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1

Treponema pallidum is commonly referred to as...

Syphilis

2

Describe the structure of Treponema pallidum

Long, thin spirochete
- Unseen in light microscope, seen by silver stain

3

What type of microscope can view Treponema pallidum?

Dark Field Microscope

4

What surrounds every Treponema pallidum cell?

Glycosaminoglycan sheath

5

How is Treponema pallidum made motile?

Endoflagella within the periplasm (3 per end)

6

What is unique about Treponema pallidum's envelope?

No LPS
Cardiolipin in membrane

7

Does Treponema pallidum have many outer membrane proteins? Significance of this knowledge?

Few OM proteins
Makes it hard for immune system to find it and make Abs

8

Method used to culture Treponema pallidum?

None. So far unculturable in lab
Grown in rabbit testes instead

9

Oxygen metabolism of Treponema pallidum?

Microaerophilic

10

What is a chancre?

Defined, Unpainful papule at site of infection

11

Describe the symptoms common to Primary Treponema pallidum infection.

Ulcerated, Chancre, Regional LN swelling
Heals spontaneously, but organisms remain in blood

12

Describe the clinical presentation of secondary Treponema pallidum infection.

Red macular/macropapular rash anywhere
Condylomas in mount areas

13

What is unique about the red macular/macropapular rash of Treponema pallidum?

One of few to appear on soles and palms

14

What is a condyloma?

Raised, White, wart-like papule (seen in Treponema pallidum)

15

Difference between the early and late latent period?

Early -- Within a year of secondary
Late -- 1-20+ years

16

What is tertiary Treponema pallidum response?

Lesions of tissues through body caused by immune response

17

Why can't you culture a tertiary Treponema pallidum response?

Treponema pallidum hasn't been able to be cultured so far
Even if it could, its only immune response at this point, not the actual bacteria

18

Important causes of vertically transmitted disease

Toxoplasma
Other -- HIV, Coxsackie, Chicken Pox, etc.
Rubella
Cytamegalovieus
HErpes
Syphilis

19

Clinical presentation of tertiary Treponema pallidum response?

Gummas
Bones: porous, bendable, fragile
Heart: aorta swells, ruptures
liver
CNS

20

Two manifectstions of Treponema pallidum in the CNS

Brain -- General paresis
Spine -- tabes dorsalis

21

Significance of Treponema pallidum in pregnant women?

20% abortion or stillbirth
80% have congenital defects

22

Primary defects associated with Treponema pallidum transmission in utero? (Name the group name)

Hutchison's triad

23

What does Hutchison's Triad entail?

Blindness
VIII Nerve Deafness
Hutchison's Teeth

24

What are Hutchison's Teeth?

Double pointed incisors

25

What organisms can carry Treponema pallidum?

Only humans

26

How is Treponema pallidum transmitted?

Exclusively STD

27

How long are infected individuals contagious with Treponema pallidum?

3-5 years

28

What population is seeing the most rapid increases in Treponema pallidum diagnosis?

Over 50

29

Two groups that should always be tested for Treponema pallidum

High-Risk Populations
After any stillbirth

30

Describe the infectivity and molecular mechanism of Treponema pallidum infection.

Highly infectious
Hyaluronidase facilitates spread/invasion of tissues + Rapid Motility

31

How is Treponema pallidum controlled (in a public health-y kind of way)?

Finding, Testing Sexual Contacts

32

How is Treponema pallidum diagnosed?

Look for spirochetes in chancres
Serologic Tests for Treponema pallidum

33

What do indirect tests look for? Direct tests?

Antibodies
the Organism

34

Descrive the Treponema pallidum indirect test.

Add Cardiolipin to patient's serum
If + Reagin will cause it to clump
Many false positives

35

What is Reagin

IgM+IgA

36

What occurs in a direct Fluorescent Treponema Antibody test?

Sandwich assay for Treponema pallidum epitopes

37

How is early Treponema pallidum typically treated?
How is latent Treponema pallidum typically treated?

1 dose Penicillin G
3 doses Peni. for latent

38

Why does tertiary Treponema pallidum require much greater levels of penicillin?

You have to get through the Blood Brain Barrier

39

Describe the structure Neisseria gonorrhea.

G-
Coffee Bean Shape
Diplococcus

40

How is Neisseria gonorrhea cultured?

Best with selective media (vanco, colistin)
Also gros on MTM or chocolate blood

41

What oxygen metabolism does Neisseria gonorrhea use?

Aerobic, but likes 5% CO2

42

Describe the genetic setup on Neisseria gonorrhea

2 identical diploid chromosomes
NEVER heterozygous

43

Neisseria gonorrhea invades _______

Mucus membranes of UGT, Rectum, Eye, Throat

44

In either gender, Neisseria gonorrhea tends to present with... (4)

Urethritis
Proctitis
Pharyngitis
Arthritis

45

Unique Neisseria gonorrhea manifestations in women (5)

Vaginitis
Salphingitis
Pelvis Inflammatory Disease
Peritonitis

Major cause of infertility in women

46

How does Neisseria gonorrhea manifest in neonates?

Conjunctivitis

47

How is Neisseria gonorrhea spread?

Human STD

48

Neisseria gonorrhea is commonly associated with ______ co-infection. So What?

Chlamydia
Treat for both (presumed coinfection)

49

Why is Neisseria gonorrhea so widely spread?

Asymptomatic Carriers

50

How is Neisseria gonorrhea diagnosed?

Males -- Gram stain of urethral drip
Females -- Culture of cervical/vaginal swab

51

Unique components of Neisseria gonorrhea attachment?

- Pilus cassette switching avoids immune response
- Opa protein has a great deal of antigenic variation caused by slippage of DNA repeats

52

In females, Opas change during...

Menstrual Cycle

53

Three proteins involved in Neisseria gonorrhea evasion

Por
Rmp
IgA Protease

54

What is Por protein in Neisseria gonorrhea?

Outer membrane porin
Prevents phagolysosome fusion in host

55

What is Rmp in Neisseria gonorrhea?

Host Abs bind to it, prevents Ab binding to Por and LOS

56

Significance of IgA protease in Neisseria gonorrhea?

Stops IgA's bacteriocidal, complement activating activity

57

What two components of Neisseria gonorrhea mediate toxicity?

LOS
PG released from autolysins at low temp/alk. pH

58

What does Fbp protein in Neisseria gonorrhea do?

Scavenges Fe from human lactoferrin and transferrin

59

Neisseria gonorrhea secretes blebs with ____ inside

PG

60

Why is Neisseria gonorrhea hard to drug?

Resistance is acquired very easily

61

What do you do for patients with Pan-resistant Neisseria gonorrhea.

Say a prayer or something - they're keeping their Neisseria gonorrhea

62

How do you typically treat Neisseria gonorrhea?

Cephtriaxone or cefixime
(plus doxycycline/erythromycin for chlamydia)

63

How is newborn Neisseria gonorrhea treated?

Tetracycline drops

64

You've cured your Neisseria gonorrhea patient! Good job! What do you need to make sure not to forget?

Treat everyone they doinked

65

How is Neisseria meningitidis spread?

Respiratory Droplets
(NOT an STD. Here because Med School is dumb)

66

Describe the structure of Neisseria meningitidis.

G-
Coffee bean shapes
Diplococcus
Polysachharide capsule

67

How many types of Neisseria meningitidis are there?
Name the top 5.

About 12
A, B, C, Y, W-135

68

Blood related presentation of Neisseria meningitidis?

Meningococcemia
Purpura and Petechial Hemorrhages
- Caused by toxic effects of LOS, soluble PG

69

Non-blood clinical presentation of Neisseria meningitidis?

15% involvement of meninges
Acute Headache, Vomiting, Stiff Neck
Sometime neurological symptoms, coma, and death

70

In CNS cases of Neisseria meningitidis, what two findings might you expect?

PMNL in CSF
Purulent exudate of PMNL and Nm surrounding brain

71

What is meningococcal septicemia?

DIC and Circulatory Collapse

72

_____ modification with ______ disrupts microcolony. This is what allows Neisseria meningitidis to spread from the respiratory tract.

Pilin
Phosphatidylglycerol

73

Name a couple placed most prone to have an Neisseria meningitidis outbreak

College dorm, Military barracks

74

Most epidemics of Neisseria meningitidis are due to...

Specific Capsular Antigen Types

75

Pathogenesis of Neisseria meningitidis is most similar to...

Gonococcus

76

Unique pathogenesis of Neisseria meningitidis?

Antiphagocytic Polysaccharide Capsule
Special Pili for BBB endothelial cells
Bonus Adhesins in OM

77

How does the antiphagocytic polysaccharide capsule work?

Antigen B is sialyted
More disguised than others

78

Why do we care that Neisseria meningitidis has BBB attaching pili?

The proteins recruit proteins away from junction complexes, depleting cell jxns, making barrier porous

79

Can Neisseria meningitidis be vaccinated for? How?

Currently there are vaccines for all types
Menvo + BEXSERO or Trumenba

80

How is Neisseria meningitidis treated?

3rd gen. Cephalosporin

81

Why are Rifampin and 3rd gen ceph. used prophylactically?

They can cross the BBB whenever they want

82

Why might you prescribe Vancomycin for Neisseria meningitidis, even though it can't penetrate BBB?

If the BBB is damaged/porous it can cross.
If a different, G+, bacteria causes meningitis, its helpful

83

How does Moraxella catarrhalis tend to present?

Opportunistic sinusitis, bronchitis, pneumonia
Otitis media in children

84

Moraxella catarrhalis tends to exacerbate what other disease in adults?

COPD

85

Top three causes of otitis media?

S. Pneu
H. flu
Moraxella catarrhalis

86

How do you treat Moraxella catarrhalis?

3rd generation Ceph. OR Cipro
OR not at all

87

Physical characteristics of Chlamydia trachomatis

Like G- Envelope
Small genome
Cell wall without MurNAc

88

How must Chlamydia trachomatis grow?

Obligate intracellular parasite

89

How is Chlamydia trachomatis often grown in the lab?

embryonated chicken eggs
McCoy cells in monolayer tissue cultures
Mouse Brains

90

Two forms of Chlamydia trachomatis?

Elementary Bodies
Reticulate Bodies

91

Describe Elementary Bodies in Chlamydia trachomatis.

Infective Form
0.3uM diameter
Tough S-S membrane

92

Describe Reticulate bodies in Chlamydia trachomatis.

Replicative Form
1.0uM diameter
Fragile SH HS

93

Does Chlamydia trachomatis tend to manifest as chronic or acute?

Chronic

94

Five ways that Chlamydia trachomatis infection may present in the clinic

Trachoma
Inclusion Conjunctivitis
Neonatal Pneumonia
Chlamydia
Latent Infection

95

How does a person get a Trachoma (Chlamydia trachomatis)?

Infection from birth from infected birth canal
Infection in early childhood by contact/mechanical vector

96

How does Trachoma (Chlamydia trachomatis) present clinically?

- Mucopurulent discharge, Pannus formation, cornea obstruction
- Irritation from pannus+eyelashes+other bac --> blindness

97

How do people get inclusion conjunctivitis from Chlamydia trachomatis? How does it present clinically?

Mostly neonates (infected birth) and adults (self-inoculation)
Less severe trachoma, maybe respiratory complications

98

Presentation of Neonatal pneumonia via Chlamydia trachomatis? When should you suspect?

Shortness of breath, no Fever
If symptoms occur with inclusion conjunctivities

99

Chlamydia trachomatis patients tend to also be infected with ________

Gonorrhea

100

Symptoms of Chlamydia (Chlamydia trachomatis) in males

Non-gonococcal urethritis
Epididymitis
Prostatis

101

Symptoms of Chlamydia (Chlamydia trachomatis) in females

Urethritis
Cervicitis
Salphingitis
PID

102

Long term significance of salphingitis in Chlamydia and Gonorrhea?

Common cause of infertility from fallopian rupture

103

Symptoms of a latent infection with Chlamydia trachomatis.

Small abscess
Inguinal Buboes form sometime thereafter
If chronic, can cause fibrous lymphatic restrictions or bowel obs.

104

How are the buboes seen in latent Chlamydia trachomatis differentiated from plague?

Chlamydia trachomatis buboes are never in cervical lymph nodes

105

The STD form of Chlamydia trachomatis is most common in...

NA, SA, Eur

106

Trachoma Chlamydia trachomatis is most common where?

Asia/Africa
Hot, Dry places with poor access to clean water

107

_________ is a leading cause of infectious blindness in the world.

Trachoma Chlamydia trachomatis

108

Why would you treat both localizations of Chlamydia trachomatis infection at the same time in a patient?

They can cross-infect

109

Pathogenesis of Chlamydia trachomatis?

- Elementary bodies bind host receptor, induce endocytosis
- Chlamydia prevent phagolysosome fusion
- Induce cytokines (IL-1) and cause inflammation
- Remain for long periods without killing host

110

Why are vaccines against Chlamydia trachomatis ineffective?

Intracellular location of pathogen

111

_____ is the key to control. This is accomplished by ___.

Screening.
PCR

112

How is Chlamydia trachomatis treated?

Azithromycin
Tetracycline and macrolides may also work

113

Drastic measures to prevent Trichiasis Chlamydia trachomatis corneal keratinization include....

Surgery
Epilation (pulling out lashes)

114

You're awesome! You just cured your patients Chlamydia trachomatis! Now, just don't forget to...

Identify and treat all of their sexual conacts
Expedited partner therapy if necessary

115

How does Chlamydia pneumoniae tend to present clinically?

Mild URT disease
Possibly progressing to mycoplasma-like pneumonia

116

Chlamydia pneumoniae may be associated with what other major diseases?

Atherosclerosis
Asthma
Stroke
Late-Onset Alzheimers

117

How to treat Chlamydia pneumoniae?

Usually Untreated
Tetracycline might help

118

Chlamydia psittaci is also known as..

Parrot Fever

119

How does Chlamydia psittaci tend to present in the clinic?

Acute, Severe Pneumonia and Sepsis
Patchy, well-defined lung involvement

120

How is Chlamydia psittaci transmitted?

Contact with psittacine birds (esp. bites or feces)

121

How is Chlamydia psittaci controlled and treated?

Quarantine of Imported Birds
Tetracycline