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Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
Spirochetes&Niesseria
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Spirochetes&Niesseria

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Spirochetes&Niesseria

Spirochetes&Niesseria

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  • 1. SPIROCHETES AND NEISSERIA Faculty: Dr. Alvin Fox www.freelivedoctor.com
  • 2. <ul><li>Spirochete </li></ul><ul><li>Axial filament </li></ul><ul><li>Treponema pallidum </li></ul><ul><li>Syphilis </li></ul><ul><li>Chancre </li></ul><ul><li>Primary lesion </li></ul><ul><li>Darkfield microscopy </li></ul><ul><li>Secondary Lesion </li></ul><ul><li>Tertiary Lesion </li></ul><ul><li>Anti-cardiolipin antibodies </li></ul><ul><li>Borrelia burgdorferi </li></ul><ul><li>Lyme disease </li></ul><ul><li>Relapsing fever (other borrelia) </li></ul><ul><li>Leptospira (leptospirosis) </li></ul><ul><li>Neisseria </li></ul><ul><li>Thayer Martin agar </li></ul><ul><li>Oxidase test </li></ul><ul><li>N. gonorrhoeae </li></ul><ul><li>Gonorrhea </li></ul><ul><li>N. meningitidis </li></ul><ul><li>Meningitis </li></ul>Key Words www.freelivedoctor.com
  • 3. SPIROCHETES Treponema, Borrelia and Leptospira www.freelivedoctor.com
  • 4. Spirochetes <ul><li>Gram negative </li></ul><ul><li>long, thin, helical, motile </li></ul><ul><li>axial filaments </li></ul><ul><ul><li>locomotion </li></ul></ul><ul><ul><li>between peptidoglycan layer/outer membrane </li></ul></ul><ul><ul><ul><li>runs parallel </li></ul></ul></ul>www.freelivedoctor.com
  • 5. Histology: Treponema pallidum - testis infected rabbit www.freelivedoctor.com
  • 6. Treponema pallidum <ul><li>transmission </li></ul><ul><ul><li>genital/genital </li></ul></ul><ul><ul><li>in utero or during birth </li></ul></ul>www.freelivedoctor.com
  • 7. Syphilis <ul><li>chronic </li></ul><ul><li>slowly progressive </li></ul>www.freelivedoctor.com
  • 8. <ul><li>primary lesion - chancre </li></ul><ul><ul><li>10 to 60 days </li></ul></ul><ul><ul><li>area of ulceration/inflammation </li></ul></ul><ul><ul><li>many organisms </li></ul></ul>www.freelivedoctor.com
  • 9. <ul><li>Secondary (2-10 weeks later) </li></ul><ul><ul><li>systemic spread </li></ul></ul><ul><ul><li>flu-like symptoms </li></ul></ul><ul><ul><li>skin, particularly </li></ul></ul><ul><ul><li>many organisms </li></ul></ul>mouth muosa www.freelivedoctor.com
  • 10. <ul><li>Tertiary </li></ul><ul><ul><li>several years later </li></ul></ul><ul><ul><li>rare </li></ul></ul><ul><ul><li>skin, </li></ul></ul><ul><ul><li>central nervous system </li></ul></ul><ul><ul><li>delayed hypersensitivity </li></ul></ul><ul><ul><li>few organisms </li></ul></ul><ul><ul><ul><li>control by immune response </li></ul></ul></ul>www.freelivedoctor.com
  • 11. Microbiological diagnosis <ul><li>not culturable </li></ul><ul><li>dark field microscopy </li></ul><ul><ul><li>actively motile organisms </li></ul></ul><ul><ul><li>brightly lit against dark backdrop </li></ul></ul><ul><ul><li>light shines at an angle </li></ul></ul><ul><ul><li>reflected from thin organisms </li></ul></ul><ul><ul><li>enters objective </li></ul></ul><ul><li>conventional light microsrcopy </li></ul><ul><ul><li>light shines through </li></ul></ul><ul><ul><li>NOT visualized </li></ul></ul>www.freelivedoctor.com
  • 12. <ul><li>fluorescence microscopy </li></ul><ul><ul><li>antibody staining </li></ul></ul>www.freelivedoctor.com
  • 13. Secondary and Tertiary Syphilis - serology <ul><li>screening method </li></ul><ul><li>antibodies to cardiolipin </li></ul><ul><li>specific diagnosis </li></ul><ul><li>antibodies to treponemal antigen </li></ul>www.freelivedoctor.com
  • 14. Autoimminty <ul><li>cardiolipin </li></ul><ul><ul><li>self antigen </li></ul></ul>www.freelivedoctor.com
  • 15. <ul><li>no vaccine </li></ul><ul><li>antibiotics (e.g. penicillin) </li></ul><ul><ul><li>effective </li></ul></ul>www.freelivedoctor.com
  • 16. Other treponemal diseases <ul><li>bejel, yaws and pinta </li></ul><ul><ul><li>extremely rare in US </li></ul></ul>www.freelivedoctor.com
  • 17. Borrelia burgdorferi and Lyme disease www.freelivedoctor.com
  • 18. Ixodes scapularis , tick vector for Lyme disease. Also known as Ixodes dammini . CDC www.freelivedoctor.com
  • 19. Lyme Disease erythematous rash www.freelivedoctor.com
  • 20. <ul><li>A tick bite leads to transmission of B. burgdorferi </li></ul>www.freelivedoctor.com
  • 21. <ul><li>Lyme disease - symptoms </li></ul><ul><li>bacteremia </li></ul><ul><ul><li>acute </li></ul></ul><ul><li>arthritis </li></ul><ul><li>cardiac </li></ul><ul><li>neurologic </li></ul><ul><ul><li>chronic </li></ul></ul><ul><ul><ul><li>weeks, months later </li></ul></ul></ul>www.freelivedoctor.com
  • 22. Therapy <ul><li>early antibiotic therapy </li></ul><ul><ul><li>curable </li></ul></ul><ul><ul><li>penicillin </li></ul></ul><ul><ul><li>tetracycline </li></ul></ul><ul><li>late antibiotic administration </li></ul><ul><ul><li>ineffective </li></ul></ul>www.freelivedoctor.com
  • 23. Diagnosis <ul><li>serum antibodies to B. burgdorferi . </li></ul><ul><li>laboratory strains </li></ul><ul><ul><li>grow extremely slowly </li></ul></ul><ul><ul><li>tissue culture media </li></ul></ul><ul><ul><li>not bacteriological media </li></ul></ul><ul><li>patient body fluids/tissue sample </li></ul><ul><ul><li>almost never growth </li></ul></ul>www.freelivedoctor.com
  • 24. <ul><li>acute </li></ul><ul><ul><li>responds to antibiotic </li></ul></ul><ul><ul><li>antibodies not detectable </li></ul></ul><ul><li>late diagnosis </li></ul><ul><ul><li>not curable </li></ul></ul><ul><ul><li>antibodies detectable </li></ul></ul>A physicians dilemma www.freelivedoctor.com
  • 25. Lyme Disease - etiology <ul><li>reactive arthritis similar to </li></ul><ul><ul><li>Reiter's syndrome </li></ul></ul><ul><ul><li>rheumatic fever </li></ul></ul><ul><li>resembles rheumatoid arthritis. </li></ul>www.freelivedoctor.com
  • 26. Relapsing fever <ul><li><100/ per year in US </li></ul><ul><li>transmission </li></ul><ul><ul><li>tick- B. hermsii </li></ul></ul><ul><ul><li>rodent, primary host </li></ul></ul><ul><ul><li>lice- B. recurrentis </li></ul></ul><ul><ul><li>human, primary host </li></ul></ul>www.freelivedoctor.com
  • 27. <ul><li>“ Relapsing” fever </li></ul><ul><li>immune response develops </li></ul><ul><ul><li>disease relapses </li></ul></ul><ul><li>new antigens expressed </li></ul><ul><ul><li>no immunity </li></ul></ul><ul><ul><li>disease reappears </li></ul></ul>www.freelivedoctor.com
  • 28. Diagnosis <ul><li>no culture </li></ul><ul><li>no serological test </li></ul><ul><li>detected - blood smear </li></ul>www.freelivedoctor.com
  • 29. Leptospirosis www.freelivedoctor.com
  • 30. <ul><li><100 cases per year in US </li></ul><ul><li>symptoms </li></ul><ul><ul><li>flu-like </li></ul></ul><ul><ul><li>severe systemic disease </li></ul></ul><ul><ul><ul><li>kidney </li></ul></ul></ul><ul><ul><ul><li>brain </li></ul></ul></ul><ul><ul><ul><li>eye </li></ul></ul></ul>Leptospirosis www.freelivedoctor.com
  • 31. <ul><li>infected urine </li></ul><ul><ul><ul><ul><li>rodents </li></ul></ul></ul></ul><ul><ul><ul><ul><li>farm animals </li></ul></ul></ul></ul><ul><li>water </li></ul><ul><li>through broken skin. </li></ul>Transmission www.freelivedoctor.com
  • 32. Laboratory Diagnosis <ul><li>serology </li></ul><ul><li>most readily culturable of spirochetes </li></ul><ul><ul><ul><li>culture still extremely difficult </li></ul></ul></ul>www.freelivedoctor.com
  • 33. NEISSERIA Neisseria gonorrhoeae www.freelivedoctor.com
  • 34. www.freelivedoctor.com
  • 35. <ul><li>Gram negative </li></ul><ul><li>diplococci (pairs of cocci) </li></ul><ul><li>oxidase positive </li></ul><ul><li>culture </li></ul><ul><li>Thayer Martin. </li></ul><ul><ul><li>selective </li></ul></ul><ul><ul><li>chocolate agar </li></ul></ul><ul><ul><ul><ul><li>heated blood (brown) </li></ul></ul></ul></ul><ul><li>Neisseria </li></ul>www.freelivedoctor.com
  • 36. <ul><li>found only in man </li></ul><ul><li>gonorrhea </li></ul><ul><li>second most common venereal disease </li></ul>N. gonorrhoeae the “Gonococcus&quot; www.freelivedoctor.com
  • 37. www.freelivedoctor.com
  • 38. Smear <ul><li>polymorphonuclear cell </li></ul><ul><li>Gram negative cocci </li></ul><ul><ul><ul><li>many in cells </li></ul></ul></ul>www.freelivedoctor.com
  • 39. <ul><li>gonoccocal arthritis </li></ul><ul><ul><li>“ septic” arthritis </li></ul></ul><ul><li>dermatitis </li></ul>Dissemination -gonococci www.freelivedoctor.com
  • 40. <ul><li> lactamase-resistant cephalosporin </li></ul><ul><ul><li>e.g. ceftriaxone </li></ul></ul><ul><li>resistant strains </li></ul><ul><ul><li>common </li></ul></ul><ul><ul><li>produce  lactamases </li></ul></ul><ul><ul><li>destroy penicillin </li></ul></ul>Antibiotic therapy www.freelivedoctor.com
  • 41. <ul><li>adhesion to genital epithelium </li></ul><ul><ul><li>outer membrane </li></ul></ul><ul><ul><li>pili </li></ul></ul><ul><ul><ul><ul><li>Antigenicity </li></ul></ul></ul></ul><ul><ul><ul><ul><li>highly variable among strains </li></ul></ul></ul></ul><ul><li>no vaccine </li></ul><ul><li>IgA protease </li></ul><ul><ul><li>also N. meningitidis </li></ul></ul>Pathogensis www.freelivedoctor.com
  • 42. <ul><li>Tissue injury </li></ul><ul><ul><li>lipopolysaccharide </li></ul></ul><ul><ul><li>peptidoglycan </li></ul></ul>N. gonorrhoeae www.freelivedoctor.com
  • 43. N. meningitidis (the “Meningococcus&quot;) www.freelivedoctor.com
  • 44. <ul><li>resides in man only </li></ul><ul><li>usually sporadic cases </li></ul><ul><ul><li>mostly young children </li></ul></ul><ul><li>outbreaks </li></ul><ul><ul><li>adults </li></ul></ul><ul><ul><li>crowded conditions </li></ul></ul><ul><ul><ul><ul><li>e.g. army barracks </li></ul></ul></ul></ul>N. meningitidis www.freelivedoctor.com
  • 45. <ul><li>upper respiratory tract infection </li></ul><ul><ul><li>adhesion pili </li></ul></ul><ul><li>bloodstream </li></ul>brain Neisseria meningitidis www.freelivedoctor.com
  • 46. <ul><li>second most common meningitis </li></ul><ul><ul><li>pneumococcus, most common </li></ul></ul><ul><li>fatal if untreated </li></ul><ul><li>responds well to antibiotic therapy </li></ul><ul><ul><li>penicillin </li></ul></ul>Meningococcal meninigitis www.freelivedoctor.com
  • 47. <ul><li>Laboratory Diagnosis </li></ul><ul><li>spinal fluid </li></ul><ul><ul><li>Gram negative diplococci </li></ul></ul><ul><li>within polymorphonuclear cells </li></ul><ul><ul><li>meningococcal antigens </li></ul></ul><ul><li>Culture </li></ul><ul><ul><li>Thayer Martin agar </li></ul></ul>www.freelivedoctor.com
  • 48. <ul><li>capsule </li></ul><ul><ul><li>inhibit phagocytosis </li></ul></ul><ul><li>anti-capsular antibodies </li></ul><ul><ul><li>stop infection </li></ul></ul><ul><li>antigenic variation </li></ul><ul><ul><li>sero-groups </li></ul></ul><ul><li>vaccine </li></ul><ul><ul><li>multiple sero-groups </li></ul></ul>Capsule www.freelivedoctor.com

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