete until antigenic variation occurs once again allowing growth and fever)
27
Q

Treponema pallidum causes

A

Syphilis

28
Q

Syphilis Mechanism of transmission

A

Sexually transmitted disease

29
Q

Syphilis Diagnosis

A
  • Take a swab of chancre or condyloma and
    • Can see spirochete by dark field microscopy
  • VDRL
    • Venereal disease Research Laboratory
    • “Non-treponemal” test
    • Serum reacted with cardiolipin antigen (non-specific)
  • RPR
    • Rapid Plasma reagin
  • Syphilis patient’s serum (antibodies) will react
    • Positive VDRL/RPR (does not necessarily mean they have syphilis and need to follow-up with a more specific test)
  • For neurosyphilis need to test CSF
    • Positive serum does not necessarily indicate CNS disease
    • Many false negatives - difficult diagnosis
  • ****FTA-ABS (“Treponemal Test”)****
    • Fluorescent Treponemal antibody absorption
    • VERY specific
    • Test results: Reactive or Non-reactive
30
Q

Clinical features of Syphilis

A

Disease has 1o, 2o and 3o stages

  • Primary Syphilis
    • occurs 2-3 weeks post-exposure
    • Painless chancre (ulcer)
      • classically on the penis
      • usually 1-2 cm diameter
      • Raised
    • often goes unnoticed (painless) -> disease progresses
  • Secondary syphilis
    • Rash
      • maculopapular rash covering all extremities including the palms and soles
    • Flu-like symptoms
      • Fever
      • headache
      • malaise
      • sore-throat
      • myalgias
    • Condyloma lata
      • Large, raised, gray-to-white lesions
      • Moist areas: perineum
      • Often close to chancre; may reflect direct spread
    • Treponema pallidum is present in condyloma and chancre
      • can visualize with dark-field microscopy
  • Tertiary Syphilis
    • Gummas
      • form of granuloma that are mass lesions that can appear anywhere: skin, (liver) and are often mistake for tumors
    • Aortitis
      • Vasa vasorum inflammation
      • risk of aortic dissection
    • Neurosyphilis
      • many, many symptoms
      • Meningitis
      • dementia
      • nerve palsies
    • Argyll Robertson pupil
      • called the “Prostitute’s pupil”
      • small pupils
      • Constrict to accomodation
      • Do NOT constrict to light
    • Tabes Dorsalis
      • Demyelination of posterior columns
      • Wide-based gate
      • Ataxia (falls, loss of balance)
31
Q

Primary Syphilis

A
  • 2-3 weeks post-exposure
  • Painless chancre (ulcer)
    • classically on the penis
    • usually 1-2 cm
    • Raised
  • often unnoticed (painless) so disease progresses
32
Q

Secondary Syphilis

A
  • Rash
    • maculopapular rash covering all extremities including the palms and soles
  • Flu-like symptoms
    • Fever
    • headache
    • malaise
    • sore-throat
    • myalgias
  • Condyloma lata
    • Large, raised, gray-to-white lesions
    • Moist areas: perineum
    • Often close to chancre; may reflect direct spread
  • Treponema pallidum is present in condyloma and chancre
    • can visualize with dark-field microscopy
33
Q

Tertiary Syphilis

A
  • Gummas
    • form of granuloma that are mass lesions that can appear anywhere: skin, (liver) and are often mistake for tumors
  • Aortitis
    • Vasa vasorum inflammation
    • risk of aortic dissection
  • Neurosyphilis
    • many, many symptoms
      • Meningitis
      • dementia
      • nerve palsies
  • Argyll Robertson pupil
    • Prostitute’s pupil
    • small pupils
    • Constrict to accomodation
    • Do NOT constrict to light
  • Tabes Dorsalis
    • Demyelination of posterior columns
    • Wide-based gate
    • Ataxia (falls, loss of balance)
34
Q

Maculopapular rashes that involve the palms and soles

A
  • Syphilis
  • Rocky Mountain Spotted Fever
  • Coxsackie virus
35
Q

What are Argyll Robertson pupil

A
  • called the “Prostitute’s pupil”
  • small pupils
  • Constrict to accomodation
  • Do NOT constrict to light
36
Q

What is Tabes Dorsalis?

A
  • Demyelination of posterior columns
  • Wide-based gate
  • Ataxia (falls, loss of balance)
37
Q

Things that can cause false positives on Syphilis VDRL/RPR tests

A
  • Mononucleosis
  • Rheumatic fever
  • SLE
  • Leprosy
  • Pregnancy
38
Q

Syphilis Definitive diagnostic test

A
  • ****FTA-ABS (“Treponemal Test”)****
    • Fluorescent Treponemal antibody absorption
    • VERY specific
    • Test results: Reactive or Non-reactive
39
Q

Congenital Syphilis mechanism of transmission

A
  • Spirochete transmitted from mother to fetus
  • Can occur in the 1st trimester
    • mothers are screened early in pregnancy
40
Q

Risk factors for Congenital syphilis

A

Most often in mothers who don’t receive pre-natal care

41
Q

When does Congenital syphilis appear on baby

A
  • Findings on the baby can be early or late
  • Early (<2 years)
  • Late (>2 years)
42
Q

Early findings of Congenital syphilis

A
  • Hepatomegaly
  • Runny nose
  • Maculopapular rash
    • Small, red or pink spots
    • Often on back, buttocks, posterior thighs and soles
  • abnormal long-bone radiographs
    • many, many abnormalities reported
43
Q

Late findings of Congenital syphilis

A

Llifelong disfigurement

  • Ears/nose
    • Saddle nose (no nasal bridge)
    • Hearing loss/deafness
  • Teeth
    • Hutchinson teeth (notched, peg shaped)
    • Mulberry molars (maldevelopment of the molars)
  • Legs
    • Saber shins (bowed legs)
44
Q

Syphilis treatment

A
  • Penicillin G
    • common adverse effect: Jarisch-Herxheimer reaction
45
Q

Jarisch-Herxheimer reaction

A

adverse drug reaction

  • Flu-like syndrome after starting antibiotics
  • killed bacteria cause immune response
  • Self-limited

Infectious Disease (82 decks)

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