1. 2009274044 조윤실 ( 발표, 자료조사 ) 2009274023 김소민 (PPT, 자료조사 ) 2009274031 양혜경 (PPT, 자료조사 ) 2009274057 남웅철 ( 퀴즈, 자료조사 )

2.  Leptospira General Characteristic  Leptospirosis Epidemiology Pathology Diagnosis, Treatment, Prevention  Borrelia General Characteristic  Relapsing fever  Lyme disease Epidemiology Pathogenesis Diagnosis, Treatment, Prevention

3. Family Genus Spirochatales Spirochataeceae Treponema Borrelia B. hermsii B. burgdorferi B. recurrentis LeptospiraceaeLeptospira L. interrogans L. biflexa Order

4.  Typical spirochetes - tight, regular indivisual coils with a bend or hook at one or both end  G(-), motility, aerobic, temp 28~30 ˚C  L. interrogans : leptospirosis (in human and animal)  L. biflexa : harmless, free-living saprobe

5.  Zoonosis  Various mammalian reservoirs  Not associated with animal bite, inhalation, human contact

7.  Principal targets  Kidneys, liver, brain, eyes  Two phase  Incubation period : 7~14 days  Leptospiremic phase(early phase)  Immune phase(second phase)

8. 1. Leptospiremic phase (early phase)  Pathogen in blood, cerebrospinal fluid  High fever, chills, headache, muscle aches, conjunctivitis, vomiting

9. 2. Immune phase (second phase)  Blood infection is cleared by natural defense  various symptoms Milder fever Leptospiral meningitis -headache Weil’s syndrome Hepatic disease / Jaundice Long-term disability / Death

10.  Severe leptospirosis  Infectious jaundice  Like anicteric leptospirosis at first, but appears jaundice during 4~9 days

11.  History & symptoms -> initial diagnosis  ELISA (Enzyme-Linked ImmunoSorbent Assay)  MAT (Microscopic Agglutination Test)  PCR

12. (cont’d)  Dark-field microscopy  Giemsa stain  Silver stain (in tissues)  Fluorescent antibody method (in urine, tissues) Silver stain Dark field microscopy Fluorescent antibody method Giemsa stain

13.  Early treatments  Penicillin, Tetracycline  Delayed therapy -> Less effective

14.  Protective footwear & clothing  Avoid swimming or wading in water  Strain-specific vaccines - Made from killed cell - Protection only to specific endemic strain

15.  Two species : L. interrogans, L. biflexa  Leptospirosis : zoonosis, contact with urine - Two phase :Leptospiremic phase & Immune phase  Weil’s syndrome  Dark field microscopy, MAT  PC, TC, strain-specific vaccine

16.  Gram (-), microaerophilic  Irregularly spaced and loose coil - periplasmic flagella 30~40  Nutritional requirements : so complex

17. Human disease  Relapsing fever 1. Tick-borne relapsing fever (B. hermsii) 2. Louse-borne relapsing fever (B. recurrentis)  Lyme disease (B. burgdorferi, B. garinii, B. afzeli)

18. 1. Tick-borne relapsing fever  Borrelia hermsii  Vector : Genus Ornithodoros - salivary glands and intestine  Mammalian reservoirs : wild rodents - zoonotic

19. Tick-borne relapsing fever (cont’d)  Human : an accidental host  Campers, backpackers, forestry personnel

20. 2. Louse-borne relapsing fever  Borrelia recurrentis  Vector : Pediculus humanus -harbors in louse’s cavity  Famine, war, natural disasters, poor hygiene, crowding and inadequate medical attention  Lice -> smashed into a wound or the skin => infected

21. 2~15 incubation period Abrupt onset of high fever, shaking chills, headache, fatigue Later nausea, vomiting, muscle aches, abdominal pain

22. (cont’d)  Extensive damage to the liver, spleen, heart, kidney and cranial nerves  Hemorrhage into organs  A rash on the shoulders, trunk, and legs  Untreated cases – mortality 40 %

23. : remarkable strategy!  Change surface antigens so, the initial antibodies -> useless => second wave of symptoms  Immune system -> new antibodies formation again, change surface antigens repeat -> cumulative immunity “ Complete recovery ”

25.  A patient’s history, clinical symptoms  Borrelia in blood smears  Tetracycline – except for pregnant and children under 7 years old  Chloramphenicol, erythromycin and doxycyline

26.  Vaccines are not available  Controlling rodents and avoiding tick bites  Louse-borne relapsing fever : Improving hygiene

27.  Borrelia burgdorferi, Borrelia garinii, Borrelia afzeli  Transmitted by hard ticks - genus Ixodes

28.  Ex) Ixodes scapularis  Larva, nymph of tick – white-footed mouse  Nymph : nonspecific – any type of vertebrate (including human)  Adult tick (reproductive phase) – completed on deer

30.  Early Lyme disease ① Localized infection(1~3 weeks) ▪Erythema migrans(50~70%) : like bull’s-eye ▪Fever, headache, stiff neck, and dizziness ② Early disseminated infection(3~10 weeks) ▪Multiple erythema migrans ▪Cardiac symptoms ▪Neurological symptoms : facial palsy

31.  Late Lyme disease ③ Chronic infection(several weeks~years) ▪Chronic erythema migrans ▪Polyarthritis ▪Chronic neuroligical complications

32. Ring-shaped lesions(erythema migrans) Isolation of spirochetes from the patient ELISA, Fluorescent antibody method DNA test Tetracycline, amoxicillin Ceftriaxone, azithromycin

33.  No vaccine  Protective clothing, boots, leggings, and insect repellent (DEET)  Remove ticks without crushing, with forceps or gloves

34.  Borrelia hermsii, Borrelia recurrentis  Change surface antigens  Blood smears, patient’s history, clinical symptoms  TC not for pregnant and children  CP, EM and doxycycline

35.  Borrelia burgdorferi, Borrelia garinii, Borrelia afzeli  Hard tick (genus Ixodes)  Erythema migrans  Bull’s-eye rash, isolation, ELISA, DNA test  TC, amoxicillin

37. 1) Individual coil 2) Bend or hook shape 3) L. biflexa cause Leptospirosis 4) Leptospires shed in the urine of an infected animal

38. 1) Bull’s-eye rash 2) Weil’s syndrome 3) jaundice 4) relapsing fever 5) both 2) and 3)

39. 1) An optical microscope is not usefulness. 2) It's spreaded by the urine. 3) It can be made the spore in extremecondition. 4) The relapsing fever can be caused by the soft tick.

40. 1) Animal urine 2) Lice and tick 3) Air 4) Mosquito

41. 1) Borrelia change their cell wall during growth. 2) The immune system forms new antibodies at each response. 3) Borrelia will die when new antigenic form appears. 4) There is no complete recovery for relapsing fever.

42. 1) Hard ticks 2) Deer 3) Mice 4) Vertebrate

43. 1) infected animal’s urine 2) human intestine 3) vector 4) salivery glands and intestines of the tick