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29 Cards in this Set

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What are spirochetes?
They are tiny Gram neg. organisms that appear as corkscrews. they move in a unique spinning fashion via 6 thin endoflagella called axial filaments.
Spirochetes cannot be cultured in ordinary media, and although are Gram neg, are to small to be seen with the light microscope. TRUE/FALSE
What are the three genera of Spirochetes/
1. Treponema(produce no known toxins).
2. Borrelia
3. Leptospira
What is the causative agent for syphilis?
Treponema pallidum. It enters the body by by penetrating intact mucus membranes or by invading through epithelial abrasions.
There are 3 clinical stages, with a latent stage between stages 2 and 3.
What is primary syphilis?
It is a painless chancre that erupts at the site of inoculation 3-6 weeks after initial contact. there is lymph node swelling. It resolves in 4-6 weeks.
What is secondary syphilis?
Untreated patients enter the bacteremic stage about 6 weeks post primary chancre has healed. This stage is systemic.
What is condyloma latum?
It is a second characteristic skin finding. It is a painless wartlike lesion, that occurs in warm moist sites like the vulva or scrotum.
Almost, any organ may be infected at this stage. This resolves in 6 weeks, and the patient enters the latent stage.
What is latent syphilis?
Though serologic tests remain positive, most patients are asypmtomatic during this period.
25% will have relapses.
After 4 years there are generally no more relapses.
App. 1/3 will progress to the tertiary stage,
What is tertiary syphilis?
It generally develops over 6-40yrs, with slow damage to organ tissue, especially vessel and nerve tissue.
Regarding tertiary syphilis, what are the three general categories?
1. Gummatous syphilis
2. Cardiovascular
3. neurosyphilis
What is Gummatous syphilis?
Occurs 3-5 yrs after the primary lesion in 155 of untreated patients. These lesions are found on the skin and bones. These will resolve with therapy.
What is cardiovascular syphilis?
Occurs 10yrs after primary infection in app 10% of untreated patients.
An aneurysm forms in the ascending aorta or aortic arch(destruction of vaso vasorum). Coronary arteries may be involved. Therapy will not reverse these changes.
What is Neurosyphilis?
Occurs in 8% of untreated cases. There are 5 neurological presentations.
1. Asymptomatic
2. Subacute meningitis
3. Meningovascular syphilis
4. Tabes dorsalis
5. General paresis
In subacute meningitis, what is revealed in the cerebrospinal fluid?
A high lymphocyte count, high protein, low glucose and + syphilis tests.
Most bacteria cause an acute meningitis with a high neutrophil count, high protein and low glucose. TRUE/FALSE
TRUE. T. pallidum and Mycobacterium tuberculosis cause a subacute meningitis with a predominance of lymphocytes.
What is Tabes dorsalis/
This condition affects the spinal cord, especially the posterior column and dorsal roots. This results in loss of temperature sensation, and ataxia.
What is general paresis syphilis?
This is a progressive disease of the nerve cells of the brain leading to mental deterioration.
What is the Argyll-Robertson pupil?
may be seen in tabes dorsalis and general paresis. It is caused by a midbrain lesion, constricts during accommodation(near vision), but does not react to light.(prostitutes pupil).
Are bones and teeth often involved in late congenital syphilis?
Yes. periosteal inflamation destroys the cartilage of the palate and nasal septum, resulting in "saddle nose".
A similar inflamation in the tibia results in "saber shins"(tibia bowing).
Upper central incisors are widely spaced(Hutchinsons teeth), and the molars have too many cusps(mulberry molars).
T. pallidum infection does not affect the fetus until the 4th month of gestation, so treating the mother with A/Bs prior to this can prevent congenital syphilis. TRUE/FALSE
What is the "Nonspecific treponemal test"?
Infection with syphilis results in cellular damage and the release into the serum of a number of lipids, including cardiolipin and lecithin. The body produces antobodies against these antigens. These antibody findings are pretty decisive in determining a patients status.
Invasion of spinal fluid as well will elicit these anti-lipoidal antibodies.
Why is this test considered non-specific?
Because 1% of adults without syphilis will also have these antibodies, resulting ina false positive. In this case a "specific treponemal test must be performed.
What is the "Specific treponemal test"?
The non-specific looks for anti-lipoidal antibodies. the specific test looks for antibodies against the spirochete itself.
How is this test executed?
It is done by first mixing the patients serum with a standardized non pathogenic strain of treponema which removes or absorbs antibodies shared by both treponema pallidum and the non pathogenic strain. (nonpathogenic strains of treponema are part of the normal flora.
The remaining serum is then added to a slide covered with killed T. pallidum(as the antigen). Antibodies that are specific to this will subsequently bind, giving a positive result.
False positives can occur with other spirochetal infections, such as Yaws, Pinta, and leptospirosis and Lyme disease. TRUE/FALSE
What is the treatment of T. pallidum?
Penicillin(depending on the stage of disease).
For those who are allergic, erythromycin and doxycycline can be used. (doxy is toxic to fetuses)
What is the Jarisch-Herxheimer phenomenon?
Most patients develop a worsening of symptoms after antibiotic therapy is started.(fever, chills and headache)The killed organisms release a killed pyrogen. This may accur with most spirochetes.
What is Yaws?
Cause is Treponema pallidum(subspecies pertenue). A disease of the moist tropics, and spreads from person to person by contact with open ulcers. A large papule appears becoming wartlike. Facial disfigurement may occur.
What is Pinta?
Cause, T. pallidum(subspecies carateum). A skin disease limited to rural latin America. A papule develops and slowly expands. These red lesions will eventually turn blue upon sun exposure.