Microbiology B7 Lecture 16

Front 1

Spirochete:

1) Shape
2) Locomotion associated with?
3) Genome
4) Gram categorization
5) Identification

Back 1

1) Corkscrew shape
2) Rotation (flagella inside)
3) Highly conserved
4) Technically gram negative but too thin to stain
5) Can't use gram stain because too thin. Use silver stain or dark field microscopy

Front 2

Spirochetes:

1) Why can't you gram stain them?
2) Why is it good to have a highly conserved genome?
3) What is inside the spirochete that makes it so motile?

Back 2

1) Too thin
2) No mutations, have regular and reliable treatment for them
3) Flagella inside spirochete

Front 3

List the 3 types of spirochetes, their types of respiration, and what they cause

Back 3

1) Treponema (anaerobic) - opportunists. Cause syphilis & ANUG (acute necrotizing ulcerative gingivitis)

2) Leptospira (aerobic) - leptospirosis

3) Borrelia (vector borne) - relapsing fever, lyme disease

Front 4

Treponema pallidus

1) Disease caused
2) Shape
3) How can you visualize it?
4) Culture
5) What kills it?
6) Mode of transmission
7) Virulence factors
8) When are patients most infectious?
9) When are patients considered not infective?

Back 4

1) Syphilis
2) Long, thin, **spiral**
3) Dark field microscopy, silver stain, IF
4) CANNOT culture on medium. Must culture on tissue
5) Drying
6) Direct contact (sexual, transplacental, close contact with active lesion including perinatal, blood transfusion, accidental inoculation)
7) Invasive, attaches to endothelial cells, relatively resistant to antibody/complement
8) In early stages of disease
9) 4 years post infection

Front 5

5 clinical stages of syphilis

Back 5

1) Primary
2) Secondary
3) Latent (you don't know you have latent TB until it manifests itself)
4) Tertiary
5) Congenital

Front 6

Primary syphilis:

1) Incubation period
2) Primary symptom
3) Serum tests
4) When does bacteremia occur and how long does it persist?
5) What is a favorite spot for chancres to appear?

Back 6

1) 3-4 weeks
2) Painless, HIGHLY INFECTIOUS chancre that's infiltrated with lymphocytes and plasma cells. Heals spontaneously after 14 days.
3) Becomes seropositive
4) Early stages, may persist for years in untreated patients
5) Orofacial complex

Front 7

Secondary syphilis

1) When does it occur?
2) Occurs in what fraction of those with primary syphilis?
3) Where are the organisms located?
4) Symptoms
5) Antibody titer

Back 7

1) 2-10 weeks after primary syphilis
2) Happens to 1/4 of people with primary syphilis. 3/4 heal spontaneously
3) Disseminated, and are HIGHLY infecitous
4) **Skin rash, widespread, on hands and soles. Erythema chronic migrans.

**Mucous patches on mucous membranes (erythematous border, "snail tracks"),

**Fever, malaise, enlarged lymph nodes. Alopecia,

**Condylomata lata (wart-like growth)
5) High antibody titer to cardiolipin and spirochetes

Front 8

Latent syphilis:

1) Symptoms, serum testing
2) Occurs in what % of patients?
3) How long can it last
4) When are patients infectious?
5) Shortened latency in what individuals?

Back 8

1) No symptoms, seropositive
2) 15% of patients with untreated secondary syphilis
3) Several years to decades
4) Within first 4 years, including transmission to fetus
5) HIV positive individuals

Front 9

Tertiary syphilis

1) When does it happen?
2) Characterized by?
3) Main symptom
4) Spirochetes in lesions
5) Infectious?
6) Involve what body systems?
7) Main symptoms in each of these systems?
8) Nickname for tertiary syphilis?

Back 9

1) Several months to 30 years after primary infection
2) Diffuse, chronic, destructive inflammation
3) GUMMA - granulatomous lesions, highly destructive, often painless
4) Very difficult to visualize
5) Unlikely to be infectious, spirochetes are not really in lesions or bloodstreams. Hard to transmit.
6) Multisystem - skin, oral cavity, bone, joints, cardiovascular, nervous
7) skin - GUMMA. Oral cavity - GUMMA, perforated palate. Joints - charcot's joints (neuropathic joint disease, due to destruction of nerves). Cardiovascular system - aortic aneurysm and aortic
8) The great imitator (TB is the other "great imitator)

Front 10

Neurosyphilis:

1) When does it occur?
2) Symptoms?
3) When does early neurosyphilis occur and what are the symptoms?
4) Symptoms of late neurosyphilis?

Back 10

1) When T. pallidum invades CNS, can happen during any stage of syphilis
2) Can be asymptomatic
3) Few months to years after infection. Acute syphilitic meningitis, ocular involvement.
4) Late neurosyphilis (tertiary) - **general paresis (brain cortex degeneration), **tabes dorsalis (damage to dorsal root ganglia, ataxia, wide based gait, foot slap, loss of sensation)

Front 11

Congenital syphilis

1) When does it occur in the fetus?
2) % fatality
3) Symptoms of infection
4) Is the newborn infectious?
5) How do you prevent it?

Back 11

1) In utero AFTER 16 weeks old
2) 50% fatality
3) **Craniofacial anomalies, growth retardation, skeletal abnormality, hepatomegaly, rash, snuffles, neurological symptoms, hearing loss
4) Yes
5) Antibiotic treatment of mother

Front 12

What are the 5 craniofacial anomalies seen with congenital syphilis?

Back 12

can't touch My HuMPS

1) Mulberry molar
2) Hutchinson's teeth
3) Mucous patches
4) Perforated palate
5) Saddle nose

Front 13

What are the methods for diagnosing syphilis?

Back 13

1) Clinical
2) Microscopic
3) Non treponemal or treponemal serology

Front 14

Non-treponemal serology

1) What are you testing for?
2) 5 types of non-treponemal serology tests

Back 14

1) Antibodies to cardiolipin

We Really Very Sick
2) Wassermann (complement fixation), RPR (rapid plasma reagin), VDRL (venereal disease research lab), screening tests, VDRL for neurosyphilis diagnosis (CSF)

Front 15

Treponemal serology

1) What are you testing for?
2) Two specific types of tests?
3) Antibodies present in spinal fluid suggest?
4) If you have antibodies for T. pallidum, what is your serum work like?

Back 15

1) Antibodies to T. pallidum
2) FTA-ABS, MHA-TP
3) Active neurosyphilis
4) Seropositive for life

Front 16

Syphilis:

1) DOC
2) Proof of cure
3) Possible complication of therapy
4) All patients with syphilis must be tested for?

Back 16

1) Penicillin (doxycycline, ceftriaxone, azithromycin in penicillin allergic pts, must be monitored for cure)

2) Non-treponemal titers decline, treponemal tests remain positive

3) Jarisch-Herxhimer reaction, like endotoxic shock - due to destruction of large numbers of treponemes, effect of cell wall substances

4) HIV

Front 17

What disease is caused by:

1) Treponema pallidum subspecies pertenue?

2) Treponema pallidum subspecies carateum?

3) Normal oral flora treponema?

Back 17

1) Yaws (skin disease - Africa)
2) Pinta (skin disease - Pinta)
3) ANUG

Front 18

Borrelia hermsii

1) Disease caused
2) Reservoir?
3) Mode of transmission?
4) DOC?

Back 18

1) Relapsing fever (endemic)
2) Rodent
3) Tick
4) Tetracycline

Front 19

Borrelia burgdorferi

1) Disease caused
2) Reservoir
3) Vector
4) Virulence factor
5) What is responsible for 90% of the cases
6) Symptoms of early infection
7) Symptoms of late infection
8) Diagnosis
9) DOC
10) Vaccine

Back 19

1) Lyme disease
2) White tailed deer
3) Tick (eastern US - ixodid deer tick, western - black legged tick)
4) LPS, antigenic variation
5) Nymph ticks (the babies)
6) Erythema migrans, non specific symptoms
7) **Meningitis, carditis, acute arthritis**
8) **Silver stain, immunofluorescence, **serology (antibodies may not be measurable for several weeks), clinical findings, culture (slow growing)
9) Early stage Lyme disease - tetracycline. Late stage - ceftriaxone (50% of patients improve)
10) Available for animals