Transcript 07. SYPHILIS

SYPHILIS
Causative Organism – Treponema pallidum
Characteristics of Treponema pallidum
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Spirochaetes or spiral organisms, they are motile,
slender.
Do not grow in artificial medium (some
treponema are part of the normal oral flora e.g.
T.denticulc)
Cannot be seen by light microscopy because they
are very thin (0.15 μm), long 5-15 μm.
Note: Does not stain with gram stain
Causative Organism – Treponema pallidum
Characteristics of Treponema pallidum
(Continued)
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Can be seen by
 Dark field microscopy, by
 Phase contract technique
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Can be stained by
 Silver impregnation
 Fluorescent antibody technique
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Sensitive to penicillin
They can be propagated by inoculation in rabbits
in testes and anterior chamber of eye.
Causative Organism – Treponema pallidum
Characteristics of Treponema pallidum
(Continued)
Treponema
Pathogenic
Pathogenic
Non-pathogenic
Non-venereal disease
by direct contact
T.pallidum
Syphilus
Oral commensals
T. Denticula
T.macrodentium
T.microdentium
T.Pertenue T. carateum T.pallidum
A sexually
transmitted disease
Yaws
Pinta
Bejal
Mode of Transmission
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Direct sexual contact (90 – 96%)
Blood transfusion
Via placenta from infected pregnant mother
faetus
causes congenital syphilis.
Contact
accidental contact E.g. Medical personnel.
Source of T. pallidum: Primary and secondary syphilis lesions.
Causative Organism:
Treponema pallidum is the
causative organism of syphilis.
Syphilis can be Acquired
Congenital
Clinical Features of Syphilis / Symptoms and signs of Acquired syphil
Syphilis is a sexually transmitted disease / a venereal disease
Incubation Period: 10 – 90 days (average – 21 days)
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3 Stage of Syphilis:
1- Primary syphilis: Primary chancre develops after 2-10
weeks a well defined indurated painless ulcer mainly on
the genitalia (90%) and extra-genital on Lips (5-10%).
In female, chancre occurs in the cervix. The chancre is
painless and exudate is formed in the centre. This fluid
is highly infectious and examination by dark field
microscopes shows Spirochaetes. There is regional
lymphadenopathy.
 Primary chancre heals spontaneously without treatment within 38 weeks.
 Primary syphilis is highly infectious.
 Serological tests for Syphilis are positive in 80% cases.
2- Secondary Syphilis:
chancre:
After 6-8 weeks of primary
 Desseminated secondary stage develops. Muco-cutaneous lesion
occurs e.g. Skin rash, mucasal ulcers, condylomata on genitalia,
Lymphadenopathy, fever headache malaise, alopecia.
 Secondary syphilis is highly infectious
 Snal – truck mucosal ulcers in the mouth Hepatitis,
glomerulonephritis, periostitis, iridocyclitis, choroidoretinitis,
arthritis.
 Serological tests for syphilis becomes almost uniformly positive.
Secondary Stage may follows by the following:
a)
b)
c)
d)
Cured spontaneously
Early latent
Late Latent
Tertiary stage
Latent Stage:
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After the secondary syphilis symptoms subsides, the
disease enters a latent stage.
After about 2 years, the syphilis is NOT normally
infectious, except from mother to the foetus.
3- Tertiary Syphilis:
After 2-20 yrs, tertiary stage
develops
produces
Gummatous Lesions in perforation
of the palate (Roof of the mouth)
which interferes with speech
Skin
Bone
Joints
Charcoat’s joints
 Cardiovascular System
E.g.
(a) Aortic aneurism
(b) Aortic valve incompetence
Central Nervous System: Neurosyphilis
E.g. a) Tabes dorsalis
b) General paralysis of insane
c)
Tertiary stage is not infectious.
Meningovascular sympilis
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Congenital Syphilis: most distressing and dangerous
form of Syphilis.
Early Congenital syphilis:
a) Skin: rash
maculopapular rash
b) Mucosal Lesion: Mucocutaneous lesions
c) Hepatospleenomegaly
d) Lymphadenopathy
Late Congenital Syphilis:
a)
b)
c)
d)
d)
Hutchinson’s teeth (Notching of the incisor teeth)
Mulberry molars, Moon’s molars
Sadle nose
Sabre shin (tibia)
Interstitial keralitis, blindness
f)
g)
h)
i)
Deafness
Bone sclerosis, Arthritis
Juvenile general paralysis of insane
Damage of Mental development and other neurological
symptoms.
j) Stillbirths
Laboratory of Syphilis
1- Dark ground microscopy
to
demonstrate,
Spirochaetes
T. pallidum in fluid or exudate from
lesions of primary and secondary syphilis.
a) Primary Syphilis
exudate from chancre
b) Secondary syphilis
mucous path
exudate
taken for dark ground microscopy.
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Direct immunofluorescent microscopy can be used.
Laboratory of Syphilis (Continued)
2- Serological tests for Syphilis for all stages
A. Non-specific Tests
B. Specific Tests
(for non-treponemal)
(for non-treponemal
or reagin antibody)
(Ag used is cardiolipin)
1- VDRL (Venereal Disease
Research Laboratory)
2- RPR (Rapid Plasma reagin)
3- WR (Wasserman Reaction)
(Ag used is Treponemal antigen)
1- FTA – ABS Test (Florescent
Treponemal Antibody Absorption)
2- TPHA (Treponema pallidum
Haemagglutination.
3- TPI (Treponema pallidum immobilization)
Congenital Syphilis
Baby’s blood IgM –FTA-ABS TEST
Serological Tests for Syphilis (With Interpretation)
Stage of disease
VDRL
TPHA
No Past or
Present Infec.
No Past /present Infection
Primary (Early)
Primary (Late)
Or
Secondary + Tertiary
Latent
Treated syphilis
(had infection before)
FTA-ABS
Or
(Active
Syphilis).
(Active
Syphilis).
(Active Syphilis)
in secondary
syphilis.
Serological Tests for Syphilis (With Interpretation)
(Continued)
Stage of disease
VDRL
TPHA
FTA-ABS
Biological false positive
(No Infection by T. pallidum)
Congenital syphilis*
* Early primary syphilis – FTA – ABS
Positive
* After successful treatment – VDRL
Negative
Note: FTA – ABS after successful
treatment remains positive for life
But FTA – ABS + TPHA
Remain positive
* V.D.R.L.
is used to see efficacy (effect) of treatment . After successful
treatment V.D.R.L. becomes negative.
Serological Tests for Syphilis (With Interpretation)
(Continued)
Treatment of syphilis :
* Penicillin is the drug of choice
Primary:
* Penicillin for 15 days.
Secondary and Tertiary syphilis : Penicillin for 21 days usually followed by 10
injection at weekly intervals.
Note:
Spirochetes are spiral motile bacteria. Their motility is due to contractile axial
fibers run along the bacterial cell.
Spirochetes (spiral bacteria)
Borrelia
Treponema
Borrelia recurrentis
Leptospira
Borrelia vincenti
Pathogenic genera of spirochaetes are : * Borrelia, * Leptaspira, * Treponema
Borrelia recurrentis
Source : Rodents
Disease : • Epidemic Louse borne relapsing fever
• Endemic Louse borne relapsing fever
Treatment:
Tetracycline
Spirochetes (Spiral bacteria) (Continued)
Borrelia vincenti : Gram –ve irregular spiral bacteria
Culture : Strict anaerobic bacteria, difficult to culture.
* Serum enriched media used
Anaerobic culture
Laboratory diagnosis : Mainly by Microscopic Examination of Gram stained smear only
Disease : Borrelia vincenti and Fusobacterium species together produce:
• Vincent’s angina (Pharynigitis)
or
Acute necrotizing ulcerative gingivitis
• Gingivo - Stomatitis
• Sore Throat
Treatment :
• Penicillin or Metronidazole
• Oral hygiene