II-A. Systemic Bacteriology | 23. Borrelia, Leptospira

Question 1

I. Borrelia
1. What is the morphology of Borrelia?

Answer 1

• Larger spirochetes,
• Gram Negative (-)
• Microaerophilic
• Difficult to culture

Question 2

I. Borrelia
2. What are the important species of Borrelia?

Answer 2

• Borrelia recurrentis
• Borrelia burgdorferi, B. afzelii, B. garnii

Question 3

I. Borrelia - Borrelia recurrentis
3. What is Borrelia recurrentis?

Answer 3

pathogen of recurrent fever

Question 4

I. Borrelia - Borrelia recurrentis
4. What is the role of virulence factors of Borrelia recurrentis?

Answer 4

• might neutralize the complement system
• able to change its surface antigens!

Question 5

I. Borrelia - Borrelia recurrentis
5. What is the source oof infection of Borrelia recurrentis?

Answer 5

infected person

Question 6

I. Borrelia - Borrelia recurrentis
5. What is the route of transmission of Borrelia recurrentis?

Answer 6

by the bite of body louse

Question 7

I. Borrelia - Borrelia recurrentis
6A. What is the disease caused by Borrelia recurrentis?

Answer 7

recurrent fever

(* 2-16 days long incubation period (7 days on average)
* fever, chills, headache, muscle pain
* symptoms disappear after 3-5 days
* symptoms restart on average a week later (due to the antigenic change of the
bacterium))

Question 8

I. Borrelia - Borrelia recurrentis
6B. What are the symptoms of recurrent fever?

Answer 8

• 2-16 days long incubation period (7 days on average)
• fever, chills, headache, muscle pain
• symptoms disappear after 3-5 days
• symptoms restart on average a week later (due to the antigenic change of the
  bacterium)

Question 9

I. Borrelia - Borrelia recurrentis
7A. What is the diagnosis for the disease (recurrent fever) caused by Borrelia recurrentis

Answer 9

Question 10

I. Borrelia - Borrelia recurrentis
7B. How do we do sampling to diagnose disease (recurrent fever) caused by Borrelia recurrentis

Answer 10

sampling: blood culture, blood (for serology)

Question 11

I. Borrelia - Borrelia recurrentis
7C. How do we do laboratory to diagnose disease (recurrent fever) caused by Borrelia recurrentis

Answer 11

• examination of Giemsa-stained blood smear
• culturing (Kelly-medium)
• serology (ELISA)

Question 12

I. Borrelia - Borrelia recurrentis
8. What is the empirical therapy and prevention for Borrelia recurrentis

Answer 12

1. tetracyclines: Jarisch-Heixheimer reaction might occur
2. ectoparasite eradication

Question 13

I. Borrelia
9. What are the pathogens of Lyme’s disease?

Answer 13

Borrelia burgdorferi, B. afzelii, B. garnii

Question 14

I. Borrelia - Borrelia burgdorferi, B. afzelii, B. garnii
10. What is the source of infection of Borrelia burgdorferi, B. afzelii, B. garnii?

Answer 14

infected/carrier animals, ticks (zoonotic!)

Question 15

I. Borrelia - Borrelia burgdorferi, B. afzelii, B. garnii
11. What is the route of transmission of Borrelia burgdorferi, B. afzelii, B. garnii?

Answer 15

through the bite of ticks (vector borne!)

Question 16

I. Borrelia - Borrelia burgdorferi, B. afzelii, B. garnii
12A. What is the disease caused by Borrelia burgdorferi, B. afzelii, B. garnii?

Answer 16

Lyme’s borreliosis (3 stages)
- primary borreliosis
- secondary borreliosis
- tertiary borreliosis:

Question 17

I. Borrelia - Lyme’s borreliosis
12B. What happen in primary borreliosis?

Answer 17

primary borreliosis: erythema chronicum migrans
- „bullseye rash”
- seen in c.a. 60% of patients at the site of tick bite
- local lypmhadenopathy might be present

(Borrelia burgdorferi, B. afzelii, B. garnii)

Question 18

I. Borrelia - Lyme’s borreliosis
12C. What happen in secondary borreliosis

Answer 18

secondary borreliosis: early disseminatipn
- secondary skin lesions
- migrating arthritis
- fatigue
* cranial nerve paresis (for e.g. facial paresis)
- cardiac arrhythmia
(Borrelia burgdorferi, B. afzelii, B. garnii)

Question 19

I. Borrelia - Lyme’s borreliosis
12D. What happen in tertiary borreliosis

Answer 19

tertiary borreliosis: late persisting / late disseminated
- acrodermatitis chronica atrophicans, encephalopathy
- polyneuritis
- fatigue
- joint pain
(Borrelia burgdorferi, B. afzelii, B. garnii)

Question 20

I. Borrelia - Borrelia burgdorferi, B. afzelii, B. garnii
12. What is the disease caused by Borrelia burgdorferi, B. afzelii, B. garnii?

Answer 20

Lyme’s borreliosis (3 stages)
- primary borreliosis
- secondary borreliosis
- tertiary borreliosis:

Question 21

I. Borrelia - Borrelia burgdorferi, B. afzelii, B. garnii
13A. What is the diagnosis for disease caused by Borrelia burgdorferi, B. afzelii, B. garnii

Answer 21

• based on clinical signs and symptoms, patient history!
• sampling: blood (for serology), CSF if neurological symptoms are present
• laboratory: serology (ELISA), immunoblot for confirmation

Question 21

I. Borrelia - Borrelia burgdorferi, B. afzelii, B. garnii
12. What is the disease caused by Borrelia burgdorferi, B. afzelii, B. garnii?

Answer 21

Lyme’s borreliosis (3 stages)
- primary borreliosis
- secondary borreliosis
- tertiary borreliosis:

Question 22

I. Borrelia - Borrelia burgdorferi, B. afzelii, B. garnii
13B. How do we do laboratory for diagnosis of diseases caused by Borrelia burgdorferi, B. afzelii, B. garnii?

Answer 22

serology (ELISA), immunoblot for confirmation

Question 23

I. Borrelia - Borrelia burgdorferi, B. afzelii, B. garnii
14. What is the empirical therapy for diseases caused by Borrelia burgdorferi, B. afzelii, B. garnii?

Answer 23

• penicillins (aminopenicillins, for e.g. amoxicillin)
• tetracyclins
• cephalosporins (3. gen cephalosporin: ceftriaxon) in neuroborreliosis

Question 24

II. Leptospira 1. What are the main features of Leptospira?

Answer 24

- Spirochetes, thin with hooks, question-mark shaped - Too thin to visualize but - Gram Negative (-) cell envelope

Question 25

II. Leptospira 1. What are the main features of Leptospira?

Answer 25

- Spirochetes, thin with hooks, question-mark shaped - Too thin to visualize but - Gram Negative (-) cell envelope

Question 25

II. Leptospira 2. What is the important species of Leptospira

Answer 25

Leptospira interrogans

Question 25

II. Leptospira 3. What are the serotypes of Leptospira interrogans?

Answer 25

Question 26

II. Leptospira 4. What is the source of infection of Leptospira interrogans?

Answer 26

infected / carrier animals (rodens mainly)

Question 27

II. Leptospira 5. What is the route of transmission of Leptospira interrogans?

Answer 27

direct inoculation through skin / mucous lesions - inoculation with contaminated soil, water

Question 28

II. Leptospira 6A. What is the disease caused by Leptospira interrogans?

Answer 28

Question 29

II. Leptospira 6B. What are the features of mild form of disease caused by Leptospira interrogans?

Answer 29

mild form (”field fever”, „harvest fever”): * fever * muscle pain * flue-like symptoms * conjunctivitis

Question 30

II. Leptospira 6B. What are the features of mild form of disease caused by Leptospira interrogans?

Answer 30

mild form (”field fever”, „harvest fever”): * fever * muscle pain * flue-like symptoms * conjunctivitis

Question 31

II. Leptospira 6C. What are the features of severe form (Weil’s disease) of disease caused by Leptospira interrogans?

Answer 31

* fever * muscle pain * flue-like symptoms * conjunctivitis * liver failure * kidney failure * coagulopathies

Question 32

II. Leptospira 7A. What is the diagnosis for disease caused by Leptospira interrogans?

Answer 32

Question 33

II. Leptospira 7B. How do we do sampling to diagnose the disease caused by Leptospira interrogans?

Answer 33

blood culture, blood (for serology), urine, CSF

Question 34

II. Leptospira 7C. How do we do laboratory to diagnose the disease caused by Leptospira interrogans?

Answer 34

Question 35

II. Leptospira 8. What is the empirical therapy for Leptospira interrogans?

Answer 35

* tetracyclines * penicillins (lack of evidence)