د. حامد الزعبي. Spirochaetes

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1 د. حامد الزعبي Spirochaetes

2 Treponema (T. pallidum) (T. pertenue) (T.endemicum) (T. carateum) orher non pathogenic spp

3 T. pallidum Syphilis: Belongs to spirochetes which are thin walled, flexible spiral rods Motile by flagella: at both sides wrap around the bacterial cell body. In contrast to other motile bacteria, these flagella do not protrude into the surrounding medium but are enclosed within the bacterial outer membrane Has not been grown on bacteriologic media

5 Syphilis Transmission: 1. Sexually 2. Contact with skin lesions 3. Congenital (mother to baby) 4. Blood donation during primary and secondary stages

6 Syphilis Pathogenesis: No toxins Multiplication at primary site of infection leading to a painless ulcer called Chancre Widespread via blood to many tissues Primary, secondary, latent, late tertiary stages Human only Infectious dose less than 10 organisms

7 Incubation period: 2-10 weeks, 3 wks usually Early (primary and secondary), latent and tertiary stages Overall and of the early diseases: 1/3 will heal without treatment 1/3 will go into latent 1/3 into tertiary

8 Syphilis / clinically 1. Primary: Painless Chancre on genitalia, cervix or anogenital area Usually single Disappear spontaneously in 3 6 weeks Infectious Inguinal LNE Exudates used for diagnosis

10 2. Secondary syphilis (infectious): 2-12 weeks after chancre disappeared Non specific symptoms (e.g fever malaise, lethargy, headache, lymph nodeenlargement) Maculopapular and pustular rash mainly on trunk and extremities Heals spontaneously There might be Multiplication and production of lesion in lymph nodes, liver, joints, muscles, skin and mucous membranes

11 3. Latent: No lesion but serological evidence exists Early and late latent Early latent phase: may reactivate and manifest as a secondary lesion i.e infectious 4. Tertiary (3-30 years): Neurosyphilis: e.g Meningoencephalitis and paralysis Cardiovascular: aneurysm of ascending aorta, aortitis Skin and bone granulomatous lesions (Gummas)

12 Congenital syphilis: Blood placenta fetus Intrauterine death, abortion, low birth weight Facial abnormalities e.g saddle shape nose Diagnosis: 1. Detection of the organism in the exudates and lesions using dark field E.M or phase contrast, Immunofluorescent antibodies Low sensitivity

13 2. Serology: A. Non-specific antibodies (1-2 weeks after the primary chancre appears): Rapid plasma regain test (VDRL test): detecting anticardiolipin antibodies Cardiolipin? B. Specific antibody detection: These tests should be used to confirm that a positive result with a non-specific test is truly due to syphilis.

14 Syphilis / serology specific antibody detection 1. FTA-Abs (fluorescent Treponema antibodies-absorption): patient's serum is first absorbed with non-pathogenic treponemes to remove cross-reacting antibodies before reaction with T. pallidum antigens 2. TPHA (Treponema pallidum Haemagglutinin antibodies)

16 Treatment: Penicillin G If allergic, Doxycycline or erythromycin is a good alternative In neurosyphilis use penicillin and Doxycycline together Prevention: No vaccine Early diagnosis and treatment of case and contact is important Sexually transmitted: Test for syphilis if any STD exists

17 Borrelia Burgdorferi: Lyme Disease.. Common USA, Biting Insects (Ticks).. Wild Animals, Rodents, Birds..Incub. Few Weeks- Months..Single/Multiple Skin Lesions.. Systemic Disease.. Arthritis, CNS.. Cardic Abnormalities.. B. recurrentis: recurrent fever, can be fatal Liptospiral diseases: Zoonosis, mild-severe fatal systemic.. Weils s disease..high Fever, Jaundice, vasculitis, Bleeding. Diagnosis: Serological Tests, Special culture

18 Chlamydia

19 Family: Chlamydiaceae Genus: Chlamydia C. trachomatis - Urogenital infections, trachoma, conjunctivitis, pneumonia and lymphogranuloma venerium (LGV) Genus: Chlamydophilia C. psittaci - Pneumonia (psittacosis) C. pneumoniae - Bronchitis, sinusitis, pneumonia and possibly atherosclerosis

20 Chlamydia- Microbiology Small obligate intracellular parasites Inner and outer membrane LPS but no peptidoglycan Cell wall not well characterized Energy parasites Can t make ATP

21 Physiology and Structure Elementary bodies (EB) Extracellular form Rigid outer membrane Disulfide linked proteins Resistant to harsh conditions Non-replicating, non-metabolically active form Infectious form Bind to columnar epithelial cells (macrophages)

22 Physiology and Structure Reticulate bodies (RB) Intracellular form Fragile membrane Fewer disulfide bonds Metabolically active form Replicating form Non-infectious

23 Developmental Cycle of Chlamydia EB bind to host cells Epithelial Macrophage Internalization Endocytosis Phagocytosis Inhibition of phagosomelysosome fusion Reorganization into RB Breakdown of disulfide bonds Growth of RB

24 Chlamydia trachomatis Trachoma Inclusion conjunctivitis Infant pneumonia Ocular lymphogranuloma venerium Urogenital infections Lymphogranuloma venerium

25 C. trachomatis Ocular infections Worldwide Poverty and overcrowding Endemic in Africa, Middle East, India, SE Asia United States - American Indians Infection of children Transmission: droplets, hands, contaminated clothing, flies, contaminated birth canal

26 Clinical Syndrome -Trachoma From: G. Wistreich, Microbiology Perspectives, Prentice Hall

27 Clinical Syndrome -Trachoma (C.trachomatis biovar: trachoma) Chronic or repeated infection Follicle formation on conjunctiva Scarring of the conjunctiva

28 Eyelids turn in and abrade cornea Ulceration Scarring Blood vessel formation

29 Flow of tears impeded Secondary infections

30 C. trachomatis - Diagnosis Histo Cytology: Iodine-staining inclusions Not sensitive Culture: Iodine staining inclusions Most specific Iodine-stained inclusion bodies

31 C. trachomatis - Diagnosis Antigen detection (ELISA or IF) Group specific LPS Strain specific outer membrane proteins Serology Can t distinguish between current or past infection Detection of high titer IgM antibodies can be helpful Nucleic acid probes Several kits available May eventually replace culture

32 C. trachomatis - Treatment and Prevention Tetracycline, erythromycin and sulfonamides Vaccines are of little value Treatment coupled with improved sanitation Safe sexual practices Treatment of patients and their sexual partners

33 Chlamydophilia (Chlamydia) psittaci Psittacosis (Parrot fever) Ornithosis

34 Pathogenesis - C. psittaci Inhalation of organisms in bird droppings Person to person transmission is rare Hematogenous spread to spleen and liver Local necrosis of tissue Hematogenous spread to lungs and other organs Lymphocytic inflammatory response Edema, infiltration of macrophages, necrosis and occasionally hemorrhage Mucus plugs may develop in alveoli Cyanosis and anoxia

35 Laboratory Diagnosis - C. psittaci Serology Fourfold rise in titer Treatment: Tetracycline or erythromycin Quarantine of imported birds Control of bird infection Antibiotic supplementation of food

36 Chlamydophilia (Chlamydia) pneumoniae Person to person spread Respiratory droplets Atypical pneumonia Atherosclerosis? Diagnosis: Serology Treatment: Tetracycline or erythromycin

37 The End

number Done by Corrected by Doctor Hamed Alzoubi

number Done by Corrected by Doctor Hamed Alzoubi . number 16 Done by Nebal AlGallab Corrected by Doctor Hamed Alzoubi The last page includes definitions for the asterisked words * Main Lecture s Points 1) Spirochetes o Trepanoma o Borrelia o Liptospiral