25b Spirochetes Flashcards by Jonathan Burgess

What is the gram status of spirochetes?

Gram -

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What is the shape and motility of Spirochetes?

Elongated, Motile, Spiral Shaped

Posses flagellum

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What are the flagellum of Spirochetes like?

Axial filament or Internal flagellum (inside the periplasm)

Spirally wound around the cell and anchored through hook-like bases at the two poles of the cells

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How do spirochetes multiply?

Binary fission

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What are the three major groups of Spirochetes?

Treponema
Borrelia
Leptospira

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What illnesses are associated with…
Treponema
Borrelia
Leptospira

T: causes syphilis, yaws, pinta, as well as normal flora in mouth, intestine, and genitalia
B: Lyme disease
L: lepotspirosis

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What are the difficulties in staining Treponema pallidum?

Gram - anaerobe
But too thin for a microscope to see
Can be made visible through special techniques (listed next)

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What special techniqes can make staining for Treponema pallidum possible?

“Darkfield” microscopy (stain slide, not bacteria. Bacteria glow)
Immunofluorescence
Deposition of silver salts on bacterial surface
Electron microscopy

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Describe the difficulties with creating live cultures of Treponema pallidum.
What is the benefit of this quality with regard to blood donation?

Cannot be grown in culture
Can be kept motile for several days in anaerobic albumin serum
If blood stores are maintained for more than a week, all Treponema die
Can be stored at -80 degrees Celsius
Injected and cultured in Rabbit testicles.

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How are Treponema killed?

Killed easily by heat, drying, soap, and water.

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How can Treponema be perpetuated for study?

Can be stored at -80 degrees Celsius
Injected and cultured in Rabbit testicles.
Say what?

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What are the modes of transmission of Treponema pallidum?

Transmisible within 4 years of initial infection
Transmitted via genitalia and mucous membranes
Mother to fetus
Blood transfusion of very fresh blood (< 1 week)
Very rarely to healthcare providers with cuts and needles

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What is the pathogenic steps of illness with Treponema pallidum?
Note: Don’t know the time periods. They vary too much.

Incubation
Primary Lesion (Chancre)
Secondary Lesions (desseminated)
Tertiary Lesions (nervous system and heart)

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What is the incubation period for Treponema pallidum?

What are symptoms?

2-6 weeks
Assymptomatic
Bacterial replication at site of entry and elsewhere

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When and where does Primary Lesion aka Chancre sore develop from Treponema?
How does the Chancre sore heal?

1-4 weeks after infection
Genitalia and focal lymphadenopathy
Heals spontaneously in 1-5 weeks after appearance (so some people don’t get treated. Bad idea.)

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What’s the difference between chancre and chancroid?

syphilus - CHANCRE
H. ducreyi - CHANCROID

See slide 15.

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When and where do Secondary Lesions from Treponema develop?

Skin rash or mucosal lesions (these are infectious)
Secondary lesions are now on upper body, flanks, face, palms, soles (primary was on the mouth or genitalia)
2-20 weeks after primary lesion appears

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What are accompanying symptoms to the secondary lesions from Treponema?

Arthritis
Renal dysfunction
Mucosal lesions are highly infectious

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When and where do tertiary lesions from Treponema develop?
What do the lesions look like?
What is the damage do to?

Many years after initial infection. Devastating illness at this stage.
CNS and Aortic Valve
Have “rubbery” consistency and is called a “gumma”
Type 4 Hypersensitivity
Affects personality and aggression.
These occur years later.

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What is Dx of Treponema pallidum?

Hx of exposure
Demonstrate organisms in open lesion via darkfield examination of exudate
Serology (positive in later primary stage) via Wassermann Antibody test or modern “specific and non-specific” tests (discussed next)

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What is Wassermann Antibody test?

Wassermann antibody reacts with specific syphilis lipid: diphosphatidylglycerol aka cardiolipin to which is added lecithin and cholesterol

Complement fixed in reaction and degree of fixation is measured.

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What is Wassermann Antibody Test (wiki answer)?

A sample of blood or cerebrospinal fluid is taken and introduced to the antigen - cardiolipin extracted from bovine muscle or heart. Syphilis non-specific antibodies (reagin, see RPR) react with the lipid - the Wassermann reaction of antiphospholipid antibodies (APAs). The intensity of the reaction (1, 2, 3, or 4) indicates the severity of the condition.

To execute the test we need to prepare two different test tubes; in the first tube:

1) we put the serum of the patient, and we heat it to 56°C for 20 minutes (this to eliminate the complement of our patient)
2) we insert the cardiolipin, our antigen
3) we insert fresh rabbit serum (that contain a determined quantity of complement; in this way we can measure exactly the quantity of complement in the test tube)
4) we insert a detector system, composed of mutton blood cells and anti-blood cells antibodies.

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What are “non-specific” tests used for Trepomena pallidum (2)?
These tests are done 1st.
SEE SLIDE 33 FOR Dx TEST FLOW CHART.

1) VDRL Veneral Disease Research Laboratory test
- —-Flocculation test (clumping on a side) with Cardiolipin
2) Rapid Plasma Reagin
- —-Antigen is absorbed to carbon particles making clumping easier to see

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What are “specific tests” used for Treponema pallidum (4)?
These tests are done 2nd.
Both specific and non-specific tests are done. Difficult to Dx. Important to get correct.

FTA-ABS (Flourescent Treponemal Antibody Absorption)
Micro-hemagglutination
ELISA
TPI (Treponema Pallidum Immobilization)

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What is the FTA-ABS (Flourescent Treponemal Antibody Absorption)?

Patient's serum is absorbed with non-pathogenic Treponemas to remove the non-specific antibodies Serum is then added to a slide with Treponema pallidum >> washed and made visible via flourescent antibody

What is Micro-hemagglutination test for Treponema pallidum?

Uses RBCs coated with Treponema pallidum antigen and serum from the patient

What is TPI Treponema pallidum immobilization test? | When is TPI used and why?

Antibody from patient reacts directly in the presence of complement with living Treponema pallidum causing organism to lose motility Difficult, but precise test. Used if "false positive" is suspected.

When do False Postitives occur in syphilis?

Infectious Mononucleosis and Malaria can produce a False Positive test in Trepomena pallidum (syphilis)

What test produces more False Positives and False Negatives?

More False + and False - with VDRL test The FTA-ABS is more accurate.

Why isn't PCR used for syphilis?

DNA primers haven't been made yet.

What is Tx for syphilis Treponema pallidum?

PENICILLIN (no resistance yet!) | also: tetracyclin and erythromycin

Are there vaccines for syphilis?

Nope. Difficult to culture and study in a lab.

Aside from syphilis, what other illnesses are caused by Treponema? NO EXAM QUESTIONS ON THESE.

Yaws Bejel Pinta

``` What is Yaws? What species of Treponema? Is it sexually transmitted? Is it mother-fetus transmitted? How does it affect syphilis Dx tests? What is its physical exam Dx syptom? ```

Yaws is a tropical disease caused by Treponema pertenue Non-venereal transmission through open sores of skin Not transmitted mother-fetus Yaws gives false positive to syphilis "Yaws" means raspberry and the primary lesion looks like a raspberry

What is Bejel? What is the species and subspecies that causes Bejel? What demographic is affected (age and country)? Is it sexually transmitted? What is Tx for Bejel?

Treponema pallidum subspecies: ENDEMICUM Disease in children in Syria Not sexually transmitted PENICILLIN

``` What is Pinta... What species causes Pinta? What countries is Pinta common? How serious is Pinta? What are symptoms of Pinta? What is Tx for Pinta? ```

``` Treponema carateum Central and South America Rarely serious Flat, non-ulcerating skin lesions of hands, feet, and scalp that heal spontaneously, but leave pink areas. PENICILLIN ```

What are two common illnesses caused by Borrelia?

Relapsing fever | Lyme disease

What species cause Relapsing fever?

Borrelia recurrentis | Borrelia hernsii

What medium is required to grow Borrelia recurrentis and Borrelia hernsii (Relapsing fever)?

Chick embryo.

Where is BORRELIA HERNSII endemic? What is the cycle of transmission and natural hosts? Where is BORRELIA RECURRENTIS epidemic? What is the cycle of transmission and natural hosts?

H: Endemic in western U.S. Rodents to ticks to humans; Rodents are natural habitat Epidemic outside of U.S. Human to human via body lice

What is the course of disease in Relapsing Fever from Borrelia recurrentis and Borrelia hernsii?

Fever 4-5 days No fever 7-10 days Repeat fever and no fever for 3 to 10 cycles

What causes the Relapsing Fever from Borrelia recurrentis and hernsii?

Variable membrane proteins coded on a linear plasmid | Antigenic variation on surface proteins

What is Dx of Relapsing Fever?

Clinical symptoms Wright's Stain: stained blood smear Dark field microscopy May need to inject blood into a mouse and examine the mouse blood

What is Tx for Borrelia recurrentis and Borrelia hernsii (Relapsing Fever)? What is the Tx for pregnant women or children?

Penicillin or Tetracycline Penicillin or Erythromycin

What species causes Lyme Disease? | Note: Most common tick-borne disease in U.S.

Borrelia burgdorferi

What is the cycle of transmission of Lyme disease? | What is the major reservior?

White-footed mouse >> deer tick >> humans | White footed mouse

What types and how many plasmids does virulent Borrelia burgdorferi carry?

7 linear 2 circular plasmids Hyperchanging organism.

What are the three stages of Lyme?

1) Bull's eye rash 3 to 14 days after tick bite, fever, headache, stiff neck, malaise 2) Neurologic and cardiac symptoms months to years later 3) Arthritis months to years later

What is Dx of Lyme?

Symptoms Bull's eye rash (erythema migrans) ELISA PCR, too

What is Tx fore Lyme? | What is Tx for Lyme in children?

Tetracyclines Ampicillin ``` Other drugs used for advanced stage: IV Cephalosporins (Rocephin) and Azithromycin ```

What is genotype that doesn't response well to Tetracycline Tx?

HLA-DR4

Is there a vaccine for Lyme?

There was. It is no longer available. Why?

What is unique about Borrelia burgdorferi and iron compared to other bacteria?

Unique non-requirement for iron | Instead uses MANGANESE-dependent enzymes and metabolic pathways

What is Leptospira... What animals? What is mode of transmission?

Rats, dogs, and other animals Infected urine transmitted through skin and uppler alimentary mucosa NOT arthropod-borne

Who is at risk for contractign Leptospira?

Sewage workers Slaughter house workers Rat infested areas

What is the pathogenesis of Leptospira?

Enters blood >> invades various tissues >> targets Kidneys, Liver, Meninges, and conjunctiva

What are Symptoms and Syndromes of Leptospira?

Symptoms: Myalgia, headache, photophobia, fever, chills (lasts for weeks) Syndromes: Nephritis Jaundice >> WEIL'S DISEASE by one serotype of Leptospira >> leads to hepatic injury, renal failure, and fatality 25% Meningitis

What is Dx of Leptospira?

Culture and serotype

What is Tx of Leptospira?

Penicillin Erythromycin Tetracyclines

Is there a vaccine for Leptospira?

No.

25b Spirochetes Flashcards

(60 cards)