Chapter 12

Spirochetes
Introduction
 The spirochetes (from Speira, meaning coil) are a large, spiral, motile, and the longest
among bacteria once being straight. They reproduce by transverse fission.

 Spirochetes share several structural characteristics:

1. They are long, slender, helically coiled, and spiral.

2. Outer sheath (or glycosaminoglycan coat): the outer most structure.

3. Outer membrane: next to the outer sheath, it contains peptidoglycan and maintains the
structural integrity of the organism

4. Endoflagella (axial filaments): next to the outer membrane (in the periplasmic space).
These filaments are flagella-like organelles responsible for organism motility.

5. Inner membrane (cytoplasmic membrane): next to endoflagella, provides osmotic stability

and covers the protoplasmic cylinder that encloses cytoplasmic tubules (body fibrils).
 Treponema pallidum
 Treponema pallidum is the causative agent of syphilis.

 Syphilis is typically acquired by the direct contact of mucous membranes during

sexual intercourse.

 The disease (primary syphilis) begins with a lesion at the point of entry, usually a
genital ulcer infiltrated with lymphocytes and plasma cells, with hard base (“hard
chancre”).

 After healing of the ulcer, the organisms spread systemically, and the disease
returns weeks later as a generalized maculopapular rash called secondary
syphilis spread to nearby lymph nodes to reach blood stream causing syphilitic
meningitis, and hepatitis.

 Both primary and secondary lesions are rich with spirochetes and are highly
infectious
• The disease then enters a second eclipse phase called
latency and is tend to be not infectious.

• The latent infection may be cleared by the immune

system or reappear as tertiary syphilis years to decades
later.

• Tertiary syphilis is characterized by development of

lesions in skin, bones, and liver; degenerative lesions in
CNS and cardiovascular organs.

• Infected mothers may transmit the infection to her

baby and cause congenital syphilis.
Diagnosis
 Tissue fluids from early lesions, for demonstration of spirochetes, and serum for serology to
diagnose the infection.

 Smears for demonstration of spirochetes: The bacterium is so thin and not readily seen
unless immunofluorescent stain or dark field illumination are applied.

 Dark field examination: a drop of fresh fluid or exudates is placed on a slid and a cover slip
pressed over it to make a thin layer. The preparation is then examined under oil immersion
with dark field illumination for typical motile spirochetes.
 Serologic tests for syphilis: These tests use are either nontreponemal or treponemal
antigens.

 Nontreponemal antigen tests: spirochetes release antibody-like substance called reagin,

which is a mixture of IgM and IgG antibodies directed against lipid extracts. Antigens
employed in this test are extracted from normal mammalian lipids,all are added as a
complex and let to react with regain.

 VDRL (Venereal Disease Research Laboratory), the RPR (Rapid Plasma Reagin), and the
Toluidine Red Unheated Serum Test (TRUST) tests are nontreponemal antigen tests used
most commonly.

 All of the tests are based on the fact that the particles of the lipid antigen remain
dispersed with normal serum but shows aggregations when combining reagin.

 To detect any aggregation, the VDRL requires microscopic examination, whereas the RPR
and TRUST have added colored particles and can read without microscope.

 VDRL & RPR are positive after 2-3 weeks of untreated infection and they revert to negative
in 6-18 months after effective treatment. They are highly positive in secondary syphilis.
 Treponemal Antibody Tests apply immune diagnostics for
investigating for bacterial antibodies.

 Culture: T. pallidum has never been cultured in artificial media.

 T. pallidum grow slowly (one division every 30 hours) due to its

metabolic inactivity.

 In whole blood or plasma stored at 4C, T. pallidum remain viable for

at least 24 hours, which is of potential importance in blood
transfusions.
 Borrelia recurrentis
 Borrelia species are transmitted by louse and ticks that bring the organism from rodent.

 Like Niesseria gonorrhea, antigenic variation of this bacterium is the most important
virulence factor; and thus relapsed disease is common.

 Borrelia recurrentis is transmitted to human by body louse causing recurrent attacks of

chills, fever, and headache.

 As a final yield, several distinct antigenic variants of borreliae and antibodies might be
isolated from a single person with several relapses. This kind of febrile conditions termed
relapsing fever.

 Blood samples are obtained during the rise in fever for smears. Thin or thick smear stained
with Wright’s or Giemsa’s stain reveal large loosely coiled spirochetes among red cells.
Treatment for a single day by erythromycin, tetracycline, or penicillin may be sufficient to
terminate an individual attack.
 Leptospira interrogans
 Leptospira genus is a zoo of worldwide distribution.

 The only virulence factor of this species is the overlapping between antigenic structures
among different subspecies of those bacteria making each subspecies on Leptospira
interrogans to cause different clinical manifestations and human immune response.

 The bacterium is transmitted from animals to human through breaks in skin lesions and cuts
and mucus membranes  first phase of liptospirosis  febrile onset  kidneys and liver 
jaundice and hemorrhage.

 Dark field examination or thick smears stained by Giemsa’s stain show the bacteria in early
infection. Dark field examination of centrifuged urine also positive. Also
immunohistochemistry are used.