T2 - Micro - 16 - Spirochetes

Front 1

describe the basic features of spirochetes, in general. Do they have LPS?

also, while we're at it, list the species of spirochetes and the diseases we care about:

Back 1

they're long and skinny and are gram negative, so they have LPS.

species include:

Treponemia palidum - syphillis

Borrelia recurrentis - epidemic (louse) relapsing fever.

Borrelia hermsii - endemic (tick) relapsing fever.

Borellia burgdorferi - lyme disease

Leptosporia interrogans - leptospirosis.

Front 2

let's talk about syhpillis - what are some virulence factors?

Back 2

Treponema pallidum - have hyaluronidase and fibronectin, first to invade and second to evade phagocytosis.

Front 3

describe the disease progression of syphillis

Back 3

Treponema palidum has several stages. Divided in primary, secondary (disseminated), and latent, and late stage.

primary disease - see a lesion, local lymphadenopathy, then a healed lesion.

secondary disease - disseminates through the blood stream, get general flu symptoms, and a telltale RASH (palms and soles of feet, which are rare). Goes away.

Now, enter the latent, asymptomatic phase, Can relapse into secondary or become late stage.

Late stage syphilis - years later, FEW SPIROCHETES PRESENT ANYWHERE - mostly an inflammatory response at this time..
see GRANULOMAS everywhere (gummas), Can be anywhere (neurosyphillis, cardiovascular syphilis, etc).

Front 4

what's the other kind of syphilis?

Back 4

neonatal - it can cross the placental barrier, killing half of kids.

those that survive have hutchins's triad - notched teeth, interstitial keratitis, and eigth-nerve deafness.

Front 5

talk about the syphilis sore

Back 5

it's usually painless and highly infectious.

Front 6

how do you diagnose/culture syphilis? what are two methods of identifying?

Back 6

CAN'T be cultured, 'cept in rabbit balls.

this is a lecture objective - tell between treponemal and non-treponemal tests. Note that both look for antibodies.

1. non-treponemal tests - VDRL and RPR - look for patient Ab's against breakdown products of yourself (cardiolipin). Shows up positive in SECONDARY and LATENT. Note that this goes DOWN OVER TIME, and in late stage disease, may not show up.

2. Treponemal test - here, look for antibodies against the treponema itself. This persists through the life of the patient. FTA, TPPA, EIA's.

Front 7

what's a consequence of killing off the little buggers with (which) antibiotic?

Back 7

use penicillin - either long lasting benzathine penicillin or PenG if later on.

Jarisch Herxheimer reaction from all the LPS being released. Looks like allergic reaction, but here there's a fever.

Front 8

Borrelia Burgdorferi - what's the reservoir and how do you get it?

Back 8

white footed mouse and the deer. get it from tiny little ticks that need to be on you for more than 48 hours.

Front 9

clinical progression of lyme disease?

Back 9

acute, disseminated, and late (unlike syphillis, which has a primary, secondary (disseminated), latent, and late).

acute - get erythema migrans (rash) around the bite for a few days. feel crappy, fever, chills, lymphademopathy.

disseminated - arthargia, skin lesions, heart problems, facial palsy, meningitis, etc.

late stage - arthritis, blue blisters in europe, immune complex driven arthritis.

Front 10

how do you diagnose lyme disease?

Back 10

just the erythema migrans is enough. or, you can have laboratory confirmation _ a symptom. Lab looks for bug or antibodies. mostly for antibodies.

Front 11

what else can boriella cause and what's the disease progression/vectors? what is its big virulence factor?

Back 11

boriella can cause relapsing fever, which comes in two forms - epidemic and endemic.

boriella recurrentis causes the louseborn epidemic relapsing fever. The tick-borne, endemic relapsing fever is caused by other species of boriella.

symptoms:
incubation at first with flu symptoms including fever. Then, it subsides. then, it ANTIGEN SHIFTS (virulence factor), and it comes back.

if it's the endemic kind caused by ticks, it can go and come back 10 times, then goes away.

if it's the epidemic kind carried by louses, then you get a single relapse and bad news myocarditis, liver damage, brain bleeds. 40% mortality.

Front 12

Leptospira - what does it look like? temperature? what does it cause generally and how does it invaed? where in the world? reservoir?

Back 12

has hook like spirochetes. Can be cultured.

it likes 30 degrees.

it causes leptospirosis, mostly in hawaii. reservoir is rats (colonizes their renal tubules), so lives in water. see it in people who do water sports and animal workers.


can penetrate intact mucous membranes or damaged skin, it's very very small.

Front 13

what disease is mistaken for it? disease proression?

Back 13

aseptic meningitis can be leptospirosis.

disease progression:

primary is flu like,

secondary has acute onset of lots of pain and eye problems/myalgia, can progress and become liver failure, bleeding, vascular collapse.

Front 14

what can leptospirosis lead to?

Back 14

often mistaken for viral meningitis.

but it has a primary flu stage

then a secondary headache ACUTE ONSET

then Weil's disease = renal/hepatic failure, vascular collapse.