Micro Spirochetes

Front 1

What are spirochetes? What do they have?

Back 1

Tiny Gram negative organisms that look like corkscrews. They have an endoflagella called axial filaments.

Front 2

Spirochetes are different than other typical Gram -- by?

Back 2

Additional phospholipid-rich outer mm with exposed proteins, providing protection against immune recognition. Axial flagella, AKA periplasmic flagella, that run sideways along the spirochete.

Front 3

What is required for observing spirochetes?

Back 3

Darkfield microscope, immunofluorescence, and sliver stains.

Front 4

Can spirochetes grow on ordinary media?

Back 4

No

Front 5

What are three categories of spirochetes?

Back 5

Treponema, Borrelia, and Leptospira

Front 6

Treponemes produce?

Back 6

No known toxins or destructive enzymes; disease results form host's own immune responses.

Front 7

What causes syphilis?

Back 7

Treponema pallidum

Front 8

Treponema pallidum enters how?

Back 8

Penetrating intact mucous mm or by invading through epithelial abrasions.

Front 9

What is the primary syphilis stage?

Back 9

Painless chancre that erupts at the site of inoculation. There is regional nontender lymph node welling.

Front 10

Describe the chancre and is it infectious?

Back 10

Firm, ulcerated, painless, with punched-out base and rolled edges. It is highly infectious.

Front 11

Secondary syphilis is what stage of the T. pallidum?

Back 11

The bacteremic stage, which the bacteria spreads. Almost any organ can become infected.

Front 12

What occurs with secondary syphilis?

Back 12

Condyloma lata (highly contagious), maculopapular rash on palms and soles; meningitis, hepatitis, arthritis, and others. Skin infection in areas of hair growth, results in patchy bald spots.

Front 13

What are the three complications to tertiary syphilis?

Back 13

Gummatous syphilis, cardiovascular syphilis, and neurosyphilis

Front 14

What is gummatous syphilis?

Back 14

Gummas are localized granulomatous lesions which eventually become necrose and fibrotic. These are found in the skin and bones. Skins lesions are painless, while bones are painful.

Front 15

What happens with cardiovascular syphilis?

Back 15

Aneurysm forms in the ascending aorta and aortic arch. Also, aortitis

Front 16

Neurosyphilis causes?

Back 16

Asymptomatic neurosyphilis subacute meningitis; meningovascular syphilis (spirochetes attach blood vessels in the brain and meninges with infarcts in the brain, spinal cord, and spectrum of neurologic impairments [circle of Willis]); tabes dorsalis; general paresis (mental deterioration and psychiatric symptoms); Argyll-Robertson pupil.

Front 17

Cogenital syphilis complications?

Back 17

High mortality rate. CN VII involvement, resulting in deafness. Corneal inflammation. Bone and teeth are frequently involved: Saddle nose; saber shins; Hutchinson's teeth; mulberry molars.

Front 18

What are two serological test used to identify T. pallidum?

Back 18

VDRL (nonspecific test: Venereal Disease Research Laboratory and Rapid Plasma Reagin--detects ABs against cardiolipin); and FTA-ABS (specific test: Indirect Immunofluorescent Treponeomal Antibody-Absorption, detects anti-treponemal ABs)

Front 19

How can you treat syphilis, congenital syphilis, and those who are allergic to the DOC?

Back 19

Penicillin for both. Penicillin can cross the placenta. If allergic, than erythromycin and doxycycline (but not doxycycline for congenital since it is toxic to the fetus).

Front 20

What is the Jarisch-Herxheimer Phenomenon?

Back 20

Syphilis treated with antibiotics, will release pyrogen, that causes the PT to become worse after treatment. This may occur with most spirochetes.

Front 21

What causes Lyme disease? Via what, and where?

Back 21

Borrelia burgdorferi, by an Ixodes tick (black legged ticks) from the reservoir of the white-footed mouse and white-tailed deer (and other mammals), in the Northeast, Midwest, and Northwestern U.S--in the woods, during summer.

Front 22

Lyme diseases is like what disease, and why?

Back 22

Is like syphilis, since they both start of as a painless skin lesion (chancre in sphilis and erythema chronicum migrans in Lyme disease). Followed by spreading throughout the body, invading organ systems with chronic problems later.

Front 23

What is the first stage of Lyme disease?

Back 23

Erythema chronicum migrans, with flulike symtpoms, and regional lymphadenopathy.

Front 24

What is erythema chronicum migrans?

Back 24

Starts off as a red (erythema), flat, round rash, which spreads out (migrans) over time (chronicum) as an annular (ring-like) rash. The outer border remains red, while the center will clear, turn blue and even necrose.

Front 25

What happens during the second stage of Lyme disease?

Back 25

Infection of skin (smaller secondary lesions), CV (carditis, AV nodal block), CNS (Bell's palsy, aseptic meningitis, and peripheral neuropathy), and joints (migratory myalgias and transient arthritis)

Front 26

What is the third stage of Lyme disease, left untreated?

Back 26

Chronic arthritis, neurologic effects (encephalopathy, Bell palsy), acrodermatitis chronicum atrophicans (skin atrophy).

Note: autoimmunity is associated with chronic disease (arthritis) with certain HLA types

Front 27

How do you treat Borrelia burgdorferi? How do you diagnose it?

Back 27

Doxycycline or amoxicillin (for children) for stage 1. Ceftriaxone for disseminated infections (arthritis or meningitis). Skin biopsy on the leading edge o the rash, with a darkfield microscopy.

Front 28

What causes relapsing fever?

Back 28

18 species of Borrelia, but only B. recurrentis is the only human host via the body louse (Pediculus humanus). Other Borrelia species are transmitted by the tick Ornithodoros.

Front 29

What is relapsing fever

Back 29

A high fever, with chills, headaches, and muscle aches. Rash and meningeal involvement may follow. Symptoms resolve with cycles of 5 days febrile/ 8 days afebrile that continues up to 10 times.

Front 30

What causes relapsing fever to occur in cycles?

Back 30

Antigenic variations.

Front 31

How do you treat B. recurrentis?

Back 31

Doxycycline or erythromycin.

Front 32

Leptospira have what kind of appearance?

Back 32

Ice tongs

Or, long, thin hook ends

Front 33

Leptospira interrogans cause?

Back 33

Leptospirosis and Weil's disease

Front 34

Leptospira interrogans infection occurs by?

Back 34

Contaminated urine from animals such as dogs, rats, livestock, and wild animals.

Front 35

What is the first stage of infection from L. interrogans?

Back 35

Bacteria invades via the blood or CSF to cause flu-like symptoms, high-spiking fever. Classically, the PT experiences photophobia and red conjunctiva.

Flu-like symptoms: fever, intense headache, myalgias, and diarrhea

Front 36

What is the second stage of infection from L. interrogans?

Back 36

Correlates with appearance of IgM ABs. PTs may develop meningismus with high WBC count in CSF

Anicteric leptospirosis (mild) --> aspetic menigitis antibody associated)

Weil's disease (severe) vasculitis with severe hemorrhagic complications, kidney damage (acute tubular necrosis), hypotension due to vascular collapse, and myocarditis

Front 37

L. interrogans can also cause? And what is it?

Back 37

Weil's disease: vasculitis with hemorrhagic complications, mental status change, kidney damage with renal failure, liver damage with jaundice.

Front 38

How do you diagnosis and treat for L. interrogans infection?

Back 38

Spirochete detectable in blood or CSF in 1st phase and urine in the second phase. Also, Serology.

Penicillin G (for hospitalization) or doxycycline (for mild treatment) for treatment. Jarisch-Herxheimer reaction may be seen.

Note: diagnosis is made in conjunction with PT history of swimming where there are animals present, such as a boating trip.