Ch. 13

Front 1

spirochetes
- special things
- labs
- genera

Back 1

have an additional outer membrane with periplasmic flagella underneath --> spins them around --> generates thrust

too small to see in microscope. use darkfield microscopy, serology, etc

1. Treponema
2. Borrelia
3. Leptospira

Front 2

Congenital syphilis
- categories
- sympotms

*useful fact- does not damage fetus until fourth month----so treat mother before this to prevent!!!*

Back 2

infects fetus

1. Death- SAB, stillbirth, neonatal death
2. Early congenital syphilis
- occurs w/in 2 years birth
- like secondary syphylis- rash, condyloma latum
- "snuffles"--due to involvement in nasal mucous membranes
- also bone infection-osteitis
3. Late congenital syphilis
- like tertiary syphilis but cardiac involvement rare
- neurosyphilis--CN VIII deafness common
- bone/teeth involvement
- "saddle nose" - inflmmation destroys cartilage/nasal septum
- "saber shins"- inflammation of tibia
- "Hutchinson's teeth"-central incisors widely spaced w/ notches
- "Mulberry molars"-too many cusps
- eye disease ie corneal inflmmation

Front 3

syphilis
- bug
- how gets into body
- stages (& timeframes)

Back 3

Treponema pallidum

penetrates intact mucous membranes & epithelial abrasions
-~6wk incubation-
1. Primary syphilis
-ulcer heals after about ~6 wks
2. Secondary syphilis
-occurs about 6 wks after ulcer heals
- sx last 2-6 wks
3. Latent syphilis
66% never recur
4. Tertiary syphilis (1/3)
takes at least 6 years to get tertiary (up to 40 yrs !!)

Front 4

Primary syphilis
- sx
- timeframes
- why a big deal

Back 4

PAINLESS CHANCRE
firm and ulcerated

- chancre happens at site of innoculation ~6 wks after infection
- chancre is HIGHLY INFECTIOUS- sheds continuously
- resolves after ~6 wks

Front 5

Secondary syphilis
- describe
- time frames
- symptoms

Back 5

- happens ~6 wks after painless chancre resolves
- lasts for ~ 6 wks

the BACTEREMIC stage
bacteria multiply --> spread via blood --> systemic

1. rash on PALMS, SOLES (small, red, macular but may become bumpy)
2. Condyloma latum- painless warlike lesions in sites like vulva, scrotum (warm, moist)-ulcerates-contagious!!
3. Skin infections --> bald spots etc
4. pretty much any organ
5. Systemic sx- generalized lymphad, wt loss, fever

Front 6

Latent syphilis

Back 6

usually aymptomatic

during first 4 years some people have relapses to secondary syphilis

pregnant women can still transmit to fetus

Front 7

Tertiary syphilis
- % infected people who get it
- time frame
- categories/symptoms

Back 7

1/3 untreated pts get tertiary syphilis after >6 yrs (up to 40 yrs!!). Due to chronic inflammation.

1. Gummas
noninfectious granulomatous lesions in skin/bone --> necrose --> fibrotic (bone ones are painful, skin painless)

2. Cardiac- esp dissecting aortic aneurysms (ascending/arch) (can also have aortic valve insufficiency, coronary artery occlusion)

3. Neurosyphilis
- Asymptomatic but CSF+
- Subacute meningitis (fever/stiff neck/h/a, CSF high lymphocytes)
- Meningovascular syphilis- spirochetes attack vessels in brain/meninges --> infarction
- Tabes dorsalis
*posterior column damage-impaired vibratory/proprioception-ataxia
*dorsal root ganglia damage-loss of reflexes and pain/temp
-General paresis- nerve cell damage in brain- mental deterioration/psych sx

Front 8

prostitute's pupil

Back 8

sign of neurosyphilis (tabes dorsalis & general paresis)

"accomodates but does not react"
accomodates for near reflex, does not react to light

Front 9

syphilis diagnosis

Back 9

primary/secondary- can diagnose specimens directly w/ darkfield microscope

Serology (for latent/tertiary)
1. Nonspecific tests
-VDRL (Venereal Disease Research Lab)
-RPR (Rapid Plasma Reagin)
cell damage --> lipid release --> anti-lipid abs ie anti-cardiolipin, lecithin
-but 1% adults have false positives

2. Specific treponemal tests
- to confirm
- detects treponeme ab's
- FTA-ABS (fluorescent treponemal antibody-absorption)
- but still can get false positives with other spirochetes ie yaws/pinta/leptispirosis/lyme dz

3. PCR

Front 10

syphilis treatment

what happens to ab levels after treatment

Back 10

- "fever box"
early 1900s- treponema are fragile --> heat kills

- PCN!! also erythromycin, doxycycline

*note-reinfection can occur*

VDRL/RPR levels decrease over months-years but FTA-ABS remains positive

Front 11

Jarisch-Herxheimer Phenomenon

Back 11

abx started for syphilis --> killed organisms release pyrogen --> mild fever/malaise/h/a (acute worsening of sx!)

Front 12

Treponema pallidum subspecies & diseases

Back 12

Nonvenereal dz- skin ulcers, +/- gummas in skin/bones in children
very similar to syphilis but do not cause cns/heart damage

1. endemicum --> "endemic syphilis/bejal"-africa, middle east; from eating/drinking utensils

2. pertenue --> "Yaws"
moist tropics; spreads through open ulcers; significant facial disfigurement (Jaws!) called "gangosa"

3. carateum --> "Pinta"
rural Latin America; red/blue skin lesions that become depigmented turning white after a year

Front 13

diseases caused by Borrelia

Back 13

1. Lyme disease
Borrelia burgdorferi
2. Relapsing fever (18 different species)

Front 14

Lyme disease
- bug
- description of bug
- vector
- reservoir

Back 14

Borrelia burgdorferi
gram neg spirochete
vector = Ixodes tick! (takes >24h for transfer after bite----so check for ticks!!)
reservoir = white-tailed deer, white-footed mouse, other rodents

Front 15

Lyme disease
-stages
- time frames

Back 15

1. Early localized stage
- starts ~10d after tick bite
- lasts 4 weeks
- erythema chronicum migrams rash + flulike illness + regional lymphadenopathy

2. Early disseminated stage
- skin- multiple smaller ECM rashes
- nervous system- aseptic meningitis, CN palsies ie Bell's palsies, peripheral neuropathy
- heart- myocarditis/LV dysfunction, AV block
- joints- breaf arthritic attacks

3. Late stage
- chronic arthritis (~10% untreated patients)
.....often have specific HLA types!
- chronic neuro damage ie encephalopathy w/ memory impairment, irritability, somnolence

Front 16

Lyme disease
- diagnosis
- treatment

Back 16

Erythema chronicum migrans rash
- can biopsy/culture too but difficult

anti-borrelia burgdorferia ab's
- ELISA
- Western blot

Tx: doxycycline or PCN abx

Front 17

Relapsing Fever
- cause
- vector
- where found
- sx

Back 17

18 species of Borrelia (spirochetes)

vector is tick except 1 species in which it is lice

campers in western U.S.---esp rodent-infested log cabins

fever with flu-like sx +/- rash....resolves after a few days....then relapses ~q8d (time to relapse becomes longer and longer)--due to antigenic variation!

Front 18

Leptospira
- human disease

Back 18

1 species:
Leptospira interrogans

found in URINE of animals ie dogs, rats, livestock, wild animals
-direct contact or swimming --> disease

1. Leptospiremic phase-high fever, h/a, malaise, pains, RED CONJUNCTIVE, PHOTOPHOBIA

2. Immune phase- appearance of IgM ab's--may get meningismus though

....can get more severe disease though: Weil's disease = infectious jaundice- renal failure, hepatitis, AMS, hemorrahge

Front 19

causes of VDRL false positives

Back 19

VDRL
Viruses- mono, hepatitis
Drugs
Rheumatic fever
Lupus, Leprosy