Spirochetal infections Flashcards
Spirochete:
spiral shaped bacteria
Most common spirochete infections:
Syphilis
Lyme disease
Lyme Disease Overall
Caused by Borrelia burgdorferi
Commonly found in North America and Europe
Vector-borne transmission
Hard-bodied tick of the Ixodes genus
Most disease is in the Northeast and upper Midwest and Pacific Coast
Lyme Disease: Clinical Manifestations (Localized)
Localized Stage:
-Erythema Migrans – most common manifestation of Lyme
-“bullseye rash” (pearl)
-Not painful or pruritic but may feel warm to touch
-Flu-like symptoms
-Malaise, headache, fever, myalgia, arthritis
-Lymphadenopathy
Lyme Disease: Clinical Manifestations (Disseminated)
-Multiple secondary annular rashes
-Flu-like symptoms
-Lymphadenopathy
-Rheumatologic -Manifestations
-Transient migratory arthritis and effusion in one or more joints
-Migratory pain in tendons, bursae, muscle, bones
-Baker’s cyst
Manifestations:
Cardiac Manifestations
-Conduction
abnormalities
-Myocarditis
Neurologic Manifestations
-Bell’s palsy
-Meningitis
-Motor and sensory
radiculoneuropathy
Other
-Conjunctivitis, keratitis,
uveitis
-Splenomegaly
Localized Stage vs atypical/late stage:
Localized Stage:
-Serology typically not needed
-Diagnosis can be made clinically
Atypical Stage or Late stage:
-Tier 1 is a screening immunoassay
-If negative, no further testing is needed.
-Tier 2 is an immunoblot
-Performed if positive or equivocal results are obtained at tier 1
Lyme Disease Treatment (pearls)
Tick exposure management:
-within 72 hours of removing that tick, i can do a single dose of doxycycline
-Management: Doxycycline for 2-4 weeks
-or Ceftriaxone IV instead if very severe
complications/disease
(in depth slide 8)
Syphilis
A spirochete capable of infecting almost any organ or tissue in the body and of causing protean clinical manifestations
The risk of syphilis after unprotected sex with an individual with infectious syphilis is ~30–50%
Congenital syphilis: transplacental transmission occurs in infants of untreated or inadequately treated mothers
Two major clinical stages:
-Early (infectious) syphilis
-Late syphilis
Stages are separated by a symptom-free latent period
During early latency (within the first year after infection) the infectious stage may recur
Syphilis: Overlapping stages based on clinical manifestations:
Primary (early/infectious syphilis)
Secondary (early/infectious syphilis)
Latent (symptom free)
Tertiary (late syphilis)
Primary Syphilis most common presentation:
Chancre (PAINLESS ulcer oozing bacteria-filled fluid) and nontender regional lymphadenopathy
Primary Syphilis: Diagnosis
Compatible historic and physical exam findings with serologic evidence of disease
2 types of serologic testing:
-Nontreponemal tests
-Rapid plasma regain (RPR)
-Venereal Disease Research Laboratory (VDRL) test
-Treponemal tests:
-Florescent treponemal antibody absorption (FTA-ABS)
-Treponemal pallidum particle agglutination (TPPA)
(Know that RPR and VDRL come before Treponemal tests)
Primary Syphillis: Treatment
Benzathine penicillin IM single dose
-if allergy, doxycycline or tetracycline
Monitor for serological cure (?)
(Reportable)
Secondary Syphilis
Presents 3 weeks- 3 months after initial exposure
May overlap with other stages
Classic presentation:
-Mucosal lesions
-Lymphadenopathy
-Rash involving palms and soles
Other manifestations:
-Oral mucous patches
-Hepatitis
-Glomerulonephritis
-Neurologic disease
(classic manifestation: it has move elsewhere)
Latent Syphilis
Seroreactivity to syphilis in an asymptomatic person
Early latent syphilis refers to infection acquired within the preceding year (Patients may be infectious in this stage)
Late latent syphilis refers to infection acquired > 1 year ago (Patients are not thought to be infectious in this stage)
