Micro 9 - Spirochetes And Zoonotics

Question 1

What are the symptoms of Leptospirosis?

Answer 1

First is fever, mialgia, chills, headache. Then there is a brief asymptomatic phase before the second phase that brings meningitis, liver damage, and renal failure.

Question 2

What is Weil’s disease?

Answer 2

The most severe form of leptospirosis, it is when patients with said disease manifest ictero-hemorrhagic leptospirosis.

Question 3

What causes Lyme disease?

Answer 3

Borrelia burgdorferi.

Question 4

What are the characteristics of stage 1 of Lyme disease?

Answer 4

Fever, fatigue, headache, depression. This comes from a few days to a month after the tick bite. The most characteristic finding of this stage is the Erythema migrans, a bulls eye rash (not always shows up).

Question 5

What are the characteristics of stage 2 Lyme disease?

Answer 5

Happens weeks or months after tick bite, consists of neurologic and cardiac manifestations; Bilateral Bell’s palsy (very few cause this bilaterally) and AV nodal block, and with or without myopericarditis.

Question 6

What are the characteristics of Stage 3 Lyme disease?

Answer 6

Occurs years after tick bite, causes chronic monoarthritis (usually a knee), migratory polyarthritis, subacute encephalitis.

Question 7

What is the treatment for Stage 1 or 2 Lyme disease?

Answer 7

Doxycycline. Amoxicillin for children. For 10-14 days.

Question 8

What is the treatment for stage 3 Lyme disease?

Answer 8

Ceftriaxone IV for 28 days.

Question 9

What is the characteristic of Primary syphilis?

Answer 9

A single painless chancre.

Question 10

What is the characteristic of Secondary syphilis?

Answer 10

Patients will have a non specific symptoms like fever, malaise, chills, and maculopapular rash in the trunks and extremities (including palms and soles), and sometimes condyloma lata in the mouth and perineum. Sometimes alopecia areata.

Question 11

What diseases cause rash that does not spare the soles and palms?

Answer 11

[You drive Kawasaki CA.R.S. with your hands and feet].

Kawasaki, CA (Coxsackie A), R (Rocky mountain spotted fever), S (Secondary Syphilis).

Question 12

What are the characteristics of Tertiary Syphilis?

Answer 12

Gumma (soft, non-cancerous growth with a firm, necrotic center surrounded by inflamed tissue, which forms an amorphous proteinaceous mass). Can grow anywhere in the body but mostly on liver. Can grow in ascending aorta (causing aortitis,”tree-barking by vaso vasorum [microscopic blood supply] destruction). Also causes Tabes dorsalis, Argyll-Robertson pupil, Charcot’s joints.

Question 13

What is Tabes dorsalis?

Answer 13

AKA syphilitic myelopathy, a slowly demyelination of the nerves of the dorsal columns and dorsal roots. Causes sensory ataxia, sudden severe stabs of pain and broad-based ataxia and positive Rhomberg sign. Seen in tertiary syphilis.

Question 14

What is Argyll-Robertson pupil?

Answer 14

The pupil constricts to accommodation but not to direct light in tertiary syphilis.

Question 15

What is Charcot’s joints?

Answer 15

Joints get damaged because you don’t know where your joint is in space because of all these neurological problems. Seen in Tertiary syphilis and diabetic neuropathy.

Question 16

What are the characteristics of late congenital syphilis?

Answer 16

Saber shins (anterior bowing of the tibia), saddle nose (bulging of the frontal nose), Hutchinson teeth (notching of the upper incisors, frontal bossing.

Question 17

What are the characteristics of Early Congenital syphilis?

Answer 17

Snuffles (blood-tinged nasal secretions).

Question 18

How do we diagnose Syphilis?

Answer 18

VDRL/RPR: Venereal disease research lab/rapid plasma reagent Which detects treponemal antibodies in the serum. Both can produce false positives, so if it is positive, it is followed by FTA-ABS which is far more specific for Treponema pallidum.

Question 19

What is the treatment for Primary syphilis?

Answer 19

Penicillin G (that is the IV form). If allergic, use doxycycline.

Question 20

What are things that can cause VDRL false positives?

Answer 20

The test can react to nonspecific antibodies that reacts with B-cardiolipid.
[VDRL]
Virus (mononucleosis, EBV), Drugs (that cause SLE-like symptoms), Rheumatic fever, Lupus and Leprosy.

Question 21

What does the Bartonella bacteria cause?

Answer 21

Cat-scratch fever; regional lymph adenopathy, usually self limited. Can bacillary angiomatosis, similar to Kaposi sarcoma in immunocompromised patients. Transmission is from cats to humans.

Question 22

What does Borrelia burgdorferi cause?

Answer 22

Lyme disease through the Ixodes tick.

Question 23

What does Borrelia recurrentis cause?

Answer 23

Recurrent fever from ticks and lice.

Question 24

What does Brucella spp. Cause?

Answer 24

Brucellosis and undulant fever.

Question 25

What does Chlamydophila psittaci cause?

Answer 25

Causes psittacosis, causing severe pneumonia. Caused by contact with parrots and other birds.

Question 26

What does Coxiella burnetti cause?

Answer 26

Q fever; flu-like symptoms, abrupt fever, perfused perspiration for 1-2 weeks. Caused by ticks and camel placenta.

Question 27

What does Ehrlichia chaffeensis cause?

Answer 27

Causes Ehrlicosis; headache, mialgia and fatigue. Can progress to blunting of the immune system, leading to opportunistic infections like candidiasis. Spread by Lone star tick.

Question 28

What does Francisella tularensis cause?

Answer 28

Causes tulerimia; tick bites and rabbits. Can be used as biological warfare.

Question 29

What does Pasteurella multocida cause?

Answer 29

Causes cellulitis and osteomyelitis from animal bites (cats and dogs).

Question 30

What does Rickettsia prowazekii cause?

Answer 30

Epidemic typhus transmitted by the louse.

Question 31

What does Rickettsia rickettsii cause?

Answer 31

Causes Rocky mountain fever caused by the Dermacentor tick bite.

Question 32

What does Rickettsia typhi cause?

Answer 32

Causes endemic typhus transmitted by fleas.

Question 33

What does Yersinia pestis cause?

Answer 33

Causes boubonic plague. Can be transmitted by prairie dogs in the US.

Question 34

What is the classic presenting symptom in a patient with Lyme disease?

Answer 34

Erythema chronicum migrans.

Question 35

What pupillary sign might point you to a diagnosis of syphilis?

Answer 35

Argyll-Robertson pupil: not reactive to light but constricts with accommodation.

Question 36

What organism is associated with the clue: lymphadenopathy + a new kitten.

Answer 36

Bartonella.

Question 37

What organism is associated with the clue: dog bite.

Answer 37

Pasteurella multocida.

Question 38

What organism is associated with the clue: Ixodes tick.

Answer 38

Borrelia burgdorferi.

Question 39

What organism is associated with the clue: Rabbit hunter.

Answer 39

Francisella tularensis.

Question 40

What organism is associated with the clue: Pet prairie dog.

Answer 40

Yersinia pestis.

Question 41

RFF: Standard treatment for T.pallidum.

Answer 41

Penicillin G.

Question 42

RFF: Cellulitis from a dog or cat bite.

Answer 42

Pasteurella multocida.

Question 43

RFF: A non-painful indurated, ulcerated genital lesion.

Answer 43

Chancre of primary Syphilis.

Question 44

RFF: Moist, smooth, flat, white genital lesion.

Answer 44

Condylomata lata of secondary syphilis.

Question 45

RFF: Large bull's-eye rash.

Answer 45

Erythema migrans due to Lyme disease.

Question 46

What disease might have Bell's palsy as a complication?

Answer 46

[my Lovely belle Had An STD] | Lyme disease, Herpes Zoster, AIDS, Sarcoidosis, Tumors, Diabetes.

Question 47

Where do we usually find Leptospira interrogans?

Answer 47

Water contaminated with animal urine.