Exam 3 Spirochetes Flashcards
(125 cards)
1
Q
Spirochetes are structurually ___ like, but are not visualized by ____
A
Gram-negative like; Gram stain
2
Q
Spirochetes should be visualized using:
A
- dark field microscopy
- silver stain
3
Q
Spirochetes are shaped like a:
A
Corkscrew
4
Q
Spirochete movement
A
Rotation locomotion via endoflagellum that wraps around the cell
5
Q
Treponema is aerobic or anaerobic?
A
Anaerobic
6
Q
Disease caused by Treponema
A
Syphilis
7
Q
Oral treponemes are implicated in:
A
- periodontal disease
- acute necrotizing ulcerative gingivitis (ANUG)
8
Q
ANUG stands for
A
Acute necrotizing ulcerative gingivitis
9
Q
___ is vector borne
A
Borrelia
10
Q
Leptospira is aerobic or anaerobic?
A
Aerobic
11
Q
Relapsing fever and Lyme disease are caused by what species?
A
Borrelia
12
Q
Third most common bacterial STD
A
Syphilis
13
Q
What group of people have the highest rates of syphilis cases?
A
- American Indian or Alaska native
- Black/African American
14
Q
___ account for the most cases of syphilis
A
Men
15
Q
Vast majority of syphilis cases occur among:
A
Men who have sex with men (MSM)
16
Q
Syphilis often occurs in patients with ____; important facilitator of ____
A
other STDs; HIV
17
Q
Treponema pallidum looks like:
A
long, thin, spiral
18
Q
True or false: Treponema pallidum can be cultured on medium
A
False - limited growth in tissue culture, rapidly dies on drying
19
Q
Treponema pallidum has limited ____ capacity; it is an _____
A
metabolic (missing TCA cycle); obligate internal parasite
20
Q
Treponema pallidum lack what two virulence factors?
A
- no catalase
- no superoxide dismutase
21
Q
Treponema pallidum virulence factors
A
- immune avoidance (few surface antigens)
- surface adhesins to bind fibronectin
- hyaluronidase facilitates infiltration
22
Q
Syphilis - modes of transmission
A
- Sexual contact
- Transplacental
- Close contact with active lesion (also perinatal)
- Blood transfusion
- Accidental direct inoculation
23
Q
Patient with syphilis is most infectious during:
A
Early disease stages
24
Q
Syphilis patient is considered not infectious after ____ years due to ____
A
4; low bacterial load
25
What are the clinical stages of syphilis?
1. Primary
2. Secondary
3. Latent
4. Tertiary
5. Congenital
26
What happens during primary syphilis?
- primary lesion formed is a chancre
- infiltrated with lymphocytes and plasma cells
- heals after 14 days
27
The chancre formed during primary syphilis is:
- painless
- highly infectious
28
How long are you seropositive for syphilis once contracted?
For life
29
Primary syphilis incubation period
3-4 weeks
30
Where can primary syphilis chancres occur?
- lip
- tongue
- on hand (infected cut)
- genitals
31
A high increase of plasma cells in tissues, exudates, or blood is indicative of:
Some kind of infection (could be syphilis)
32
When does secondary syphilis occur?
2-10 weeks after primary syphilis
33
Secondary syphilis occurs in ____ of those with untreated primary syphilis
25%
34
What happens during secondary syphilis?
- Wide dissemination of T. pallidum (highly infectious)
- causes skin rashes, mucous patches, condylomata lata
35
Condylomata lata
Wart-like growths
36
Syphilis skin rashes are:
- widespread (palms, soles)
- macular/papular
37
Secondary syphilis mucous patches can occur on:
- tonsil
- soft palate
- palms and soles
- scalp (alopecia)
38
Latent syphilis is characterized as being:
Seropositive with no symptoms
39
Latent syphilis occurs in ____ of patients with untreated secondary syphilis
15%
40
How long can latent syphilis last?
Several years to decades
41
____ is more infectious than late latent stage, including transmission to fetus
Early latent
42
Those with HIV experience ____ if they have syphilis
Shortened latency
43
Tertiary syphilis is not common anymore due to _____
Antibiotics
44
In the beginning of a syphilis infection, bacterial load is ____. Towards the end of the infection (tertiary syphilis), bacterial load is ___
high; low
45
Tertiary syphilis occurs ____ after the primary infection
Several months to 30 years
46
In _____ syphilis, 50% develop gumma
Tertiary
47
Is gumma contagious?
No
48
Gumma is highly ____ but often painless
Destructive
49
What does a gumma look like?
- white-grey
- rubbery
- single or multiple
- tiny to tumor like sizes
50
Tertiary syphilis is associated with ____ involvement. Organisms ____
Multisystem; spread to other body parts
51
Where can a gumma occur?
- skin
- oral cavity
- bone
- joints
- cardiovascular system
- nervous system
can occur in most organs
52
A ____ is a soft tumor-like inflammation
Gumma
53
A gumma in the oral cavity can lead to:
Perforated palate (can bore holes in the tissue)
54
Gumma in the joints can lead to:
Charcot's joints (neuropathic)
55
Gumma in the cardiovascular system can lead to:
Aortic aneurism (abnormal bulge that occurs in the wall of the aorta)
| caused by syphilitic aortitis
56
_____ can lead to collapse of midfoot arch
Charcot's foot (joint) - tertiary syphilis
57
Aortic aneurism (definition)
Abnormal bulge that occurs in the wall of the aorta
58
When does neurosyphilis occur?
At any stage of syphilis
59
True or false: neurosyphilis is symptomatic
False - can be asymptomatic
60
Early neurosyphilis occurs:
A few months to a few years after infection
61
Acute syphilitic meningitis and ocular involvement occur during what stage of neurosyphilis?
Early neurosyphilis
62
Late neurosyphilis occurs during what stage of syphilis?
Tertiary syphilis
63
Late neurosyphilis can lead to:
- general paresis
- tabes dorsalis
64
General paresis
Brain cortex degeneration
65
Tabes dorsalis
- damage to dorsal root ganglia
- **ataxia**, wide based gait, foot slap
- loss of sensation
66
Ataxia
without coordination (tabes dorsalis, late neurosyphilis)
67
Recently, syphilis cases have been:
Increasing
68
Those who use ____ are at higher risk of contracting syphilis
Methamphetamine; injection drugs
69
Congenital syphilis cases must be reported within:
24 hours
70
40% of syphilis pregnancies result in:
- miscarriage
- stillbirth
- infant death
71
If a baby survives with congenital syphilis, they may develop:
- developmental delays, seizures (due to meningitis)
- craniofacial anomalies
72
A newborn with congenital syphilis is:
Infectious (fluid is contagious - syphilistic rhinitis snuffles)
73
How is congenital syphilis prevented?
Antibiotic treatment of mother
74
What craniofacial anomalies can result from congenital syphilis?
- Hutchinson's teeth
- Mulberry (Moon's) molars
- mucous patches
- perforated palate
- saddle nose
- keratitis
75
Hutchinson's teeth affects:
Permanent incisors
76
Describe Hutchinson's teeth phenotype
- incisor crown wider in cervical portion than incisal edge
- incisal edge has crescent shaped notch
- incisors can also have triangular shaped deformity
77
Mulberry (Moon's) molars can affect:
First permanent molars
78
What do Mulberry molars look like?
Occlusal surface is composed of an aggregate of enamel nodules
79
Syphilis diagnosis involves:
2-tiered serology: non-treponemal and treponemal
80
Non-treponemal serology is ____ to treponemes
Non-specific
81
Non-treponemal serology tests for:
- cellular damage
- antibodies to cardiolipin
82
Examples of non-treponemal tests
- Wassermann test
- VDRL (Venereal disease research laboratory)
- RPR (rapid plasma reagin)
83
Wassermann test tests for
Complement fixation
84
VDRL tests for:
Neurosyphilis in CSF
85
Non-treponemal serology can show _____ for other diseases
False positive results
86
Which non-treponemal serology tests are agglutination assays?
- VDRL
- RPR
87
For RPR, mix ____ with patient's blood. They will agglutinate bith blood ____
cardiolipin antigen; Reagin (antibodies to materials released by damaged cells)
88
Treponemal serology is for
Syphilis disease confirmation
89
Treponemal tests (Identification of T. pallidum)
- PCR
- FTA-ABS (fluorescent treponemal antibody absorption)
- TPPA (Treponema pallidum particle agglutination)
- MHA-TP (micro hemagglutination to T. pallidum)
90
TPPA allows for clotting of:
Ab:Ag
91
Treponemal serology - Antibodies in spinal fluid is highly suggestive of:
Active neurosyphilis
92
2-tiered syphilis testing - which test is first?
Either can be first (non-treponemal or treponemal)
93
If non-treponemal test is first:
- RPR or VDRL first
- then confirmatory TT (TPHA or TPPA)
94
2 tiered syphilis testing - it is less expensive but has high rates of false negatives to do which test first?
Non-treponemal
95
When first test is treponemal test:
- first TT immunoassay
- then NTT (RPR or VDRL) if there is previous history of treatment
96
Syphilis DOC
Penicillin - single dose intramuscular
97
Treatment of late latent syphilis or latent syphilis of unknown duration; or pregnant women
Three doses of penicillin recommended
98
Possible complication of Syphilis antibiotics therapy
Jarisch-Herxheimer reaction - similar to endotoxic shock; Allergic reaction from rapid release of treponemal antigen from cell wall
99
All patients with syphilis must be tested for
HIV
100
Other treponemes
- Yaws (skin disease in Africa)
- Pinta (skin disease in South america)
- Normal oral flora (Treponema denticola): associated with periodontal disease, ANUG
101
Borrelia is ___ than treponemes
Larger
102
Some Borrelia sp are visualized by:
Giemsa staining
103
What causes Lyme disease?
Borrelia burgdorferi
104
Borrelia species that causes epidemic relapsing fever
Borrelia recurrentis
105
What is relapsing fever?
- febrile illness that goes away and comes back
106
Borrelia hermsii is endemic in:
Western US
tick vector, rodent reservoir
107
Borrelia miyamotoi is endemic in
NE uS
deer tick vector, rodent reservoir
108
Relapsing fever DOC
Tetracyclines
109
B. burgdorferi reservoir
White tailed deer
110
B. burgdorferi vector
Tick (can transfer pathogen to others)
Eastern US - Ixodid deer tick
Western US - black legged ticks
111
Is the nymph or adult tick responsible for majority of Lyme disease cases?
Nymph
112
Early infection of lyme disease involves localized ____
Erythema migrans (bulls eye rash)
113
Patients with untreated Lyme disease can progress to early disseminated stage, which involves:
arthritis, neurologic manifestations (Bell's palsy), cardiac dysfunction
114
Late Lyme disease involves:
- arthritis
- chronic skin involvement
- carditis
115
Muscle weakness on one side can be due to
Bell's palsy caused by untreated Lyme disease
116
Lyme disease - what does rash look like
Bulls-eye
117
Diagnosis of Lyme Disease
Serology 2-tiered
1. ELISA or immunofluorescence
2. Western blot to confirm
118
Early stage Lyme disease treatment
Tetracycline
119
Disseminated/late stage Lyme disease treatment
IV ceftriaxone
120
Acrodermatitis chronica atrophicans
Skin rash/fibrosis that can occur during late disseminated Lyme disease
121
Leptospira interrogans is a:
Human pathogen
122
Leptospira sp. is an ____ spirochete with ____
aerobic; hooked ends
123
Leptospira interrogans causes what disease
Leptospirosis
124
Tx for Leptospirosis
Doxycycline
125
How can you get infected by Leptospira?
- Rodent urine can contaminate water/soil/food and becomes more of an issue after natural disaster
- infects eyes, ingestion, wound contamination
