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 Large,

motile, refractile spirochetes with irregular, wide, open coils.  5-30µm long and 0.3-0.7µm wide.  Gram negative.  Commensals – buccal and genital mucosa.  Medical importance : Relapsing fever caused by B. recurrentis, fusospirochetosis by B. vicenti and Lyme disease by B. burgdorferi.

Occurs in epidemic, endemic and sporadic.  Arthropod borne infection : louse and tick borne.  Causative agent of epidemic or louse borne RF is B. recurrentis observed by Obermeier in 1873 in blood of patients.  Human pathogen – no reservoir.  Transmitted by body louse.  Endemic : tick borne – rodents & other mammals – natural hosts.  Accidental in humans.  About 10 species infect man

is 28-30oC.  Optimum temp.  Grows on complex media containing serous fluids.  Grows on CAM of chick embryos.4µm wide.  CULTURAL CHARACTERISTICS : Micro aerophilic.  5-10 loose spiral soils – stains with Giemsa and is gram negative.2-0.  Primary isolation by inoculation into mice or rats – intraperitoneally.  8-20µm long & 0.Irregular spiral with one or both ends pointed.  .

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another bout of fever sets in – borrelia reappear.  Disease subsides after 3-10 relapses. mice & guinea pigs – survive in brain.  Borreliae are abundant in the blood.  Agglutinating. complement fixing and lytic antibodies develop during infection.  .  PATHOGENICITY : IP of 2-10 days with fever of sudden onset.Antigenic variation Invivo – DNA rearrangements in linear plasmids.  After an afebrile period of 4-10 days.  Experimental animals – rats.

 Survives in parts of Africa.  Common during wars and in jails. hemorrhages and high rate of fatality.  Milder but relapses are common. Epidemics whenever poverty. overcrowding and lack of personal hygiene.  Tick borne : sporadic cases in endemic areas.  Louse borne more severe clinical picture with jaundice.  ‘place disease’ – associated with dwellings or other locations inhabited by infected ticks. .

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.  Laboratory infection through contact with blood of patients or experimental animals.  Transmitted to humans through bite and discharges. Persists in body and transmitted transovarially.  Rarely may be acquired congenitally.  Borreliae are shed in saliva and feces.  Soft ticks of genus Ornithodorus – live for 10 years.

 Smears : Giemsa or Leishman stain with dilute Carbol fuchsin.  False positive serological tests for Syphilis.  Cultivation and demonstration of antibodies is unreliable. .  Agglutinins for Proteus OXK in high titres. Wet film examination by dark ground or phase contrast microscope – lashing movement.  Experimental inoculation into mice intraperitoneal (1-2ml).

 PREVENTION OF LOUSE INFESTATIONS BY Insecticides. . Chloramphenicol.  TREATMENT : Tetracyclines. Penicillin & Erythromycin.  No vaccine is available.

 Stained with dilute carbol fuchsin & gram negative.  Predisposing conditions – malnutrition or viral infection lead to ulcerative gingivo stomatitis or oropharyntitis.6µm wide with 3-8 coils.  Associated with fusiform bacilli – fusospirochetosis.  Normal mouth commensal.  .  Penicillin and metronidazole are effective.  Anaerobically in enriched media.2-0.Motile spirochete.  Diagnosis by stained smears from exudates of lesions. 5-20µm long & 0.

 First observed in Lyme. myalgia. USA.  Transmitted by bite of Ixodid ticks.  Meningeal or cardiac involvement.  IP is 3-30 days. Identified in 1975 – suspected juvenile Rheumatoid Arthritis cases. arthralgia & lymphadenopathy. . headache. Connecticut.  Localised infection – expanding annular skin lesion.  Second stage – disseminated infection – fever.

 Fastidious bacterium – grown in modified Keley’s medium – incubated for 2 weeks or more optimally at 33oC.  Grows in midgut of the tick – infection occurs by regurgitation of the gut contents during biting.  Natural reservoir hosts are rodents.Third stage : ‘persistant infection’ months or years later with chronic arthritis.  . encephalopathy & acrodermatits.  Ixodid dammini and related species are the vectors. deer and other mammals.  Three species have been identified. polyneuropathy.

CSF and the blood of patients.  False positive syphilis serology seen with FTA-ABS being positive & VDRL negative.  Doxycycline.  Serological tests – ELISA & IF and immunoblotting for confirmation.Laboratory diagnosis by isolation of the borrelia or by serology.  .  Antibodies take 1-2 months to appear. with initial IgM response followed by IgG.  Can be isolated from ticks as well as from skin lesions. amoxycillin and cefuroxime for treatment.

delicate spirochetes.  Too thin to be seen under the light microscope.  A large no.  Sp.  .  Saprophytic – many parasitic in rodents & other animals.  Stimson in 1907 observed slender spirochetes in silver stained sections of kidneys from a fatal case of jaundice. Interrogans – shape – question mark. of closely wound spirals & characteristic hooked ends.Actively motile.  Spirochetal jaundice described by Weil in 1886.

 L. sewage & other sources. biflexa saprophytic leptospires  Species are again can be identified into over 22 serogroups and 200 serovars. . icterohaemorrhagiae. interrogans containing pathogenic leptospires. Causative agent of Weils disease – isolated in 1915 by Inada – L.  Genus classified into 2 species .L.  Saprophytic – from water.

2µm thick.  Ends are hooked and resemble umbrella handles.  Stain poorly with aniline dyes – Giemsa and better results with silver impregnation methods. flexible helical rods – 6-20µm long & 0.  Actively motile. Delicate. .

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Grown in media enriched with rabbit serum.  Demonstrated in the blood of allantoic vessels 45 days after incubation – 5-fluorouracil – inhibit contaminants.  Generation time 12-16 hr in media & 4-8 hrs in experimental animals.  May be grown on the CAM of chick embryos.  Optimum temp.  Semisolid – growth few mm below the surface.5. is 25-30oC and pH 7.  Semisynthetic – EMJH – commonly used.2-7. Stuarts & Fletchers media.  Liquid and semisolid media – Korthof’s.  Aerobic and microaerophilic.  .

 Survive for days in moist conditions at pH 6. . at 60oC.  Readily destroyed by chlorine & other antiseptics & disinfectants. Very susceptible to heat – 10 min at 50oC and 10 sec.8-8.  Sensitive to acid and destroyed by gastric juice in 30 min.

 Serotypes – agglutination & cross.absorption reactions.  Genetic methods : Restriction endonuclease analysis & DNA pairing – further classified into serovars.  Genus specific somatic antigen . . Exhibit antigenic cross reactions.  Classification into serogroups & serotypes based on surface antigens.

 IP is 10 days.Natural reservoir hosts – asymptomatic.  Purpuric rashes – skin & mucosa –albuminuria.  Humans – infected when contaminated water comes in contact with cuts or abrasions on skin & mucosa of mouth.  Severe cases – onset acute with rigor vomitting. headache & intense injection of the eyes. conjunctiva.  C/F: mild undifferentiated pyrexia to severe or fatal illness with hepatorenal damage.  Jaundice occurs in 10-20% by about 2nd or 3rd day. nose.  .

.  Leptospires – blood in acute phase seldom demonstrated after 8-10 days.  Commonest serotype is icterohaemorrhagiae.  Persist in internal organs – mostly kidneys – urine.  Aseptic meningitis common with canicola. Two clinical types : icteric and nonicteric.  Aseptic meningitis is seen some.

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 Serological tests.  By isolating them in culture.  By inoculation of guinea pigs.  EXAMINATION OF BLOOD : helpful in early stages before antibiotics are given.  Examined under dark field microscope or by immunofluorescence. Demonstration of lelptospires microscopically in blood or urine. .

3 or 4 drops of blood – inoculation in Bijou bottles with EMJH – incubated at 37oC for 2 days & at room temperature in the dark for 2 weeks.  Primary isolation – weeks to months.  Isolated from the CSF also.  Blood – inoculated intraperitoneally into young guinea pigs.  Examined every third day. .

 Centrifuged deposit – dark ground illumination.  Third day after inoculation – dark ground examination & blood with cardiac puncture inoculated into culture media.  Identification of isolate – agglutination with type specific sera.  EXAMINATION OF URINE : second week of the disease & intermittently for 4-6 weeks – should be examined immediately – killed in acid urine.  .Icterohaemorrhagiae – animals develop fever & die with in 8-12 days with jaundice & haemorrhage into lungs & serous cavities.

 Type specific tests for infecting serovar. CFT.  GENUS SPECIFIC TESTS : without indicating serovar.  Tests include – sensitised erothrocyte lysis.  ELISA – IgM & IgG indicate stage of the infection.  Prepared from non pathogenic L. agglutination & indirect IF. biflexa Patoc I strain.SEROLOGICAL DIAGNOSIS : antibodies appear in serum towards the end of the first week of the disease & increase till fourth week.  .  Simple and rapid dipstick assay – IgM specific antibody.

 Examination of water for pathogenic leptospires : shaved & scarified area of the skin of guinea pig exposed to water for an hour.  Leptospirosis in animals – rodents & other – serological or by culturing pieces of kidney.  Microscopic or MAT : live cultures of different serotypes & agglutination observed under low power dark field microscope.Macroscopic and microscopic agglutination tests.  More specific & done in reference laboratories.  .  Macroscopic : formalinised suspensions of prevalent leptospira serovars – macroscopic agglutination with serial dilutions of test serum.

 . multiply & are shed in urine. insanitation.Most widespread of zoonoses.  Infected urine contaminating the water or mud that is neutral or slightly alkaline.  Pathogenic : survive in the convoluted tubules of kidneys in natural hosts.  Occupational groups such as agricultural workers in rice or cane fields.  Mostly a rural problem – now becoming urban due to overcrowding. the leptospires survive for weeks. increasing rat population and the habit of walking barefoot. miners – leptospirosis is common.

 Doxycycline 200 mg orally given once a week is effective. disinfection of water and wearing of protective clothing. .  Penicillin given IV.  TREATMENT : sensitive to penicillin and tetracyclines. General measures of prevention such as rodent control. cattle and pigs. 1-2 million units 6 hourly for 7 days in serious cases.  Vaccination – dogs.

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