syphillis and lyme Flashcards
spirochetes
thin + helical, gram-negative, cork screw motility
organism causing syphillis
treponema pallidum
primary syphilis
chancre at site of inoculation (genitals, mouth, eyes) + painless lymphadenopathy
lasts 1-6 weeks
secondary syphillis
generalized rash (red, not itchy, entire body - starts at trunk and spreads)
highly infectious
Condyloma lata (look like genital warts)
Can have flu-like symptoms
latent syphilis
asymptomatic, + test
early: <1 year
later: >1 year
tertiary syphilis
diffuse chronic inflammatory state
tertiary cardiovascular syphilis
endarteritis obliterans (vaso vasorum) –> ascending aortic aneurysm
tertiary syphilis - gumma
granulomatous lesions filled with immune cells + necrotic center
can affect bone, mouth, liver, etc
leads to organ damage, hepatitis, fractures
neurosyphilis
can spread via blood to brain
meningitis, cranial nerve palsy, meningovascular –> stroke
dark field microscopy
can take exudate from lesion and view under microscope
need motile spirochetes
can get false positive from oral lesions
non-treponemal serology
VDRL: venereal disease research lab (CSF)
RPR: rapid plasma reagin (blood)
non-specific antibodies to cardiolipin
treponemal serology
specific antibody tests against treponemal cellular components
Fluorescent treponemal antibody absorption (FTA-ABS)
Micro hemaggluutination test for antibodies to T. pallidum (MHA-TP)
T. pallidum particle agglutination assay (TPPA)
T. pallidum enzyme immunoassay (TP-EIA)
Chemiluminescence immunoassay (CIA)
false positive w/non-treponemal
viral infection, rheumatoid arthritis, SLE, pregnancy, malaria, leprosy, TB, HIV, etc
false positive w/ treponemal
autoimmune disease, IVDA, fever, age, lyme, endemics syphilis, leprosy
congenital syphillis
based via placenta or vagina
can cause fetal death
if born, “snuffles” -rhinorrhea, widespread desquamating rash, bone destruction, CVD, organ damage, deafness, saddle nose
organism causing lyme
borrelia burgdorferi - Ixodes scapularis (blacklegged tick)
rash caused with lyme
erythema migrans (bullseye)–> starts around lesion and spreads outward
8-10 days post bite, >5cm
can be associated with fatigue, malaise, headache, fever, chills, myalgias
lyme associated arthritis
starts as migratory arthralgia - can progress to lyme arthritis
spreads from one joint to another
lyme carditis
risk of arrhythmias (AV block) and myocarditis
adam-stokes syndrome (lose consciousness due to heart block)
neurologic symptoms with lyme
cranial nerve disorders: facial nerve palsy, paresthesia, paresis
Polyneuropathy
Meningitis due to benign intracranial HTN
Encephalomyelitis (appears like MS - later stage), encephalopathy
make a weird FACE when eating a LIME
F: facial nerve palsy
A: arthritis
C: carditis
E: erythema migrans
i think a patient has lyme, how do I diagnose?
enzyme immunoassay (EIA) + immunofluroesence assay
or ELISA
if positive, confirm with IgG +/- IgM
i do have lyme, treat me
localized: doxy is first line, amoxicillin, cefuroxime
disseminated: ceftriaxone
