Spirochaetales

Front 1

What is the Order? Family? Genus? For Treponema, Borellia, and Leptospira

Back 1

Order: Spirochaetales
Family: Spirochaetaceae
Genus: Treponema and Borrelia

Family: Leptospiraceae
Genus: Leptospira

Front 2

General overview of Spirochaetales:
Gram results and shape

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Gram negative spirochaetes

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Spirochete is greek for...

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Coiled hair

Front 4

General overview of Spirochaetales:
How do they look?

Back 4

Tightly coiled helical cells with tapered ends
-super thin and can be very long

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General overview of Spirochaetales:
Are they motile?

Back 5

Yes, by periplasmic flagella
(axial fibrils of endoflagella)

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General overview of Spirochaetales:
What does the outer sheath enclose?

Back 6

Axial fibrils that are wrapped around protoplasmic cylinder

Front 7

General overview of Spirochaetales:
Do all geni have the same number of endoflagella?

Back 7

No, there are differing numbers depending on the Genus and species

Front 8

Spirochaetale diseases:
Treponema pallidum

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-Syphilis
- Bejel
- Yaws
-Pinta

Front 9

Spirochaetale diseases:
Borrelia burgdorferi

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-Lyme disease
-Epidemic relapsing fever
- Endemic relapsing fever

Front 10

Spirochaetale diseases:
Leptospira interrogans

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Leptospirosis
-Well's disease

Front 11

General Characteristics of Treponema pallidum:
How is it that they look under a light microscope?

Back 11

They are too thin to be seen with light microscopy

Front 12

General Characteristics of Treponema pallidum:
How is it that you can see the motile spirochaetes?

Back 12

They can be seen with darkfield microscopy

Front 13

General Characteristics of Treponema pallidum:
What type of pathogen is this?

Back 13

Intracellular
-have outer sheath and high lipid content

Front 14

General Characteristics of Treponema pallidum:
Can you grow it in vitro?

Back 14

No

Front 15

General Characteristics of Treponema pallidum:
How well do they grow outside of the host?

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Not at all
-you have to take care during the testing procedure
-very difficult to study

Front 16

General Characteristics of Treponema pallidum:
What pH conditions does it require? Oxygen?

Back 16

pH 7.2-7.4
Microaerophilic

Front 17

Epidemiology of T. pallidum:
How is it transmitted?

Back 17

From direct sexual contact or from mom to fetus

Front 18

Epidemiology of T. pallidum:
Is it contagious?

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Not highly contagious (~30% chance of getting it after getting exposed to it)

Front 19

Epidemiology of T. pallidum:
What is the transmission rate dependent on?

Back 19

The stage of the disease

Front 20

Epidemiology of T. pallidum:
How long is the incubation period?

Back 20

Very long (10 days-3 months)
- in this time period the host is non-infectious

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Epidemiology of T. pallidum:
How is the incubation period useful?

Back 21

This is useful for contact tracing and administration of therapy
-typically found in prostitution

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Epidemiology of T. pallidum:
What is an interesting statistic of syphilis?

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~10% of gonorrhea patients have siphilis

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Epidemiology of T. pallidum:
When looking at the Siphilis cases you notice that there was a huge drop, why is that?

Back 23

The mass production of PENICILLIN

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Pathogenesis of T. pallidum:
What is it that causes the tissue destruction and lesions?

Back 24

It is actually the person's own immune system

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Pathogenesis of T. pallidum:
Siphilis is a disease of...

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Blood vessels and of the perivascular areas

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Pathogenesis of T. pallidum:
Is infection fully controlled?

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No, it hasn't been eradicated

Front 27

Pathogenesis of T. pallidum:
What is it that the inhibition of CMI reduces in..

Back 27

late stages of the disease
-the lesions are therefore more localized

Front 28

Virulence Factors of T. pallidum:
The outer membrane proteins promote...

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adherence

Front 29

Virulence Factors of T. pallidum:
_____ may facilitate perivascular infiltration

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Hyaluronidase
- it allows it to get in deeper into tissues

Front 30

Virulence Factors of T. pallidum:
There is antiphagocytic coating of...

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Fibronectin

Front 31

Virulence Factors of T. pallidum:
Again, The tissue destruction and lesions are a result of...

Back 31

Primarily the result of the hosts immune system

Front 32

Pathogenesis of T. pallidum, Primary Syphilis:
After how many days may an incoculated individual get symptoms?

Back 32

Few days after contact

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Pathogenesis of T. pallidum, Primary Syphilis:
What is one symptom that a person may get?

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HARD CHANCRE

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Pathogenesis of T. pallidum, Primary Syphilis:
Why does the hard chancre look like that?

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This is because there is a swelling of capillary walls
- release of spirochetes

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Pathogenesis of T. pallidum, Primary Syphilis:
In what stages may a person be able to contaminate?

Back 35

1-2 stages
- it is important to get treated early even if symptoms aren't too bad

Front 36

Pathogenesis of T. pallidum, Secondary Syphilis:
Secondaru disease happens how long after that first chancre?

Back 36

2-10 weeks after

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Pathogenesis of T. pallidum, Primary Syphilis:
What is a symptom that a person may get?

Back 37

Mucocutaneous rash
- an all over body rash

Front 38

Pathogenesis of T. pallidum, Primary Syphilis:
Where is the mucocutaneous rash typically concentrated at?

Back 38

Typically on the feet

Front 39

Pathogenesis of T. pallidum, Primary Syphilis:
Are the secondary lesions of the skin and mucous membranes contagious?

Back 39

HECK YES!

Front 40

Pathogenesis of T. pallidum, Latent Stage Syphilis:
During the first 4 years, what stage are you at? After?

Back 40

first 4 years: Early latent
After 4 years: Late Latent

Front 41

Pathogenesis of T. pallidum, Primary Syphilis:
What % of people with late latent eventually make it to late tertiary syphilitic disease?

Back 41

40%

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Pathogenesis of T. pallidum, Tertiary (late) Syphilis:
How much later do you get this?

Back 42

Can be 20-30 years later

Front 43

Pathogenesis of T. pallidum, Primary Syphilis:
What is Gummae?

Back 43

They are lesions on the skin and mucous membranes

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Pathogenesis of T. pallidum, Primary Syphilis:
There is damage to what organs?

Back 44

The internal organs, cardiovascular, and even nervous system damage

Front 45

Pathogenesis of T. pallidum, Primary Syphilis:
Why is it that you get gummae?

Back 45

The body is trying to wall off the chronic infection!

Front 46

How is it that a Granuloma looks like?

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It is just a walling off of the bacteria by T cells
-AKA Gumma

Front 47

Pathogenesis of T. pallidum, Congenital Syphilis:
What does it result from?

Back 47

Transplacental infection

Front 48

Pathogenesis of T. pallidum, Congenital Syphilis:
T. pallidum gives what to the fetus?

Back 48

They get septicemia and widespread dissemination

Front 49

Pathogenesis of T. pallidum, Congenital Syphilis:
What are the consequences of this?

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Abortion, neonatal mortality, and late mental or physical problems

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Clinical Disease: Congenital Syphilis
Where is it acquired?

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In utero
-gives long term deformities

Front 51

Prevention and treatment of Syphilis:
What is the drug of choice?

Back 51

Penicillin
-for 7-21 days depending on how progressed the infection has gone

Front 52

Prevention and treatment of Syphilis:
How can it be prevented?

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Some condoms!!
Prevention is key!

Front 53

Diagnostic tests for Treponoma:
Direct ___ Antibody staining

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Fluorescent

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Diagnostic tests for Treponoma:
What does the Wasserman test look for?

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Antibodies against the lipin

Front 55

Lab diagnosis of Syphilis:
Nontrepomonal serological test

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VDLR test

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Diagnostic tests for Treponoma:
What is the VDRL?

Back 56

Venereal Disease Resistance Lab test
-tests for Antibody response
-this is simple and inexpensive

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Diagnostic tests for Treponoma:
Treponomal serological test

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ELISA

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Nonvenereal Treponemal Diseases:
Where may you find them?

Back 58

In primitive tropical and subtropical regions

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Nonvenereal Treponemal Diseases:
Who typically gets them?

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Impoverished children :(

Front 60

Nonvenereal Treponemal Diseases:
BEWEL: what is it? Name of orgs?

Back 60

Endemic syphilis
- caused by T. pallidum subsp. endemicum

Front 61

Nonvenereal Treponemal Diseases:
Yaws, it is what kind of disease?

Back 61

Granulomatis disease
- T. pallidum subsp. pertenue

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Nonvenereal Treponemal Diseases:
Pinta, caused by what orgs.?

Back 62

T. carateum

Front 63

Treponema pallidum ssp. endemicum:
Bejel is also known as?

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Endemic syphilis

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Treponema pallidum ssp. endemicum:
What are the inital symptoms?

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Initial lesions
-they are nondescriptive oral lesions

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Treponema pallidum ssp. endemicum:
What is the secondary thing to happen?

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Secondary lesions
-oral papules and mucosal patches

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Treponema pallidum ssp. endemicum:
What is the LATE thing to happen?

Back 66

GUMMA (granulomas)
- on the skin, bones, and nasopharynx

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Treponema pallidum ssp. endemicum:
How is it transmitted?

Back 67

Person-2-person
eating contaminated utensils
hands with broken skin

Front 68

Treponema pallidum ssp. endemicum:
Where may you find this?

Back 68

In primitive tropical and subtropical ares
-Africa, asia, Australia

Front 69

Treponema pallidum ssp. endemicum:
Is it transmitted sexually?

Back 69

No. Just through contact
- skin may be first to be infected then it moves to the bones

Front 70

Treponema pallidum ssp. pertenue:
Yaws, is also known as...

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Granulomatous disease

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Treponema pallidum ssp. pertenue:
What are the early and late symptoms?

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Early: Skin leasions
Late: Destructive lesions of the skin, lymph nodes and bones

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Treponema pallidum ssp. pertenue:
How is it transmitted?

Back 72

Direct contact with the lesions?

Front 73

Treponema pallidum ssp. pertenue:
Where may you find this?

Back 73

Primitive tropical areas (S. america, Central Africa, etc)

Front 74

Treponema pallidum ssp. pertenue:
The lesions of Yaws, where are they on the body?

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They are painless nodules that are widely distributd over the body with many contagious spirochetes

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Treponema pallidum ssp. pertenue:
How can you treat it?

Back 75

Penicillin

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Treponema carateum
Pinta, where may you find it?

Back 76

Primarily restricted to skin

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Treponema carateum:
How long is the incubation period?

Back 77

1-3 weeks

Front 78

Treponema carateum:
How many stages are there?

Back 78

3, Initial, Secondary, and Late

Front 79

Treponema carateum:
What are the symptoms of Initial infection?

Back 79

Initial lesions
-small pruritic papules

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Treponema carateum:
What are the secondary infection symptoms?

Back 80

Enlarged plaques that persist for months to years

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Treponema carateum:
What are the late infection symptoms?

Back 81

Disseminated, recurrent hypopigmentation or depigmentation of skin lesions
- they get lighter

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Treponema carateum:
How is it transmitted?

Back 82

Through direct contact with skin lesions

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Treponema carateum:
Where may you find it?

Back 83

In primitive tropical area
- Mexico, Central, and S. america

Front 84

Treponema carateum:
Does this infection go deeper into the organs?

Back 84

No, this is only a cutaneous infection

Front 85

How do you get Borrelia

Back 85

Body lice and tick pathogens

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Borrelia characteristics

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Grow well in 30 to 35 degrees in specialized media. Have 3-10 loose coils

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How Borrelia is found in the lab

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Borrelia are often noted on Wright’s-stained smears of peripheral blood. So, the lab may detect the organism on a review of white blood cells during a CBC.
-thick blood films
-serology, antigen may be found in blood 3 weeks after
-ELISA detects IgG and IgM; IgM rise at 2 weeks IgG rise at 6-8 weeks.

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Borrelia recurrentis

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-only disease with lice vector
-reoccurs 3-10 times lasting 4-5 days
-fever, chills, malaise
-followed by 4-10 days afebile where spirochetes are absent from the blood.

Front 89

vBorrelia burgdorferi disease

Back 89

-Lyme disease
-small part stays on skin for 24 hours after locked on
-causes arthritis
-can cause congestive heart failure in babies from pregnant woman.
-begins in skin, then disseminates
-disseminates in the blood causing all body system problems

Front 90

vBorrelia burgdorferi if untreated

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Can exist in csf, skin, and joint fluid for years

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Primary stage of Lyme disease

Back 91

vEarly Lyme Borreliosis is usually associated with fatigue, chills, fever, muscle and joint pain, swollen lymph nodes or characteristic skin rash called erythema migrans. (Primary disease) Erythema migrans usually appears in about 3-4 weeks after the tick bite and near the site of the bite-red circular patch with a bull’s eye center. This occurs in about 80% of cases

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Secondary stage of Lyme disease

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Symptoms associated with secondary Lyme disease may not appear for days. Symptoms include arthritis (brief period of pain and swelling most likely of one of the large joints); nervous system abnormalities (pain, numbness, Bell’s palsy, and meningitis); irregular heart beat (uncommon)-they are flulike symptoms.

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Tertiary stage of Lyme disease

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This is late disseminated disease (month to years later) arthritis, encephalopathy (CNS), chronic fatigue skin infection

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General treatment of Borrelia burgdorferi

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vLyme disease can be identified through serological testing and successfully treated in any stage with broad spectrum antibiotics

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Best treatment for Lyme disease in adults

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The best treatment for adults is doxycycline because it has good brain barrier penetration

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Best treatment for Lyme disease in pregnant woman or children

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Penicillin

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How to confirm suspected Lyme disease in the lab

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vThe Western Blot assay is available and is strongly recommended to confirm all positive ELISA.