 Faculty : Dental medicine and surgery

 Year : 1st year

 Batch :15
 Course: Principles of disease –I (DE-DIS-
212)
 Instructor : Mawada Mohammed
Yahia
 Phone No: 0908205000
Spirochetes

MAWADA M.YAHIA
Objectives

 By the end of this lecture you should know:

 Normal habitat and mode of transmission.
 General characteristics.
 Subspecies .
 Pathogenesis.
 Culture and Identification.
 Treatment and prevention.
Introduction

 Spirochaetes are a diverse group of spiral, motile

organisms comprising five genera.
 Spirochaetes are helical organisms with a central
protoplasmic cylinder surrounded by a
cytoplasmic membrane .
 All spirochaetes are strictly anaerobic or
microaerophilic.

 Underneath the cell wall run three to five axial
filaments that are fixed to the extremities of the
organism. Contractions of these filaments distort
the bacterial cell body to give it its helical shape.
 Three genera are human pathogens:
 Treponema: causes syphilis, bejel , yaws, pinta and, in the
oral cavity, acute necrotizing ulcerative gingivitis (together
with fusobacteria)
 Borrelia : causes relapsing fever and Lyme disease
 Leptospira: causes leptospirosis.
Treponema

 The coils of Treponema are regular, with a longer

wavelength than that of Leptospira
 Some of which are important systemic pathogens,
whereas others are oral inhabitants implicated in
periodontal disease.
Treponema pallidum
Treponema pallidum

 Habitat and transmission

 Lesions of primary and secondary syphilis
 Transmission is by direct contact with lesions, body
secretions, blood, semen and saliva, usually
during sexual contact, and from mother to foetus
by placental transfer.
 Spirochaetales Associated
Human Diseases

Genus Species Disease

Treponema pallidum ssp. pallidum Syphilis

pallidum ssp. endemicum Bejel
pallidum ssp. pertenue Yaws
carateum Pinta
Syphilis - Treponema pallidum
Syphilis - Treponema
pallidum on darkfield
Characteristics

 Slender.
 corkscrew-shaped cells .
 6–12 coils.
 Too thin to visualize by light microscopy
but can be seen by silver impregnation
or immunofluorescent techniques.
 Strictly anaerobic and extremely sensitive
to drying and heat.
 Dies rapidly outside the body.
Pathogenicity

 Causes syphilis, a sexually

transmitted disease .,The virulence
factors of Treponema pallidum are
not well characterized.
 Immunopathology plays a
significant role in disease
manifestations, especially in the
late (tertiary and quaternary)
stages of the disease.
Syphilis

 Sexually acquired infection

 Etiologic agent: Treponema pallidum

 Disease progresses in stages

 May become chronic without treatment

Transmission 16

 Sexual and vertical

 Most contagious to sex partners during the primary and

secondary stages
Stages

 primary Syphilis
 Secondary Syphilis
 Latent Syphilis
 Tertiary (Late) Syphilis
 Neurosyphilis
 Congenital Syphilis
Culture and identification

 Cannot be cultured in vitro, but

can be propagated in the testes of
rabbits.
 Detect specific antibody in the
patient’s serum.
 Dark-ground microscopy of tissue
fluid from primary and secondary
clinical lesions helps identification,
but serological tests are the
mainstay of diagnosis.
Oral treponemes

 All oral spirochaetes are classified in the genus

Treponema. Although many species have been
described, only four have been cultivated and
maintained reliably:
 Treponema denticola.
 Treponema vincentii.
 Treponema pectinovarum
 Others
 In another classification, they are categorized
according to cell size as small, medium and large
spirochaetes.
Habitat and transmission

 Predominantly the oral cavity of humans and at

the gingival margin and crevice in particular.
 Transmission routes are unknown. Infections are
endogenous.
Characteristics

 Motile.
 helical rods.
 5–15 × 0.5 μm, with irregular (three to eight)
spirals,
 which are less tightly coiled than Treponema
pallidum.
 Cell walls are Gram-negative but stain poorly. The
size is variable and can be used as a basis for
classification (large, medium or small).
Culture and identification
 In contrast to Treponema pallidum, oral
spirochaetes can be grown in vitro.
 They are strict anaerobes, slow-growing in oral
treponema isolation (OTI) medium.
 Subspecies can be differentiated by fermentation
reactions and serology (agglutination).
Pathogenicity

 These organisms are a component of the

fusospirochaetal complex of acute
necrotizing ulcerative gingivitis and
Vincent’s angina, and are a coagent of
advanced periodontal disease.

 The ability to travel through viscous

environments enables oral spirochaetes
to migrate within the gingival crevicular
fluid and to penetrate epithelial linings as
well as gingival connective tissue.
Cont …..

 Virulence factors are little known; endotoxin is

possibly contributory to disease. Treponema
denticola is more proteolytic than other species
and degrades collagen and dentine.
Treatment and control

 Sensitive to penicillin and metronidazole.

 Prevention of infection is achieved by good oral
hygiene practices.