spriochetes and zoonotic bacteria

Question 1

Leptospiral interrogans

Answer 1

spirochete w/ ? shape at end of tail
water contaminated w/ animal urine

enter via mucous membranes, conjunctivae, breaks in skin

abrupt onset fever, chills, body aches headache

hyponatremia, renal failure, liver damage w/ jaundice
aseptic meningitis
pulmonary hemorrhage

Subclinical –> death
-severe = Weil’s disease

Dx: serology - Ab

Tx: PCN, cetriaxone, doxycycline

Question 2

Borrelia burgdorferi

Answer 2

Lyme Dz

spirochete
Ixodes tick - ixodes scapularis

Stage 1: early localized dz
erythema migrans (EM) after several dyas, up to 2 weeks after tick bite
-expands outwards w/ central clearing - target or bulls eye
-fever, HA, body aches, fatigue

Stage2: early disseminated dz

• weeks to months after
• blood borne spread
• multiple EM lesions
• cardiac - AV block - 1st –> 3rd, regress too
• myopericarditis
• Neuro: CN palsies - **B/L CN VII
• peripheral neuropathy, lymphocytic meningitis

Stage 3: late - months to years after bite
arthritis - intermittent, large joints - knees
Neuro findings

Tx: early 1-2: doxycycline 10-21 days
Kids under 8 amoxicillin

late: doxycycline, ceftriaxone 28 days

Question 3

Treponema pallidum diagnostics and treatment

Answer 3

non-treponemal test - screen

• VDRL
• RPR
• against cardiolipin antigen, not specific

Treponemal test - confirm
Dark field microscopy

Tx: PCN G IV or Doxycycline if true PCN allergy

Question 4

Primary syphilis

Answer 4

local infection at site of inoculation

painless, solitary ulcer - chancre

Question 5

Secondary syphilis

Answer 5

disseminated infection
fever, malaise
**maculopapular rash of palms and soles
Condyloma lata: large white raised lesions in moist areas and mucous membranes

Question 6

Early latent and late latent syphilis

Answer 6

Early: asx infection acquired less than 12 mo ago

late: asx infection acquired more than 12 mo ago

Question 7

Tertiary syphilis

Answer 7

late complications

Gummas: granulomatous lesions - skin, bones, internal organs

cardiac - ascending thoracic aorta
–> inflammation of intima –> aortic dilation and insufficiency

Question 8

Neurosyphilis

Answer 8

Chronic meningitis

general paresis - dementing illness

Tabes dorsalis - dorsal root/columns –> sensory ataxia, lancinating pain, loss of proprioception/vibratory sense in legs –> charcot joint d/t repeated trauma

Argyll Robinson pupil: unreactive to direct light, accommodates

Question 9

Bartonella henselae

Answer 9

Cat scratch fever
cat scratch or bite –> LAD proximal to inoculation site
self limited
tx: azythromycin

Bacillary angiomatosis

• small vascular lesions in immunocompromised
• confused with kaposi sarcoma in AIDS pts

Question 10

Borrelia recurrentis

Answer 10

recurrent fever

ticks, lice of rodent

Question 11

Brucella sp.

Answer 11

Brucellosis: acute febrile
infected cattle, sheep, goat body fluid contact
unpasteurized dairy

Question 12

Chlamydophila psittaci

Answer 12

psittacosis - fever, dry cough

birds, parrots*

Question 13

Ehrlichia chaffeensis

Answer 13

Ehrlichiosis - HA, muscle aches, fatigue

lone star tick - white tail deer

Question 14

Francisella tularensis

Answer 14

tularemia - rabbit, squirrel, or tick vector

bioterrorism risk

Question 15

Mycobacterium leprae

Answer 15

leprosy

nine banded armadillo

Question 16

Pasturella multocida

Answer 16

cat or dog bite –> cellulitis, osteomyelitis

Question 17

Rickettsia prowazekii

Answer 17

epidemic typhus
lice

“I sounds” - prowazekII, epIdemic, tYphus, LIce

Question 18

Rickettsia typhi

Answer 18

“e sounds”

endemic (murine) typhus, flEas

Question 19

Rickettsia rickettsii

Answer 19

Rocky mountain spotted fever

Tick borne
can be fatal

fever, HA, rash on palms and soles

Question 20

Yersinia pestis

Answer 20

bubonic plague
inflammed and painful LN - bubos

fleas - prairie dogs