21 - SPIROCHETES Treponema, Borrelia and Leptospira...

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Unformatted text preview: SPIROCHETES Treponema, Borrelia and Leptospira Spirochetes Spirochetes • Gram negative Gram • Long, thin, helical, motile Long, • axial filaments – locomotion locomotion – between peptidoglycan layer/outer membrane * runs parallel runs Spirochete Spirochete spirochaetaceae leptospiraceae cristispira leptonema serpulina leptospira spirochaeta treponema borrelia Treponema Treponema T.pallidum T.carateum subsp.pallidum subsp.endemicum subsp.pertenue Histology: Treponema pallidum Treponema - testis infected rabbit testis Treponema pallidum Treponema 0.1-0.2 x 6-15um; 8-14 small, 0.1-0.2 regular spirals; actively motile. regular • transmission transmission – genital/genital – in utero or during birth in syphilis syphilis After initial infection, a primary chancre (an area of After ulceration/inflammation) is seen in genital areas or elsewhere within 10-60 days. The organism, meantime, has penetrated and systemically spread. The patient has flu-like symptoms with secondary lesions The particularly affecting the skin . These occur 2-10 weeks later. The final stage (if untreated) is tertiary syphilis (several years The later). In primary and secondary syphilis organisms are often present in large numbers. However, as the disease progresses immunity controls bacterial replication and fewer organisms are seen. It is extremely difficult to detect spirochetes in tertiary syphilis. The systemic lesions of skin, central nervous system and elsewhere are suggestive of a delayed hypersensitivity reaction. Primary stage Syphilis Syphilis ch r on ic slow ly pr ogr e ssive • 1 0 t o 6 0 da ys • pr im a r y le sion ­ ch a n cr e y le sion ncr • a r e a of ulce r a t ion/ infla m m a t ion ion / in fla • m a ny or ga n ism s ny or • rich in TP • a predom inance of lym phocyt es and plasm a cells • hard chancre 硬 硬 硬 • infect ious highly • heal spont aneously Secondary stage Se conda r y ( 2 ­ 1 0 w e e k s aft er prim ary st age ) • • • • Tertiary stage • • • • • • • sy st e m ic spr e a d flu ­ lik e sym pt om s sy m sk in , pa r t icu la r ly in, pa m a ny or g a nism s rich in TP red m aculopapular rash anyw her e on t he here on t body infect ious highly subside spont aneously Te r t ia r y se ve r a l ye a r s la t e r rare sk in, ce nt r a l ne r vous syst e m de la ye d hype r se nsit ivit y fe w or ga nism s cont r ol by im m une r e sponse 3 ­ 5 years aft er infect ion few TP granulom at ous lesions in skin,bone, and liver degenerat ive changes in t he cent ral nervous cardiovascular lesions 3w 2y Congenital syphilis Congenital Interstitial keratitis 硬硬硬 Hutchinson’s teeth Saddlenosema 硬硬硬 Periostitis 硬硬硬 A variety of central nervous system anomalies Microbiological diagnosis Microbiological • not culturable • dark field microscopy – actively motile actively organisms – brightly lit against brightly dark backdrop dark – light shines at an light angle – reflected from thin reflected organisms • conventional light conventional microscopy microscopy – light shines through – NOT visualized NOT screening method screening antibodies to cardiolipin specific diagnosis specific antibodies to treponemal antigen fluorescence microscopy antibody staining PCR Autoimminty: cardiolipin/self antigen Autoimminty: cardiolipin/self no vaccine no antibiotics (e.g. penicillin) antibiotics (e.g. – effective effective Other treponemal diseases bejel 地地地地地 bejel yaws 地地 地地 pinta 地地地 pinta Borrelia burgdorferi and Lyme disease Borrelia Ixodes scapularis, tick vector for Lyme disease. Also known as Ixodes dammini. CDC Lyme disease - symptoms Lyme disease • acute – responds to antibiotic –antibodies not detectable • late diagnosis – not curable – antibodies detectable Lyme Disease Disease erythematous rash erythematous • bacteremia bacteremia – acute • arthritis • cardiac • neurologic – chronic chronic * weeks, months later Lyme Disease Lyme - etiology etiology • reactive arthritis similar to – Reiter's syndrome Reiter's – rheumatic fever rheumatic • resembles rheumatoid arthritis. resembles B . Recurrentis and Relapsing fever Recurrentis • immune response develops disease immune response develops disease relapses • new antigens expressed • no immunity : disease reappears • transmission –tick-B. hermsii * rodent host rodent – lice-B. recurrentis lice* human host human Diagnosis Diagnosis • serum antibodies to B. burgdorferi. B. • laboratory strains laboratory – grow extremely slowly – tissue culture media –patient body fluids/tissue sample Therapy Therapy • • early antibiotic therapy – curable * penicillin * tetracycline late antibiotic administration – ineffective Leptospirosis Leptospirosis Leptospirosis • symptoms symptoms –flu-like flu-like –severe systemic disease * kidney kidney * brain * eye eye 0.1-0.2 x 6-20um; 0.1-0.2 fine coiling, one or both ends are usually hooked; deep brown color stained with silver impregnation stain (Fontana stain), Gramstain), negative. Morphology Morphology Transmission • infected urine – rodents – farm animals • water • through broken skin. Epidemiology Epidemiology worldwide zoonosis animal hosts: rats,mice,wild rodents,dogs,swine,and cattle Human is accidental Epidemiology Epidemiology 地地地地地地地地地 硬硬硬硬 % % 硬硬硬硬硬硬硬硬 硬硬硬 % 硬硬硬硬硬硬 硬硬硬 硬硬硬 硬硬硬 硬硬硬 硬硬硬硬硬 E $ $paddy planting area Leptospirosis area % 硬硬硬硬硬硬硬 $ 硬硬硬 % % 硬硬硬 $硬硬硬 E %% 硬硬硬 % 硬硬硬 硬硬硬 %E硬硬硬 E 硬硬硬 % $ $ 硬硬硬 硬硬硬 % E % E E % $ $ 硬硬硬 %E $ 硬硬硬 硬硬硬 E % 硬硬硬 E %E $ $% $ E硬硬硬 % $ 硬硬硬 硬硬硬 $ 硬硬硬硬硬硬硬 硬硬硬 E % E E % E %$ % $ $ 硬硬硬 % E $ Pathogenicity Pathogenicity Multiply in kidney and liver. Shed in the urine for life long of animal. Damage to the capillary endothelium is the main cause 12/27/11 Laboratory Diagnosis Laboratory • • serology most readily culturable of spirochetes – culture still extremely difficult ...
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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