Download - SPIROCHETES
SPIROCHETESSPIROCHETES
Treponema, Borrelia Treponema, Borrelia andand LeptospiraLeptospira
SpirochetesSpirochetes
• Gram negativeGram negative• Long, thin, helical, motileLong, thin, helical, motile
• axial filaments axial filaments – locomotionlocomotion– between peptidoglycan layer/outer membrane between peptidoglycan layer/outer membrane
* runs parallelruns parallel
SpirocheteSpirochete
spirochaetaceae leptospiraceaespirochaetaceae leptospiraceae
cristispira cristispira leptonemaleptonema serpulina serpulina leptospiraleptospira spirochaetaspirochaeta treponematreponema borrelia borrelia
TreponemaTreponema T.pallidum T.carateumT.pallidum T.carateum
subsp.pallidumsubsp.pallidum subsp.endemicum subsp.endemicum subsp.pertenuesubsp.pertenue
Histology: Histology: Treponema pallidumTreponema pallidum - testis infected rabbit- testis infected rabbit
Treponema pallidumTreponema pallidum
• transmissiontransmission – genital/genital genital/genital – in uteroin utero or during birth or during birth
0.1-0.2 0.1-0.2 x 6-15um; 8-14 x 6-15um; 8-14 small, regular spirals; small, regular spirals; actively motileactively motile..
syphilissyphilis After initial infection, a primary chancre (an area of After initial infection, a primary chancre (an area of
ulceration/inflammation) is seen in genital areas or elsewhere ulceration/inflammation) is seen in genital areas or elsewhere within 10-60 days. The organism, meantime, has penetrated and within 10-60 days. The organism, meantime, has penetrated and systemically spread. systemically spread.
The patient has flu-like symptoms with secondary lesions The patient has flu-like symptoms with secondary lesions particularly affecting the skin . These occur 2-10 weeks later. particularly affecting the skin . These occur 2-10 weeks later.
The final stage (if untreated) is tertiary syphilis (several years The final stage (if untreated) is tertiary syphilis (several years later). In primary and secondary syphilis organisms are often later). In primary and secondary syphilis organisms are often present in large numbers. However, as the disease progresses present in large numbers. However, as the disease progresses immunity controls bacterial replication and fewer organisms are immunity controls bacterial replication and fewer organisms are seen. It is extremely difficult to detect spirochetes in tertiary seen. It is extremely difficult to detect spirochetes in tertiary syphilis. The systemic lesions of skin, central nervous system and syphilis. The systemic lesions of skin, central nervous system and elsewhere are suggestive of a delayed hypersensitivity reaction. elsewhere are suggestive of a delayed hypersensitivity reaction.
SyphilisSyphilis chronicchronic slowly progressiveslowly progressive
Primary stagePrimary stage•• 10 10 to 60 days to 60 days •• primary lesion primary lesion -- chancre chancre •• area of area of
ulceration/ inflammationulceration/ inflammation•• many organismsmany organisms•• rich in rich in TPTP•• a predominance of a predominance of
lymphocytes and plasma cellslymphocytes and plasma cells•• hard chancrehard chancre硬下疳•• infectious highlyinfectious highly•• heal spontaneouslyheal spontaneously
Secondary stageSecondary stage Secondary (2Secondary (2--10 10
weeks weeks after primary after primary stagestage))•• systemic spread systemic spread •• fluflu--like symptomslike symptoms•• skin, particularlyskin, particularly•• many organismsmany organisms
rich in rich in TPTP red red maculopapularmaculopapular
rash anywhere on the rash anywhere on the bodybody
infectious highlyinfectious highly subside spontaneouslysubside spontaneously
Tertiary stageTertiary stage Tertiary Tertiary
•• several years laterseveral years later•• rarerare•• skin, skin, •• central nervous system central nervous system •• delayed hypersensitivity delayed hypersensitivity •• few organismsfew organisms•• control by immune control by immune
responseresponse 33--5 years after infection5 years after infection few few TPTP granulomatousgranulomatous lesions in lesions in
skin,bone, and liverskin,bone, and liver degenerative changes in degenerative changes in
the central nervousthe central nervous cardiovascular lesionscardiovascular lesions
3w
2y
Congenital syphilisCongenital syphilis Interstitial keratitisInterstitial keratitis 角膜炎 Hutchinson’s teeth Hutchinson’s teeth SaddlenosemaSaddlenosema 马马鞍鼻 PeriostitisPeriostitis 骨膜炎 A variety of central nervous system A variety of central nervous system
anomaliesanomalies
Microbiological diagnosisMicrobiological diagnosis• not culturablenot culturable• dark field microscopydark field microscopy
– actively motile actively motile organisms organisms
– brightly lit against brightly lit against dark backdropdark backdrop
– light shines at an light shines at an angle angle
– reflected from thin reflected from thin organisms organisms
• conventional light conventional light microscopymicroscopy– light shines throughlight shines through– NOT visualized NOT visualized
screening methodscreening methodantibodies to cardiolipin
specific diagnosisspecific diagnosisantibodies to treponemal antigen
fluorescence microscopyantibody staining
PCR
Autoimminty: Autoimminty: cardiolipin/self antigencardiolipin/self antigen no vaccine no vaccine antibiotics antibiotics (e.g. penicillin)(e.g. penicillin)
– effective effective
Other treponemal diseasesOther treponemal diseases bejelbejel 地方性梅毒地方性梅毒 yaws yaws 雅司雅司 pintapinta 品他病品他病
Borrelia burgdorferiBorrelia burgdorferi and Lyme disease and Lyme disease
Ixodes scapularis, tick vector for Lyme disease. Also known as Ixodes dammini. CDC
LymeLyme Disease Disease erythematouserythematous rashrash
LymeLyme disease disease -- symptomssymptoms
•• bacteremia bacteremia –– acuteacute
•• arthritisarthritis•• cardiaccardiac•• neurologicneurologic
–– chronic chronic ** weeks, months laterweeks, months later
• acuteacute–– responds to antibioticresponds to antibiotic––antibodies not detectableantibodies not detectable
•• late diagnosislate diagnosis–– not curablenot curable–– antibodies detectableantibodies detectable
Lyme DiseaseLyme Disease - - etiologyetiology
• reactive arthritis similar to reactive arthritis similar to – Reiter's syndromeReiter's syndrome– rheumatic feverrheumatic fever
• resembles rheumatoid arthritis.resembles rheumatoid arthritis.
B . Recurrentis and Relapsing feverB . Recurrentis and Relapsing fever
• immune response develops disease immune response develops disease relapsesrelapses• new antigens expressednew antigens expressed • no immunity : disease reappearsno immunity : disease reappears• transmissiontransmission
–tick-tick-B. hermsiiB. hermsii* rodent hostrodent host– lice-lice-B. recurrentisB. recurrentis * human hosthuman host
DiagnosisDiagnosis• serum antibodies to serum antibodies to B. burgdorferiB. burgdorferi.
• laboratory strainslaboratory strains– grow extremely slowly grow extremely slowly – tissue culture media tissue culture media –patient body fluids/tissue samplepatient body fluids/tissue sample
TherapyTherapy
• early antibiotic therapyearly antibiotic therapy– curable curable * penicillin penicillin * tetracyclinetetracycline
• late antibiotic administrationlate antibiotic administration– ineffectiveineffective
LeptospirosisLeptospirosis
• symptomssymptoms–flu-like flu-like –severe systemic diseasesevere systemic disease
* kidneykidney* brain brain * eyeeye
LeptospirosisLeptospirosis
MorphologyMorphology 0.1-0.2 x 6-0.1-0.2 x 6-20um; fine 20um; fine coiling, one or coiling, one or both ends are both ends are usually usually hooked; deep hooked; deep brown color brown color stained with stained with silver silver impregnation impregnation stain (Fontana stain (Fontana stain), Gram-stain), Gram-negative.negative.
• infected urine infected urine – rodentsrodents– farm animalsfarm animals
• water water
• through broken skin.through broken skin.
TransmissionTransmission
EpidemiologyEpidemiology
worldwide zoonosis
animal hosts: rats,mice,wild rodents,dogs,swine,and cattle
Human is accidental
EpidemiologyEpidemiology
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湖北省安徽省
江苏省
浙江省
福建省江西省湖南省
台湾省广东省广西壮族自治区
贵州省
河南省山东省
天津市
海南省
北京市河北省山西省
陕西省
宁夏回族自治区
四川省
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云南省
甘肃省
青海省西藏自治区
新疆维吾尔自治区辽宁省
吉林省
黑龙江省
内蒙古自治区
中华人民共和国地图
E$paddy planting areaLeptospirosis area
23/4/2323/4/23
PathogenicityPathogenicity
Multiply in kidney and liver.
Shed in the urine for life long of animal.
Damage to the capillary endothelium is the main cause
Laboratory DiagnosisLaboratory Diagnosis• serologyserology• most readily culturable of spirochetes most readily culturable of spirochetes
– culture still extremely difficult culture still extremely difficult