SPIROCHETES

SYPHILIS

• Sexually transmitted (enters the body by penetrating intact mucous membranes or by invading through epithelial tissues).
• Skin contact (with an ulcer infected with the bacteria).

(3) PRIMARY SYPHILIS, SECONDARY SYPHILIS, . TERTIARY SYPHILIS

CHANCRE

• Primary lesions of syphilis.
• Erupts at the site of inoculation, 3 to 6 weeks after initial contact.
• Firm, ulcerated, painless lesion with a punched-out base and rolled edge.
• Highly infectious.
• Non-suppurative
• Accomapanied with bilateral, non-tender lymph node swelling.
• Resolves over 4 to 6 weeks without a scar.

: Penicillin (drug of choice)

Jarisch-Herxheimer Reaction: Due to antigens released by dead T. pallidum →
neutropenia, hypotension

BACTEREMIC STAGE

→ The spirochete multiply and spread via the blood
throughout the body.
→ 6 weeks after the primary chancre has healed

• Widespread rash (small, red, macular lesions, symmetrically
distributed over the body.
• Generalized lymphadenopathy
• CONDYLOMA LATUM
• Rash and Condyloma lata resolves over 6 weeks

→ Painless, wart-like lesions.
→ Occurs in warm, moist sites like the vulva or scrotum
→ Packed with spirochetes, ulcerates and is extremely
contagious.

→ Features of secondary syphilis have resolved.
→ Most patients (2/3) will remain asymptomatic. Others (1/3) who are untreated will progress to tertiary syphilis.
→ 25% of patients may have relapse of secondary syphilis.
→ After 4 years, there are generally no more relapses; patient is considered non-infectious (except pregnant women).

GUMMATOUS SYPHILIS
CARDIOVASCULAR SYPHILIS
NEUROSYPHILIS

→ Localized granulomatous lesions (fibrotic and necrotic)
→ Resolves with antimicrobial therapy

→ Aneurysm in the ascending aorta
→ Not reversed with antimicrobial therapy

CONGENITAL SYPHILIS

Placental transmission

→ High mortality rate
→ T. pallidum does not damage the fetus until the fourth month of
gestation, so treating the mother with antibiotic therapy prior to this time
can prevent congenital syphilis.

• Intrauterine death
• CONGENITAL ABNORMALITIES AT BIRTH

o Hutchinson’s triad:
Hutchinson’s teeth, Interstitial keratitis, CN VIII deafness
o Saber shin
o Scaphoid scapula
o Saddle nose

LEPTOSPIROSIS

1. ANICTERIC LEPTOSPIROSIS
2. ICTERIC LEPTOSPIROSIS

• High fever
• HA, malaise
• Muscle ache

Aka: Weil’s Disease
• Meningitis
• Liver and renal failure

PROPHYLAXIS: Doxycycline 200 mg OD x 3-5 days
TREATMENT: Full course of Doxycycline

→ Biggest bacteria

LYME DISEASE

White-footed mouse/ White-tailed deer

Ixodes tick (Ixodes scapularis)

1. Early Localized Stage
2. Late Disseminated Stage

ECM (Erythema Chronicum Migrans)

Skin: ECM → multiple lesions
Neurologic: Bell’s palsy, peripheral neuropathies
Cardiovascular: AV block
Joint pain—arthritis

RELAPSING FEVER

Endemic form → Vector: Body louse (Pediculus humanus)
Host: Human