Spirochaetes

Dr.M.N.Sumana
 Sprochaetes
• Treponema- T.pallidum
• Leptospira-L. icterohaemorrhagica
• Borellia- B. vincenti, B.recurrentis,
B.burgdoriferi

• Spiral shaped- motile-endoflagella- cork screw

motility, flexion extension, gliding, tumbling
 Treponema pallidum
• Syphilis- venereal disease, transplacental,
blood transfusion
• Range- small lesion to neuro/cardiovascular
• Span-30yrs
• Very thin organisms- cant be seen under light
microscope
• Dark ground or silver staining
Microscopy
 Epidemiology
• 0.5% among reproductive age group
• Transmission-3 routes
– Sexual
– Trans-placental
– Blood transfusion
 Syphilus
• Discovered in 1495- came from sheep and
cattle
• Bacteria discovered in 1905
• Cure- Penicillin
• Incubation period-10-90 days
• 3-4 stages- primary, secondary, latent, tertiary
 Primary syphilis
• Painless, hard, genital or oral ulcer (chancre)
• Heals spontaneously in 4-6 weeks- but
organisms spread throughout body lymph or
blood
• Asymptomatic 24 weeks
Chancre
 Secondary syphilis
• Red maculo-papular rashes on all parts of the body
including palms and soles
• Pale, moist, flat papules seen primarily on ano-
genital region- condylomata lata
• Can be seen in arm pits and mouth
• Highly infectious- both primary and secondary
• Secondary stage- multi-organ involvement-
hepatitis, meningitis, nephritis, or chorio-retinitis.
• Healing-latent stage
Muco-cutaneous rash
Condyloma lata
 Latent stage
• Lasts for many years
• 40% of untreated individuals- tertiary stage
 Tertiary stage
• Degeneration of nervous system
• Cardiovascular lesions- ascending aortic
aneurysm
• Granulmatous lesions- Gumma-liver, skin,
bones
Aortic aneurism
Gummas
 Congenital syphilis
• After 4 months of gestation
– Death
– Spontaneous abortion
– Born with symptoms
Congenital syphilis
 Laboratory diagnosis
• Mainly serological
– Non-treponemal antibodies-reagin-cardiolipin-
screening- VDRL, RPR
– Anti-treponimal antibodies to surface proteins-
confirmatory- FTA-ABS, TPHA, TPPA
 Interpretation
Non Treponemal test Treponemal test Interpretation
Reactive Non reactive False positive non
treponemal test
Non-reactive Reactive Past treated syphilis
Reactive Reactive Active syphilis
 Treatment
• Penicillin G- no resistance
• Alternatives- Erythromycin or Tetracyclines
• Resistance to macrolides developed
• Stat therapy
•  A single intramuscular injection of long acting
Benzathine penicillin G (2.4 million units
administered intramuscularly) will cure a person
who has primary, secondary or early
latent syphilis.
• Only after days of treatment- cure
• Treatment effect monitored by VDRL

• Late and latent- Doxycycline

• Regimens of doxycycline of 100 mg orally
twice daily for 14 days for early syphilis and 28
days for late syphilis have been used for many
years.
 Non Venereal Treponemes
• T.pertenue- Yaws
• T.endemicum- endemic syphilis
• T.carateumPinta
 Yaws-T.perteue
• Endemic in Africa, S E Asia, Central America
• India- seen in Tribal population
• Eradicated now in India
• Yaws free status by WHO in 2016
• Transmission Direct contact
• Papule-strawberry like lesion with local LN
• On feet- Painful- crab like gait
• Treatment-Azithromycin
 Endemic syphilis- Bejel
• T.pallidum endemicum
• Seen in arid areas of Africa, Asia, Australia but
not in Europe
• Transmission- Direct contact, Kissing
• Oral papule- resembling Condylomata lata-
with regional LN
• Late manifestations- destructive gummas
 Pinta- T,carateum
• In remote villages of America
• Skin to skin contact
• Pruritic papule-disseminate, deeply
pigmented pruritic lesions
• Treatment-Benzathine penicilin
 Lyme disease- B. burgdoriferi
• Seen in US
• Transmission-tick bite, scratches
• Clinical manifestations
– Early-annular maculo-papular lesion at the site of
entry- Erythema migrans
– Stage 2- spreads hematogenously- annular skin lesion
– Arthralgia , malaise and fatigue
– Neurological manifestation
– Stage 3 late persistent infection- Lyme arthritis
 Diagnosis

• PCR- RFLP
• Serology- ELISA Western blot
• Treatment-Doxy
• CNS & CVS manifestations- Ceftriaxone