Spirochetes Flashcards
1
Q
What are spirochetes
A
- bacteria with long corkscrew shape
- difficult to culture
- usually used serology to Dx
2
Q
Spirochetes to know
A
Leptospira (leptospirosis)
Borrelia (Lyme disease)
Treponema (Syphilis)
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
4
Q
Leptospira interrogans Dx
A
- Usually from classic history/exam
- serology available
5
Q
Leptospira interrogans treatment
A
Doxycycline or Azithromycin
6
Q
Classic case of Leptospira interrogans
A
- Surfer or swimmer in tropics
- Flu-like illness
- Conjunctival suffusion
- Jaundice
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)
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
9
Q
How are spirochetes usually Dxed?
A
They are difficult to grow and culture so antibody tests are usually used for diagnosis
10
Q
Spirochetes to know
A
- Leptospira
- Borrelia
- Treponema
11
Q
What causes Leptospirosis?
A
Leptospira interrogans
12
Q
What causes Lyme disease?
A
Borrelia burgdorferi
13
Q
What causes Syphilis?
A
Treponema
14
Q
Leptospirosis mechanism of transmission
A
- lives in rodents -> shed in urine
- usually get sick from swimming in contaminated water or lakes
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
16
Q
Leptospirosis complications
A
Rare complication
Weil’s Disease
- Liver damage (jaundice)
- Renal failure
- Bleeding
17
Q
Diagnosis of Leptospirosis
A
- Usually from classic history/exam
- Serology (antibody) tests
18
Q
Treatment of Leptospirosis
A
- Doxycycline or Azithromycin
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
What causes Relapsing Fever?
* 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
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)
27
Treponema pallidum causes
Syphilis
28
Syphilis Mechanism of transmission
Sexually transmitted disease
29
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
30
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
* 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
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
32
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
33
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
* 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
Maculopapular rashes that involve the palms and soles
* Syphilis
* Rocky Mountain Spotted Fever
* Coxsackie virus
35
What are Argyll Robertson pupil
* called the "Prostitute's pupil"
* small pupils
* Constrict to accomodation
* Do NOT constrict to light
36
What is Tabes Dorsalis?
* Demyelination of posterior columns
* Wide-based gate
* Ataxia (falls, loss of balance)
37
Things that can cause false positives on Syphilis VDRL/RPR tests
* Mononucleosis
* Rheumatic fever
* SLE
* Leprosy
* Pregnancy
38
Syphilis Definitive diagnostic test
* \*\*\*\*FTA-ABS ("Treponemal Test")\*\*\*\*
* Fluorescent Treponemal antibody absorption
* **VERY specific**
* Test results: Reactive or Non-reactive
39
Congenital Syphilis mechanism of transmission
* Spirochete transmitted from mother to fetus
* Can occur in the 1st trimester
* mothers are screened early in pregnancy
40
Risk factors for Congenital syphilis
Most often in mothers who don't receive pre-natal care
41
When does Congenital syphilis appear on baby
* Findings on the baby can be early or late
* Early (\<2 years)
* Late (\>2 years)
42
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
43
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)
44
Syphilis treatment
* Penicillin G
* common adverse effect: Jarisch-Herxheimer reaction
45
Jarisch-Herxheimer reaction
adverse drug reaction
* Flu-like syndrome after starting antibiotics
* killed bacteria cause immune response
* Self-limited
