Spirochetes

Question 1

Borrelia burgdorferi (Lyme disease)

lab tests

Answer 1

The bows and arrows of borrelia

Spirochete (Do not gram stain)

Helical and longer than Treponema

(the only spirochete that can be seen with microscope)

Wright and Giemsa stains can be used.

Question 2

Borrelia burgdorferi (Lyme disease)

source

Answer 2

The bows and arrows of borrelia

Primarily in northeastern U.S.

Transmitted by ticks (Ixodes scapularis)

* Ixodes also transmits erliciosis (bacteria) and bubesiosis (protozoa)

Question 3

Borrelia burgdorferi (Lyme disease)

life cycle

Answer 3

The bows and arrows of borrelia

1. Mouse (main reservoir); Tick larvae
2. Deer (obligatory host); Tick adult form
3. Humans (incidental host); Tick is the vector

Question 4

Borrelia burgdorferi (Lyme disease)

1st Stage

Answer 4

The bows and arrows of borrelia

Erythema chronic migrans “bulls eye” rash.

Sweating, feverish, flu-like illness.

Papule will form (Ixodes tick)

Question 5

Borrelia burgdorferi (Lyme disease)

2nd Stage

Answer 5

The bows and arrows of borrelia

Heart block caused by myocarditis

Bilateral facial nerve Bell’s palsy

Question 6

Borrelia burgdorferi (Lyme disease)

3rd Stage

Answer 6

The bows and arrows of borrelia

Joint pain and arthritis of large joints (like knees) that may move from joint to joint (Migratory polyarthritis).

Memory difficulty.

Lymphocytic meningitis.

Suttle encephalopathy.

Question 7

Borrelia burgdorferi (Lyme disease)

treatment

Answer 7

The bows and arrows of borrelia

Stage 1: doxycycline

(child under 8 use amoxicillin)

Stage 2: ceftriaxone

Question 8

Borrelia hermsii and duttonii

Endemic Relapsing Fever

Answer 8

The bows and arrows of borrelia

Endemic is caused by tick vs. Epidemic is caused by lice.

Most people who are infected develop sickness between five and 15 days after they are bitten.

Sudden fever, chills, headaches, muscle or joint aches, and nausea. A rash may also occur.

These symptoms usually continue for two to 9 days, then disappear. This cycle may continue for several weeks if the person is not treated

Question 9

Treponema palladium (Syphilis)

lab tests

Answer 9

Pallidum Observatory

• Spirochete (Do not gram stain)
• Cannot be grown in culture (only in rabbit testes)
• Dark field microscopy is needed for direct visualization of the bacteria
• VDRL (Venereal Disease Research Lab) screening** test** (not specific)
• RPR (Rapid plasmin reagent) screening test (high incidence of false (+) due to cross antigenicity)
• FTA ABS is an antibody specific test to confirm a (+) screen. (fluorescent treponemal antibody absorption )

Question 10

Treponema palladium (Syphilis)

Early stages (1º, 2º, early latent)

1º

(3-90 days after exposure)

Answer 10

Pallidum Observatory

Painless* genital chancre

* Syphilis locally invades small blood vessels causing ischemic necrosis, taking out nerves and making it painless.

Heals in 3-6 weeks

Question 11

Treponema palladium (Syphilis)

Early stages (1º, 2º, early latent)

2º ( Systemic!)

(4-10 weeks after initial infection)

Answer 11

Pallidum Observatory

• Systemic maculopapular rash** that also occurs on the **palms and soles* of feet, weeks to months after infection.
• Condoloma Latta, a lot of bumps that are flat topped.
• Spirochetes can be visualized in the condoloma latta using dark field microscopy.

(* Only a few organisms cause rash on palms and soles of feet! )

Question 12

Treponema palladium (Syphilis)

Condoloma Latta vs. Condoloma acuminata

Answer 12

Pallidum Observatory

Condoloma Latta is from 2º Syphilis.

• Bumbs that are flat topped.

Condoloma acuminata is from HPV

• Bumps are more wart like (rounded top)

Question 13

Treponema palladium (Syphilis)

Late stages (3º, late latent)

3º

(3-15 years after initial infection)

Answer 13

Pallidum Observatory

• Formation of Gummas (soft growth with a firm necrotic center). Can be anywhere, including skin, organs, and bone.
• Aortitis → leading to an ascending pathologic aneurysm
• Destroys the vasovasorum (that supply blood to the aorta) → leading to tree barking on aorta (thick and wrinkled)
• Tabes Dorsalis
• Argyle Robertson

Question 14

Treponema palladium (Syphilis)

Late stages (3º, late latent)

Tabes Dorsalis

Answer 14

Pallidum Observatory

Demyelination of nerves and posterior walls of the spinal cord.

Leads to loss of vibration sense, discriminating touch, and proprioception (can cause awkward gait).

Can also cause lancing pain and neurologic issues.

Question 15

Treponema palladium (Syphilis)

Late stages (3º, late latent)

Argyle Robertson

Answer 15

Pallidum Observatory

AKA Prostitutes pupil

Pupils will accommodate distance… but…

Will not react to light!

Question 16

Treponema palladium (Syphilis)

Congenital symptoms

Answer 16

Pallidum Observatory

* TORCHeS** infection!

• Saber shins (an anterior bowing of the tibia)
• Saddle shaped nose
• Hutchinson teeth (notched incisors)
• Mulberry molars (molars with several enamel outgrowths)
• Deafness

Question 17

Treponema palladium (Syphilis)

treatment

Answer 17

Pallidum Observatory

Penicillin

If allergic, desensitize them and use penicillin!

Question 18

Treponema palladium (Syphilis)

Jarisch Herschimer reaction

Answer 18

Pallidum Observatory

After treatment* for Syphilis (within an hour!)

Dying spirochetes release a bunch of cytokines that make people feel sick.

fever and chills

headache

* Indicates the tx is working!

Question 19

TORCHeS Infections

Answer 19

TORCHeS Infections:

Toxoplasmosis

Other (HIV, VZV, Parvovirus B19, enteroviruses, others)

Rubella

Cytomegalovirus

Herpes

Syphilis

Question 20

Leptospirosis

lab tests

Answer 20

The Surfers Oasis

Spirochete (Do not gram stain).

The spirochete may be ? shaped.

Question 21

Leptospirosis

source

Answer 21

The Surfers Oasis

Tropical regions.

Urine or Tissue of infected animals.

Water contaminated with animal urine.

Water sports or people who work with animals are common buzz words.

Question 22

Leptospirosis

Mild form

(usually 5-7 days)

Answer 22

The Surfers Oasis

Flu-like symptoms (Fever, chills, muscle pain, etc)

Conjunctival suffusion (redness of the conjunctiva that resembles conjunctivitis, but it does not involve inflammatory exudates / pus)

Question 23

Leptospirosis

Severe form

(Weil’s disease)

Answer 23

The Surfers Oasis

Leptospirosis travels in the blood stream and lymph and damage many organs.

Major symptoms include renal dysfunction and liver damage (_jaundice!_).

Can also cause abdominal pain, diarrhea, skin rash, and muscle pain.