Downloaded 148 times
Uploaded byAmir Rajaey
Treponema pallidum and syphilis
The document discusses Treponema pallidum, the causative agent of syphilis, detailing its history, morphology, pathogenicity, clinical manifestations, laboratory diagnosis, and treatment. It outlines the stages of syphilis, including primary, secondary, latent, and late manifestations, along with congenital syphilis. Additionally, it covers various diagnostic methods, including serologic tests and microscopy techniques, utilized for the detection and diagnosis of syphilis.
More Related Content
Similar to Treponema pallidum and syphilis
![Syphilis new.pptx [repaired]](https://cdn.slidesharecdn.com/ss_thumbnails/syphilisnew-190407075658-thumbnail.jpg?width=640&height=640&fit=bounds)
Treponema pallidum and syphilis
- 1.
- 2. Contents History Introduction Pathogenicity Syphilis Laboratory diagnosis Treatment Prophylaxis
- 3. History Fritz Schaudinn(1871-1906) and Paul E. Hoffmann (1868-1959) discovered Treponema pallidum in serum in 1905.
- 4. Recent Years Scientistsequenced the genome of the bacteria Treponema Pallidum in 1998. From this information scientist hoped to advance their ability to diagnose, treat, and prevent Syphilis
- 5. Morpholgy Spiral structure iswound around endoflagella length: 4-14µm width: 0.1-0.2µm Motility includes rotation and flexion Darkfield demonstrates spirochetes Many are thin and take stains poorly have not been isolated in culture
- 7. Resistance Delicate and inactivatedby drying or by heat(41-42ºC in 1hr) Fever therapy for syphilis killed in 1-3 days at 0- 4ºC inactivated by soap, arsenicals, common antiseptic agents
- 8. Pathogenesis Organism entry(Sexual contact) bypenetrating the intact mucous membrane or entering through breaks in the skin Invade the blood stream and spreads to other body sites endarteritis Progressive tissue destruction
- 9. Syphilis Origin not definitelyknown widely spread disease in Europe in 15th century Types Early Syphilis Late Syphilis Neuro Syphilis Cardiovascular Syphilis Late “Benigin” Syphilis Congenital Syphilis
- 11. Primary Syphilis Primary lesionor "chancre" develops at the site of inoculation after 18- 21 days Chancre: Progresses from macule to papule to ulcer Typically painless, indurated, and has a clean base Highly infectious Cartilage-like consistency Heals spontaneously within 1 to 6 weeks 25% present with multiple lesions chancre also can develop on the cervix, tongue, lips or other parts of the body Regional lymphadenopathy
- 12. Primary lesion inpenile region Primary lesion in tongue Serologic tests for syphilis may not be positive during early primary syphilis
- 13. Secondary Syphilis Secondary lesionsoccur 3 to 6 weeks after the primary chancre appears may persist for weeks to months Primary and secondary stages may overlap Mucocutaneous lesions most common Symptoms: fever swollen lymph glands sore throat patchy hair loss headaches weight loss muscle aches fatigue
- 14. Palmar/Plantar Rash Generalized Body Rash Alopecia Serologictests are usually highest in titer during this stage
- 15. Latent Syphilis Host suppressesinfection-no lesions are clinically apparent Only evidence is positive serologic test May occur between primary and secondary stages secondary relapses after secondary stage ◦ Categories: ◦ Early latent: <1 year duration ◦ Late latent: 1 year duration
- 16. Late Syphilis Approximately 30%of untreated patients progress to the tertiary stage within 1 to 20 years Rare because of the widespread availability and use of antibiotics Manifestations ◦ Gummatous lesions ◦ Cardiovascular syphilis ◦ Neurosyphilis
- 17. Late “Benign” Syphilis characterized by formation of non specific granulomatous lesion called gumma most common complication 15% of untreated patients indicates fully active cellular immune response Destory surrounding tissue as it enlarge
- 18. Cardiovascular Syphilis 10% ofuntreated patients inflammation of the small vessel that feed aorta and affect primarily the ascending aorta Complications Aortic aneurysm dilation of aortic ring
- 19. Neuro Syhilis Maybe symptomatic or asymptomatic asymptomatic disease is characterized by CSF abnormalities symptomatic infection is either meningovascular or parenchymatous In meningovascular syphilis any cranial nerve may be inflammed and deafness and visual impairement may occur Parenchymatous disease may involve the neurons of cerebrum or the spinal cord
- 20. Congenital Syphilis Occurswhen T. pallidum is transmitted from a pregnant woman to her fetus May lead to stillbirth &neonatal death infant disorders such as deafness neurologic impairment and bone deformities Transmission can occur during any stage of syphilis risk is much higher during primary and secondary syphilis Fetal infection can occur during any trimester of pregnancy
- 21.
- 22. Laboratory Diagnosis Identification ofTreponema pallidum in lesions ◦ Darkfield microscopy ◦ Direct fluorescent antibody - T. pallidum (DFA- TP) ◦ PCR Serologic tests ◦ Nontreponemal test ◦ Treponemal tests
- 23.
- 24. Direct fluorescent antibodytest Identifies T. pallidum in direct lesion smear by immunofluorescence smear are stained flourescein-isothyocyanide labelled anti-T.pallidum globulin Advantages: ◦ Commercially available ◦ detects and differentiate pathogenic treponemes from non pathogenic ◦ applicable to the sample of oral, rectal, intestinal lesion Disadvantages: ◦ Turnaround time 1-2 days
- 25.
- 27. Complement fixation test (Wassermannreaction) Formerly used for serodiagnosis of Syphilis consist of 2 steps Inactivated serum + (wassermann antigen + 2 unit of guinea pig complement) incubate for 1hr at 37ºC 2nd step addition of sensitized sheep red cell and incubate at 37ºC for 30 min No lysis--- Posituve Lysis----- Negative
- 28. Flocculation test Soluble antigen+ antibody---- antigen-antibody complex form remain suspended as floccules Khan test is the first flocculation test and has been replaced by VDRL test VDRL test can be used for CSF but not for plasma Modification of VDRL test is RPR which uses the VDRL antigen containing carbon particles RPR test can be done in unheated serum but not CSF Automated RPR is also available Automated VDRL-ELISA test is also developed
- 29. ◦ Intepretation ofRPR test
- 30. Sensitivity & Specificityof non treponemal test % Sensitivity % Specificity Test Primary Secondary Latent Late Non- Syphilis VDRL 78 100 95 71 98 RPR 86 100 98 73 98 USR 80 100 95 99 TRUST 85 100 98 99
- 31. Treponemal tests Treponema pallidumImmoblisation Test serum is incubated with complement and T.pallidum maintained in a complex medium anaerobically If antibody is present the treponemas are immobilized i.e. non-motile when observed under dark ground ilumination Complex procedure
- 32. Fluorescent treponemal antibody Indirect immunofluorescent test using as antigen, smears prepared on slides with Nichol`s strain Currently used modification is FTA-absorption (FTA-ABS) test serum is pre-absorbed with sorbent (heat extract from cultures of non pathogenic Reiter strain) to eliminate group specific reactions serum is layered on slide to which T.pallidum is fixed FITC-labelled anti human immunolobulin is added and combine with patient antibodies adhering to T.pallidum, resulting in FITC stained spirochetes
- 33. ◦ Modification ofFTA-ABS is the FTA-ABS double stain ◦ Conjugate used is rhodamine isothiocyanate-labeled antihuman globulin and counterstain FITC- labeled anti T.pallidum conjugate
- 34. Hemagglutination methods TPHA usestanned erythrocytes sensitised with sonicated extract of T.pallidum as antigen presence of treponemal antibodies in patient serum was detected by indirect agglutination of sensitized erythocytes The procedure now employed is MHA-TP which can be automated simpler to perform than flourescent antibody tests
- 35. Particle agglutination methods MHA test has been modified to use gelatin particles rather than erythocytes as the antigen carrier creating T.pallidum particle agglutination removal of preabsorption process procedure similar to MHA-TP Sensitivity and specificity similar to that of the FTA-ABS test
- 36. Latex agglutination methods In 1985 1st report of latex agglutination was publish use cloned T. pallidum antigens bound to latex particles easy to perform, fast and require less than 30 min for result
- 37. Enzyme immunoassay Firstapplied in 1975 as a serology test for syphilis 2 types of EIA tests are available one uses sonicated T.pallidum as anitgen one uses cloned antigen Advantage of EIA are capability to automate the test and run large number of samples in relatively short time
- 38. Immunoblotting Used to detectIgG or IgM to prepare the strips for T.pallidum immuno-blotting, intially boiled sodium dodecyl sulphate (SDS) extract of organism is electrophoresed through a gradient gel After electrophoresis a sheet of nitrocellulose is placed on the top of gel & the protein immuno- determinants are electrophoretically transfer to blot The blot is cut into strips and incubated with the patient serum after incubation strips with patient serum are detected using enzyme and substrate lebeled antibody IgM western blot is most sensitive to diagnose the congenital syphilis
- 39. Sensitivites and Specifitesof treponemal test % Sensitivity Specificity Test Primary Secondary Latent Non- Syphilis FTA-ABS 84 100 100 97 TP-PA 88 100 100 98 FTA-ABS DS 86 100 100 98 EIA 90 100 100 98 Western blot 90 100 100 98