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1 Spirochetes Spiral , motile organism, 3 genera are pathogenic to man 1. Trepanoma syphilis , yaws and pinta 2. Borrelia Relapsing fever and lyme disease 3. Leptospira Leptospirosis 2 Trepanoma e.g. Trepanoma pallidum Syphilis Morphology Spiral filaments , motile Seen by dark-field microscopy Stained by immune fluorescence Cultural character Not cultured 3 Syphilis Sexually transmitted disease (venereal disease) , it has 3 stages 1. Primary stage (chancre): 6-12 weeks after exposure Ulceration of genitalia papule 2. Secondary stage 6-12 weeks after appearance of chancre Characterized by generalized manifestation e.g skin rash Condylomata of anus and vulve and mucous patches in the mouth T. pallidum found in large number in the lesion of both stages 4 3. Tertiary stage:- if not treated Appearance of gummata in the internal organs years after infection General paralysis Diagnosis: 1. Detection of spirochetes in the lesion: lesion exudates examined by : a. Dark field microscopy b. Direct IF stain antitrepanomal Abs labeled 5 2. Serological Diagnosis to detect antigen, the most common serological test: a. Venereal disease research laboratory (VDRL) b. Rapid plasma Region (RPR) a&b are not specific test and may give false positive result in case of e.g. autoimmune disease. c. Flourescent trepanomal antibody (FTA) test: indirect IF test in which patient serum is layered on killed trepanoma incubation fixed then on slide – flourescein labeled anti-human gamma globulin is added wash positive or negative. It is very sensitive test and specific 6 d. Trepanoma pallidum haemagglutination (TPHA) test: depend on the ability of Abs in syphilitic patient sera to bring agglutination of sheep RBCs coated with extract of T. pallidum. This test is specific and easy to use. Treatment: Penicillin is a drug of choice 7 Borrelia Cause Relapsing fever and lyme disease Large spiral , stained with gram stain (Gram negative) Cultured in fluid media containing blood or serum. Relapsing fever Transmitted by lice or ticks Rodent are the reservoir Causative agent Borrelia recurrentis Characterized by repeated attack of fever, alternating with period of apyrexia 8 Pathogenicity Lice /tick infected by feeding of patient / rodent blood during bacteremia stage ↓ Borrelia multiplies in insect body ↓ Infection transmit by insect bite ↓ Incubation 3-10 days ↓ Sudden onset of fever for 4 days ↓ Afebrile 3-10 days ↓ Another attack of fever ↓ Organism found in large numbers in blood during febrile stage 9 Diagnosis 1. During Febrile stage blood film stained with leishman's stain / Giemsa stain large number of spirochetes 2. During afebrile stage the organism is scanty in blood and blood film negative Treatment: Penicillin 10 Lyme disease Caused by Borrelia Burgdorferi Transmitted to human by tick bite Rodent is the animal reservoir Disease characterized by early and late Stage: 1. Early stage Skin lesion, fever, chills , muscle pain and headache 2. Late stage appear week/month later arthritis , myocarditis, neurological disorder 11 Diagnosis 1. PCR to detect DNA of B. burgdofferi in CSF, joint fluid 2. Serology (IgM) or high titer IgG Treatment : penicillin and tetracycline.