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1 SpirochetesNeisseria Spirochetes and Neisseria (Gram negative) Lecture 36 Faculty: Dr. Alvin Fox
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2 Spirochete Axial filament Treponema pallidum Syphilis Chancre Primary lesion Darkfield microscopy Secondary Lesion Tertiary Lesion Anti-cardiolipin antibodies Anti-treponemal antibodies Borrelia burgdorferi Lyme disease Relapsing fever (other borrelia) Leptospira (leptospirosis) Neisseria Thayer Martin agar Oxidase test N. gonorrhoeae Gonorrhea N. meningitidis Meningitis Key Words
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3 SPIROCHETES Treponema, Borrelia and Leptospira
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4 Spirochetes Gram negative long, thin, helical, motile long, thin, helical, motile axial filaments – locomotion – between peptidoglycan layer/outer membrane * runs parallel
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5 Histology: Treponema pallidum Histology: Treponema pallidum - testis infected rabbit www.orl.cz/choroby/ustni/jazyk/zanet/1
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6 Treponema pallidum transmission – genital/genital – in utero or during birth
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7 Syphilis chronicchronic slowly progressiveslowly progressive
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8 Secondary (2-10 weeks later) Secondary (2-10 weeks later) - systemic spread - flu-like symptoms - skin, particularly - many organisms - Highly infectious
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9 Tertiary – several years later – rare – skin – central nervous system – delayed hypersensitivity – few organisms * control by immune response
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10 Microbiological diagnosis not culturablenot culturable dark field microscopydark field microscopy –actively motile organisms –brightly lit against dark backdrop –light shines at an angle –reflected from thin organisms –enters objective conventional light microsrcopyconventional light microsrcopy –light shines through –NOT visualized
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11 fluorescence microscopy –antibody staining
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12 Secondary and Tertiary Syphilis - serology screening methodscreening method antibodies to cardiolipinantibodies to cardiolipin specific diagnosisspecific diagnosis antibodies to treponemal antigenantibodies to treponemal antigen
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13 Autoimminty cardiolipincardiolipin – self antigen
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14 no vaccineno vaccine antibiotics (e.g. penicillin)antibiotics (e.g. penicillin) –effective
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15 Other treponemal diseases bejel, yaws and pinta –extremely rare in US
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16 Borrelia burgdorferi and Lyme disease
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17 Ixodes scapularis, tick vector for Lyme disease. Also known as Ixodes dammini. CDC
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18 Lyme disease - symptoms bacteremiabacteremia –acute arthritisarthritis cardiaccardiac neurologicneurologic –chronic *weeks, months later
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19 Therapy early antibiotic therapyearly antibiotic therapy – curable * penicillin * tetracycline late antibiotic administration late antibiotic administration –ineffective
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20 Diagnosis serum antibodies to B. burgdorferi serum antibodies to B. burgdorferi. laboratory strains – grow extremely slowly – tissue culture media – not bacteriological media patient body fluids/tissue sample patient body fluids/tissue sample – almost never growth
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21 acute – responds to antibiotic –antibodies not detectable late diagnosis late diagnosis – not curable – antibodies detectable A physicians dilemma
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22 Lyme Disease - etiology reactive arthritis similar to reactive arthritis similar to – Reiter's syndrome – rheumatic fever resembles rheumatoid arthritis
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23 Relapsing fever <100/ per year in US transmission transmission –tick-B. hermsii * rodent, primary host – lice-B. recurrentis * human, primary host
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24 “Relapsing” fever “Relapsing” fever immune response developsimmune response develops –disease relapses new antigens expressednew antigens expressed –no immunity –disease reappears
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25 Diagnosis no cultureno culture no serological testno serological test detected - blood smeardetected - blood smear
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26 Leptospirosis
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27 <100 cases per year in US symptoms symptoms –flu-like –severe systemic disease * kidney * brain * eye Leptospirosis
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28 infected urineinfected urine –rodents –farm animals waterwater through broken skin.through broken skin. Transmission
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29 Laboratory Diagnosis serologyserology most readily culturable of spirochetesmost readily culturable of spirochetes –culture still extremely difficult
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30 Neisseria gonorrhoeae NEISSERIA
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32 Gram negative Gram negative diplococci (pairs of cocci) diplococci (pairs of cocci) oxidase positive oxidase positive culture culture Thayer Martin. Thayer Martin. – selective – chocolate agar * heated blood (brown) Neisseria Neisseria
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33 found only in man found only in man gonorrhea gonorrhea second most common venereal disease second most common venereal disease N. gonorrhoeae the “Gonococcus"
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34 Smear polymorphonuclear cellpolymorphonuclear cell Gram negative cocciGram negative cocci – many in cells
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35 gonoccocal arthritis – “septic” arthritis dermatitis dermatitis Dissemination -gonococci
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36 lactamase-resistant cephalosporin β lactamase-resistant cephalosporin – e.g. ceftriaxone resistant strains resistant strains – common – produce lactamases – produce β lactamases – destroy penicillin Antibiotic therapy
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37 adhesion to genital epithelium adhesion to genital epithelium – outer membrane – pili *Antigenicity highly variable among strains highly variable among strains no vaccine IgA protease – also N. meningitidis Pathogensis
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38 Tissue injury – lipopolysaccharide – peptidoglycan N. gonorrhoeae
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39 N. meningitidis N. meningitidis (the “Meningococcus")
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40 resides in man only usually sporadic cases usually sporadic cases – mostly young children outbreaks outbreaks – adults – crowded conditions *e.g. army barracks, dorms N. meningitidis
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41 upper respiratory tractinfection upper respiratory tract infection – adhesion pili bloodstream bloodstream brain Neisseria meningitidis
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42 second most common meningitis second most common meningitis – pneumococcus, most common fatal if untreated fatal if untreated responds well to antibiotic therapy responds well to antibiotic therapy – penicillin Meningococcal meninigitis
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43 Laboratory Diagnosis spinal fluid – Gram negative diplococci within polymorphonuclear cells within polymorphonuclear cells – meningococcal antigens Culture Culture – Thayer Martin agar
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44 capsule capsule – inhibit phagocytosis anti-capsular antibodies anti-capsular antibodies – stop infection antigenic variationantigenic variation – sero-groups vaccine vaccine –multiple sero-groups Capsule
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