Spirochetes

Question 1

How are Spirochetes transmitted? (3)

Answer 1

Sexually - syphillis
Vectors - lyme disease, relapsing fever
Environmentally - Lep-to-spi-ro-sis

Question 2

What are there VF for?

Answer 2

Immune Evasion

Question 3

Whats the problem in diagnosing T. pallidum (Syphillis)?

Answer 3

Too small for standard microscopy

Question 4

What is the problem in diagnosing B. burgdorfi (Lyme Disease)?

Answer 4

No good lab diagnostic

Question 5

Why is an eye exam useful in diagnosing spirochetes?

Answer 5

Argryll-Robertson pupil –> Neurosyphilis
Conjunctival suffusion (redness w/o exude) –>
lep-to-spi-ro-sis

Question 6

What does Argryll-Robertson pupil do?

Answer 6

One or both pupils fail to constrict in response to light

But does constrict to focus on near object

Question 7

What is the general treatment for spirochetes if caught early?

Answer 7

Curable by standard Abt - little resistance

Question 8

What is the general treatment for spirochetes if caught late?

Answer 8

Infection can still be cured, but recovery of immune system and nerves can take months-yrs (if ever)

Question 9

What rxn usually occurs do to treatment?

Answer 9

Ja-risch Herx-hei-mer

Question 10

What occurs during Ja-risch Herx-hei-mer?

Answer 10

Occurs 24hrs after Abt treatment
Flulike symptoms
Last 24-48hrs

Question 11

What are the two ex of spirochetes used?

Answer 11

Treponema pallidum

Borrelia burgdorferi

Question 12

What is Treponema pallidum?

Answer 12

Syphyllis

Question 13

What is Borrelia burgdorferi?

Answer 13

Lyme disease

Question 14

What is the bacteriology of Treponema pallidum?

Answer 14

Spirochetes are motile - flagella corkscrew motion
NOT culturable
Very slow growing
Too slender to Grain Stain

Question 15

How is T. pallidum transmitted? (3)

Answer 15

Sexually - low ID50
Mother to baby during birth
Blood transfusin

Question 16

Is the incidence of T. pallidum increasing/decreasing?

Answer 16

Increasing

Question 17

What does T. pallidum infect?

Answer 17

Endothelium of small blood vessels

Question 18

What kind of infection is T. pallidum?

Answer 18

It is a triphasic infection (3 phases)

Question 19

What is Primary Syphillis?

Answer 19

Weeks after infection
Initial replication at site of infection
Forms ulcers
Initiates bacterimia

Question 20

What is Secondary Syphillis?

Answer 20

Months after infection
Macropapular rash on palms and soles
Moist papules on skin and mucous membrane
HIGHLY infectious moist lesion in genitals called
–>condylomata lata

Question 21

What happens after secondary syphillis? (3)

Answer 21

1/3 - Resolved
1/3 - Enter latency
1/3 - Enter tertiary syphillis

Question 22

What classifies early latency?

Answer 22

Symptoms come and go

Patient Remains Infectious

Question 23

What classifies late latency?

Answer 23

Symptoms absent

Not infectious

Question 24

What makes up the tertiary syphillis?

Answer 24

Gummatous syphilis
Cardiovascular syphillis
Neurosyphilis

Question 25

What is Gummatous syphilis?

Answer 25

``` granulomatous lesions (gummus) w/ rubbery, necrotic center Primarily liver, bones, testes ```

Question 26

What is cardiovascular syphilis?

Answer 26

After 10 yrs | Aneurysm of ascending aorta caused by chronic inflammation of vasa vasorum

Question 27

What is neurosyphilis?

Answer 27

Syphilitic meningitis - 6 months Meningovascular syphillis - damage blood vessels of meninges, brain, spinal cord Parenchymal neurosyphilis - extensive damage and dangerous brain damage

Question 28

What is congenital syphilis?

Answer 28

Mom to child during birth | Crosses placenta--> still birth or fetal abnormalities

Question 29

How do you diagnose syphilis?

Answer 29

Exam | Lam

Question 30

What makes up an exam?

Answer 30

look for chancre, rash, condylomata lata, granulomas, CNS symptoms

Question 31

What are some lab procedures used to diagnosis? (2)

Answer 31

Microscopy - darkfiled microscopy or IF Serology -Reagin -Specific Abs

Question 32

How do you treat syphilis?

Answer 32

Antibiotics -Single injection of BEN_ZA_THINE penicillin G for primary or secondary syphilis (slow release) -Alternate is DOXYCYCLINE Patients should dev flulike symptoms for 24hrs after treatments (Ja-rish Herxheimer)

Question 33

What does Borrelia burg-dor-feri cause?

Answer 33

Lyme Disease

Question 34

What is Borrelia burg-dor-feri's bacteriology?

Answer 34

``` Motile spirochete Visible by standard microscopy Tick borne Small mammal (mouse/rat) reservoirs Large mammal host ```

Question 35

How is Borrelia burg-dor-feri transmitted?

Answer 35

Tick nymphs | Require 24-48hrs to transmit

Question 36

What is Borrelia burgdorferi's pathogenesis?

Answer 36

Does not involve toxins, primarily immune evasion | Symptoms are spread

Question 37

Where are the symptoms spread to?

Answer 37

Bite site Blood Heart, joints, CNS

Question 38

How do you diagnose Borreloa burgdorferi?

Answer 38

Exam | Lab

Question 39

How do you diagnose Borrelia burgdorferi using an Exam?

Answer 39

``` Different symptoms for different stages Stage 1 (days) Stage 2 (weeks) Stage 3 (months) Post-treatment ```

Question 40

How do you diagnose Borrelia burgdorferi using Lab?

Answer 40

Serology (ELISA) or IF, BUT likely to be negative <2 wks post-infection Confirm with western blot or PCR