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19 Cards in this Set
- Front
- Back
spirochetes
- special things - labs - genera |
have an additional outer membrane with periplasmic flagella underneath --> spins them around --> generates thrust
too small to see in microscope. use darkfield microscopy, serology, etc 1. Treponema 2. Borrelia 3. Leptospira |
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Congenital syphilis
- categories - sympotms *useful fact- does not damage fetus until fourth month----so treat mother before this to prevent!!!* |
infects fetus
1. Death- SAB, stillbirth, neonatal death 2. Early congenital syphilis - occurs w/in 2 years birth - like secondary syphylis- rash, condyloma latum - "snuffles"--due to involvement in nasal mucous membranes - also bone infection-osteitis 3. Late congenital syphilis - like tertiary syphilis but cardiac involvement rare - neurosyphilis--CN VIII deafness common - bone/teeth involvement - "saddle nose" - inflmmation destroys cartilage/nasal septum - "saber shins"- inflammation of tibia - "Hutchinson's teeth"-central incisors widely spaced w/ notches - "Mulberry molars"-too many cusps - eye disease ie corneal inflmmation |
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syphilis
- bug - how gets into body - stages (& timeframes) |
Treponema pallidum
penetrates intact mucous membranes & epithelial abrasions -~6wk incubation- 1. Primary syphilis -ulcer heals after about ~6 wks 2. Secondary syphilis -occurs about 6 wks after ulcer heals - sx last 2-6 wks 3. Latent syphilis 66% never recur 4. Tertiary syphilis (1/3) takes at least 6 years to get tertiary (up to 40 yrs !!) |
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Primary syphilis
- sx - timeframes - why a big deal |
PAINLESS CHANCRE
firm and ulcerated - chancre happens at site of innoculation ~6 wks after infection - chancre is HIGHLY INFECTIOUS- sheds continuously - resolves after ~6 wks |
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Secondary syphilis
- describe - time frames - symptoms |
- happens ~6 wks after painless chancre resolves
- lasts for ~ 6 wks the BACTEREMIC stage bacteria multiply --> spread via blood --> systemic 1. rash on PALMS, SOLES (small, red, macular but may become bumpy) 2. Condyloma latum- painless warlike lesions in sites like vulva, scrotum (warm, moist)-ulcerates-contagious!! 3. Skin infections --> bald spots etc 4. pretty much any organ 5. Systemic sx- generalized lymphad, wt loss, fever |
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Latent syphilis
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usually aymptomatic
during first 4 years some people have relapses to secondary syphilis pregnant women can still transmit to fetus |
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Tertiary syphilis
- % infected people who get it - time frame - categories/symptoms |
1/3 untreated pts get tertiary syphilis after >6 yrs (up to 40 yrs!!). Due to chronic inflammation.
1. Gummas noninfectious granulomatous lesions in skin/bone --> necrose --> fibrotic (bone ones are painful, skin painless) 2. Cardiac- esp dissecting aortic aneurysms (ascending/arch) (can also have aortic valve insufficiency, coronary artery occlusion) 3. Neurosyphilis - Asymptomatic but CSF+ - Subacute meningitis (fever/stiff neck/h/a, CSF high lymphocytes) - Meningovascular syphilis- spirochetes attack vessels in brain/meninges --> infarction - Tabes dorsalis *posterior column damage-impaired vibratory/proprioception-ataxia *dorsal root ganglia damage-loss of reflexes and pain/temp -General paresis- nerve cell damage in brain- mental deterioration/psych sx |
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prostitute's pupil
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sign of neurosyphilis (tabes dorsalis & general paresis)
"accomodates but does not react" accomodates for near reflex, does not react to light |
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syphilis diagnosis
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primary/secondary- can diagnose specimens directly w/ darkfield microscope
Serology (for latent/tertiary) 1. Nonspecific tests -VDRL (Venereal Disease Research Lab) -RPR (Rapid Plasma Reagin) cell damage --> lipid release --> anti-lipid abs ie anti-cardiolipin, lecithin -but 1% adults have false positives 2. Specific treponemal tests - to confirm - detects treponeme ab's - FTA-ABS (fluorescent treponemal antibody-absorption) - but still can get false positives with other spirochetes ie yaws/pinta/leptispirosis/lyme dz 3. PCR |
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syphilis treatment
what happens to ab levels after treatment |
- "fever box"
early 1900s- treponema are fragile --> heat kills - PCN!! also erythromycin, doxycycline *note-reinfection can occur* VDRL/RPR levels decrease over months-years but FTA-ABS remains positive |
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Jarisch-Herxheimer Phenomenon
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abx started for syphilis --> killed organisms release pyrogen --> mild fever/malaise/h/a (acute worsening of sx!)
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Treponema pallidum subspecies & diseases
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Nonvenereal dz- skin ulcers, +/- gummas in skin/bones in children
very similar to syphilis but do not cause cns/heart damage 1. endemicum --> "endemic syphilis/bejal"-africa, middle east; from eating/drinking utensils 2. pertenue --> "Yaws" moist tropics; spreads through open ulcers; significant facial disfigurement (Jaws!) called "gangosa" 3. carateum --> "Pinta" rural Latin America; red/blue skin lesions that become depigmented turning white after a year |
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diseases caused by Borrelia
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1. Lyme disease
Borrelia burgdorferi 2. Relapsing fever (18 different species) |
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Lyme disease
- bug - description of bug - vector - reservoir |
Borrelia burgdorferi
gram neg spirochete vector = Ixodes tick! (takes >24h for transfer after bite----so check for ticks!!) reservoir = white-tailed deer, white-footed mouse, other rodents |
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Lyme disease
-stages - time frames |
1. Early localized stage
- starts ~10d after tick bite - lasts 4 weeks - erythema chronicum migrams rash + flulike illness + regional lymphadenopathy 2. Early disseminated stage - skin- multiple smaller ECM rashes - nervous system- aseptic meningitis, CN palsies ie Bell's palsies, peripheral neuropathy - heart- myocarditis/LV dysfunction, AV block - joints- breaf arthritic attacks 3. Late stage - chronic arthritis (~10% untreated patients) .....often have specific HLA types! - chronic neuro damage ie encephalopathy w/ memory impairment, irritability, somnolence |
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Lyme disease
- diagnosis - treatment |
Erythema chronicum migrans rash
- can biopsy/culture too but difficult anti-borrelia burgdorferia ab's - ELISA - Western blot Tx: doxycycline or PCN abx |
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Relapsing Fever
- cause - vector - where found - sx |
18 species of Borrelia (spirochetes)
vector is tick except 1 species in which it is lice campers in western U.S.---esp rodent-infested log cabins fever with flu-like sx +/- rash....resolves after a few days....then relapses ~q8d (time to relapse becomes longer and longer)--due to antigenic variation! |
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Leptospira
- human disease |
1 species:
Leptospira interrogans found in URINE of animals ie dogs, rats, livestock, wild animals -direct contact or swimming --> disease 1. Leptospiremic phase-high fever, h/a, malaise, pains, RED CONJUNCTIVE, PHOTOPHOBIA 2. Immune phase- appearance of IgM ab's--may get meningismus though ....can get more severe disease though: Weil's disease = infectious jaundice- renal failure, hepatitis, AMS, hemorrahge |
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causes of VDRL false positives
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VDRL
Viruses- mono, hepatitis Drugs Rheumatic fever Lupus, Leprosy |