Spirochaetes

Gram –ve, helical, motile (Group 1)

Genera Treponema Borrelia Leptospira
Genus species T pallidum B vincenti L biflexa
T pertenue B burgdoferi L interrogans
T carateum B recurrentis
B duttoni
ogypholMor

Typical Helical, central protoplasmic cylinder bounded by cytoplasmic membrane. Axial filament between thin peptidoglycan layer & outer membrane
(internal flagella)
T pallidum B vincenti 5-20 x 0.1um. Numerous
6-14um x 0.2um Large, 5-15um x 0.5um w 3-8 closely-set coils & hooked
6-12 evenly spaced coils irregular open coils ends
B burgdorferi
0.18-0.25 x 4.3um, flexible
helical
Culture T pallidum
No in vitro culture
Inoculation to anterior chamber of rabbit eye
Agnc Common gp Ag. In addtn, they (mentioned species) share other Ag that make
structure them similar to each other but diff from other treponemes
Growth 3 types of motility: Rotation about long axis, flexion of cells, True movement
characteristic
T pallidum
Strict parasite dies rapidly outside body
Very sensitive to drying & heat
tionducPro

Enxymes&
others
Toxin Endo
Exo
Habitat T pallidum B vincenti L biflexa
Lesion of 1° & 2° syphilis Oro pharynx as commensal & Pools, ditches, streams
potential pathogen L interrogans
B burgdorferi Kidneys of some rodents &
Deer, other small mammals domestic animals
Pathology T pallidum B vincenti- Gingivo- Leptospira interrogans-
Venereal disease: syphilis stomatitis, Vincent’s angina Leptospirosis (zoonosis)
T carateum B burgdorferi- Lyme disease
Non-venereal: pinta B recurrentis- Louse-borne
T pertenue relapsing fever
Non-venereal: Yaws B duttoni- Epidemic tick-
borne relapsing fever
Epidemiology T carateum
Dark-skinned people in Central & North America
T pertenue
Widespread in tropics
Aetiology
Pathogenesis 1° syphilis Conjunctival haemorrhage
10-60 days after exposure Jaundice
endarteritis, periarteritis, PMN & mΦ infiltration, spirochete in phagocytes
2° syphilis
1-6 weeks after chancre heals
Last 3-6 weeks, will continue to progress w/out trtmnt
3° syphilis
3-10yrs after 1° lesion
Lesion of late benign syphilis sometimes 2-40 yrs from onset of ifxn
Congenital syphilis
Within 2 years of life
Late congenital syphilis
Manifestation after 2 y/o. 60% subclinical
Lesion 1° syphilis Lyme disease
LN inflame Generalized ifxn w arthritis,
2° syphilis neurological & cardiac
3° syphilis complications
Gumma (granulomatous) lesion., if untrtd frequently lead to destructn of soft Characteristic rash from
t/s or bone. Gumma of critical organs are fatal initial tick bite- erythema
Cardiovascular: aortitis, aneurysm chronicum migrans
Meningovascular meningitis
Congenital syphilis
Mucocutaneous & skin lesion like adult
Pinta
Hyperkeratotic & depigmented skin
Yaws
Ulcerative & granulomatous lesion in skin, mucous membrane, bone
Clinical signs 1° syphilis
chancre (1° site of initial replication) anywhere on xposd skin (common:
 genital/ mouth) - may leave scar
Chancre heal 4-6 weeks, w/out trtmnt
2° syphilis
Pale red rash on palms/ soles of feet/ entire body, fever, sore throat, headache,
arthralgia, poor appetite, weight loss, hair loss
3° syphilis
Neurosyphilis: ataxic gait, trophic changes in joints, optic atrophy
General paralysis in insane: dementia, tremor, spastic paralysis
Congenital syphilis
Stillborn/ fulminating case manifested withn 2y/o- rhinitis, snuffles,
osteochondritis, osteitis, hepatosplenomegaly, lymphadenopathy, immune
complex-induced glomerulonephritis, death d/t pulmonary hemorrhage, 2°
bacterial ifxn, hepatitis
Late congenital syphilis
Glutton’s joints, deafness, Hutchinson’s teeth, Rhagades, Bone abnormalities-
saddle nose, Saber shins
Complication 3° syphilis
Death d/t syphilis complictn in skin, bones, CNS, heart & blood vessels.

Diagnosis Microscopy- Dark field illumination, Direct IFA

Serology- Nontreponemal VDRL, Rapid Plasma Reagin: IgG & IgM Abs
(regain Abs devlpd against lipid from damaged cells d/r early stage) Ag used is
cardiolipin derivd from beef heart. Both tests measure coagulation of
cardiolipin Ag by pt serum. Only VDRL can b used to test CSF
Treponemal tests- FTA-ABS (fluorescent Treponemal Antibody Absorption),
TPHA (Treponema pallidum Haemagglutination). Treponemal tests can be +ve
b4 nontreponemal tests become +ve. May also remain +ve when nonspecfc
tests revert to –ve in some pt who have late syphilis
Stage of disease VDRL TPHA FTA-
Abs
Primary +- - +
Late primary + +- +
2° & 3° + + +
Late (quartenry) + + +
Latent +- + +
Treatd - + +
Congenital + + +
1° syphilis
Histo- endarteritis, periarteritis, PMN & mΦ infiltration, spirochete frequently
survive in phagocytes

Treatment Penicillin Lyme disease- Penicillin & Penicillin

1° syphilis- large doses for 15-21 days Tetracycline tetracyline
Late or latent- large doses for 21 days, followed by 10 injections at weekly
interval
Erythromycin or tetracycline (doxycycline) for HS pt

Spirochete
Spirochateaceae
Treponemataceae
1. Treponema
2. Borrelia
3. Leptospira