(F) Lesson 14: Spirochetes, Chlamydia, Rickettsia, and Miscellaneous Bacteria (Part 1) Flashcards
(108 cards)
1
Q
- -teles refers to Order
- Family: Leptospiraceae
- Genus: Leptospira
- Familly: Spirochaetaceae
- Genera: Borrelia and Treponema
A
Spirochaeteles
2
Q
General Property
- Difficult to G/S
- Morphology is helically coiled
- Long and slender
- Oxygen Requirement: Anaerobes, Facultative microaerophilic
A
Spirochaeteles
3
Q
- Slender, flexuous, helically-shaped, unicellular bacteria
- 0.1-0.5um wide and 5-20um long, with one or more complete turns in the helix
- Producing a helix-shape
- Contains a motility structure for movement: periplasmic flagella or axial fibrils, axial filaments, endoflagella, periplasmic fibrils
- Usually used: periplasmic flagella and axial filaments
- Produces a corkscrew-like motility
A
Spirochetes
4
Q
- The three genera under Spirochaeteles can be differentiated by the ____ and ____ it has.
A
Number of axial filaments and insertion disk
5
Q
Identify the genera.
- Arrangement: Tightly coiled
- Axial Filament: 6 to 10
- Insertion Disk: 1
A
Treponema
6
Q
Identify the genera.
- Arrangement: Thicker coiling
- Axial Filament: 30 to 40
- Insertion Disk: 2
A
Borrelia
7
Q
Identify the genera.
- Arrangement: Thicker coiling with hook ends
- Axial Filament: 2
- Insertion Disk: 3 to 5
A
Leptospira
8
Q
The connection between axial filaments
A
Insertion disk
9
Q
Has the most number of filaments
A
Borrelia
10
Q
Has its characteristic hook ends
A
Leptospira
11
Q
- Aside from the number of insertion disks and axial filaments, it can also be differentiated by its method of ____ as well as the different ____ it can cause.
A
DIagnosis and diseases
12
Q
Identify the genera.
Diagnosis: Serology
Disease: Syphilis, Bejel, Pinta, Yaws
A
Treponema
13
Q
Identify the genera.
Diagnosis: Serology, Giemsa
Disease: Lyme Disease, Relapsing Fever
A
Borrelia
14
Q
Identify the genera.
Diagnosis: Culture, Serology
Disease: Weil’s Disease or Infectious Jaundice
A
Leptospira
15
Q
- If serological assay is mentioned, the sample used will automatically be ____.
A
Serum
16
Q
- The serum will contain ____ against Treponema.
A
Antibodies
17
Q
- Borrelia, also known as ____, since it is mainly found in the blood through peripheral blood smear, which utilizes the Giemsa stain
A
Blood spirochete
18
Q
Borrelia, also known as blood spirochete, since it is mainly found in the blood through peripheral blood smear, which utilizes the ____.
A
Giemsa stain
19
Q
- ____ is the only one that can be cultured.
A
Leptospira
20
Q
The culture for Leptospira is (in vivo/in vitro) which uses artificial culture medium.
Not used for Treponema and Borrelia.
A
In vitro
21
Q
- These genera are commonly diagnosed using ____.
A
Serological assays
22
Q
- Difficult to visualize under a brightfield microscope due to its morphology and size
- Microscope of choice: darkfield microscope or fluorescent microscope (can observe motility)
- Spirals: Regular, angular with 4-14 per organism
- Three periplasmic flagella were inserted into each end of the cell
- Ends are pointed and covered with a sheath
- Are motile with graceful flexuous movements in liquid
- 4 genera pathogenic for humans
A
Treponema or Treponemes
23
Q
Contains different specific subspecies wherein these subspecies are the ones that cause specific diseases.
A
Treponema pallidum
24
Q
Identify the species.
Venereal syphilis
A
Treponema pallidum subsp. pallidum
25
# Identify the species.
Yaws
Treponema pallidum subsp. pertenue
26
# Identify the species.
Endemic syphilis or Bejel
Treponema pallidum subsp. endemicum
27
# Identify the species.
Pinta
Treponema carateum
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* Sexually transmitted diseases (STDs)
* The main mode of transmission
Venereal
29
* An infection of the skin and bones
Yaws
30
* A disease of the skin and bones
Yaws
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* Disease of the skin, bones, and mucus
Bejel
32
* An infection of the skin
Pinta
33
* Discovered by **Fritz Schaudin and Hoffman** in 1905
* Obligate intracellular pathogen
* Not cultivable in agar medium
* Can be cultured **in vivo using rabbit’s epithelial cell**
* Causes **venereal syphilis** or sexually-transmitted syphilis
Treponema pallidum subsp. pallidum
34
* Also called **Great Pox DIsease, Antique disease, Halian disease, French disease**
* Aka **Great Imitator** since it imitates signs and symptoms of other diseases
Syphilis
35
Two theories on how syphilis spreads
1. Pre-Columbian Theory or Old World Theory
2. Columbian or New World Theory
36
* States that syphilis was already present in Europe and the travels to America have caused its spread to the West
* Europe to America
Pre-Columbian/Old World Theory
37
* States that syphilis originated in America and was spread to Europe by Americans, specifically from Christopher Columbus’ crew who engaged in trades
* America to Europe
Columbian/New World Theory
38
Familiarize yourself of the mode of transmission of syphilis.
* Sexual contact with an infected individual
* Direct blood transfusion
39
T or F: T. pallidum subsp. pallidum cannot cross the placenta
F *(can cross)*
40
T or F: T. pallidum is cold-sensitive, so they are destroyed after >72hrs (some 48) in storage.
T
41
Incubation time for Syphilis?
10 to 90 days *(Average: 14 to 21 days)*
42
What are the primary stages of syphilis?
* Primary
* Secondary
* Latent
* Tertiary
43
* The first time you get infected with it
* **Characteristic lesion:** chancre (hard chancre), painless, firm, smooth with regional lymphadenopathy and early invasion of blood
* During this stage, there is active multiplication of the organism in the infected area, making it highly contagious
* **Healing**: spontaneous (3-6 weeks)
Primary Syphilis
44
# Primary Syphilis
T or F: The lesion contains plenty of bacteria.
T
45
# Primary Syphilis
* ____ to observe the motility and its characteristics arrangement (tightly coiled with 4-14 spirals)
* Using an aspirate of the lesion
* (+) confirms primary-stage syphilis
Darkfield microscopy
46
# Primary Syphilis
* (+) except during the early stages
* Will only (+) 1-3 weeks after the appearance of hard chancre
* Not recommended during the primary stage
Serologic Testing
47
* Weeks after the primary stage, which is **usually missed out** due to painless chancre
* Appears if **primary syphilis was not treated**
* Chancre heals leaving **little to no scarring**
* Infections spreads from the genital area to the skin and mucus membrane resulting in the appearance of a characteristic lesion: **condylomata lata usually seen on the palms of the hands and soles of the feet**
* If not treated, it proceeds or **disseminates** to other organs: liver, eyes, bones, CNS, mimicking different diseases affecting these organs
Secondary Syphilis
48
What are the two diagnosis methods for secondary syphilis?
* Darkfield Microscopy
* Serology Testing
49
# Secondary Syphilis
* Using lesions to observe motility and morphology
Darkfield Microscopy
50
# Secondary Syphilis
* Always (+) at this stage, making it the best stage for serological testing
* Uses serum which contains antibodies
* Best used at the secondary stage
Serology Testing
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* Absence of clinical symptoms with a positive serological test
* In some cases, some individuals produce a (+) serological test even without signs and symptoms or lesions
Latent Syphilis
52
* It is either: untreated syphilis or treated syphilis, recurring
* Can occur years (5-30) after syphilis
* May include CNS, producing neurological abnormalities
* **Specimen of choice:** CSF since it already involves the CNS
* Signs and symptoms are mainly neurological
Tertiary (Late) Syphilis
53
* Paralysis, delusions, blindness, deafness, cardiovascular abnormalities, and the appearance of granulomatous lesions: ____ or ____, which are painful ulcers that enlarge and erupt
Gummas or Gummata
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* The late syphilis also involves the ____ system
Cardiovascular
55
* Are sterile or contain few spirochetes, if any due to intense cellular immune response against the spirochete
Ulcers
56
What are the main method of diagnosis of Tertiary Syphilis?
Serologic Testing
57
# Tertiary Syphilis
This method is not recommended for this stage since the lesions are sterile.
Darkfield Microscopy
58
* The baby acquires the said infection because of an infected mother
* Syphilis may be passed from the infected mother to the fetus during primary, secondary, or latent stages, which may result in miscarriage or stillbirth.
* Transfer usually occurs **after the 4th month of pregnancy**
* Bone malformation, widespread skin rashes, meningitis or hepatosplenomegaly
* **Characteristic**: notched teeth or Sabershins (Hutchinson’s Teeth)
Congenital Syphilis
59
Paki-aral yung table about Syphilis sa transes.
Sensha n kau pagod n aq hehe
60
Microscopic laboratory diagnosis of Syphilis methods.
| Five (5)
* Darkfield microscopy
* Immunofluorescence
* Levaditi Silver Impregnation
* Animal Inoculation
* Serological Testing
61
Two types of Ab detection for Syphilis.
* Non-treponemal Ab
* Treponemal Ab
62
# Ab Detection for Syphilis
* Nonspecific to T. pallidum subsp. pallidum or venereal syphilis
* Only for **screening**
* (+) is correlated with signs and symptoms since it is also produced by other diseases such as Systemic Lupus Erythematous (SLE), Rheumatoid Arthritis (RA), during pregnancy
* **Rapid Plasma Reagin (RPR) or Wasserman Ab**
* **Venereal Disease Research Laboratory (VRDL)**
Non-treponemal Ab
63
* Produced specifically during cases of **venereal syphilis**
* **Confirmatory Tests:** Fluorescent Antibody Absorption Test (FTA-ABS)
* Microhemagglutination Treponomal Test (MHT)
* Treponema Pallidum Inhibition Test (TPI)
Treponemal Ab
64
Drug of Choice for Syphilis?
Benzathine Penicillin G
65
Alternative drug for Syphilis?
Tetracycline or Doxycline
66
# Syphilis
* First DOC for syphilis by **Paul Erlich**
Salvarsan
67
# Syphilis
* An adverse reaction to penicillin treatment, exhibiting: fever, body pain/malaise, vomiting, and headache
Jarisch-Herxheimer Syndrome
68
* The causative agent of **Yaws**
* Chronic, non-venereal disease of the skin and bones
* **MOT**: direct contact with open skin lesion
Treponema pallidum subsp. pertenue
69
# Identify the lesion for Treponema pallidum subsp. pertenue.
* Appear 3-4 weeks after exposure, heals spontaneously and reappears as secondary lesions months later
Primary/Initial lesions
70
# Identify the lesion for Treponema pallidum subsp. pertenue.
* Ulcerate, heals, and re-appear in crops for several years
Secondary lesions
71
# Identify the lesion for Treponema pallidum subsp. pertenue.
* Can occur in the skins and bones leading to disfiguration of the face
Tertiary lesions
72
* The causative agent of **Bejel**
* Endemic, non-venereal syphilis
* **MOT**: Poor sanitation or personal hygiene
Treponema pallidum subsp. endemicum
73
# Identify the lesion for Treponema pallidum subsp. endemicum.
Oral cavity
Primary lesions
74
# Identify the lesion for Treponema pallidum subsp. endemicum.
Oral mucosa
Secondary lesions
75
# Identify the lesion for Treponema pallidum subsp. endemicum.
Widespread, in the skin, bones, nasopharynx.
Tertiary lesions
76
* The causative agent of **Pinta** *(an ulcerative skin disease)*
* **MOT**: Direct contact with infective lesions
* **Skin lesions** are flat red and become depigmented but do not ulcerate
* Lesions remain confined to the skin, unlike Bejel and does not disseminate to the bones
Treponema carateum
77
* Loosely twisted, resembling a stretched spiral
* **MOT**: Tick/Lice bite
* Microaerphilic
* Stains well with **Giemsa or Wright’s Stain** as blue
* Seen in **PBS**
* Produces 2 specific diseases: Relapsing fever and Lyme disease
Borrelia spp.
78
* Main sign of infection is **intermittent fever**
* **Agents**: B. recurrentis, B. hermisii, and B. parkerii
Relapsing Fever
79
* Agent of **Louse-Borne Relapsing Fever**
* **Vector**: Human Louse (Pediculus humanus subsp. humanus) or infected lice
* Fever, muscle and bone pain, and confusion
* A patient appears to have recovered 6 days after fever episodes only to relapse a few days or weeks later
* Relapse is attributed to the ability of the organism to alter its antigenicity
Borrelia recurrentis
80
* Agent of **Tick-Borne Relapsing Fever**
* **Vector**: Ornithodoros hermisii and Ornithodoros parkerii
* Same signs and symptoms as Louse-Borne
Borrelia recurrentis
81
Borrelia grows well on what type of media that can also be used for Borrelia burgdorferi?
Modified Kelly’s Medium or Barbour Stoenner-Kelly Medium (BSK-II)
82
* Preferred due to low number of organisms in the blood
* Highly diagnostic if collected and performed during febrile episodes, during the highest peak of infection when the organism is found in the blood
* Much better if (+) signs and symptoms of relapsing fever
Thick Blood Film
83
* **Agent**: B. BURGDORFERI
* First epidemiologically investigated during an increased incidence of RA in children in Lyme and Old Lyme, Connecticut, USA in 1975
* Most common arthropod-borne disease in the USA
* Also infects the bone, hence its association with RA
Lyme Disease
84
# Match the vectors with the place.
1. NE, E, NC, USA
2. NW, USA
3. EUR
A. Ixodes dammini
B. Ixodes pacificus
C. Ixodes ricinus
1. A
2. B
3. C
85
* Characterized by these non-specific signs and symptoms mistaken for other diseases such as RA, SLE, and viral meningitis
* Headache, low-grade fever, fatigue, and abdominal pain
Lyme Disease
86
# Identify the stage of Lyme Disease.
* (+) Erythema chronicum migrans after tick bite
* Bull’s eye skin lesion → dark red area surrounded by a clear area and then another red area
* Unique to this stage of Lyme disease
Stage One
87
# Identify the stage of Lyme Disease.
* Dissemination occurs through the blood and may affect several organs: bones, CNS, heart, liver
Stage Two
88
# Identify the stage of Lyme Disease.
* Chronic stage with chronic neurological abnormalities, arthritis, and skin lesions
Since it is widespread spread in the CNS and skin
Stage Three
89
Used in the laboratory diagnosis of Lyme Disease but is not preferred since the yield of growth is very low.
**Modified Kelly’s Medium** or **Barbour Stoenner-Kelly Medium (BSK-II)**
90
Four (4) immunoserological Tests to demonstrate antibodies (proteins) against Lyme Disease.
1. Fluorescent immunoassay
2. Indirect immunofluorescence
3. Enzyme-Linked Immunoassay
4. **Western Blot** → gold standard, like in HIV
91
* Aerobic
* Differentiates it from the first two
* **Morphology**: Tightly twisted with one or both ends into a hook
Leptospira
92
Two important members of leptospira?
1. Leptospira biflexa
2. Leptospira interrogans
93
# Leptospira spp.
* Non-pathogenic, found in soil and water
Leptospira biflexa
94
* Causes human and animal leptospirosis
* Very important human pathogen
* Very common in the PH due to infected water systems
* **Primarily parasitic on vertebrates** other than humans such as rodents, cattle, dogs, cats, raccoons, and bats.
* Sheds the organism in **urine** (why it easily spreads)
* **MOT**: Direct contact with urine of animals carrying the organism OR indirect contact through close contact with contaminated soil and water
Leptospira interrogans
95
# Leptospira spp.
* Involves 3 main organs: kidney, liver, CNS
* First to be affected is the kidney, especially if not treated immediately
* In the PH, it is spread by infected rodents that urinate everywhere
Leptospirosis
96
# Leptospirosis
* Infectious can be mild or severe accompanied by myalgia, nausea, vomiting, fever, headache, and chills
Acute phase
97
# Leptospirosis
* Follows the acute phase
* Associated with Ab production and elimination of the organism
* Patient may recover 2-3 weeks after
* Requires complete treatment, otherwise, it might spread to the kidneys, liver, and CNS
Immune phase
98
# Match the serovarities.
1. Weil’s Syndrome
2. Infectious jaundice
3. Fort Bragg/Pretibial Fever
4. Seven Day Fever
5. Marsch Fever
6. Swine Herd Disease
A. L. interrogans SEROVAR mitis/Pomona
B. L. interrogans SEROVAR grippotyphosa
C. L. interrogans SEROVAR hebdomanis
D. L. interrogans SEROVAR autumnalis
E. L. interrogans SEROVAR icterohaemorrhagiae
F. L. interrogans SEROVAR canicola
1. E
2. F
3. D
4. C
5. B
6. A
99
T or F: L. interrogans SEROVAR canicola can spread in the liver.
T
100
T or F: SEROVAR icterohaemorrhagiae and canicola are important in humans.
T
101
# Laboratory Diagnosis for Leptospira spp.
* Culture media of choice
* Incubated in the dark for 4-6 weeks at RT (25-300C)
* Leptospires grows 1-3cm below the agar surface and may form linear disk of growth and is examined under darkfield microscopy
* (+) spiral w/ hooked ends
Fletcher's or Stuart's Medium or Ellinghausen-McCullough-Johnson-Harris (EMJH) Medium
102
# Specimen
* 1st 10 days
* CSF, blood, and tissues during early bacteremic phase
Acute Phase
103
# Specimen Used
* Urine → requires alkalinization if cannot be cultured immediately
Immune Phase
104
# Direct Detection of Leptospiral Antigens
* From clinical specimens
* ELISA
* RIA
* Immunogenic capture
105
# Direct Detection of Leptospiral Antigens
* From infected tissue samples
* Immunofluorescence
* Immunohistochemistry
106
# Serological Methods (Leptospira)
What are the four serological methods?
* Macroscopic Agglutination Test (MAT)
* Microscopic Agglutination Test (MIT)
* Hemagglutination assay
* Enzyme Immunoassay (EIA)
107
# Serological Methods
* Used for **screening**
Macroscopic Agglutination Test
108
# Serological Methods
* Used for **confirmatory**
Microscopic Agglutination Test
