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micro sprirochetes


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Treponema pallidllm and syphilis
A. One of the major sexually transmitted diseases worldwide
B Associated with lower socioeconomic status
Primary syphilis
-how long after exposure
Occurs 3-4 weeks after exposure
-Consists of a skin lesion called a chancre. Shallow ulcer with raised edges that is soft and painless. Usually occurs in the genital area, but can be in other locations including the lip, oral mucosa, and rectum. Ulcer lasts 1- 5 weeks and heals
Secondary syphilis
-6-8 weeks after exposure (up to 6 months)
-Consists of generalized rash and systemic flu-like illness. The rash is called a papulosquamous rash with discrete lesions a few millimeters up to 1 cm in diameter that have a scaly surface. This rash includes the palms and soles. Patients may also experience fever, myalgias, arthralgias, headache, hair loss, and mucous patches in the mouth and on genitalia during this stage. This stage also spontaneously resolves after 1-2 weeks.
Early latent syphilis

-after secondary syphilis and lasts up to 4 years. There are no symptoms, but tests for syphilis will be positive
Late (tertiary) syphilis
-how many will have active disease
-late benign disease
-2 other serious problems
-4-20 years after exposure . Only 1/3 of untreated patients will have active disease.
- infiltrative process with proteinaceous material in various body locations, usually superficial.
Can be disfiguring, but usually doesn't cause major illness.
- will have cardiovascular disease: inflammation of major arteries including the aorta that can lead to aortitis, aortic dissection, and rupture.
-central nervous system disease: this can be a slowly progessive meningitis, spinal cord disease that causes peripheral sensory neuropathy (tabes dorsalis), or dementia

. Direct examination: a wet prep from a chancre viewed with a darkfield
-nottreponemal serology tests
-treponemal (specific)
Nontreponemal serologic tests (VDRL, RPR). (non specific
-titer levels
- There are biologic false positive results with this test, hence a positive must be confirmed with additional testing.
-The higher the titer, the greater the likelihood that the result is a true positive. For older patients with a prior history of syphilis, a higher titer correlates with' ongoing active tertiary disease.
-when turn positive?
-what happens to non-specific tests?
-specific tests
Tests begin to turn positive 4-6 weeks after infection, hence some with primary disease will still have negative results. By secondary disease, all tests are positive. Nonspecific tests may revert to negative over time in untreated disease whether it remains active or not. Specific tests remain positive for life. Rough guidelines are:
A.Borrelia burgdorferi 1.Common illness in
-Lyme disease)
-New England, upper Atlantic coast, and upper Midwest. Rare to nonexistent in Utah
primary, secondary, tertiary
Primary disease with a rash called Erythema Chronicum Migrans (unique, has circles), a discrete red rash that increases in size over a 1-2 week period to be several centimeters in size
Secondary disease with either cardiac manifestations mostly heart block or neurological manifestations most often individual peripheral nerve palsies
Tertiary disease with arthritis
relationship bw primary/secondary
-duration of entire illness
Of patients with primary disease: 10-20% will have secondary disease; of those with secondary disease 10- 20% will have tertiary disease. The entire clinical illness rarely lasts longer than I year
Diagnosis is
-by clinical history that includes appropriate rash, tick exposure, and serology
B. Borrelia recurrentis (relapsing fever)
-world vs. US
-clinical illness
1 Endemic in other parts of the world, not U.S.
2 Transmitted to humans by ticks or lice
3 Clinical illness is characterized by relapsing fever: patient has shaking chills and high fever for 3-5 days, feels well for 4-10 days, then experiences the fever again. Relapses correlate with changes in the surface protein of the organism to the extent that the body believes it is a new infection.

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