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38 Cards in this Set
- Front
- Back
What are spirochetes? What do they have?
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Tiny Gram negative organisms that look like corkscrews. They have an endoflagella called axial filaments.
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Spirochetes are different than other typical Gram -- by?
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Additional phospholipid-rich outer mm with exposed proteins, providing protection against immune recognition. Axial flagella, AKA periplasmic flagella, that run sideways along the spirochete.
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What is required for observing spirochetes?
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Darkfield microscope, immunofluorescence, and sliver stains.
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Can spirochetes grow on ordinary media?
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No
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What are three categories of spirochetes?
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Treponema, Borrelia, and Leptospira
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Treponemes produce?
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No known toxins or destructive enzymes; disease results form host's own immune responses.
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What causes syphilis?
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Treponema pallidum
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Treponema pallidum enters how?
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Penetrating intact mucous mm or by invading through epithelial abrasions.
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What is the primary syphilis stage?
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Painless chancre that erupts at the site of inoculation. There is regional nontender lymph node welling.
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Describe the chancre and is it infectious?
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Firm, ulcerated, painless, with punched-out base and rolled edges. It is highly infectious.
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Secondary syphilis is what stage of the T. pallidum?
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The bacteremic stage, which the bacteria spreads. Almost any organ can become infected.
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What occurs with secondary syphilis?
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Condyloma lata (highly contagious), maculopapular rash on palms and soles; meningitis, hepatitis, arthritis, and others. Skin infection in areas of hair growth, results in patchy bald spots.
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What are the three complications to tertiary syphilis?
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Gummatous syphilis, cardiovascular syphilis, and neurosyphilis
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What is gummatous syphilis?
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Gummas are localized granulomatous lesions which eventually become necrose and fibrotic. These are found in the skin and bones. Skins lesions are painless, while bones are painful.
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What happens with cardiovascular syphilis?
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Aneurysm forms in the ascending aorta and aortic arch. Also, aortitis
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Neurosyphilis causes?
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Asymptomatic neurosyphilis subacute meningitis; meningovascular syphilis (spirochetes attach blood vessels in the brain and meninges with infarcts in the brain, spinal cord, and spectrum of neurologic impairments [circle of Willis]); tabes dorsalis; general paresis (mental deterioration and psychiatric symptoms); Argyll-Robertson pupil.
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Cogenital syphilis complications?
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High mortality rate. CN VII involvement, resulting in deafness. Corneal inflammation. Bone and teeth are frequently involved: Saddle nose; saber shins; Hutchinson's teeth; mulberry molars.
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What are two serological test used to identify T. pallidum?
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VDRL (nonspecific test: Venereal Disease Research Laboratory and Rapid Plasma Reagin--detects ABs against cardiolipin); and FTA-ABS (specific test: Indirect Immunofluorescent Treponeomal Antibody-Absorption, detects anti-treponemal ABs)
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How can you treat syphilis, congenital syphilis, and those who are allergic to the DOC?
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Penicillin for both. Penicillin can cross the placenta. If allergic, than erythromycin and doxycycline (but not doxycycline for congenital since it is toxic to the fetus).
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What is the Jarisch-Herxheimer Phenomenon?
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Syphilis treated with antibiotics, will release pyrogen, that causes the PT to become worse after treatment. This may occur with most spirochetes.
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What causes Lyme disease? Via what, and where?
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Borrelia burgdorferi, by an Ixodes tick (black legged ticks) from the reservoir of the white-footed mouse and white-tailed deer (and other mammals), in the Northeast, Midwest, and Northwestern U.S--in the woods, during summer.
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Lyme diseases is like what disease, and why?
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Is like syphilis, since they both start of as a painless skin lesion (chancre in sphilis and erythema chronicum migrans in Lyme disease). Followed by spreading throughout the body, invading organ systems with chronic problems later.
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What is the first stage of Lyme disease?
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Erythema chronicum migrans, with flulike symtpoms, and regional lymphadenopathy.
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What is erythema chronicum migrans?
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Starts off as a red (erythema), flat, round rash, which spreads out (migrans) over time (chronicum) as an annular (ring-like) rash. The outer border remains red, while the center will clear, turn blue and even necrose.
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What happens during the second stage of Lyme disease?
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Infection of skin (smaller secondary lesions), CV (carditis, AV nodal block), CNS (Bell's palsy, aseptic meningitis, and peripheral neuropathy), and joints (migratory myalgias and transient arthritis)
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What is the third stage of Lyme disease, left untreated?
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Chronic arthritis, neurologic effects (encephalopathy, Bell palsy), acrodermatitis chronicum atrophicans (skin atrophy).
Note: autoimmunity is associated with chronic disease (arthritis) with certain HLA types |
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How do you treat Borrelia burgdorferi? How do you diagnose it?
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Doxycycline or amoxicillin (for children) for stage 1. Ceftriaxone for disseminated infections (arthritis or meningitis). Skin biopsy on the leading edge o the rash, with a darkfield microscopy.
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What causes relapsing fever?
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18 species of Borrelia, but only B. recurrentis is the only human host via the body louse (Pediculus humanus). Other Borrelia species are transmitted by the tick Ornithodoros.
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What is relapsing fever
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A high fever, with chills, headaches, and muscle aches. Rash and meningeal involvement may follow. Symptoms resolve with cycles of 5 days febrile/ 8 days afebrile that continues up to 10 times.
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What causes relapsing fever to occur in cycles?
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Antigenic variations.
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How do you treat B. recurrentis?
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Doxycycline or erythromycin.
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Leptospira have what kind of appearance?
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Ice tongs
Or, long, thin hook ends |
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Leptospira interrogans cause?
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Leptospirosis and Weil's disease
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Leptospira interrogans infection occurs by?
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Contaminated urine from animals such as dogs, rats, livestock, and wild animals.
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What is the first stage of infection from L. interrogans?
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Bacteria invades via the blood or CSF to cause flu-like symptoms, high-spiking fever. Classically, the PT experiences photophobia and red conjunctiva.
Flu-like symptoms: fever, intense headache, myalgias, and diarrhea |
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What is the second stage of infection from L. interrogans?
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Correlates with appearance of IgM ABs. PTs may develop meningismus with high WBC count in CSF
Anicteric leptospirosis (mild) --> aspetic menigitis antibody associated) Weil's disease (severe) vasculitis with severe hemorrhagic complications, kidney damage (acute tubular necrosis), hypotension due to vascular collapse, and myocarditis |
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L. interrogans can also cause? And what is it?
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Weil's disease: vasculitis with hemorrhagic complications, mental status change, kidney damage with renal failure, liver damage with jaundice.
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How do you diagnosis and treat for L. interrogans infection?
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Spirochete detectable in blood or CSF in 1st phase and urine in the second phase. Also, Serology.
Penicillin G (for hospitalization) or doxycycline (for mild treatment) for treatment. Jarisch-Herxheimer reaction may be seen. Note: diagnosis is made in conjunction with PT history of swimming where there are animals present, such as a boating trip. |