9-8 Spirochetes-Treponemes Flashcards Preview

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Flashcards in 9-8 Spirochetes-Treponemes Deck (22)
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1

A: Why are Spirochetes able to Flex and rotate in a spiral? 

 

B: Describe this structure in [Treponema Pallidum] 

A: Axial Fibrils wind around the cell wall of Spirochetes

 

B: Axial Fibril – “internal flagellum”, THREE in T. pallidum. Contained in periplasm 

2

A: 3 Growth Characteristics of [Treponema Pallidum] 

B: Can NOT be spread sexually after __ years from acquisition 

1. Only cultured in [Rabbit epithelial cells] 
2. Very sensitive to Drying and Heat
3. Microaerophilic (survives 3-5% Oxygen)

 

B: Can NOT be spread sexually after 4 years from acquisition 

3

Pathogenesis of [Treponema Pallidum] 
A: Transmission (2) 

B: How does it disseminate once it invades

C1: When do Sx/signs first appear? 
C2: What are the sx mostly caused by? 

D. Primary and secondary stages are ________. Each are followed by periods of ________

E: Explain how immunity works for both early and late stage Syphilis   

Pathogenesis
A. Passes through [intact mucus membrane] or abraded skin

B. Multiplies locally in subepithelial tissue and disseminates to lymph nodes and other organs

C. Symptoms and signs = 10-90 days after initial infection
C2: Pathologic lesion is from an [obliterative endarteritis] and hypersensitivity response later in dz

D. Primary and secondary stages are self-limiting (HEAL SPONTANEOUSLY). Each are followed by periods of latency

E. Immunity to reinfection after treatment of EARLY syphilis is not sufficient to prevent reinfection. PT ACQUIRES GREATER IMMUNITY AFTER BEING INFECTED WITH LATER STAGE

4

Describe the Syphilis Chancre (3) 

Syphilis Chancre
1. Appears 10-90 days after initial infection 

2. Ulcer has smooth, heaped margins and crusted dry base

3. Accompanied with [Firm local adenopathy] 

5

LATENT SYPHILIS Definition 

B: What fraction of infected individuals develop this? 

Latent syphilis - Defined as the presence of a positive treponemal serologic test in the absence of clinical manifestations

B: 2/3 develop LATENT "quiet" syphilis  

6

A: 1/3 of untreated develop ____ syphilis: neurosyphilis, _____ syphilis or[ ____ benign ___ syphilis]

B: Describe NEUROSYPHILIS
1. Asymptomatic 

2. Meningovascular 

3. Paresis 

4. [Tabes Dorsalis] 

A: 1/3 of untreated develop late syphilis: neurosyphilis, cardiovascular syphilis, [late benign "gummatous" syphilis]

Neurosyphilis
1. Asymptomatic - evidence of infection in CSF without symptoms or signs
2. Meningovascular - chronic meningitis which can affect major arteries to brain
3. Paresis - cortical degeneration of the brain with mental changes
4. Tabes dorsalis - Demyelination of posterior columns and dorsal roots ---> loss of pain, temperature and position sense in limbs with or without ataxia

7

Describe the process of [Nontreponemal reaginic tests for Syphilis"] 


B: What is Cardiolipin? 

Describe these Types: 
C. VDRL

D. RPR - Rapid Plasma Reagin

E: These Tests are _______ and used to follow treated
patients. Pt Should revert to _______ after successful treatment of primary (1 year) and secondary (2 years) syphilis.

NonTreponemal reaginic tests  for Syphilis"=  reaginic antibodies are [IgG and IgM] directed against cardiolipin, BUT NOT [Treponema Pallidum]  

B: Cardiolipin = a lecithin-cholesterol mixture present on mitochondrial membrane. Is extracted from beef heart. 

C. VDRL [Venereal Diseases Research Laboratories] is the Only NonTreponemal test done on CSF

D. RPR - Rapid Plasma Reagin = Most commonly performed on serum

E: These Tests are QUANTITATED (diluted) and used to follow treated patients. Pt Should revert to negative after successful treatment of primary (1 year) and secondary (2 years) syphilis.

8

Specific treponemal tests – Measure specific ______ against _________

B: Describe the [FTA-Abs] Test (2) 

Specific treponemal tests – Measure specific antibody against T. pallidum
i. FTA-Abs - Fluorescent Treponemal Antibody - Absorption Test.
􏰇 Serum is absorbed with extracts of cultivated non-T. pallidum treponeme
􏰇 Antigen is killed Reiter strain of T. pallidum on a slide

9

Specific treponemal tests – Measure specific ______ against _________

B: Describe the [MHA-TP-TPPA] (MTT) Test (2) 

Specific treponemal tests – Measure specific antibody against T. pallidum
ii. [MHA-TP-TPPA] (Microhemagglutination Treponemal pallidum) 
􏰇1.  Treponemal antigens adsorbed onto erythrocytes or
latex particles.
􏰇2.  Agglutinated by serum containing antibody against T.
pallidum.

 

10

Specific treponemal tests – Measure specific ______ against _________

B: Describe the [EIA] Test (2) 

C: What is CIA

Specific treponemal tests – Measure specific antibody against T. pallidum
B. EIA –automated, inexpensive tests done in large laboratories, used to SCREEN. 
-Positive EIA should be confirmed with [Quantitative Nontreponemal test].

 

C. CIA (chemiluminescence immunoassay) automated like EIA

11

A: What are the 4 things that can give FALSE POSITIVE [Treponema Pallidum] Result? 

B: Which Test do they skew? 

1. Febrile Illness -Skews NONTreponemal
2. Pregnancy - Skews NONTreponemal 

3. Autoimmune Dzs - Skews SPECIFIC Treponemal 
4. Chronic Infections - Skews SPECIFIC Treponemal

"Treponema Pallidum False Positives Aren't Conclusive! "  

12

A: What Abx do you use to treat [Treponema Pallidum] 

B: Why this specific Abx? 

C: What's the alternative? What are the 2 contraindications to this? 

A: [Benzathine LA Penicillin G]

B: Long acting injectable formulation for long generation time of [Treponema Pallidum] 

C: [DOXY-Tetracycline] is alternative BUT NOT FOR NEUROSYPHILIS OR PREGNANT WOMAN 

13

A: What bacteria causes Bejel

B: How is it transmitted? 

A: [Treponema Pallidum ss. Endemicum] 

B: CONTAMINATED UTENSILS

14

A: What bacteria causes YAWS?

B: How is it transmitted?

A: [Treponema Pertenue]

B: DIRECT LESION CONTACT

15

A: What bacteria causes Pinta?

B: How is it transmitted?

A: [Treponema Carateum]

B: DIRECT LESION CONTACT

16

A: Describe [Relapsing Fever] 

B1: Why does [Borrelia _____] cause [EPIDEMIC RELAPSING FEVER]
B2: [Borrelia _____] uses Body LICE as its Vector and _____ as its Reservoir 

C: 
1. WHERE does [Lice-bourne] [EPIDEMIC Relapsing Fever] occur? 

2. WHERE does [TICK-bourne] Relapsing Fever occur? 

A: [Epidemic Relapsing Fever] = systemic illness in which Borrelia is in bloodstream 

B: [Borrelia Recurrentis] evade immunity by altering antigenic structure (similar to N. gonorrheae) ---> [EPIDEMIC RELAPSING FEVER] 
B2: [Borrelia Recurrentis] uses [Body Lice] as its Vector and has NO Reservoir. 

C: 
-Lice-bourne [EPIDEMIC Relapsing Fever] occurs where war/famine are

-TICK-bourne [Relapsing Fever] occurs in the [U.S. NorthWEST Mountains] 

17

Borrelia Recurrentis 

A: Human infection from [Borrelia LOUSE] occurs from what?

B: Do [Borrelia LICE Vectors] participate in [Transovarian passage]? 
-------------------------------------------------------------------------------
C: Human infection from [Borrelia TICK] occurs from what?

D: Do [Borrelia TICK Vectors] participate in [Transovarian passage]?  

Borrelia Recurrentis 

A: Human infection from [Borrelia LOUSE] occurs from CRUSHING a [Louse infected w/Borrelia] onto skin

B: [Borrelia Lice Vectors] DO NOT PASS ON INFECTED BORRELIA LARVAE to their [children Lice]
-------------------------------------------------------------------------------
C: Human infection from [Borrelia TICK] occurs from 
Tick bite (since borrelia exist in their saliva)

D: [Borrelia TICK Vectors] do engage in [Transovarian passage]. After acquiring Borrelia from rodent, the Borrelia multiply in TICK salivary glands.  

18

A: Clinical Manifestations of [Epidemic Relapsing Fever] (5) 

B: Tx (2) 

A: 
-Fever
-Chills
-Myalgia 
-HA

-Jarisch-Herxheimer rxns are common with tx 

B: Tx= " E.T."
*Erythromycin 
*Tetracycline  

19

A: [LYME Borreliosis] is caused by _______ 

B: Vectors = TICKS = 
1: [Ixodes ______] in [NE / midwest U.S.] 

2. [ixodes _______] in Western 

B2: ___ Ticks Stages feed on humans but ______ is responsible for transmission! 

A: [LYME Borreliosis] is caused by [Borrelia Burgdorferi] 

B: Vectors = TICKS = 
1: [Ixodes Scapularis] in [NE / midwest U.S.] 

2. [ixodes Pacificus] in Western 

B2: All Ticks Stages feed on humans but [NYMPH is responsible for transmission]! 

20

**[LYME Borreliosis] **

After an INFECTIOUS Tick (_____ form) Bite, [Borrelia _______] replicate locally and enter blood/lymph. 

B: CLINICAL MANIFESTATIONS  
1st: (2) 

2nd: (2)  

3rd: (3) 

[LYME Borreliosis] 
Post- INFECTIOUS Tick (NYMPH form) Bite, [Borrelia Burgdorferi] replicate locally and enter blood/lymph. 

B: CLINICAL MANIFESTATIONS  
1st: [Erythema migrans] = Expanding erythematous skin lesion at Tick bite (Bull's Eye Rash) accompanied with [flu-like sx]

2nd: [Bell's Palsy] and [Heart Block] 

3rd: 
-Neurologic: [Encephalitis]
-[Migratory Arthritis]
-[Acrodermatitis Skin Lesions] 

21

A: Lab Dx for [Lyme Borreliosis] 
A2: Any false positives? 

B: 
-Early Tx: (7) 

-Late Tx: (2) 

A: Lab Dx for [Lyme Borreliosis] 
1. ELISA  or IFA (IgM and IgG) responses are measured
2. Western Blot is used for Confirmation 

A2: Syphilis pt may have False Positives 

B: Tx
Early: 
Doxy/PCN/amoxicillin/Clarithromycin/Azithromycin/Cefuroxime/CefTRiaxone

LATE: 
CefTRiaxone or [IV PCN] 

22

Describe the 2 Stages of [Leptospira Interrogans] Infection 

1st: (4) 

2nd (3) 

B: Diagnosis 
Early on (after ___ week): (2)  

IF TOO LATE: Culture the ______

Describe the 2 Stages of [Leptospira Interrogans] Infection 

1st: Bacteremia w/ [Conjunctival Suffusion] /Fever / Myalgia

2nd: 
-Detectable Serum Antibodies 
-[Aseptic Meningitis] 
-[Uveitis] 

B: 
Early on: [Culture Blood/CSF] or use [Serology-Microscopic Agglutination Test (MAT) after first week

IF TOO LATE: Culture Urine