Anda di halaman 1dari 2

Spirochetes

-Long, thin flexible w/ characteristic spirals


-Possess cytoplasmic & outer membranes
-Thin peptidoglycan wall
-Motile
**periplasmic flagella**: attached at ends of bacteria, wrap around cell body, e& end near middle of bug
--> rotation of periplasmic flagella --> typical cork-screw motility of spirochetes (involv. in disseminiation throughout body)

Treponema pallidum pallidum

Other Treponema:

Borrelia recurrentis & hermsii

Borellia burgdorferi

Leptospira interrogans

Shape

Helical bacillus (very long and thin, too thin to see)

Helical bacillus (visible)

Helical bacillus

Helical bacillus

Aerobicity

Microaerophilic

Microaerophilic

Microaerophilic

Aerobe

-visible by light microscopy w/ aniline dyes


-seen in blood smear

Characteristics

Optimal temp 30C

Variable Major Protein:


--> antigenic variants cause cycles/relapses
--> each bacterium has ~30 genes for VMP (major surface
protein)
--> Each VMP gene diff, so Ab directed vs. one VMP won't kill
bacteria expressing another VMP
Virulence Factors

Expression Plasmid (EP)


--> contains expression site of VMP, w/ single VMP gene
Storage Plasmid (SP):
--> contains library of ~30 unexpressed VMP genes, which can
be switched into EP expression site --> cause Ag variation

Pathophys

Reservoir

Coming into contact with urine or water


contaminated by urine of infected animals

T. pallidum (pallidum): syphilis


T. pallidum (pertunue): yaws
T. pallidum (endemicum): endemic syphilis
Trepnoma carateum: pinta

-High bacteremia

**Obligate parasite of humans**

-Transmission: arthropods (ticks & lice)

-Transmission: small, hard-bodied ticks

Non-pathogens found in oral cavity & perianal

From rodents to humans via ticks (hermsii)


Human to Human via lice (recurrentis)

To humans via ticks


--> DEER req. for adult tick phase

-Transmission: mucuous embranes or breaks in


skin
Rodents, Dogs, Cattle, Swine

Transmission (syphilis): direct, sexual contact


Urine - may contaminate water

Primary Syphilis: **CHANCRE** (days to weeks) - local infection


--> Penetrates epidermis/mucous membrane & estab. local infection = chancre
--> chancre = round, painless lesion 1-2 cm in diameter, often ulcerated; contains large #s of bugs
--> spontaneously heals after ~1-5 weeks

T. pallidum endemicum
Endemic (nonvenereal) syphilis
Tropics of Africa & Asia
Spread by direct contact

Secondary Syphilis: **RASH** (weeks to months) - disseminated infection


--> ~6 weeks after chancre occurs
--> multiple skin lesions & lymphadenopathy w/ fatigue & malaise
--> may have involv. of internal organs (ex: meningovascular syphilis)
--> large #s of bugs in skin lesions
--> spontaneously heals after ~2-6 wks, but can recur

T. carateum:
Pinta
Contagious, non-venereal dz
Primitive Latin America
Chronic depigmenting skin lesions on distal extremities

Latent Syphilis: (asymptomatic)


--> (1/3 patients): persist for life w/no further complications
--> (1/3 patients): "spontaneous" biological cure: no signs of infection, loses serological reactivity
Diseases

Tertiary Syphilis "late": (Persistent infection with severe sequelae) (months to years later)
Gummatous:
--> granulomatous lesions w/ accumulations of lymphocytes & macrophages reacting to few # of bugs
--> immune response --> marked tissue destruction & pathology
--> can occur anywhere in body
Neurosyphilis:
--> long-term infection of CNS
--> paresis: infection of brain w/ psych effects
--> tabes dorsalis: infection of lower spinal column w/ loss of sensory & motor fcn in lower extremities
Cardiovascular syphilis:
--> esp aorta --> aortic aneurisms

T. pallidum pertenue
Yaws
Non-venereal, communicable dz in Africa & Asia
Nondestructive skin lesion, bad bone deformities

Relapsing fever:
Louse borne (B. recurrentis):
--> Epidemic human to human by lice
-->more severe & more relapses
--> severe damage to internal organs: liver necrosis, miliary
splenic abscesses, CNS hemorrhage, myocariditis, GIT & renal
lesions
Tick-borne (B. hermsii):
--> Endemic rodents primary host and is spread by ticks
Both Diseases:
-Cyclic dz w/ relapses d/t Ag variation of bugs
--> Each cycle rep. a new Ag variant w. diff. VMP
-Patient improves after 3-5 days, then undergoes RELAPSE
--> cycle repeat 2-5x

Stage 1: Local infection (days to weeks)


--> Erythema migrans = red rash with expanding margin
-->Fever, malaise, swollen nodes
--> lasts 3-4 wks
Stage 2: Disseminated infection (weeks to months)
--> Severe malaise, multiple skin lesions, myalgia/ arthralgia,
lymphadenopathy
--> Neurologic- Bell's pals, neuritis, enhephalitis
--> Cardiovascular- cardiac arrhythmias
Stage 3: Persistent infection (months to years)
***Arthritis***
--> Chronic neurologic dz
--> Raised skin lesions (in Europe)
--> 10% have persistent sx

Periodontal Disease
Accumulation of normal flora, incl. oral spirochetes &
fusiform anaerobic bugs in gingivial crevices around teeth [sx]: Fever, headache, rigors, muscle& joint pain, conjunctivitis,
Inflamm, reraction of gums, exposure of tooth root
macular &/or petechial rash
Acute necrotizing gingivitis/ Trench Mouth

[mild - fatal]
-Incubation: 7-14 days
[onset sx]:
-High fever, chills
-HA
-Severe myalgias of legs & back
-Confusion
-Conjunctival suffusion
-Skin rash (maculopapular, petechial, purpuric,
peripheral gangrene)
-lymphadenopathy, haptomegaly, acalculous
cholecystitis
Secondary phase/ Immune phase
(leptospires gone from blood & CSF, but persist in
urine & aqueous humor)
-Recurrence of fever
-Meningismus
-CSF pleocytosis
Weil's syndrome:
-Severe illness w/ hemorrhage, azotemia,
jaundice
-Associated w/ L. interrogans serovar
icterohaemorrhagiae

Congenital:
--> infection of fetus by transplacental passage of bug by mother in early stages of syphilis (<1 yr duration)
--> miscarriage, stillbirth & earlyor late sx in live born children

Specimen

Exudate from skin

Blood

Serum, skin biopsy

Blood, CSF, urine

Visualized via:
Darkfield microscopy **definitive dx**
Silver impregnation stains
Immunofluorescence

Blood smears:
-Shows spirochetes w/ broad spirals
-Animal inoculation to verify infection

**Clinical dx backed by serological tests**

**Urine is positive for weeks to months**

Nontreponemal tests: Detect Ig against cardiolipin (VDRL, RPR)


--> titer decr & turns (-) after effective therapy
--> false (+) d/t: autoimmune dz, pregnancy, IVDA

Some have:
--> Proteus agglutinin OX-K titers
--> (+) serologic tests for syphilis (STS)
--> Bugs in CSF (10-15%) w/CNS sx

Lab Diagnosis
Treponemal tests: Detect Ig against T. pallidum (FTA-ABS, MHA-TP)
--> confirmatory test for syphillis
--> (+) for life

Treatment

-Characteristic hx & sx: tick bite followed by erythema migrans Culture of blood may be positive 1st week, but
may require weeks to grow
-Serological tests:
--> anti-B. burgdorferi Ab in serum
Serology: Ab agglutination of Leptospira
-- "2-tiered":
1. ELISA
2. Western Blot
-Culture
--> not reliable, req. special medium, take weeks

Dx confirmed by any of the following:


-characteristic lesions + (+) darkfield microscopy exam
-characteristic lesions & history (+) RPR
-reactive RPR + reactive treponemal test

-PCR
--> not used routinely

**PCN**
--> In fulminant 2 syphilis this treatment can cause Jarisch-Herxheimer reaction: fever, chills

Doxycycline
Amoxicillin

tetracycline

Long-term infections/severe cases:


Amoxicillin
PCN
Ceftriaxone

Dogs are vaccinated but still can shed it

Prevention/
Control

Notes

Doxycycline?
B-lactams?
Streptomycin?

Congenital syphilis is 100% preventable:


TX LAW: says a RPR test must be done @ 1st maternity visit & within 24 hr of delivery
(early sx): fulminant T. pallidum infection w/ many bugs present --> multiple manifestations
--> skin & mucous membrane lesions, lung, liver, bone involv.
(late sx): [early teens]: bone & tooth deformities, rhagades, interstitial keratitis, deafness, mental
impairment

-Highest in NE US & Great Lake states


Other dz that mimic relapsing fever:
leptospirosis, typhus, typhoid fever, dengue fever, malaria, &
typhoid

Southern Tick Associated Rash Illness (STARI)


--> Acts like normal lyme disease and is all over SE US
--> Amblyomma americanum (lone star) tick
--> Borelia lonestari

Occupational disease (formerly):


Sewer workers, veterinarians, dairy farmers who
have contact with urine of infected dogs and rats
Organism may live for weeks or more after being
shed in urine if stagnant water

Anda mungkin juga menyukai