류정희 ( 자료조사,PPT 제작, 발표 ) 임창하 ( 자료조사,PPT 제작, 발표 ) 고원정 ( 자료조사,PPT 제작, 발표 )

CONTENTS

Helical form Motility - periplasmic space periplasmic flagella =endoflagellum=axial flagella →flexing →rotation & crawling motion Gram-negative Free-living saprobes or commensals of animals endoflagellum Periplasmic space endoflagellum Outer membrane Cell body

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phylumfamilyGenus Spirochete s Spirochaetacea e Borrelia Brevinema Cristispiraeta Spirochaeta Spironema Treponema Brachyspiracea e Brachyspira Leptospiraceae Leptospira leptonema

Schematic designation of spirochetes based on general morphology. (From Baron EJ, Finegold SM. Bailey and Scott’s diagnostic microbiology. St. Louis: Mosby, 1990, with permission.)

Thin, regular, coiled cells Strictly anaerobic & microaerophilic Perigenital regions of humans, Oral cavity, intestinal tract, Strict parasites : complex growth requirements Treponematoses

Diseases caused by Genus Treponema Syphilis –Treponema pallidum ss. Pallidum Nonsyphilis –Bejel: Treponema pallidum ss. endemicum –Yaws: Treponema pallidum ss. pertenue –Pinta: Treponema carateum

Treponema pallidum : The Spirochete of Syphilis 1. Epidemiology and virulence factors Host - Human Extremely fastidious - not survive for long outside the host - Destroyed heat, drying, disinfectants, soap, high oxygen tension, pH changes

The risk of infection from an infected sexual partner: 12~30% Uncommon mode - the fetus in utero, medical accident Coinfection with other STDs - gonorrhea, chlamydia, herpes simplex, AIDS

 Direct contact with Mucous membranes or abraded skin  Hooked tip to the epithelium  Multiplies and penetrates the capillaries.  Slow generation time(but progressive disease)

Outer membrane proteins : virulence facter  No toxins, not directly kill cells Formed phagocytes and antitreponemal antibodies.  but, cell-mediated immune responses are unable to contain it  Form granulomas and block blood circulation.  organs damaged

Primary Syphilis - Hard chancre internal and external Genitalia lips, oral cavity, nipples, finger, rectum - Painless; - heals spontaneously, but the spirochete into the circulation.

Treponema pallidum : The Spirochete of Syphilis 3. Clinical Manifestations Secondary Syphilis fever, headache, sore throat  Lymphadenopathy, Peculiar red or brown rash on all skin surfaces  Disappears spontaneously

Latency - Early and late latency / spirochete is not detected Tertiary Syphilis - Cardiovascular syphilis/Gumma/neurosyphilis

Treponema pallidum : The Spirochete of Syphilis 3. Clinical Manifestations

Congenital syphilis - spontaneous miscarriage or stillbirth - nasal discharge, skin eruption and loss, bone deformation, nervous system abnormalities Huntchinson’s teeth

Treponema pallidum : The Spirochete of Syphilis 4. Clinical and Laboratory Diagnosis * Overlapping symptoms of concurrent, sexually transmitted infections(gonorrhea, chlamydiosis) can further complicate diagnosis Direct detect method Serological Test for Syphilis(STS) - Non-treponemal test - Treponemal test

Treponema pallidum : The Spirochete of Syphilis 4. Clinical and Laboratory Diagnosis dark-field microscopy of a suspected lesion direct immunofluorescence staining DNA PCR Direct detect method

Treponema pallidum : The Spirochete of Syphilis 4. Clinical and Laboratory Diagnosis Serologic Test for Syphilis ; STS RPR (Rapid Plasma Reagin) VDRL(Veneral Disease Research Laboratory) - based on Wasserman test - anti-cardiolipin antibodies screening test for syphilis

Treponema pallidum : The Spirochete of Syphilis 4. Clinical and Laboratory Diagnosis MHA-TP ( T. pallidum micro-hemagglutination assay), TPHA - treponemal antigen coated red blood cells + patient’s serum → agglutination TPI ( T. pallidum immobilization) test - live syphilis spirochetes + test serum → observed microscopically for loss of motility

Treponema pallidum : The Spirochete of Syphilis 4. Clinical and Laboratory Diagnosis FTA-ABS (Fluorescent Treponemal Antibody Absorbance) test - test serum is absorbed with treponemal cells → reacted with antihuman globulin labeled with fluorescent dyes → the fluorescent on the outside of these cells with fluorescent microscope

Treponema pallidum : The Spirochete of Syphilis 4. Clinical and Laboratory Diagnosis Direct detect method Dark-field microscopy Direct immunofluorescence staining DNA PCR DNA hybridization Serological Test for Syphilis Nontre ponem al Test Rapid Plasma Reagin(RPR) VDRL Trepon emal Test MHA-TP, TPHA FTA-ABS TPI(T. pallidum immobilization)test

Treponema pallidum : The Spirochete of Syphilis 4. Clinical and Laboratory Diagnosis

Treponema pallidum : The Spirochete of Syphilis 5. Treatment and Prevention Treatment - Penicillin G with benzathine or procaine - Tetracycline & erythromycin : if penicillin allergy Prevention - Barrier effect of a condom

Rarely transmitted sexually or congenitally Bejel, Yaws, Pinta Local invasion to skin mucous membrane → subcutaneous tissues, bones, joints Penicillin, erythromycin, tetracycline

Nonvenereal childhood syphilis T. pallidum endemicum : Reservoir of Nomadic people In arid areas Chronic, inflammatory childhood disease, small, moist patches

Bouba, frambesia tropica, patek T. pallidum pertenue Endemic to warm, humid, tropical regions Symptom - Large, abscessed papule ‘mother yaw’ on leg or lower trunk → moist nodular tumors → mutilating ulcerations of the face, extremities

Chronic skin infection(mal del pinto, carate) T. carateum Tropical forest, valley regions : Central & South America Symptom - scaly papule (reminiscent of leprosy)→ pigmented secondary macules → blanched tertiary lesions

Q &A

Quiz

1.Which of the follwing is correct about Spirochaeta ? a.Helical form b.Non-motility c.Gram posive d. aerophilic

2. Treponema pallidum is cultured in/on a. blood agar b. animal tissues c. serum broth d. eggs

3. The treatment of choice for syphilis is a. amphicillin b. antiserum c. penicillin d. sulfa drugs

4. Which of the treponematoses is /are not(an) STD(s)? a. yaws b. pinta c. syphilis d. both a and b

reference Clinical Laboratory Medicine2nd Edition / 2002 년 / williams&wikins  최신진단미생물학 / 서흥출판사 / 정윤섭외 6 명 / 제 4 판 /p  Microbiology/Higher Education/Kathleen Park Talaro / 제 7 판 /p