Chapter XIV Early morning is a time of magic in Cannery Row . . . It is a time of great peace, a deserted time, a little era of rest. Cats drip over the fences and slither like syrup over the ground to look for fish heads. Silent early morning dogs parade majestically picking and choosing judiciously whereon to pee. From John Steinbeck’s Cannery Row

Spirochetes Lecture 20 Summer, 2004 Demosthenes Pappagianis, M.D., Ph.D. MMI 480B

Order Spirochetales

Spirochete Basic Structure

Borrelia

Borrelia recurrentis, B. hermsii

Time course of Lyme disease Incubation period 3 +/- 30 days Stage 1 Localized infection, 1 +/- 4 weeks Stage 2 Disseminated infection 1 week to 6 months; Symptoms are commonly intermittent Latent infection Stage 3 Persistent infection 6 months to 30 years Bite by Ixodes tick infected with B. burgdodrferi Organisms multiply in skin Dissemination of organisms in blood Erythema migrans Meningitis Carditis Musculoskeletal pain Eye abnormalitiers Secondary annular skin lesions Residual organisms in protected niches Acrodermatitis chronica arophicans Intermittent or chronic arthritis Chronic cardiomyopathy Chronic encephalopathy, Polyneuropathy or leukoencephalitis

Lyme borreliosis 3 week erythema migrans

Lyme borreliosis erythema migrans annular 2 months old

Lyme borreliosis acrodermatitis chronica

Lyme Borreliosis Borrelia burgdorferi WINTER Year 3 Year 2 Deer Year 1 ♀ ♂ mate Attach to deer Adult ♀ SPRING Eggs Infected larva FALL feed on mice On ground Adult Fall off mouse Larva Nymph (infected) Field Mice (infected) Infects Infects Nymph Lyme disease SUMMER Borrelia burgdorferi

(scanning electron micrograph) Leptospira (scanning electron micrograph)

Stages of Icteric and Anicteric Leptospirosis

Treponemal Diseases Syphilis Yaws Endemic Syphilis Pinta Worldwide Tropical: Africa, Caribbean, So. America, India, Pacific Islands Africa, Western Asia, Australia, Syria, Balkans South Mexico, Central and South America 3 weeks primary lesion (chancre); about 6 weeks later secondary, e.g. mucous patches, condyloma lata; latent for years, late or tertiary of cardiovascular and central nervous system, other organs (gummas). Basic lesion periarteritis and endarteritis. 3-4 weeks primary lesion, or “mother yaw” usually of lower extremities. Granuloma ulcerates; 6-12 weeks generalized eruption heal slowly, relapse. Papule - papillomatous skin lesions; later destructive periosteal lesions (even “saber” shins) Oral primary; 2 oropharyngeal mucous patches, condyloma lata, periostitis, region lymphadenopathy; late gummas of skin, nasopharynx, bone 17-20 days - 1 papules, then slightly squamous coalesce into larger; later dyschromic brown, gray or blue, then hypopigmented ( sequence is hyperkeratonic, hyperpigmented or hypopigmented like vitiligo); late aortitis! Polymerase Chain Reaction can’t distinguish among these treponemes.

Yaws lesion in Dominican, West Indies

Treponema pallidum

General Paresis T. pallidum in brain (silver stain)

Effect of Temperature on Progression of Syphilitic Lesions

Natural History of Untreated Syphilis

Syphilis - chancre

Syphilis Chancre of Labium Major

Skin secondary Syphilis arteritis

Syphilis - arteritis

Secondary Syphilis Pityriasis Rosea

Secondary Syphilis

Secondary Syphilis macular-papulo-squamous

Secondary Syphilis

Secondary Syphilis mucous patch on tongue

Syphilis Condylomata lata

Syphilitic aortitis with calcium in ascending aorta

Syphilitic aortitis with calcium in ascending aorta

Syphilis Aortic aneurysm eroding scapula

Tabes dorsalis - demyelination of posterior columns and (dorsal) roots

Syphilis Charcot’s joint (loss of proprioception)

Trophic Ulceration secondary to tabes dorsalis

Gummas of liver

Mucous patches and skin lesions of early congenital syphilis

Saber shins of late congenital syphilis

Cardiolipin

FTA-Abs Test Positive fluoresces Negative

FA - Treponema pallidum