Spirochetes Flashcards
What are spirochetes
- bacteria with long corkscrew shape
- difficult to culture
- usually used serology to Dx
Spirochetes to know
Leptospira (leptospirosis)
Borrelia (Lyme disease)
Treponema (Syphilis)
Leptospira interrogans
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
Leptospira interrogans Dx
- Usually from classic history/exam
- serology available
Leptospira interrogans treatment
Doxycycline or Azithromycin
Classic case of Leptospira interrogans
- Surfer or swimmer in tropics
- Flu-like illness
- Conjunctival suffusion
- Jaundice
Borrelia burgdorferi
- 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)
Lyme disease
- 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
How are spirochetes usually Dxed?
They are difficult to grow and culture so antibody tests are usually used for diagnosis
Spirochetes to know
- Leptospira
- Borrelia
- Treponema
What causes Leptospirosis?
Leptospira interrogans
What causes Lyme disease?
Borrelia burgdorferi
What causes Syphilis?
Treponema
Leptospirosis mechanism of transmission
- lives in rodents -> shed in urine
- usually get sick from swimming in contaminated water or lakes
Leptospirosis symptoms
flu-like illness
- fever
- Rigors
- Myalgias
- Headache
- Conjunctival suffusion
- Aseptic meningitis
- Rare complication is Weil’s Disease
- liver damage (jaundice)
- renal failure
- bleeding
Leptospirosis complications
Rare complication
Weil’s Disease
- Liver damage (jaundice)
- Renal failure
- Bleeding
Diagnosis of Leptospirosis
- Usually from classic history/exam
- Serology (antibody) tests
Treatment of Leptospirosis
- Doxycycline or Azithromycin
Classic history and exam of Leptospirosis
- Surfer or swimmer in the tropics
- Flu-like illness
- Conjunctival suffusion (very red eyes)
- Jaundice
Mechanism of Transmission of Lyme Disease
- 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***
Lyme Disease region
Common in Northeast US (Lyme, Connecticut)
Reservoir for Lyme Disease
Mice
Clinical presentation of Lyme Disease
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
Treatment of Lyme Disease
Doxycycline or Ceftriaxone
What causes Relapsing Fever?
- US
- Transmitted by Tick bites
- Borrelia hermsii
- Borrelia turicatae
- Transmitted by Tick bites
- Developing world
- Transmitted by louse (insect) can be spread from persont-to-person by the louse
- Borrelia recurrentis
- Transmitted by louse (insect) can be spread from persont-to-person by the louse
Relapsing Fever clinical presentation
- 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)
Treponema pallidum causes
Syphilis
Syphilis Mechanism of transmission
Sexually transmitted disease
Syphilis Diagnosis
- 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
Clinical features of Syphilis
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
- Rash
- 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)
- Gummas
Primary Syphilis
- 2-3 weeks post-exposure
- Painless chancre (ulcer)
- classically on the penis
- usually 1-2 cm
- Raised
- often unnoticed (painless) so 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
- many, many symptoms
- 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)
Maculopapular rashes that involve the palms and soles
- Syphilis
- Rocky Mountain Spotted Fever
- Coxsackie virus
What are Argyll Robertson pupil
- called the “Prostitute’s pupil”
- small pupils
- Constrict to accomodation
- Do NOT constrict to light
What is Tabes Dorsalis?
- Demyelination of posterior columns
- Wide-based gate
- Ataxia (falls, loss of balance)
Things that can cause false positives on Syphilis VDRL/RPR tests
- Mononucleosis
- Rheumatic fever
- SLE
- Leprosy
- Pregnancy
Syphilis Definitive diagnostic test
- ****FTA-ABS (“Treponemal Test”)****
- Fluorescent Treponemal antibody absorption
- VERY specific
- Test results: Reactive or Non-reactive
Congenital Syphilis mechanism of transmission
- Spirochete transmitted from mother to fetus
- Can occur in the 1st trimester
- mothers are screened early in pregnancy
Risk factors for Congenital syphilis
Most often in mothers who don’t receive pre-natal care
When does Congenital syphilis appear on baby
- Findings on the baby can be early or late
- Early (<2 years)
- Late (>2 years)
Early findings of Congenital syphilis
- 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
Late findings of Congenital syphilis
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)
Syphilis treatment
- Penicillin G
- common adverse effect: Jarisch-Herxheimer reaction
Jarisch-Herxheimer reaction
adverse drug reaction
- Flu-like syndrome after starting antibiotics
- killed bacteria cause immune response
- Self-limited
