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SpirochaetesSpirochaetesSpirochaetesSpirochaetes

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Presentation OutlinePresentation Outline

MorphologyMorphology OrganismsOrganisms DiseasesDiseases

LeptospirosisLeptospirosis Lyme diseaseLyme disease SyphilisSyphilis

TestsTests

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Spirochete MorphologySpirochete Morphology

Gram negative cell wallGram negative cell wall often too small to see by light microscopyoften too small to see by light microscopy special stainsspecial stains

Spiral morphologySpiral morphology distinctive distinctive tight coilstight coils MotileMotile

Periplasmic flagellaPeriplasmic flagella

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Spiral

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Spiral bacterium

Spirillum volutans

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Spirochete

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Axial FilamentAxial Filament

Between cell wall and Between cell wall and cytoplasmic membranecytoplasmic membrane

Attached at either end of cellAttached at either end of cell Overlap in the centreOverlap in the centre

constrict at overlapconstrict at overlap pulls ends togetherpulls ends together

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Spirochetes:FeaturesSpirochetes:Features

ChemoorganotropicChemoorganotropic Range of oxygen requirementsRange of oxygen requirements Life styleLife style

Free livingFree living host associatedhost associated

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Spirochaete MotilitySpirochaete Motility

Click on image

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Spirochetes: generaSpirochetes: genera

Borrelia Borrelia (lyme disease)(lyme disease) BrachyspiraBrachyspira CristispiraCristispira LeptonemaLeptonema Leptospira Leptospira (Leptospirosis)(Leptospirosis) SerpulinaSerpulina SpirochaetaSpirochaeta Treponema Treponema (Syphilis)(Syphilis)

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LeptospirosisLeptospirosis

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Leptospira biflexaLeptospira biflexa

free living saprophyte in moist environmentsfree living saprophyte in moist environments motile, flagellamotile, flagella aerobicaerobic can be grown in 2 weekscan be grown in 2 weeks

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LeptospirosisLeptospirosis

Leptospira interrogansLeptospira interrogans Zoonosis of wild & domestic animalsZoonosis of wild & domestic animals

acquired from urine of infected animalsacquired from urine of infected animals Dogs, rodentsDogs, rodents

Portal of entryPortal of entry broken skin or mucosabroken skin or mucosa

BacteremiaBacteremia

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L. interrogansL. interrogans

Carried by wild and domestic animalsCarried by wild and domestic animals source of human infectionsource of human infection Streams, rivers, moist soil Streams, rivers, moist soil contaminated by animal urine contaminated by animal urine Person to person very rare.Person to person very rare.

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Occupational exposureOccupational exposure

farmers, slaughter housefarmers, slaughter house workers, veterinarians.workers, veterinarians.

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L. interrogans L. interrogans

mild flu like febrile illnessmild flu like febrile illness Weil’s diseaseWeil’s disease

renal and hepatic failurerenal and hepatic failure vasculitisvasculitis meningitismeningitis myocarditismyocarditis deathdeath

Penetrate all organs including CNSPenetrate all organs including CNS Enter through small cutsEnter through small cuts

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LeptospirosisLeptospirosis

Febrile illness not clinically distinctiveFebrile illness not clinically distinctive Acute phaseAcute phase

Leptospiremic phaseLeptospiremic phase incubation 7 -14 daysincubation 7 -14 days fever, headache, muscle pain nauseafever, headache, muscle pain nausea

Immune phaseImmune phase found in urinefound in urine meningitismeningitis

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BorreliaBorrelia

Relapsing FeversRelapsing Fevers

Lyme DiseaseLyme Disease

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Relapsing Fever Relapsing Fever

Borrelia recurrentisBorrelia recurrentis Tick borne Relapsing feverTick borne Relapsing fever

rodents are reservoirrodents are reservoir soft shelled tickssoft shelled ticks

Louse borne Relapsing feverLouse borne Relapsing fever humans are reservoirhumans are reservoir body lousebody louse

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BorreliaBorrelia

Easily seen in blood smearEasily seen in blood smear Also confirmed by injecting mouseAlso confirmed by injecting mouse

blood stream teaming with Borreliablood stream teaming with Borrelia

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B.recurrentisB.recurrentis

Tick borne relapsing fever is a zoonoticTick borne relapsing fever is a zoonotic Clinical evolution: relapsing fever Clinical evolution: relapsing fever Serological tests not usefulSerological tests not useful treatmenttreatment

tetracyclinetetracycline

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Lyme DiseaseLyme Disease

Lyme, Conneticut USA - Lyme, Conneticut USA - spring/fallspring/fall

Borrelia burgdorfiiBorrelia burgdorfii reservoir reservoir rodents, pets, rodents, pets,

deerdeer vectorvector hard shelled ticks hard shelled ticks Bite: incubation 3-30 daysBite: incubation 3-30 days

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Lyme Disease: Early SignsLyme Disease: Early Signs

Erythema chronicum migransErythema chronicum migrans Erythematous skin lesion Erythematous skin lesion

small macule or papule - enlarges to 68 mm.small macule or papule - enlarges to 68 mm. Malaise, severe fatigue, headache, fever, Malaise, severe fatigue, headache, fever,

chills, chills, chronic neurologic, cardiac rheumatic chronic neurologic, cardiac rheumatic

manifestations.manifestations.

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Lyme Disease: ComplicationsLyme Disease: Complications

1 month or more1 month or more myalgia, lymphadenopathy myalgia, lymphadenopathy

Up to 2 yearsUp to 2 years meningitis, encephalitis, peripheral nerve meningitis, encephalitis, peripheral nerve

neuropathy. neuropathy. Cardiac disfunction, myopericarditis.Cardiac disfunction, myopericarditis.

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Lyme Disease: SerologyLyme Disease: Serology

Immunofluorescence assayImmunofluorescence assay Enzyme-linked immunoabsorbent assay Enzyme-linked immunoabsorbent assay

(ELISA)(ELISA) False positivesFalse positives

other spirochaetesother spirochaetes infectious mononucleosisinfectious mononucleosis autoimmune diseaseautoimmune disease

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Lyme Disease:Treatment Lyme Disease:Treatment

tetracycline or penicillintetracycline or penicillin

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SyphilisSyphilis

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Stages of SyphilisStages of Syphilis

PrimaryPrimary SecondarySecondary TertiaryTertiary

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Primary syphilisPrimary syphilis

Chancre: painless blister at the site of contact

Heals spontaneously even if untreated

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Syphilitic lesions of vulvaSyphilitic lesions of vulva

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Secondary SyphilisSecondary Syphilis

Lesions of secondary Lesions of secondary syphilis are dispersed syphilis are dispersed over the bodyover the body

Lesions appear on the Lesions appear on the cooler parts of the bodycooler parts of the body

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Secondary syphilisSecondary syphilis

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Syphilitic lesion on the cooler parts of the bodySyphilitic lesion on the cooler parts of the body

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Neuronal SyphilisNeuronal Syphilis

Treponemes have Treponemes have invaded the nerve invaded the nerve and set up a and set up a lesionlesion

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Syphilic lesions on bonesSyphilic lesions on bones

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Cardio SyphilisCardio Syphilis

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Tests for SyphilisTests for Syphilis

Break down products Break down products of infected cellsof infected cells cardiolipincardiolipin VDRL, WassermanVDRL, Wasserman Simple, well Simple, well

documenteddocumented cross reactive eg TBcross reactive eg TB presumtive testpresumtive test

Treponemal antigensTreponemal antigens more expensivemore expensive more specificmore specific confirmatory testconfirmatory test

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Performance ObjectivesPerformance Objectives

Key terms, concepts Key terms, concepts

short answersshort answers

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Key TermsKey Terms

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Key TermsKey Terms

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Key OrganismsKey Organisms

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Key ConceptsKey Concepts

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Epidemiology of ???Epidemiology of ???

Disease/bacterial factorsDisease/bacterial factors TransmissionTransmission Who is at riskWho is at risk Geography/ seasonGeography/ season IncidenceIncidence Modes of controlModes of control

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Short AnswersShort Answers

Construct a table of the virulence factors Construct a table of the virulence factors associated with ??? and the biological associated with ??? and the biological activity of eachactivity of each

Use a series of no more than four diagrams Use a series of no more than four diagrams to describe the mechanism of ??? activityto describe the mechanism of ??? activity

Describe the clinical manifestions ???Describe the clinical manifestions ??? Construct a table listing the common ??? Construct a table listing the common ???

species and the associated human diseases.species and the associated human diseases.

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The EndThe End

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Icteric leptospirosisIcteric leptospirosis

first stage: 3-7 days - septicemicfirst stage: 3-7 days - septicemic 10-30 days - immune10-30 days - immune Cultures positive: blood, then CSF, then Cultures positive: blood, then CSF, then

urineurine

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Icteric leptospirosis Icteric leptospirosis

Jaundice, hemorrhage, renal failure, Jaundice, hemorrhage, renal failure, myocarditismyocarditis

Anicteric describedAnicteric described Best in CSF, blood, and urine culture -- 1st Best in CSF, blood, and urine culture -- 1st

weekweek Lab test -- slide agglutinationLab test -- slide agglutination Doxycycline - treatmentDoxycycline - treatment Prevention: rodent controlPrevention: rodent control

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So WhatSo What

Know importanceKnow importance #1 communicable disease growing fast#1 communicable disease growing fast

Know how it is spreadKnow how it is spread Sexual intercourseSexual intercourse skin-skin contactskin-skin contact

Know the symptomsKnow the symptoms Syphilis can be identified and curedSyphilis can be identified and cured