Published on March 4, 2014
SPIROCHAETES Dr. Ashish Jawarkar M.D.
Spirochaetes Spiro = flexible, motile Three families Treponema – syphilis Borrelia – relapsing fever, Lyme disease Leptospira - leptospirosis
Treponema pallidum regular spirals Cannot be seen by ordinary microscopy in wet films, cannot be stain by ordinary stains Can be seen under dark ground microscopy Can be stained by silver impregnation
Syphilis Acquired by sexual contact Enter through abrasions Multiply at site of lesion Primary Secondary Tertiary
Primary syphilis Hard chancre – at site of entry Usually on genitalia Covered by thick pus – rich in treponemes Regional lymphnodes swollen and rubbery Heals in 2 weeks – leaving a scar – without treatment
Secondary syphilis 1-3 months after chancre Rashes in oro pharynx, condylomata at mucocutaneous junctions Spirochetes are abundant in lesions
Latent syphilis Following secondary syphilis, there is a latent period During this time, diagnosis is possible only by serological tests
Tertiary syphilis Months to years after primary lesion Represents delayed hypersensitivity Organisms are not present in lesions Include aneurysms, gummata, neurological manifestations
Lab diagnosis Sample – serum from chancre, gumma Collected by scraping base/margin Highly infectious – handle with care Wet films examined under dark background DFA-TP – direct fluoroscent antibody test for Treponema pallidum
Serological tests Non specific VDRL (veneral disease research laboratory) RPR (rapid plasma reagin) TPI Specific FTA-ABS TPHA EIA
VDRL We use cardiolipin antigen obtained from bovine heart Look for antibodies in serum of patient Mix serum with antigen – look for agglutination under microscope
RPR – rapid plasma reagin test Antigen is attached to carbon particles – can see agglutination with naked eye
False positive reactions Leprosy Malaria Relapsing fever Infectious mononucleosis Hepatitis Tropical eosinophlia
FTA-ABS Fluoroscent treponemal antibody absorption test Mix patients serum with artificial treponemes The artificial treponemes are immotile under dark field microscope
Treatmemt Penicillin G injection single shot is sufficient in early cases Doxycycline Ceftriaxone in neurosyphilis
Borrelia Transmitted to humans through skin Bite of lice or ticks B. recurrentis – relapsing fever B. burgdorferi – Lyme disease
Leptospira Lepto – thin Delicate spirochaetes with large number of closely wound spirals and characteristic hooked ends
L. Interrogans - leptospirosis
Selective media EMJH MEDIUM – (Ellinghausen, Mc Cullough, Johnson, Harris)
Leptospirosis Fever Jaundice Hepato renal damage (Weil’s disease)
Lab diagnosis Demonstration of leptospira in urine Serological tests like sensitized erythrocyte lysis test complement fixation agglutination indirect immunofluorosence
Calcification Inhibitors in CKD and Dialysis Patients
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