Kingdom II: Bacteria Section XXV: The Spirochetes Phylum X: Spirochetes Class I: Spirochaetes Order I: Spirochaetales Famil I: spirochaetaeceae (9 genus) Genus I: borrelia (30 spp.) Genus IX: Treponema (18 spp) Family III: Leptospiraeceae Genus III: Spirochaeites* Family: Spirochaetaceae Genus Treponema Borrelia Leptospira

Genus: Treponema Spp T.Pallidum ssp. T. Pallidum -> Syphilis - T. Pallidum ssp. Pertenue T. Pertenue -> Yaws - T.pallidum ssp. Endemicum T.Endemicum 0> BEJEL (Endemic syphilis) T. arateum -> Pinta T. Vincentii (Vincent s spirilium) -> Vincent s angina (ulcero membranous gingivitis) Normal flora, but numbers increase in acute necrotizing gingivitis and chronic adult periodontitis (opportunistic) = T. denticola, T. soceanskii, T. Pectinovorum SPIROCHAETES


Slender unicellular HELICAL or SPIRAL rods Cytoplasm surrounded by cytoplasmic membrane and peptidoglycan layer -> Rigid shape In treponema spp. Fine cytoplasmic filaments (+) on EM Borvelia : (-)

Both:Motile (very active) Several flagella attached to each pole of cell, wrapped around bacterial cell body Flagella DO NOT PROTRUDE INTO SURROUNDING MEDIUM but enclosed within outer membrane ? Capsule (+) Gram stain: Not stainable! (So we assume them as Gram negative) Pathogenic treponemes do not grow in artificial media (so we subculture in animals)

SYPHILIS Etiology: Teponema pallidum Family: Spirochaetaeae Genus: Treponema Species: T. pallidum ssp. Pallidum Causative agent for SYPHILIS 1905: First isolated from syphilitic lesion Infection: i. Sexual contact = usually ii. Congenital syphilis (vertical transmission) iii. Neonatal syphilis iv. Transfusion (Rarely)

Pathogenesis If left untreated: Primary -> Secondary -> latent -> Tertiary (late) Enter tissue penetrate through abraded skin or intact mucosa --move to-> lumphatics -> disseminated.

- Also hematogenous spread - Initial entry site -> chancre (primary syphilis) i. Usually single, painless ii. with border, [looks clean (Prof Nasa)] iii. base induration

iv. Common sites: foreskin, coronal sulcus, vulva, fourchette, uterine cervis, penile shaft v. 5% ectragenital (lips, mouth, etc.) Incubation period: 18-21 days


Chancre usually heals spontaneously within 3-6 weeks SECONDARY SYPHILIS 2-12 weeks later -> Symptoms (+) Highly variable & widespread Usually skin: macular or pustular lesions at trunk or extremities (including palm + soles too!) Serpiginous mouth ulcers Flat warty lesions of perineum (condyloma lata) Sestemic (meningitis, arthritis, patchy alopecia, iritis, retinitis)


TERTIARY (LATE) SYPHILIS May occur years/decades after primaty infection 3 most common forms a. Neurosyphilis b. Cardiovascular syphilis ( Bovine heart ) c. Gummatous syphilis Pathogenesis: Autoimmunity??


T.PALLIDM - First isolated from syphilitic lesion in 1905 - Causes one of the >30 sexually transmitted diseases - Tightly coiled helical rods - 5-15 microm long x 0.1 0.5 microm in m - highly motile Dx: Direct darkground microscopy IF Serology (serological tests for syphilis Non-Specific: i. VDRL (Venereal disease research laboratory) the antigen used is cardiolypin. Useful as a screening test. A lot of false positive reactions because it is non specific. People

who are pregnant can be VDRL positive. Also, some autoimmune diseases are VDRL positive. After screening, do a more specific test Specific: i. ii. iii. TPHA (T.pallidum haemagglutination test) usually use turkey s RBC because it is a huge cell. FTA-Abs (flourescein treponema antibody absorption test) TPI (treponema pallidum immobilization test) Antibodies will immobilize the moving organism. [ It s a hassle Prof Nasa ]

Rx: Penicllin Allergic Erythromycin, chloramphenicol, tetracycline Procaine peniclline Benzyl penicillin

Non-pathogenic spirochaetes (free living or saprophytes) T. Buccalis Macrodentium Microdentium Genitalis - genitals Pseudopallidum - genitals B.Refringens B. Phagedenis Zuelzerae (free living in mind) Lab strains: (Used in TPI) T. Reiter s strain Boguchi Kroo Nicol BORRELIA Family: Spirochaetaceae

Genus: Borrelia Spp: - Borrelia recurrentis & some other B -> Relapsing fever - B. burgdorferi -> LYME disease RELAPSING FEVER Characterized clinically by recurrent periods of fever and spirochaetaemia 2 forms: 1. EPIDEMIC (louse-norme) Etiology : B. recurrentis Transmitted by body louse (Pediculus humanus) 2. ENDEMIC (tick-borne) Etiology: B. duttoni, B. hermsii, B. parkeri, B. turicatei, etc (at least 15 spp) Transmitted by ticks (soft bodied) = Ornithodorus Relapse: Due to antigenic variation (it keeps on changing its antigenicity, so that new antibodies need to be formed every time)


Clinical picture (after 1 week of exposure) Fever Rigors Headache Myalgia/arthralgia Photophobia Cough Resolves in 3-6 days Then relapse resolves relapse, etc

Case fatality: Epidemic RF = 4-40% Endemic RF = 2-5% Causes of fatality: Myocarditis Cerebral hemorrhage Liver failure

Diagnosis: (Thick or thin blood smear) Stained with Giemsa or acridine orange Serological tests are different because of antigenic variation

Treatment: Tetracycline Chloramphenicol Erythromycin Penicillin

Prevention: Avoidance & eradication of arthropod vectors Personal hygiene Delousing

LYME DISEASE (Lyme borreliosis a place in USA. 1975) USA Europe China, Japan, Australia 1975 in Lyme USA: Cluster of ? juvenile rheumatoid arthritis Common factor History of insect bite B. burgdorferi (later isolated from Ixodex tick)

Natural host: wild and domesticated animals Vectors: Ixodes dammini I. pacificus I. ricinus

3 stages of disease I. Early Stage Erythema chronicum migrans (ECM) at site of bite 3-22 days later + malaise, fatigue, headache, rigors, neck stiffness Disseminated infection Abnormalities: Cardiac Neurological Musculoskeletal Late / Persistent Months or years later



Annormalities: Chronic skin Nervous system Joint Congenital infection may be fatal LEPTOSPIRA Genus: Leptospia (12 spp) Species: L. interrogens (parasitic strain) L. biflexa (free-living saprophytes) * both spp. Morphologically indistinguishable * Slender spirals with numerous coils with hooked ends * 6-20 microm x 0.1 microm * mobile rotation and gliding * staining: - Levaditi & Fontana stain - Immunofluorescence Culture
y y y y

Obligate aerobes Optimum temperature: 28 33 C Primart isolation: in fluid medium, pH 7.2, 2-3 weeks Media: EMJH (Ellinghausen & McCollough) L.interrogens require additional animal proteins (serum, BSA)

Serogroups & Serovariants (serovars) L. interrogens: 23 serogroups 218 serovars L. biflexa: 28 serogroups 60 serovaris

LEPTOSPIROSIS (Weil s disease) [German physician 1886]
y y y

Etiology : L interrogens Zoonosis worldwide L. -> infects animals (wild, some domesticated ones also) -> urine -> humans -> acute febrile illness

y y y

L-> skin abrasions, nasal mucosa, mouth, eyes -> multiply in blood -> disseminate May begin as influenza-like Can -> meningitis & renal involvement

Leptospirosis 2 forms
y y

Benign (Canicola fever) Severe (Weil s disease) - jaundice - hemorrhage of the eyes (these two symptoms usually due to serovar ictero-hemorrhagiae

Other serovars Australis Andamana Bataiviae Pyrogenes

Carriers: Rodents Small mammals Diagnosis: -History of exposure to animal sources
y y y

Work Recreation Living

-microscopy: blood and urine, dark ground microscopy -Culture: Blood


Liquid medium Animal (peritoneum)

-serotype -serology (IgM, IgG) Treatment Antibiotics
y y y y

Benzylpenicilline (7/7 IV), 6-8 mega units Streptomycin Tetracycline Erythromycin

Prevention Human unnatural/end-host Rodents eradicate/control