Spirochetes and Rickettsia
 Small, gram negative
 Non motile
 Rod to coccoid-shaped bacterium
 Obligate intracellular
 Requires arthropod vector
 Replicates in the cytoplasm
 Some Rickettsia shares antigenic
characteristics with certain strains of
Proteus bacteria
 Proteus is not involved at all rickettsial
disease
 Weil-felix reaction - test that uses these
cross reacting Proteus antigens to help
confirm a diagnosis of a rickettsial
infection
 Diagnosis with Rickettsia infection can
also be made with Indirect
immunofluorescence assay (IFA),
compliment fixation test (CF), enzyme-
linked immunosorbent assay (ELISA)
 Therapy: primarily doxycycline and
chloramphenicol
Rickettsia rickettsii
 More common in southern US tick belt
rather than in the Rocky Mountain
region
 The disease should be called the
Appalachian spotted fever – most cases
currently occur in the South Atlantic
and South central states
 Organism proliferate in the endothelial
lining of small blood vessels and
capillaries, causing small hemorrhages
and thrombi (explaining the
conjunctival redness and rash)
Rickettsia askari
 Rickettsial pox is a mild, self-limited
febrile disease
 Starts with an initial localized red skin
bump at the site of the animal bite
 Bump turns into blister and days later,
fever and headache develop.
 Vesicles also appear throughout the
body
 Self-limiting but has good response to
Doxycycline
 Elimination of rodents (reservoir) is
important in preventing disease
Rickettsia prowazekii
 Also called epidemic typhus
 Epidemic typhus characterized by an
abrupt onset of fever and headache
following a 2 week incubation period
 Small pink macule appear around the
fifth day on the upper trunk and quickly
cover the entire body
 Rocky Mountain spotted fever (RMSF)
-spares palms, soles and face
 In RMSF patient may become delirious
or stuporous
 Since Rickettsia invade the endothelial
cells of blood vessels – there is an
increase risk of blood vessel clotting
leading to gangrene of the feet or
hands
 Besides doxycycline and
chloramphenicol, improved sanitation
and eradication of human lice will help
control epidemics
Brill-Zinsser Disease
 Patients who recovers from louse-borne
typhus without antibiotics (becomes
latent stage)
 Occasionally breaks out of its latent
state to produce Brill-Zinsser disease
 Symptoms milder due to the presence
of pre formed antibodies
 Diagnosis is made by demonstrating
early rise of IgG titer specific for
Rickettsia prowazekii rather than rise in
IgM which occurs in the primary
infection
Rickettsia typhi
 Rickettsia typhi causes the endemic
typhus
 Rodents are the primary reservoir
 Transmitted to humans via the rat flea,
Xenopsylla Cheops’s
 Following 10 day incubation period,
fever, headache and a rash develop
 Treatment: doxycycline or
chloramphenicol
Rickettsia tsutsugamushi
 Found in Asia and the southwest pacific
 Spread by the bite of larvae (chiggers)
of mites
 Mites live on rodents and the larval
chiggers live in the soil
 After 2 week incubation period, there is
high fever, headache and scab at the
original bite site
 A flat or maculopapular rash develops
Rickettsia Parker
 First established in 2002 in the
southeastern coastal United States
 Vector is Gulf Coast tick (Amblyomma
maculatum)
 Patient will present with fever,
headaches, eschars and regional
lymphadenopathy
Rickettsia Africa
 Responsible for African tick bite fever
(ATBF)
 Increasingly identified in travelers
returning from sub saharan
 Africa as a cause of unexplained fever
Spirochetes
 Gram negative organisms
 Corkscrew like
 Has axial filaments
 Spirochetes are slender and tightly
coiled
 Have thin peptidoglycan layer
surrounded by LPS containing outer
lipoprotein membrane
 Spirochetes are surrounded by an
additional phospholipid-rich outer
membrane with few exposed proteins
 Axial flagella come out of the end of the
spirochete wall
 These specialized flagella are called
Periplasmic flagella
 These organism replicates by transverse
fission
 Cant be cultured in ordinary media
 Too small to be seen in a light
microscope (needs darkfield
microscopy, immunoflourescence and
silver stains)
Spirochetes decided into 3 genera:
1. Treponema
2. Borrelia
3. Leptospira
Treponema
 Produce no known toxins or tissue
destructive enzymes
 Disease manifestations are caused by
the host’s own immune responses such
as inflammatory cell infiltrates,
proliferative vascular changes and
granuloma formation
Treponema pallidum
 Responsible for the sexually
transmitted disease syphilis
 Enters the body by penetrating intact
mucous membranes or by invading
through epithelial abrasions
 Skin contact with an ulcer infected with
Treponema palladium can result in
infection
 If untreated, patients with syphilis will
progress through 3 clinical stages, with
a latent period between stages 2 and 3
Primary Syphilis
 Painless chancre that erupts at the site
of inoculation 3-6 weeks after the initial
contact
 Regional non tender lymph node
swelling occurs
 Chancre -can be described as a firm
ulcerated painless lesion with a
punched out base and rolled edges
Secondary Syphilis
 Untreated patients enter the
bacteremic stage or secondary syphilis
often about 6 weeks after the primary
chancre has healed
 Bacteria multiply and spread via the
blood throughout the body
 Systemic with wide spread rash,
generalized lymphadenopathy and
involvement of many organs
 Condyloma latum - characteristic skin
finding of the second stage
 Rash and condyloma revolve over 6
weeks and then enters the latest phase
Latent Syphilis

 Features of secondary syphilus have 3. Meningovascular syphilis -spirochetes attack

resolved blood vessels the brain and meninges
 Most patients asymptomatic during this
4. Tabes dorsalis -affects the spinal cord
period
(posterior column and dorsal roots)
 25% will have 1 or more relapses
 After 4years, there are generally no 5. General paresis -progressive disease of the
more relapses and considered non nerve cells in the brain, leading to mental
infectious deterioration and psychiatric symptoms
 1/3 of untreated patients will slowly
progress from this stage to tertiary
syphilis
Argyll-Robertson pupil -constricts during
Tertiary Syphilis accommodation but does not react to light

 Develops over 6-40 years with slow

inflammatory damage to organ tissue,
small blood vessels and nerve cells

Can be grouped into 3 general categories:

1. gummatous syphilis
2. cardiovascular syphilis
3. neurosyphilis

Gummatous syphilis occurs 3-10 years after the

primary infection in 15% of untreated patients

Cardiovascular syphilis occurs at least 10 years

after the primary infection in 10% of untreated
patients

Characteristically an aneurysm on the ascending

aorta or aortic arch (caused by chronic
inflammatory destruction of small arterioles

Neurosyphilis occurs in 8% of untreated cases

1. Asymptomatic neurosyphilis -patient

clinically normal, CSF positive for syphilis

2. Subacute meningitis -fever, stiff neck and

headache. CSF high lymphocyte count, high
protein, low glucose and positive syphilis test
Congenital Syphilis  Specific treponema test - Indirect
Immunoflourescent Treponema
 Occurs in the fetus of an infected
 Antibody-Absorption (FTA-ABS)
pregnant woman
 Crosses the placental blood barrier
 High mortality rate in the fetus
Treatment
 All the survive will develop early or late
congenital syphilis  DOC - penicillin
 Early congenital syphilis occurs within 2  Erythromycin and doxycycline
years (wide spread was and Condyloma
latum)
 Late congenital syphilis similar to adult
Jarisch-Herxheimer phenomenon -acute
tertiary syphilis except that
worsening of their symptoms immediately after
cardiovascular involvement that rarely
antibiotics are started
occurs
 Neurosyphilis is the same as in adults
and eight nerve deafness is common
 Cone and teeth are frequently involved
(periosteal inflammation destroys the
cartilage of the palate and nasal septum
0- saddle nose)
 Inflammation of the tibia leads to
bowing - saber shins
 Widely spaced central incisors with
central notch on each tooth
 (Hutchinson’s teeth) and molar have
too many cusps (mulberry molars)
 Eye disease such as corneal
inflammation can occur

Diagnostic tests for Syphilis

 Absolute diagnosis during the first and 3 subspecies of Treponema pallidum:

second staged can be made by direct
examination under dark field  endemicum
microscopy revealing tiny helically-  pertenue
shaped organism moving in a  carateum
corkscrew-like fashion
-Causes non venereal disease (endemic syphilis,
 Non-specific treponema tests -
yaws and pinta)
Venereal Disease Research Laboratory
(VDRL) and Rapid Plasma Reagin (RPR)  All 3 species causes skin ulcers and
gummas of the skin