SPIROCHETESSPIROCHETES

Treponema, Borrelia Treponema, Borrelia andand LeptospiraLeptospira

SpirochetesSpirochetes

• Gram negativeGram negative• Long, thin, helical, motileLong, thin, helical, motile

• axial filaments axial filaments – locomotionlocomotion– between peptidoglycan layer/outer membrane between peptidoglycan layer/outer membrane

* runs parallelruns parallel

SpirocheteSpirochete

spirochaetaceae leptospiraceaespirochaetaceae leptospiraceae

cristispira cristispira leptonemaleptonema serpulina serpulina leptospiraleptospira spirochaetaspirochaeta treponematreponema borrelia borrelia

TreponemaTreponema T.pallidum T.carateumT.pallidum T.carateum

subsp.pallidumsubsp.pallidum subsp.endemicum subsp.endemicum subsp.pertenuesubsp.pertenue

Histology: Histology: Treponema pallidumTreponema pallidum - testis infected rabbit- testis infected rabbit

Treponema pallidumTreponema pallidum

• transmissiontransmission – genital/genital genital/genital – in uteroin utero or during birth or during birth

0.1-0.2 0.1-0.2 x 6-15um; 8-14 x 6-15um; 8-14 small, regular spirals; small, regular spirals; actively motileactively motile..

syphilissyphilis After initial infection, a primary chancre (an area of After initial infection, a primary chancre (an area of

ulceration/inflammation) is seen in genital areas or elsewhere ulceration/inflammation) is seen in genital areas or elsewhere within 10-60 days. The organism, meantime, has penetrated and within 10-60 days. The organism, meantime, has penetrated and systemically spread. systemically spread.

The patient has flu-like symptoms with secondary lesions The patient has flu-like symptoms with secondary lesions particularly affecting the skin . These occur 2-10 weeks later. particularly affecting the skin . These occur 2-10 weeks later.

The final stage (if untreated) is tertiary syphilis (several years The final stage (if untreated) is tertiary syphilis (several years later). In primary and secondary syphilis organisms are often later). In primary and secondary syphilis organisms are often present in large numbers. However, as the disease progresses present in large numbers. However, as the disease progresses immunity controls bacterial replication and fewer organisms are immunity controls bacterial replication and fewer organisms are seen. It is extremely difficult to detect spirochetes in tertiary seen. It is extremely difficult to detect spirochetes in tertiary syphilis. The systemic lesions of skin, central nervous system and syphilis. The systemic lesions of skin, central nervous system and elsewhere are suggestive of a delayed hypersensitivity reaction. elsewhere are suggestive of a delayed hypersensitivity reaction.

SyphilisSyphilis chronicchronic slowly progressiveslowly progressive

Primary stagePrimary stage•• 10 10 to 60 days to 60 days •• primary lesion primary lesion -- chancre chancre •• area of area of

ulceration/ inflammationulceration/ inflammation•• many organismsmany organisms•• rich in rich in TPTP•• a predominance of a predominance of

lymphocytes and plasma cellslymphocytes and plasma cells•• hard chancrehard chancre硬下疳•• infectious highlyinfectious highly•• heal spontaneouslyheal spontaneously

Secondary stageSecondary stage Secondary (2Secondary (2--10 10

weeks weeks after primary after primary stagestage))•• systemic spread systemic spread •• fluflu--like symptomslike symptoms•• skin, particularlyskin, particularly•• many organismsmany organisms

rich in rich in TPTP red red maculopapularmaculopapular

rash anywhere on the rash anywhere on the bodybody

infectious highlyinfectious highly subside spontaneouslysubside spontaneously

Tertiary stageTertiary stage Tertiary Tertiary

•• several years laterseveral years later•• rarerare•• skin, skin, •• central nervous system central nervous system •• delayed hypersensitivity delayed hypersensitivity •• few organismsfew organisms•• control by immune control by immune

responseresponse 33--5 years after infection5 years after infection few few TPTP granulomatousgranulomatous lesions in lesions in

skin,bone, and liverskin,bone, and liver degenerative changes in degenerative changes in

the central nervousthe central nervous cardiovascular lesionscardiovascular lesions

3w

2y

Congenital syphilisCongenital syphilis Interstitial keratitisInterstitial keratitis 角膜炎 Hutchinson’s teeth Hutchinson’s teeth SaddlenosemaSaddlenosema 马马鞍鼻 PeriostitisPeriostitis 骨膜炎 A variety of central nervous system A variety of central nervous system

anomaliesanomalies

Microbiological diagnosisMicrobiological diagnosis• not culturablenot culturable• dark field microscopydark field microscopy

– actively motile actively motile organisms organisms

– brightly lit against brightly lit against dark backdropdark backdrop

– light shines at an light shines at an angle angle

– reflected from thin reflected from thin organisms organisms

• conventional light conventional light microscopymicroscopy– light shines throughlight shines through– NOT visualized NOT visualized

screening methodscreening methodantibodies to cardiolipin

specific diagnosisspecific diagnosisantibodies to treponemal antigen

fluorescence microscopyantibody staining

PCR

Autoimminty: Autoimminty: cardiolipin/self antigencardiolipin/self antigen no vaccine no vaccine antibiotics antibiotics (e.g. penicillin)(e.g. penicillin)

– effective effective

Other treponemal diseasesOther treponemal diseases bejelbejel 地方性梅毒地方性梅毒 yaws yaws 雅司雅司 pintapinta 品他病品他病

Borrelia burgdorferiBorrelia burgdorferi and Lyme disease and Lyme disease

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

LymeLyme Disease Disease erythematouserythematous rashrash

LymeLyme disease disease -- symptomssymptoms

•• bacteremia bacteremia –– acuteacute

•• arthritisarthritis•• cardiaccardiac•• neurologicneurologic

–– chronic chronic ** weeks, months laterweeks, months later

• acuteacute–– responds to antibioticresponds to antibiotic––antibodies not detectableantibodies not detectable

•• late diagnosislate diagnosis–– not curablenot curable–– antibodies detectableantibodies detectable

Lyme DiseaseLyme Disease - - etiologyetiology

• reactive arthritis similar to reactive arthritis similar to – Reiter's syndromeReiter's syndrome– rheumatic feverrheumatic fever

• resembles rheumatoid arthritis.resembles rheumatoid arthritis.

B . Recurrentis and Relapsing feverB . Recurrentis and Relapsing fever

• immune response develops disease immune response develops disease relapsesrelapses• new antigens expressednew antigens expressed • no immunity : disease reappearsno immunity : disease reappears• transmissiontransmission

–tick-tick-B. hermsiiB. hermsii* rodent hostrodent host– lice-lice-B. recurrentisB. recurrentis * human hosthuman host

DiagnosisDiagnosis• serum antibodies to serum antibodies to B. burgdorferiB. burgdorferi.

• laboratory strainslaboratory strains– grow extremely slowly grow extremely slowly – tissue culture media tissue culture media –patient body fluids/tissue samplepatient body fluids/tissue sample

TherapyTherapy

• early antibiotic therapyearly antibiotic therapy– curable curable * penicillin penicillin * tetracyclinetetracycline

• late antibiotic administrationlate antibiotic administration– ineffectiveineffective

LeptospirosisLeptospirosis

• symptomssymptoms–flu-like flu-like –severe systemic diseasesevere systemic disease

* kidneykidney* brain brain * eyeeye

LeptospirosisLeptospirosis

MorphologyMorphology 0.1-0.2 x 6-0.1-0.2 x 6-20um; fine 20um; fine coiling, one or coiling, one or both ends are both ends are usually usually hooked; deep hooked; deep brown color brown color stained with stained with silver silver impregnation impregnation stain (Fontana stain (Fontana stain), Gram-stain), Gram-negative.negative.

• infected urine infected urine – rodentsrodents– farm animalsfarm animals

• water water

• through broken skin.through broken skin.

TransmissionTransmission

EpidemiologyEpidemiology

worldwide zoonosis

animal hosts: rats,mice,wild rodents,dogs,swine,and cattle

Human is accidental

EpidemiologyEpidemiology

EE

E

EE

E

E

EE

E E

E

E

E

E

湖北省安徽省

江苏省

浙江省

福建省江西省湖南省

台湾省广东省广西壮族自治区

贵州省

河南省山东省

天津市

海南省

北京市河北省山西省

陕西省

宁夏回族自治区

四川省

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云南省

甘肃省

青海省西藏自治区

新疆维吾尔自治区辽宁省

吉林省

黑龙江省

内蒙古自治区

中华人民共和国地图

E$paddy planting areaLeptospirosis area

23/4/2323/4/23

PathogenicityPathogenicity

Multiply in kidney and liver.

Shed in the urine for life long of animal.

Damage to the capillary endothelium is the main cause

Laboratory DiagnosisLaboratory Diagnosis• serologyserology• most readily culturable of spirochetes most readily culturable of spirochetes

– culture still extremely difficult culture still extremely difficult