1. 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

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

3. Order Spirochetales

4. Spirochete Basic Structure

5. Borrelia

7. Borrelia recurrentis, B. hermsii

9. 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

10. Lyme borreliosis 3 week erythema migrans

11. Lyme borreliosis erythema migrans annular 2 months old

12. Lyme borreliosis acrodermatitis chronica

13. 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

15. (scanning electron micrograph)
Leptospira
(scanning electron micrograph)

16. Stages of Icteric and Anicteric Leptospirosis

18. 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.

19. Yaws lesion in Dominican, West Indies

20. Treponema pallidum

21. General Paresis T. pallidum in brain (silver stain)

22. Effect of Temperature on Progression of Syphilitic Lesions

23. Natural History of Untreated Syphilis

24. Syphilis - chancre

25. Syphilis Chancre of Labium Major

26. Skin secondary Syphilis arteritis

27. Syphilis - arteritis

28. Secondary Syphilis
Pityriasis Rosea

29. Secondary Syphilis

30. Secondary Syphilis macular-papulo-squamous

31. Secondary Syphilis

32. Secondary Syphilis mucous patch on tongue

33. Syphilis Condylomata lata

35. Syphilitic aortitis with calcium in ascending aorta

36. Syphilitic aortitis with calcium in ascending aorta

37. Syphilis Aortic aneurysm eroding scapula

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

39. Syphilis Charcot’s joint (loss of proprioception)

40. Trophic Ulceration secondary to tabes dorsalis

41. Gummas of liver

42. Mucous patches and skin lesions of early congenital syphilis

43. Saber shins of late congenital syphilis

45. Cardiolipin

46. FTA-Abs Test
Positive
fluoresces
Negative

47. FA - Treponema pallidum