Emmanuel John Genio

BSMT L3

SPIROCHETES
● Long (8-10 µm), slender, helically curved gram (-) bacilli
● With 8 – 14 tightly coiled, even spirals
● With axial filaments or axial fibrils
○ Flagella-like organelles
○ Wrap around bacterial cell wall
○ Enclosed within the outer sheath
○ Facilitate motility of organism
○ Attached within cell wall by plate-like structures called INSERTION DISKS

PATHOGENIC SPIROCHETE
● Non-cultivable
● Stain poorly with Gram Stain or Giemsa Stain
● Best observed with the use of darkfield or phase contrast microscope

GENUS AXIAL FILAMENTS INSERTION DISK

Treponema 6-10 1

Borrelia 30-40 2

Leptospira 2 3-5

GENUS TREPONEMA

NON-PATHOGENIC TREPONEMA GENERAL DISEASE ASSOCIATED

WITH GENUS TREPONEMA
● Normal inhabitants of oral cavity or the human genital tract Vincent’s disease
● Cultivable anaerobically on artificial media ● Acute necrotizing ulcerative
○ Treponema vincentii gingivitis
○ Treponema denticola ● Destructive lesions of the gums

○ Treponema refringens
○ Treponema socranskii
○ Treponema pectinovorum
Treponema Identification/structures
species
Treponema ● Fine spiral organism
pallidum ● Difficult to visualize
under ordinary
microscope
● Seen through dark
field microscopy
● Spirals are regular and
angular with 4 – 14
spirals per organism
● Three periplasmic
flagella are inserted into
each of the cells
● Ends are pointed and
covered with a sheath
Treponema
TREPONEMA SPECIES
Other significant
characteristics
4 pathogenic treponemes
cannot be grown in vitro
Diagnosis:
Animal inoculation not
routinely performed for
patient diagnosis
● If done, rabbit testes is
the animal of choice
MOT:
Emmanuel John Genio
BSMT L3
OTHER TREPONEMAL DISEASE:
● Non-venereal diseases
● Rarely transmitted by sexual contact
● Congenital infection do not occur
● All three stages have primary and
secondary stages
● Tertiary manifestations may develop
● Found in developing countries
○ with poor hygiene
○ little clothing worn
○ direct skin contact common due
to over crowding
Associated infection Growth / Culture characteristics
Cells are motile with graceful flexous
movement in liquid media
In primary cell culture some limited growth are
achieved
Microaerophilic
Dies rapidly on drying and is susceptible to a
wide range of disinfecting agents
Causative agent of Syphilis (Sy)/French

pallidum Direct sexual contact with an
subspecie individual who has an active
pallidum primary or secondary syphilitic
lesion
● Genital organs are
usual sites of
inoculation
○ Vagina and
cervix
○ Penis
Non genital contact with a
lesion or by transplacental
transmission to the fetus
Invasion: Break in epidermis or
possible penetration through
intact mucous membranes
Rapid multiplication and
disseminate throughout the
body
Inoculation: multiply rapidly
and disseminate to local lymph
nodes and other organs through
blood stream
TREATMENT: Penicillin – drug
of choice
JARISCH-HERXEIMER
REACTION
2 -12 hours following the
treatment of active Sy with
either heavy metals or
penicillins
Emmanuel John Genio
BSMT L3
Disease/Italian Disease/The Great Pox/ Lues
● Disease of blood vessel and the perivascular
area
SYPHILIS
Primary Disease
● Develops 10 -90 days after infection
● Chancre: a single, erythematous lesion that is
nontender and firm with clean surface and raised
border
○ Lesion is teeming with treponemes and is
extremely infectious
○ Maybe in apparent in females: commonly
situated on cervix or vaginal wall
○ Can also be in the anal canal of either
sex and remain undetected
○ No systemic signs and symptom
Secondary Disease
● 2 – 10 weeks following the primary lesion
○ Fever, sore throat, generalized
lymphadenophathy, headache and
rash (palms and soles)
○ All secondary lesions of the skin and
mucous membranes are highly
infectious
○ May last for several weeks and may
relapse
○ May be mild and go unnoticed
Tertiary Disease
● 35% of untreated cases develop tertiary
manifestations some 10 – 25 years after the
initial infection
● Development of granulomatous lesions
(GUMMAS) in skin, bones and liver
○ Syphilitic cardiovascular lesions
○ Degenerative changes in the CNS
 Emmanuel John Genio
BSMT L3

variable proportion of patients
develop an acute focal and
systemic reaction (headache,
malaise, fever to 38°C or
above)
Resolution within a day
(neurosyphilis)
○ Patients are usually not infectious
CONGENITAL SYPHILIS
Treponemes can cross the placenta and be transmitted
from an infected mother to the fetus
A multi-system disease, very severe and mutilating

Observed most commonly in

early stages of Sy

Cause not clear but often

attributed to sudden release of
toxins from the dying and
dead treponemes

LABORATORY DIAGNOSIS

Molecular Dark field microscopic Direct Fluorescent Serological tests for Syphilis Specimen collection
diagnostics examination
 Emmanuel John Genio
BSMT L3

Not currently Key aid to detection of primary Antibody Detection for T. TREPONEMAL ANTIBODIES Collect from ulcers of lesions and should not
available within and secondary syphilis pallidum(DFA-TP) produced against antigens of the organism themselves be contaminated
many clinical ● Visualizes specimens on
laboratories Treponemes appear white slides with fluorescein NON TREPONEMAL ANTIBODIES Sites should be cleansed and sterilized with
against a dark background isothiocyanate (FITC) often referred to as REAGIN ANTIBODIES - produced gauze moistened with saline
Polymerase Chain labelled antibodies in infected patients against components of mammalian
Reaction (PCR) Corkscrew motility observed ● Polyclonal and cells Sample is placed in a clean glass slide and
for Treponema monoclonal antibodies cover slip
pallidum detection may be used Detects antibodies to cardiolipin called reagin
have been PCR samples should be collected on a
developed Can be used to determine antibody quantitative titers sterile Dacron or cotton swab and placed in
useful to follow patient’s response to therapy a cryotube containing nucleic acid transport
medium or universal transport medium
Venereal Disease Research Laboratory (VDRL)
Tissue or needle aspirates of lymph nodes
Rapid Plasma Reagin (RPR) should be placed in 10% buffered formalin at
room temperature
TREPONEMAL SEROLOGIC TESTS:
● Detects syphilitic treponemal antibody For Congenital Sy: small section of
● Once positive to the following tests, usefulness umbilical cord collected and fixed in
is limited formalin or refrigerated until processed
○ Tend to yield positive results
throughout patient’s life Serum is the specimen of choice for
serology, however, whole blood or plasma may
● Enzyme ImmunoAssays (EIA) be used in some assays
● T. pallidum Particle Agglutination (TP-PA)Test
● Microhemagglutination Assay (MHA-TP)
● T. pallidum Indirect Hemagglutination (TPHA)
● Particle Gel Immunoassay (PaGIA)
● Fluorescent Treponemal Antibody
Absorption (FTA-ABS) Test

OTHER TREPONEMA PALLIDUM SUBSPECIE

Treponema pallidum subspecie Other significant characteristics

 Emmanuel John Genio
BSMT L3

Treponema pallidum subspecie pertenue ● Causative agent of Yaws

● Resembles Sy but tertiary stage is rare
● Readily treated with Penicillin

Treponema pallidum subspecie endemicum ● Causative agent of Bejel or endemic Sy

● Closely resembles Yaw
● Primary and secondary lesions occur in oral cavity and often unnoticed

Treponema pallidum subspecie carateum ● Causative agent of Pinta

● Treatment: Penicillin

GENUS BORRELIA
● Much less tightly coiled than Leptospira
● Spirals vary in number, 3-10 per organism
● Stain easily and can be examined under regular light microscope unlike Treponema and Leptospira
● Can be cultivated easily in their arthropod vectors or in a variety of vertebrae hosts such as small rodents
● Require long chain fatty acid for growth
● Microaerophilic

BORRELIA SPECIES

Borrelia Other significant Associated infections Laboratory diagnosis

species characteristics

Borrelia Causes relapsing fever Direct Microscopic Examination Serological Test Culture
recurrentis ● acute infection characterized by
febrile episodes that subside Blood Smear Not proven reliable due to many Cumbersome and
spontaneously but tend to recur ● Giemsa or Wright Stain antigenic shifts unreliable
over a period of weeks ● Only spirochetal disease ● Complement Fixation (CF) ● Kelly’s Medium
● Relapses are due to the mutability in which organism is visible ● (+) VDRL ● Also grown in chick
of the antigens associated with in blood with bright field embryo and fluid
Borrelia microscopy media containing
● Organism undergo several blood, serum or tissue
 Emmanuel John Genio
BSMT L3

antigenically distinct variations Wet Preparation of peripheral blood

within host during single ● Under dark field illumination
infection ● Move rapidly, often pushing
● Succeeding episode is usually the RBC around
shorter than and not as severe as
the preceding one
● Can either be Tick-borne or
Louse-born

TICK-BORNE DISEASE
Transmitted by ticks of the genus
Ornithodoros

Transmission to vertebrae host is via

infected saliva or infectious body fluid of
the tick

LOUSE-BORNE DISEASE
Human-to-human spread via the body
louse, Pediculus humanus humanus

Humans are the only reservoir

Transmission occurs by the

contamination of the bite wound with
the infectious hemolymph

Organisms escape the louse to infect the

host when the louse is traumatized or
smashed by scratching

Borrelia Causative agent of LYME DISEASE Rarely seen on direct examination Antibody detection is the only Culture permits definitive
burgdorferi Lyme Disease or Early stage: Fever, headache, of blood or skin transudate laboratory method for Lyme diagnosis but lacks
Pseudojuvenille generalized muscle pain, fatigue and specimens Disease Diagnosis sensitivity
rheumatoid arthritis weight loss ● IFA
OFten negative ● ELISA, Often negative
 Emmanuel John Genio
BSMT L3

Transmitted via Exhibit Erythema Chronicum Migrans ● Western Blot

Ixodes ticks (Ixodes (ECM) – classic skin lesion at the site of
dammini) tick bite

TREATMENT: Begins as red macule that expands to

● Tetracycline form a large annular erythema with partial
(9 years and central clearing
older)
● Penicillin Late manifestation: Joint, cardiac and
(under 9 years neurologic systems involvement
old)
Arthritis is the most common
PREVENTION manifestation, occuring weeks to years
Wear protective later
clothing in areas
where tick exposure is
intense

Attached ticks should

always be removed

Epidemiology, Associated infections, Laboratory diagnosis, other significant characteristics


Epidemiology Other significant
characteristics
Etiologic agent of Principal Animal
Leptospirosis include Reservoir: Dogs, Rats
approximately 200 and other rodents
serovars
Can survive in neutral or
Most common in the slightly alkaline water for
U.S. are L interrogans months
serovar
icterohaemorrhagiae
(Weil Sisease or TREATMENT:
Icteric Leptospirosis) ● Supportive
and L. interrogans management
serovar canicola ● Ceftriaxone,
Penicillin,
Most common in the Amoxicillin,
Philippines is L. Doxycycline and
interrogans serovar Tetracycline
hebdomadis
PREVENTION:
Vaccination of domestic
livestock and pet dogs ▪
Use of protective clothing
Rodent control measures
Preventing recreational
exposures
● Freshwater ponds
Emmanuel John Genio
BSMT L3
GENUS LEPTOSPIRA
Associated infections Laboratory diagnosis
● Pretibial Fever Direct Examination Culture Serological Molecular Testing
● Infectious Jaundice
● Marsh Fever Successful only in a small Blood or CSF collected Microscopic Real-time PCR (not
● Seven-day fever percentage of cases during acute phase Agglutination Test useful for serovar
Swineherder’s Disease (MAT) differentiation)
Organism exhibits Urine collected after the
Zoonotic disease in humans rotational motion first week of disease Indirect Pulsed Field
Hemagglutination Electrophoresis
Increased risk in people ● Dark field Can be grown in artificial (PFGE)
working with animals: Microscopy media at 30°C using the ELISA
● Veterinarians ● Phase-Contrast following: Restriction Fragment
● Dairy workers Microscopy ● Ellinghausen-McCul Length
● Swineherds ● Immunofluorescence lough-Johnson-Harr Polymorphism
● Slaughterhouse Microscopy is (EMJH) (RFLP)
workers ● Silver Impregnation ● Fletcher’s Medium ● PFGE and
● Miners ● Stuart Liquid Media RFLP useful
● Sewer workers for serovar
● Fish and Poultry identification
processors
Leptospiremia occurs during
the acute illness
Usually kidneys are infected
MOT: Direct contact with
bodies of water
contaminated with the urine
of carriers
 Emmanuel John Genio
BSMT L3

Avoid flooded are ● Enter human host

through small breaks in
the skin or intact
mucosa