Spirochetes

Question 1

What dz’s are caused by spirochetes?

Answer 1

• Lyme
• Rockey Mountain Spotted Fever (RMSF)
• Syphilis

Question 2

What causes lyme?

Answer 2

• Borrelia burgdorferi

- gram (-) spirochete

Question 3

How is lyme spread?

Answer 3

• Ixodes (deer) tick in spring and summer

Question 4

What is the most common vector borne illness in US?

Answer 4

• Lyme

Question 5

What are the stages of Lyme?

Answer 5

• primary or localized
• early disseminated
• chronic

Question 6

What are the signs and symptoms of primary or localized lyme?

Answer 6

• erythema migrans

- non specific viral syndrome sx (fatigue, myalgias, arthralgias, headache, fever, chills, & neck stiffness)

Question 7

Describe erythema migrans in association with lyme

Answer 7

• expanding, warm annular erythematous rash

- central “bullseye”

Question 8

When is the onset of primary or localized lyme?

Answer 8

• w/in 30 d of tick bite

Question 9

When does the erythema migrans occur in primary or localized lyme?

Answer 9

• 7-10d after tick bite

Question 10

What are the signs and symptoms of early disseminated lyme?

Answer 10

• musculoskeletal and neurologic sx MC (arthralgias & bells palsy)
• weeks to months after bite

Question 11

What are the signs and symptoms of chronic lyme?

Answer 11

• persistent musculoskeletal and neurologic sx

Question 12

T/F: Lyme can present with heart block.

Answer 12

• true

Question 13

What is the workup for lyme?

Answer 13

• erythema migrans = you win the dx w/o testing
• culture
• two tier immunoglobulin testint
• CSF

Question 14

What is the oral v. IV rx therpy for lyme?

Answer 14

• oral: doxy in pts >8y/o, amoxicilin

- IV: ceftriaxone

Question 15

How long is oral tx for lyme?

Answer 15

• 14-21 d

- 28 d w/ arthritis

Question 16

T/F: There is no prophylaxis tx for lyme.

Answer 16

• false

- doxy w/in 72 hrs of tick removal

Question 17

What causes RMSF?

Answer 17

• Rickettsia ricketsii

- spread by Dermacentor variabilis/andersoni (dog/wood tick)

Question 18

What is the most common rickettsial infx?

Answer 18

• RMSF

Question 19

What are the signs and symptoms of RMSF?

Answer 19

• petechial rash that does not blanch beginning on the palms/soles
• febrile
• H/A
• myalgias
• encephalitis
• bradycardia
• arrhythmias
• N/V
• insomnia/ photophobia

Question 20

What are the lab findings for RMSF?

Answer 20

• leukopenia
• thrombocytopenia
• anemia + elevated BUN + abnormal LFTs

Question 21

What are the tests for RMSF?

Answer 21

• serology
• blood culture
• LP

Question 22

What is the tx for RMSF?

Answer 22

• everyone gets doxy

- chloramphenicol is 2nd line

Question 23

What causes syphilis?

Answer 23

• Treponema pallidum

Question 24

What is “The Great Imposter/Intimidator”?

Answer 24

• syphilis

Question 25

How is syphilis transmitted?

Answer 25

- sexual contact - mother to fetus in utero - blood product transfusion - breaks in the skin

Question 26

What is the pathophys of syphilis?

Answer 26

- penetrates intact mucous membranes or microscopic dermal abrasions

Question 27

Describe primary syphils

Answer 27

- painless chancre at the site of transmission - punched-out base and rolled edges - highly infectious

Question 28

Describe primary syphilis healing

Answer 28

- w/ or w/o tx, healing occurs w/in 3-12w w/considerable residual fibrosis

Question 29

What are the stages of syphilis?

Answer 29

- primary - secondary - latent - tertiary

Question 30

Describe primary syphilis healing

Answer 30

- w/ or w/o tx, healing occurs w/in 3-12w w/considerable residual fibrosis

Question 31

What are the signs and symptoms of secondary syphilis?

Answer 31

- 4-10w s/p primary lesions appear - malaise, fever, myalgias, arthralgias, LAD - *maculopapular rash, palms/soles common, that blanches* - condylomata lata

Question 32

What are condylomata lata?

Answer 32

- painless, highly infectious, grey-white lesions | - develop in warm, moist areas

Question 33

What is latent syphilis?

Answer 33

- secondary syphilis sx have resolved but pt remains seroreactive

Question 34

T/F: 2/3 of untreated latent syphilis pts go on to develop tertiary syphilis.

Answer 34

- false, 1/3

Question 35

What are the types of tertiary syphilis?

Answer 35

- cardiovascular - neurosyphilis - gummatous

Question 36

Describe gummatous syphilis

Answer 36

- gummas with center of necrotic tissue w/ rubbery texture; breakdown and form ulcers - liver, bone, & testes

Question 37

Describe cardiovasular syphilis

Answer 37

- destruction of vasa vasorum --> aortic valve insufficiency

Question 38

Describe neurosyphilis

Answer 38

- syphilitic meningitis - meningovascular - parenchymal (tabes dorsalis, general paresis) - Argyll-Roberston pupil

Question 39

Describe Argyll-Roberston pupil

Answer 39

like a prostitute | - does not react but accomodates

Question 40

What are the signs and symptoms of congenital syphilis?

Answer 40

- widespread condylomata lata and rash - saddle nose - saber chins - Cluttons joints - Hutchinson's teeth - mulberry molars - tabes dorsalis and general paresis

Question 41

T/F: T. pallidum cannot survive outside host on drying surface or on exposure to disinfectants.

Answer 41

- true

Question 42

What is the workup for syphilis?

Answer 42

- serologic testing | - notreponemal test must be followed with teponemal test

Question 43

What is the treatment for syphilis?

Answer 43

- PCN

Question 44

What is a risk of treating syphilis?

Answer 44

- procaine toxicity | - Jarish-Herxherimer reaction

Question 45

Define Jarish-Herxherimer reaction

Answer 45

- dying treponemes release inlam response