Lecture 9: Gram Negative Spirochetes

Front 1

What are the 3 genera of Gram negative spirochetes that are important concerning human infections?

Back 1

Treponema, Borrelia, Leptospira

Front 2

Describe the meaning and characteristics of spirochete

Back 2

meaning coil and hair from the greek, tightly coiled hair like bacteria, widespread in aquatic environment and amimals

Front 3

How many total genera of spirochete are there?

Back 3

8

Front 4

Spirochetes are anaerobic or aerobic?

Back 4

aerobic, microaerobic, and anaerobic

Front 5

Animal associated spirochetes are

Back 5

parasites

Front 6

diseases associated with animal associated spirochetes are

Back 6

syphilis, relapsing fever, Lyme disease, meningitis, hepatitis

Front 7

Genera Treponema cause what disease?

Back 7

Syphillis

Front 8

Genera Borrelia causes what disease?

Back 8

Relapsing fever and lyme disease

Front 9

Genera Leptrospira causes what disease?

Back 9

Leptospirosis (Well's Disease)

Front 10

Where is the flagella of spirochetes located and what is the significance of this?

Back 10

in the periplasmic space, which is useful when in aquatic sediment and allows them to travel through viscous medium

Front 11

spirochetes are highly invasive with

Back 11

endoflagella

Front 12

The endoflagella of spirochetes are located

Back 12

between the CM and OM

Front 13

Om contains

Back 13

the flagella within the periplasm

Front 14

The flagella rotation creates

Back 14

torsion on the cell body causeing the entrire body to rotate like a corkscrew

Front 15

The corkscrew rotation caused by the endoflagella enables spirochetes

Back 15

to travel through highly viscous media such as mud, mucus, and host connective tissue

Front 16

Treponema pallidum is the causative agent of

Back 16

syphillis

Front 17

Treponema pallidum is a delicate organism that cannot be

Back 17

grown in vitro

Front 18

Treponema pallidum is sensitive to

Back 18

drying, pH change, elevated temperature (lethal at 41 C), elevated oxygen tension (microaerophillic), and detergents and disinfectants

Front 19

What resulted in the introduction of "fever therapy" about one century ago

Back 19

The sensitivity of treponema pallidum to elevated temperatures (lethal at 41)

Front 20

Fever therapy was used to treat

Back 20

patients that were infected with malaria

Front 21

T.pallidum infects what tissues of the body

Back 21

all

Front 22

Syphilis is

Back 22

contagious, about 30% of rick after a single exposure

Front 23

How is syphilis (Treponema pallidum) transmitted

Back 23

person to person, sexually, or transmitted congenitally

Front 24

Progression of syphilis is

Back 24

painless, slow, short symptomatic periods when organism is multiplying, followed by prolonged asymptomatic periods.

Front 25

What is the incubation time for syphilis (T.pallidum)?

Back 25

10-90 days, during this time the pt is asymptomatic, however the organism disseminated immediately

Front 26

Syphilis is primarily a disease of

Back 26

blood vessels and perivascular areas

Front 27

Virulence factors of Treponema pallidum (syphilis)

Back 27

are largely unknown, maybe outer membrane proteins

Front 28

Despite the vigorous host response, tremponema pallidum (syphilis(,

Back 28

are capable of persisting for decades, infection is neither fully controlled or eradicated

Front 29

People usually think that they are cured from syphilis before they actually are due to

Back 29

prolonged asymptomatic periods

Front 30

The primary stage of syphilis (treponema pallidum) can last

Back 30

for weeks to months

Front 31

The primary stage of syphilis (treponema pallidum) is characterized by

Back 31

the hard chancre commonly found on the genitals, but can also be found on the face

Front 32

Describe the chancre found on the genitals or facial area of people who have syphilis

Back 32

painless but filled with organism, high contagious, heals spontaenously

Front 33

Describe the development of the chancre that appears in pt's with syphilis

Back 33

infection initiates inflammation and proliferates endothelial cells, reduces the local blood supply, eventually causes tissue necrosis

Front 34

Describe the secondary stage of syphilis

Back 34

a spreading skin rash that could also be localized, from the palms of the hands to the soles of the feet, may last 2-6 weeks, highly contagious, and heals spontaneously

Front 35

Describe the latent stage of syphilis

Back 35

asymptomatic, pt's tend to think that they are cured at this time, still contagious, may last decades

Front 36

What percentage of pt;s in the latent stage of syphilis progress to the tertiary stage

Back 36

40%

Front 37

The tertiary stage of syphilis (treponema pallidum)

Back 37

localized granuloma dermal lesions (15%), cardiovascular complications (10%), neurological sx developments (8%),

Front 38

What are the neurological sx that can occur in the tertiary stage of syphilis?

Back 38

CNS damage including the spinal cord, dementia, seizures, wasting

Front 39

Congenital syphilis

Back 39

results form trans-placental infection, septicemia in the developing fetus, abortion, neonatal mortality, and mental and physical problems

Front 40

Bejel/Edemic Syphilis

Back 40

Endemic to eastern Mediterranean region, called Sahel disease in west Africa, not as aggressive and can be treated with one dose abx

Front 41

Bejel/Edemic Syphilis generally results from

Back 41

mouth to mouth contact or sharing of eating utensils, transmission is not venereal in nature

Front 42

Bejel/Edemic Syphilis sx

Back 42

usually begins in childhood as a small mucous patch, often on the interior of the mouth, followed by the appearance of raised, eroding lesions on the limbs and the trunk,

Front 43

10% pf gonorrhea pt's also have _________ because ______

Back 43

Syphilis, because the route of transmission is the same

Front 44

Syphilis is found where in the world

Back 44

everywhere, it is worldwide

Front 45

What ages are most effected by syphilis (treponema pallidum)?

Back 45

20-24

Front 46

Sanitary control of syphilis (treponema Pallidum)

Back 46

Prevention with barrier methods like condoms, but monogamy is better

Front 47

Immunological control of syphilis

Back 47

there is no vaccine available

Front 48

Chemotherapeutic control of syphilis (Tpallidum)

Back 48

Penicillin is the drug of choice, 7-10 days continuous for early stage, at least 21 days continuously beyond the early stage, can cause various hypersensitivity reactions because of rapid antigen release

Front 49

What are the causative agents of Borreliosis?

Back 49

Borelia burgdorferu, borellia recurrentis

Front 50

Borreliosis is

Back 50

a febrile disease characterized by remittent fever

Front 51

What organism causes lyme disease?

Back 51

B.burgdorferi

Front 52

What organism causes relapsing fever?

Back 52

B. recurrentis

Front 53

Borrelia genus (burgdorferi and recurrentis) are transmitted by

Back 53

lice or ticks

Front 54

The cell envelope of Borrelia genus contains

Back 54

various lipids including cholesterol

Front 55

Borrelisosis is left untreated

Back 55

is fatal

Front 56

Louse born borreliosis (relapsing fever) infects host only when

Back 56

the louse is injured, usually by stratching

Front 57

How many louse are required for infection of a single person in louse borne borreliosis (relapsing fever)?

Back 57

one single louse

Front 58

When do lice leave a host

Back 58

when the host develops a fever they seek a normal temperature host

Front 59

Tick borne borreliosis (lyme disease) cases are

Back 59

sporadic

Front 60

Sx development of louse borne borreliosis

Back 60

acute sx development in 2-14 days of incubation period which is followed by recurring febrile episodes , and constant spriochetemia worsens during febrile stages

Front 61

What occurs during each febrile episode of pt's with relapsing fever cause by borrelia recurrentis?

Back 61

about 100 spirochetes per ml of blood, the organism disappears from the blood with normal l body temperature, the organism reappears during relapse, different antigenic property id responsible for each clearing.

Front 62

What is the mortality rate of relapsing fever in people who are not treated

Back 62

40%

Front 63

What is the mechanism of pathogenesis of relapsing fever caused by borrelia recurrentis?

Back 63

had endotoxin like features but the exact mechanism is unknown

Front 64

Describe the first stage of lyme disease

Back 64

a uique skin lesion 3-30 days post tick bite, erythema migans (EM), also called bulleye rash, not seen in all infected hosts, ECM periodically reappear, fatigue, chills fever, swollen lymph nodes

Front 65

Describe the second stage of lyme disease

Back 65

early dissemination phase, additional EM lesions on other parts of the body, sever HA, and neck stiffness due to meningitis, joint pain and swelling.

Front 66

Describe the 3rd stage of lyme disease

Back 66

occurs months to years after tick bite, late dissemination phase, about 60% of untreated pt's develops arthritis with sever joint pain and swelling particularly in the knees, about 5% of untreated pt's develop chronic neurological sx including memory loss, frank psychosis, delusions, and depersonalizations, cardiac arrest can also occur.

Front 67

Post treatment lyme disease syndrome (PTLDS)

Back 67

late sequelae, about 10-20% of pt's have sx after antibiotic treatment, muscle and joint pains, cognitive defects, sleep disturbance, fatigue, the cause is unclear, may be type 2 sensitivity, continuing abx therapy on this stage is harmful making the sx worse

Front 68

When was lyme disease first recognized?

Back 68

In 1975 with outbreak in connecticut

Front 69

Lyme disease is transmitted by

Back 69

hard shelled tick, also called deer ticks

Front 70

Primary reservoirs of lyme disease ( borrelia burgdorferi)

Back 70

deer and white footed deer mice

Front 71

Up to _____% of deer ticks carry B.burgdorferi

Back 71

50

Front 72

what are some favorable conditions for the increase in the number of tick vectors of lyme disease in the US?

Back 72

reforestation around homes, development in wooded habitats, increase of deer population

Front 73

Emerging infections

Back 73

are thoes that newly appear in the population or have existed but are rapidly increasing in incidence or geographic range

Front 74

Sanitary control of lyme disease (Borrelia burgdorferi)

Back 74

measures to eliminate tick and louse vecotrs

Front 75

Immunological control of lyme disease ( borrelia burgdorferi)

Back 75

vaccination is available with 75-90% efficacy, usually for people who spend a lot of time outside

Front 76

Chemotherapeutic control of lyme disease (borrelia burgdorferi)

Back 76

tetracycline is the drug of choice, which inhibits protein synthesis by binding to the ribosome

Front 77

Leptospira interrogans have unique

Back 77

hooked ends

Front 78

Leptospirosis is also called

Back 78

Weil's disease

Front 79

How is an entry provided for leptospira interogans?

Back 79

mucosa and broken skin

Front 80

What are the progression of sx of leptospirosis (Leptospira interrogans)

Back 80

first generalized bacteremia (leptospiremic phase), second multiplication in the kidney and shedding in the urine (leptospiruric phase), renal failure can lead to death

Front 81

What is responsible for the lesions that occur in leptospirosis?

Back 81

the host immune response, there are no known endotoxins of leptospira interrogans

Front 82

how effective are antibiotics against leptospria interrogans ( leptospirosis)

Back 82

not effective after 4 days or more of persisted sx

Front 83

What is the progression of sx in leptospirosis (leptospira interrogans)

Back 83

starts with mild flu like sxs for 10-12 days, progresses through two clinical stages of leptospiremia and leptospiuria, then finally acute febrile jaundice with hepatic injury

Front 84

Why does hepatic injury occur in leptospirosis?

Back 84

destruction occurs die to bacterial invasion and the strong immune response required to kill the bacteria

Front 85

Leptospirosis is tranmitted via

Back 85

zoonotic, froma varitey of wild and domesticated animal hosts, most common in the US are rats, dogs, and farm animals

Front 86

What animals shed leptospira interrogans for the rest of its life once infected?

Back 86

rats

Front 87

Other than animal vectors, what is another way that a person can get infected with leptospira interrogans (leptospirosis)

Back 87

contaminated, unchlorinated, water and soil with the urine from animals withleptospriruia

Front 88

Sanitary control of leptospirosis

Back 88

reducing the prevalence in domestic animals via vaccination

Front 89

Immunological control for leptospirosis

Back 89

vaccine is available for animals, and sometimes placed in wild life bait food, but there is no vaccine for humans

Front 90

Chemotherapeutic control of leptospirosis

Back 90

penicillin or tetracycline is effective if given early