2 SpirochaetalesClassification Spirochetes are members of the order Spirochaetales which contains 2 familiesSpirochaetaceae – contains 2 medically important generaTreponemaBorreliaLeptospiraceae – 1 medically important genusLeptospiraMorphology and general characteristicsIs composed of:A helical protplasmic cylinder with a peptidoglycan layer similar to G-B, cytoplasmic membrane, and cytoplasm
3 SpirochaetalesA multilayered outer membrane that surrounds the cylinderPeriplasmic flagella which are attached to each end of the protoplasmic cylinder and extend toward the opposite end.Are not typical flagella and are often called axial filaments
4 SpirochaetalesNone of the pathogenic Treponemes have been successfully cultured on artificial mediaT. pallidum is usually cultured in the testes of rabbits, although it has been grown in tissue culture for short periods of time.T. pallidum does not survive for long outside the host.Visualized by darkfield microscopy or iron staining
6 SpirochaetalesBorrelia may be grown on a complex media called Kelly’s media, but this is not usually done in diagnostic labs.Borrelia may be observed with darkfield microscopy or be stained in a blood sample with a Giemsa stain or Wright stain.
8 Spirochaetales Identification Leptospira can be grown on semi-solid media containing peptone, beef extract supplemented with rabbit serum or bovine serum albumin and tween 80.Incubation may be for as long as 28 days.Visualize using darkfield microscopyIdentificationTreponemaObservation of organisms in lesionsDetection of antibodies made in the host.Two types of tests may be used:
9 SpirochaetalesNonspecific, nontreponemal tests – used for screening purposesVery sensitive, but not specificMany diseases give positive resultsIs inexpensive and easy to doDetects non-treponemal antibodies, called reagenic or Wasserman antibodies, that react with a phospholipid (cardiolipin-lecithin) that is a normal tissue constituentTests include: VDRL test, rapid plasma reagin card tests (RPR), and automated reagin test (ART)
10 Spirochaetales Borrelia Leptospira Specific, treponemal tests – used to confirm positive nontreponemal resultsVery specific, expensive, and more difficult to performInclude T. pallidum immobilization tests, Fluorescent Treponemal antibody absorption test, indirect Treponemal hemagglutination testBorreliaDemonstration of Spirochetes in the bloodLeptospiraIsolate and cultureSpecific agglutination test or C’ fixation test – look for 4-fold rise in titer in patient’s antibodies against the organism
11 Spirochaetales Virulence factors Treponema Borrelia Molecular mimicry – the outer sheath contains molecules that resemble the molecules commonly found on the surface of human cells.This allows the organism to resist host defenses.HyaluronidaseBorreliaAntigenic variation
12 Spirochaetales Clinical significance Leptospira Treponema Unknown T. pallidum causes venereal (transmitted by sexual contact) and non-venereal (transmitted by directly by non-sexual contact, and indirectly by common usage of eating and drinking utensils) syphilis.In venereal syphilis the primary lesion is on the genitalsIn non-venereal syphilis it is on oral mucous membranes.The normal untreated course of the disease occurs in several stages:
13 SpirochaetalesPrimary stage – following penetration of the skin or mucous membranes, a characteristic, painless hard chancre develops at the site of entry within 3 weeks.The chancre is highly contagious and filled with Treponemes.Simultaneously the organism enters the lymphatics and becomes disseminated.The chancre heals without treatment in a few weeks due to local immunity, but by that time the organism has already disseminated.
15 SpirochaetalesSecondary stage – 4-8 weeks after the primary stage, the secondary stage develops.Typically there are lesions (filled with treponemes) throughout the body including the skin, mucous membranes, organs, and eyes.Most lesions are on the skin and mucous membranes.The patient may also have a loss of hair, a mild fever, and the development of malaise.This also heals without treatment and the patient may either spontaneously get well or develop a latent infection
18 SpirochaetalesLatent infection – during this stage there are no symptoms, but specific anti-treponemal antibodies are found.This stage may last 3-10 years.During this time these is a biological balance between the organism and the host.1/3 to ½ may eventually progress to the next stage.Tertiary syphilis – this stage is characterized by granulomatous lesions, called gummas, of the skin, internal organs, CNS, bones, eyes, and cardiovascular system.They are cause by the body’s hyperimmune reaction to remaining spirochetes.When lesions develop in the CNS it is called neurosyphilis and it can lead to paralysis.In the eyes it can lead to blindnessIn the heart it can lead to aortic damage or aneurisms.
20 SpirochaetalesCongenital syphilis – occurs when the treponemes cross the placenta during the fifth month to infect the unborn fetus (occurs usually when mom is in the latent stage).This can result in damage to mental development or other neurological symptoms or the child may be born with generalized syphilis.In a pregnant woman who has a primary or secondary stage of the disease, this usually results in stillbirth.T. pertenue - causes Yaws or tropical syphilis which transmitted by non-venereal direct contact.T. carateum – causes Pinta, a skin disease with hyperpigmentation in patches.
21 SpirochaetalesBorrelia – are arthropod transmitted Spirochetes and they cause:Relapsing fever – two types:Epidemic – is caused by B. recurrentis and is transmitted by human lice.This is a more severe form of the disease than the endemic form.Endemic – is caused by many Borrelia species and is transmitted by ticksBoth types of relapsing fever follow the same clinical pattern.12-15 days after infection there is an abrupt onset of fever, headache, and myalgia for 4-10 days.Antibodies are formed and the number of organisms decrease.This leads to an afebrile period for a few days to several weeks
22 SpirochaetalesThe fever then relapses because the organism has undergone antigenic variation.The antibodies are no longer effective and the organism numbers increase.Several relapses may occur with each one being less severe than the previous one.Lyme disease – caused by Borrelia burgdorferi and transmitted by ticks.This is a systemic illness that may begin with the appearance of a red skin lesion called erythema chronicum migrans (ECM) because the lesion expands in a circular manner.The patient may also have a fever, headache, nausea, vomiting, myalgia, and fatigue.If untreated, the patient may develop arthritis (acute or chronic), and cardiac or neurologic complications weeks or months later due to immune complexes.
25 SpirochaetalesLeptospira – L. interrogans causes Weil’s disease or leptospirosisThis disease is acquired by contact with the urine of an infected animal or ingestion of contaminated food or water.It is more a disease of animals other than man.Infection can vary from asymptomatic to fulminant.The CNS, liver, and kidneys are most commonly infected.
26 Spirochaetales Antibiotic therapy/treatment In most cases the incubation is 2-20 days followed by fever, chills, severe headache, myalgia, malaise, nausea and vomiting.Jaundice occurs in severe casesDeath may occur due to renal failure.Antibiotic therapy/treatmentTreponema – penicillin, tetracycline, or erythromycinBorrelia - for relapsing fever use tetracycline or erythromycin; for Lyme disease use amoxicillin or doxycyclineUse protective clothing and repellents to prevent infectionLeptospirosis provide supportive care; antibiotics (penicillin or erythromycin) are only effective if given during the first 2-4 days of illness