1. 1 SpirochetesNeisseria Spirochetes and Neisseria (Gram negative) Lecture 36 Faculty: Dr. Alvin Fox

2. 2 Spirochete Axial filament Treponema pallidum Syphilis Chancre Primary lesion Darkfield microscopy Secondary Lesion Tertiary Lesion Anti-cardiolipin antibodies Anti-treponemal antibodies Borrelia burgdorferi Lyme disease Relapsing fever (other borrelia) Leptospira (leptospirosis) Neisseria Thayer Martin agar Oxidase test N. gonorrhoeae Gonorrhea N. meningitidis Meningitis Key Words

3. 3 SPIROCHETES Treponema, Borrelia and Leptospira

4. 4 Spirochetes Gram negative long, thin, helical, motile long, thin, helical, motile axial filaments – locomotion – between peptidoglycan layer/outer membrane * runs parallel

5. 5 Histology: Treponema pallidum Histology: Treponema pallidum - testis infected rabbit www.orl.cz/choroby/ustni/jazyk/zanet/1

6. 6 Treponema pallidum transmission – genital/genital – in utero or during birth

7. 7 Syphilis chronicchronic slowly progressiveslowly progressive

8. 8 Secondary (2-10 weeks later) Secondary (2-10 weeks later) - systemic spread - flu-like symptoms - skin, particularly - many organisms - Highly infectious

9. 9 Tertiary – several years later – rare – skin – central nervous system – delayed hypersensitivity – few organisms * control by immune response

10. 10 Microbiological diagnosis not culturablenot culturable dark field microscopydark field microscopy –actively motile organisms –brightly lit against dark backdrop –light shines at an angle –reflected from thin organisms –enters objective conventional light microsrcopyconventional light microsrcopy –light shines through –NOT visualized

11. 11 fluorescence microscopy –antibody staining

12. 12 Secondary and Tertiary Syphilis - serology screening methodscreening method antibodies to cardiolipinantibodies to cardiolipin specific diagnosisspecific diagnosis antibodies to treponemal antigenantibodies to treponemal antigen

13. 13 Autoimminty cardiolipincardiolipin – self antigen

14. 14 no vaccineno vaccine antibiotics (e.g. penicillin)antibiotics (e.g. penicillin) –effective

15. 15 Other treponemal diseases bejel, yaws and pinta –extremely rare in US

16. 16 Borrelia burgdorferi and Lyme disease

17. 17 Ixodes scapularis, tick vector for Lyme disease. Also known as Ixodes dammini. CDC

18. 18 Lyme disease - symptoms bacteremiabacteremia –acute arthritisarthritis cardiaccardiac neurologicneurologic –chronic *weeks, months later

19. 19 Therapy early antibiotic therapyearly antibiotic therapy – curable * penicillin * tetracycline late antibiotic administration late antibiotic administration –ineffective

20. 20 Diagnosis serum antibodies to B. burgdorferi serum antibodies to B. burgdorferi. laboratory strains – grow extremely slowly – tissue culture media – not bacteriological media patient body fluids/tissue sample patient body fluids/tissue sample – almost never growth

21. 21 acute – responds to antibiotic –antibodies not detectable late diagnosis late diagnosis – not curable – antibodies detectable A physicians dilemma

22. 22 Lyme Disease - etiology reactive arthritis similar to reactive arthritis similar to – Reiter's syndrome – rheumatic fever resembles rheumatoid arthritis

23. 23 Relapsing fever <100/ per year in US transmission transmission –tick-B. hermsii * rodent, primary host – lice-B. recurrentis * human, primary host

24. 24 “Relapsing” fever “Relapsing” fever immune response developsimmune response develops –disease relapses new antigens expressednew antigens expressed –no immunity –disease reappears

25. 25 Diagnosis no cultureno culture no serological testno serological test detected - blood smeardetected - blood smear

26. 26 Leptospirosis

27. 27 <100 cases per year in US symptoms symptoms –flu-like –severe systemic disease * kidney * brain * eye Leptospirosis

28. 28 infected urineinfected urine –rodents –farm animals waterwater through broken skin.through broken skin. Transmission

29. 29 Laboratory Diagnosis serologyserology most readily culturable of spirochetesmost readily culturable of spirochetes –culture still extremely difficult

30. 30 Neisseria gonorrhoeae NEISSERIA

31. 31

32. 32 Gram negative Gram negative diplococci (pairs of cocci) diplococci (pairs of cocci) oxidase positive oxidase positive culture culture Thayer Martin. Thayer Martin. – selective – chocolate agar * heated blood (brown) Neisseria Neisseria

33. 33 found only in man found only in man gonorrhea gonorrhea second most common venereal disease second most common venereal disease N. gonorrhoeae the “Gonococcus"

34. 34 Smear polymorphonuclear cellpolymorphonuclear cell Gram negative cocciGram negative cocci – many in cells

35. 35 gonoccocal arthritis – “septic” arthritis dermatitis dermatitis Dissemination -gonococci

36. 36 lactamase-resistant cephalosporin β lactamase-resistant cephalosporin – e.g. ceftriaxone resistant strains resistant strains – common – produce lactamases – produce β lactamases – destroy penicillin Antibiotic therapy

37. 37 adhesion to genital epithelium adhesion to genital epithelium – outer membrane – pili *Antigenicity highly variable among strains highly variable among strains no vaccine IgA protease – also N. meningitidis Pathogensis

38. 38 Tissue injury – lipopolysaccharide – peptidoglycan N. gonorrhoeae

39. 39 N. meningitidis N. meningitidis (the “Meningococcus")

40. 40 resides in man only usually sporadic cases usually sporadic cases – mostly young children outbreaks outbreaks – adults – crowded conditions *e.g. army barracks, dorms N. meningitidis

41. 41 upper respiratory tractinfection upper respiratory tract infection – adhesion pili bloodstream bloodstream brain Neisseria meningitidis

42. 42 second most common meningitis second most common meningitis – pneumococcus, most common fatal if untreated fatal if untreated responds well to antibiotic therapy responds well to antibiotic therapy – penicillin Meningococcal meninigitis

43. 43 Laboratory Diagnosis spinal fluid – Gram negative diplococci within polymorphonuclear cells within polymorphonuclear cells – meningococcal antigens Culture Culture – Thayer Martin agar

44. 44 capsule capsule – inhibit phagocytosis anti-capsular antibodies anti-capsular antibodies – stop infection antigenic variationantigenic variation – sero-groups vaccine vaccine –multiple sero-groups Capsule