Chapter 46: Spirochetes 2.

Borreliae
- Equipped with periplasmic flagella (axial fibrils,
endoflagella)  General Characteristics
- Slender, flexous and helical - Less tightly coiled (3 -10 coils)
- Arthropod-borne
1. Leptospira - Can be visualized by bright-field microscopy
- Family Leptospires - Grown in Kelly medium
A. L. interrogans: - Giemsa stain peripheral blood smear:
causative agent of human leptospirosis test of choice for relapsing fever borreliosis
B. L. biflexa - Actively motile/microaerophilic
- Most common serovars: - SOC: Peripheral blood
1. Icterohaemorrhagiae
2. Australis a. Borrelia recurrentis
3. canicola - Endemic relapsing fever
Tickborne (saliva)
 General Characteristics - Epidemic relapsing fever
- Tightly coiled, thin, flexible spirochetes with louse-borne (lice are crushed & scratched into
hooked ends skin )
- Obligate aerobe; rapid rotational motility - Relapses due to antigenic variation
- Visible by dark-field, phase contrast and - Drug of choice: Tetracycline
Immunofluorescent microscopy - Jarisch-Herxheimer rxn: associated with the
clearance of the organisms from release
 Possible virulence factors
- Reduced phagocytosis in the host b.Borrelia burgdorferi
- Cell mediated sensitivity to leptospiral Ag - Sensulato
- Hemolysin - Lyme disease/syndrome
- Endotoxin - Ixodes tick
- Natural host: Deers and rodents
 Infections - Stage 1
- Leptospirosis (zoonoses) IP: Localized (ECM): target or bull’s-eye skin lesion
10-12 days, flu-like symptoms. at the site of tick bite
- Hepatic,renal, CNS involvement. Fever, joint pain, malaise and fatigue
- Conjunctival suffusion - Stage 2
- Early disseminated
A. Weil disease neurologic disorders, meningitis and carditis
- Icteric leptospirosis - Stage 3
- Severe systemic disease with, renal and hepatic Late persistent
failure & intravascular disease Chronic arthritis (weeks or years later)
- 1st week: IgM Acrodermatitis
- 1 month onwards: IgG Chronica atrophicans (ACA) – diffuse skin rash
Erythema chronicum migrans
 Laboratory diagnosis  Treatment
- Acute phase (1st week) - Doxycycline, Amoxicillin
Blood or CSF specimen
- 2nd week 3. Treponemes
Urine
- Culturable to Fletcher’s, Stuart or EMJH  General Characteristics
(Dark/Room temperature) - 4-14 spiral
- Serotyping by MAT/ELISA - Visualize by dark-field microscopy
- Motile with graceful flexuous movements in
 Treatment liquid
- Doxycycline, Tetracycline
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 a. Treponema pallidum subsp. Pallidum
- Sexually transmitted / transplacental “great
imitator” human pathogen
- Congenital syphilis: (2 years)
Mucocutanoes lesions
SOC: Umblical cord
- Syphilis
1. Primary stage (10 – 90 days)
- Chancre (firm)
2. Secondary stage (2 – 12 weeks)
- Lesions, rashes, etc.
3. Tertiary stage (CNS)
- Gummas
- Neurosyphilis

 Serologic Tests
1. VDRL and RPR (Non – treponemal)
- Antigen: cardiolipin antigen
- VDRL: non – specific antibodies capable of
reacting with the cardiolipin; + within 1 – 12
weeks; SOC: Serum/CSF
- RPR: based on the presence of reagin; SOC:
Plasma/Serum
2. FTA-ABS
- Reiter treponeme remove nonspecific
treponemal
- Ab. T. pallidum Nichols strain affixed
3. TP-PA and EIA
- Confirmation on later stages of syphilis.

 Other Treponemal (non-venereal) Diseases

1. Treponema pallidum subsp. Pertenue

- Yaws (granulomatous nodules)

2. Treponema pallidum subsp. endemicum

- Endemic Syphilis (Bejel)- papules

3. Treponema carateum
- Pinta - scaling, erythema

2 Types of antibodies:

1. Nontreponemal antibody
- VDRL and RPR
- Refers an indirect method of blood test for
diagnosis of infection with syphilis
2. Treponemal antibody
- FTA-ABS, MHA, TP-PA and EIA
- Antibody produced against antigen of the
organism
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