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Premium member Presentation Transcript SPIROCHETES: SPIROCHETES Dr.T.V.Rao MD Dr.T.V.Rao MD 1Spirochetes: Spirochetes Spirochetes -are elongated motile, flexible bacteria twisted spirally along the long axis are termed spirochetes Contain – endoflegalla which are polar flagella wound along the helical protoplasmic cylinder and situated between the outer membrane and cell wall Dr.T.V.Rao MD 2PowerPoint Presentation: Order : Spirochaetales Family : Spirochaetaceae Genus : Trepanoma Borrelia Family : Leptospiraceae Genus : Leptospira Taxonomy Dr.T.V.Rao MD 3Human pathogen: Human pathogen Genera Trepanoma Borreilia Leptospira Dr.T.V.Rao MD 4How they appear : How they appear Dr.T.V.Rao MD 5What are Trepanoma : What are Trepanoma Trepos – Turn Nema Meaning thread Relatively short and slender With fine spirals pointed and round ends May be pathogenic or commensals in the mouth Dr.T.V.Rao MD 6PowerPoint Presentation: Genus Species Disease Treponema pallidum ssp. pallidum pallidum ssp. endemicum pallidum ssp. pertenue carateum Syphilis Bejel Yaws Pinta Borrelia burgdorferi recurrentis Many species Lyme disease (borreliosis) Epidemic relapsing fever Endemic relapsing fever Leptospira interrogans Leptospirosis (Weil’s Disease) Spirochaetales Associated Human Diseases Dr.T.V.Rao MD 7Venereal Syphilis : Venereal Syphilis Venereal Syphilis caused by T.pallidum Endemic syphilis T. pallidum Yaws T.pertune Pinta T.carateum Dr.T.V.Rao MD 8Discovery “Everything” happened mostly in Germany from 1905 to 1910 ! With a short life of 35 years, Fritz Schaudinn (1871-1906) and Paul E. Hoffmann (1868-1959) discovered Treponema pallidum in serum in 1905. : Discovery “Everything” happened mostly in Germany from 1905 to 1910 ! With a short life of 35 years, Fritz Schaudinn (1871-1906) and Paul E. Hoffmann (1868-1959) discovered Treponema pallidum in serum in 1905. Paul Ehrlich, father of immunochemistry and his assistent Hati. Fritz Schaudinn Dr.T.V.Rao MD 9Syphilis: Syphilis Named from poem published by the Italian physician and poet Girolamo Fracastoro – shepherd from Hispaniola named Syphilis who angered Apollo and was given the disease as punishment Dr.T.V.Rao MD 10Syphilis : Dr.T.V.Rao MD 11 Syphilis "He who knows syphilis, knows medicine" Sir William OslerTreponema pallidum: Treponema pallidum Described in 1905 by Schaudinn and Hoffman, Hamburg Dr.T.V.Rao MD 12Trepanoma pallidum Greek words trepo “turning” & nema “head”: Trepanoma pallidum Greek words trepo “turning” & nema “head” Morphology Motile, sluggish in viscous environments Size: 5 to 20 μ m in length & 0.09 to 0.5 μ m in diameter, with tapered ends Structure Multilayer cytoplasmic membrane Flagella-like fibrils Cell wall Outer sheath (outer cell envelope) Capsule-like outer coat Dr.T.V.Rao MD 13Treponema pallidum. : Treponema pallidum . Spiral spirochete that is mobile of spirals varies from 4 to 14 Length 5 to 20 microns and very thin 0.1 to o.5 microns. Can be seen on fresh primary or secondary lesions by dark field microscopy or fluorescent antibody techniques Dr.T.V.Rao MD 14General Overview of Spirochaetales: General Overview of Spirochaetales Gram-negative spirochetes Spirochete from Greek for “coiled hair” Extremely thin and can be very long Tightly coiled helical cells with tapered ends Motile by Periplasmic flagella (a.k.a., axial fibrils or endoflegalla) Dr.T.V.Rao MD 15General Overview of Spirochaetales: General Overview of Spirochaetales Outer sheath encloses axial fibrils wrapped around protoplasmic cylinder Axial fibrils originate from insertion pores at both poles of cell May overlap at centre of cell in Treponema and Borrelia, but not in Leptospira Differing numbers of endoflegalla according to genus & species Dr.T.V.Rao MD 16Trepanoma palladium: Trepanoma palladium Physiology Difficult to culture Maintained in anaerobic medium with albumin, sodium bicarbonate, pyruvate, cysteine Microaerophilic Dr.T.V.Rao MD 17PowerPoint Presentation: Cross-Section of Spirochete with Periplasmic Flagella NOTE : a.k.a., endoflegalla , axial fibrils or axial filaments. (Outer sheath) Cross section of Borrelia burgdorferi Dr.T.V.Rao MD 18Staining with special stains : Staining with special stains Staining by Giemsa and Fontana Dr.T.V.Rao MD 19Antigenic structure: Antigenic structure The Antigens are complex Infection with Treponema will induce 3 types of Antigens Reagin Antibodies – STS Detected by Standard tests for Syphilis 1 Wasserman Test, 2 Kahn Test VDRL Test Dr.T.V.Rao MD 20Beef Heart Extracts - Antigen: Beef Heart Extracts - Antigen Lipid Hapten – Cardiolipin Chemically Dipphostidyl glycerol Cardiolipin present in the Trenonems ? Or a product of tissue Damage ? Dr.T.V.Rao MD 21Second Group Antigen T.pallidum: Second Group Antigen T.pallidum Present in T.pallidum and Non pathogenic cultivable treponemes Reiter's Trenonems Dr.T.V.Rao MD 22Third Antigen: Third Antigen Polysaccharide species specific Positive only in sera of patients infected with pathogenic Treponema Dr.T.V.Rao MD 23Dark field Microscopy: Dark field Microscopy Dr.T.V.Rao MD 24Treponema cannot be cultivated in Culture Media: Treponema cannot be cultivated in Culture Media The inability to grow most pathogenic Treponema in vitro, coupled with the transitory nature of many of the lesions, makes diagnosis of Treponema infection impossible by routine bacteriological methods Dr.T.V.Rao MD 25Cultivation of .. ?: Cultivation of .. ? Although the Treponemes are distantly related to Gram-negative bacteria, they do not stain by Gram's method, and modified staining procedures are used. Moreover, the pathogenic Treponemes cannot be cultivated in laboratory media and are maintained by subculture in susceptible animals . Dr.T.V.Rao MD 26Trepanoma pallidum: Trepanoma pallidum Clinical Infection: Syphilis Transmission Usually through sexual contact from an infected individual by invading intact mucous membranes or abraded skin Pathogenesis Disease of blood vessel & perivascular areas Primary lesion due to inflammation at site of inoculation Secondary lesion due to inflammation of ectodermal tissues Tertiary lesion due to diffuse chronic inflammation to organ systems Dr.T.V.Rao MD 27Trepanoma pallidum: Trepanoma pallidum Clinical Infection: Syphilis Clinical Manifestations Primary Disease Chancre : single lesion, non-tender & firm with a clean surface, raised border & reddish color Usually on the cervix, vaginal wall, anal canal Draining lymph nodes enlarged & non-tender Dr.T.V.Rao MD 28PowerPoint Presentation: Pathogenesis of T. pallidum Tissue destruction and lesions are primarily a consequence of patient’s immune response Syphilis is a disease of blood vessels and of the perivascular areas In spite of a vigorous host immune response the organisms are capable of persisting for decades Infection is neither fully controlled nor eradicated In early stages , there is an inhibition of cell-mediated immunity Inhibition of CMI abates in late stages of disease, hence late lesions tend to be localized Dr.T.V.Rao MD 29Pathology: Penetration: T. pallidum enters the body via skin and mucous membranes through abrasions during sexual contact Also transmitted transplacentally Dissemination: Travels via the lymphatic system to regional lymph nodes and then throughout the body via the blood stream Invasion of the CNS can occur during any stage of syphilis 30 Pathology Pathogenesis Dr.T.V.Rao MDPathology: The bacteria rapidly enter the lymphatic's, are widely disseminated via the bloodstream and may lodge in any organ. The exact infectious dose for man is not known, but in experimental animals fewer than ten organisms are sufficient to initiate infection. Pathology Dr.T.V.Rao MD 31Pathology: Pathology The bacteria multiply at the initial entry site forming a chancre, a lesion characteristic of primary syphilis, after an average incubation period of 3 weeks Dr.T.V.Rao MD 32STAGES OF SYPHILIS: Primary Secondary Latent Early latent Late latent Late or tertiary May involve any organ, but main parts are: Neurosyphilis Cardiovascular syphilis Late benign (gumma) Dr.T.V.Rao MD 33 STAGES OF SYPHILISBasic lesion of syphilis: Basic lesion of syphilis The chancre is painless and most frequently on the external genitalia, but it may occur on the cervix, perianal area, in the mouth or anal canal. Dr.T.V.Rao MD 34Stages of syphilis: Stages of syphilis Untreated syphilis may be a progressive disease with primary , secondary , latent and tertiary stages. T. pallidum enters tissues by penetration of intact mucosae or through abraded skin. Dr.T.V.Rao MD 35Primary syphilis : a ) One or more painless chancres (indurated raise edges & clear bases) that erupt in the genitalia, anus, nipples, tonsils or eyelids. b) Starts as papule and then erode c) Disappear after three to six weeks even without treatment. d) Lymphadenopathy that is either unilateral or bilateral Primary syphilis Dr.T.V.Rao MD 36Trepanoma pallidum: Trepanoma pallidum Clinical Infection: Syphilis Clinical Manifestations Latent disease Early latent (1 st 4 years) No signs & symptoms of active syphilis but remain seroactive Late latent (after 4 years) If untreated, 60% continue to be asymptomatic while 40% progress to tertiary stage Dr.T.V.Rao MD 37Pathology: Pathology The chancre is painless and most frequently on the external genitalia, but it may occur on the cervix, peri-anal area, in the mouth or anal canal. Chancres usually occur singly, but in immunocompromised individuals, Dr.T.V.Rao MD 38Chancre: The chancre usually heals spontaneously within 3-6 weeks, and 2-12 weeks later the symptoms of secondary syphilis develop. These are highly variable and widespread but most commonly involve the skin where macular or pustular lesions develop, particularly on the trunk and extremities. The lesions of secondary syphilis are highly infectious. Chancre Dr.T.V.Rao MD 39Progress of Disease: Relapse of the lesions of secondary syphilis is common, and latent syphilis is classified as early (high likelihood of relapse) or late (recurrence unlikely). Individuals with late latent syphilis are not generally considered infectious, but may still transmit infection to the fetus during pregnancy and their blood may remain infectious. Progress of Disease Dr.T.V.Rao MD 40Trepanoma pallidum: Trepanoma pallidum Clinical Infection: Syphilis Clinical Manifestations Primary Disease Chancre : single lesion, non-tender & firm with a clean surface, raised border & reddish color Usually on the cervix, vaginal wall, anal canal Draining lymph nodes enlarged & non-tender Dr.T.V.Rao MD 41PRIMARY SYPHILIS (The Chancre): Incubation period 9-90 days, usually ~21 days. Develops at site of contact/inoculation. Classically: single, painless, clean-based, indurated ulcer, with firm, raised borders. Atypical presentations may occur . Mostly anogenital, but may occur at any site (tongue, pharynx, lips, fingers, nipples, etc...) Non-tender regional adenopathy Very infectious. May be darkfield positive but serologically negative. Untreated, heals in several weeks, leaving a faint scar. PRIMARY SYPHILIS (The Chancre) Dr.T.V.Rao MD 42Primary Syphilis: Primary Syphilis Dr.T.V.Rao MD 43Primary Syphilis- Penile Chancre: Primary Syphilis- Penile Chancre 44 Clinical Manifestations Source : CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides Dr.T.V.Rao MDPrimary Syphilis: Primary Syphilis Dr.T.V.Rao MD 45Primary Syphilis - Chancre: Primary Syphilis - Chancre Dr.T.V.Rao MD 46Primary Syphilis - Chancre: Primary Syphilis - Chancre Dr.T.V.Rao MD 47PowerPoint Presentation: Secondary disease 2-10 weeks after primary lesion Widely disseminated mucocutaneous rash Secondary lesions of the skin and mucus membranes are highly contagious Generalized immunological response Pathogenesis of T. pallidum (cont.) Secondary Syphilis Dr.T.V.Rao MD 48Treponema pallidum: Treponema pallidum Clinical Infection: Syphilis Clinical Manifestations Tertiary Disease Gummas (3-10 years after secondary disease) Non-progressive, localized dermal lesions Benign tertiary syphilis Pronounced immunologic host reaction Neurosyphilis (>5 years after primary disease) Paralytic dementia, tabes dorsalis, amyotropic lateral sclerosis, meningovascular syphilis, seizures, optic atrophy, gummatous changes of the cord Dr.T.V.Rao MD 49Secondary Syphilis: Secondary Syphilis Secondary syphilis at 6-8 weeks – diffuse symptoms: Fever Headache Skin pustules Usually disappears even without treatment Dr.T.V.Rao MD 50Treponema pallidum: Treponema pallidum Clinical Infection: Syphilis Clinical Manifestations Congenital Syphilis Transplacental infection of the developing fetus Abortion occurs during 2 nd trimester of pregnancy Early symptoms: Hepatosplenomegaly, jaundice, hemolytic anemia, pneumonia, multiple long bone involvement, snuffles, skin lesions, testicular masses Dr.T.V.Rao MD 51Treponema pallidum: Treponema pallidum Clinical Infection: Syphilis Clinical Manifestations Congenital Syphilis Late symptoms: Frontal bossae of Parrott, Short maxilla, high palatal arch, Hutchinson’s triad (Hutchinson’s teeth, Interstitial keratitis, eighth-nerve deafness), saddle nose, mulberry molars, Higoumenakis sign, relative protruberance of mandible, rhagades, saber shin, scaphoid scapulas, Clutton’s joint) Dr.T.V.Rao MD 52Secondary Syphilis: Secondary Syphilis Dr.T.V.Rao MD 53PowerPoint Presentation: Secondary disease 2-10 weeks after primary lesion Widely disseminated mucocutaneous rash Secondary lesions of the skin and mucus membranes are highly contagious Generalized immunological response Pathogenesis of T. pallidum (cont.) Secondary Syphilis Dr.T.V.Rao MD 54Secondary Syphilis: Secondary Syphilis Dr.T.V.Rao MD 55Secondary Syphilis: Secondary Syphilis Dr.T.V.Rao MD 56Secondary syphilis: Secondary syphilis Dr.T.V.Rao MD 57Tertiary Syphilis: Affects 2/3 of untreated cases Gummata : rubbery tumors Bone deformities Blindness Loss of coordination Paralysis Insanity Tertiary Syphilis Dr.T.V.Rao MD 58PowerPoint Presentation: Following secondary disease, host enters latent period First 4 years = early latent Subsequent period = late latent About 40% of late latent patients progress to late tertiary syphilitic disease Pathogenesis of T. pallidum (cont.) Latent Stage Syphilis Dr.T.V.Rao MD 59PowerPoint Presentation: Tertiary syphilis characterized by localized granulomatous dermal lesions (gummas) in which few organisms are present Granulomas reflect containment by the immunologic reaction of the host to chronic infection Pathogenesis of T. pallidum (cont.) Tertiary Syphilis Dr.T.V.Rao MD 60Neurosyphilis : Neurosyphilis Late Neurosyphilis develops in about 1/6 untreated cases, usually more than 5 years after initial infection Central nervous system and spinal cord involvement Dementia, seizures, wasting, etc. Cardiovascular involvement appears 10-40 years after initial infection with resulting myocardial insufficiency and death Dr.T.V.Rao MD 61Latent Syphilis: Latent syphilis a) Reactive serologic test b) Asymptomatic until death Late syphilis Three subtypes of Late syphilis Late, benign syphilis *Develops between 1 to 10 years after the infection *Presence of gumma Latent Syphilis Dr.T.V.Rao MD 62PowerPoint Presentation: Dr.T.V.Rao MD 63Mother to Child Transmission: Mother to Child Transmission Infection in utero may have serious consequences for the fetus. Rarely, syphilis has been acquired by transfusion of infected fresh human blood. Dr.T.V.Rao MD 64PowerPoint Presentation: Congenital syphilis results from trans placental infection T. pallidum septicemia in the developing fetus and widespread dissemination Abortion, neonatal mortality, and late mental or physical problems resulting from scars from the active disease and progression of the active disease state Pathogenesis of T. pallidum (cont.) Congenital Syphilis Dr.T.V.Rao MD 65Treponema pallidum and Immunity: Treponema pallidum and Immunity Clinical Infection: Syphilis Immunity Syphilis has persistent infection for decades in spite vigorous host response due to: Dense coat (with fibronectin, transferrin, cerruloplasmin) Evasion from PMN detection Inhibition of cell-mediated immunity Relative but unreliable protection from reinfection in untreated patients Minor protection from reinfection in treated patients Dr.T.V.Rao MD 66Congenital Syphilis: Passed from mother to fetus during pregnancy Abnormally shaped teeth Nasal septum collapses Skeletal abnormalities Congenital Syphilis Dr.T.V.Rao MD 67DIAGNOSIS OF SYPHILIS: 1. History and clinical examination. 2. Dark-field microscopy: special technique use to demonstrate the spirochete as shiny motile spiral structures with a dark background. The specimen includes oozing from the lesion or sometimes L.N. aspirate. It is usually positive in the primary and secondary stages and it is most useful in the primary stage when the serological tests are still negative. DIAGNOSIS OF SYPHILIS Dr.T.V.Rao MD 68Diagnosis of syphilis : Diagnosis of syphilis Direct detection of spirochetes : Darkfield microscopy (motile bugs + experience + prompt examination) Silver stain Culture : not used Serology: non-specific and specific tests Dr.T.V.Rao MD 69Serologic Tests: Serologic Tests Reveal patients immune status not whether they are currently infected Use lipoidal antigens rather than T. pallidum or components of it; non-treponemal antigen tests RPR; rapid plasma reagin VDRL; Venereal Disease Research Laboratory Dr.T.V.Rao MD 70Treponema pallidum: Treponema pallidum Laboratory diagnosis Serologic testing Nontreponemal Tests (uses Cardiolipin-lecithin as antigen) Complement-fixation tests (Wasserman & Kolmer test) Flocculation tests (Venereal Disease Research Laboratory, (VDRL), Hinton & rapid reagin tests) Dr.T.V.Rao MD 71Serologic Tests: Serologic Tests Positive within 5 to 6 weeks after infection Strongly positive in secondary phase Strength of reaction is stated in dilutions May become negative with treatment or over decades Dr.T.V.Rao MD 72Treponema pallidum: Treponema pallidum Laboratory diagnosis Serologic testing Treponemal Tests (uses syphilitic tissue as complement-fixing antigen) Reiter Protein Complement Fixation Antigen is an extract from nonvirulent treponeme (Reiter strain) Nonreactive in late stages of syphilis Dr.T.V.Rao MD 73Non-treponemal tests : Non-treponemal tests Antigen: cardiolipin (beef heart) + lecithin + cholesterol Detect nonspecific antibody (Reagin) : a mixture of IgM & IgG direct against some normal tissue antigens VDRL (Venereal Disease Research Laboratory) test for serum and CSF samples Dr.T.V.Rao MD 74Venereal Disease Research Laboratory - VDRL: Flocculation test, antigen consists of very fine particles that precipitate out in the presence of reagin. Utilizes an antigen which consists of cardiolipin, cholesterol and lecithin . Antigen very technique dependent. Must be made up fresh daily. Serum must be heated to 56 C for 30 minutes to remove anti-complementary activity which may cause false positive, if serum is not tested within 4 hours must be reheated for 10 minutes . Calibrated syringe utilized to dispense antigen must deliver 60 drops/mL +/- 2 drops. Venereal Disease Research Laboratory - VDRL Dr.T.V.Rao MD 75VDRL: VDRL Each preparation of antigen suspension should first be examined by testing with known positive or negative serum controls. The antigen particles appear as short rod forms at magnification of about 100x. Aggregation of these particles into large or small clumps is interpreted as degrees of positivity Reactive on left, non-reactive on right Dr.T.V.Rao MD 76Rapid Plasma Reagin Test - RPR: General screening test, can be adapted to automation. CANNOT be performed on CSF . Antigen VDRL cardiolipin antigen is modified with choline chloride to make it more stable attached to charcoal particles to allow macroscopic reading antigen comes prepared and is very stable. Serum or plasma may be used for testing, serum is not heated. Rapid Plasma Reagin Test - RPR Dr.T.V.Rao MD 77Treponema pallidum: Treponema pallidum Laboratory diagnosis Serologic testing Treponemal Tests (uses syphilitic tissue as complement-fixing antigen) Treponema Pallidum Immobilzation (TPI) Reaginic antibody & complement immobilize a suspension of living and motile treponemes maintained in rabbit testes & determined by darkfield microscopy Difficult, expensive, requires living organisms Positive for nonvenereal treponematoses, bejels , yaws & pinta Dr.T.V.Rao MD 78Treponema pallidum: Treponema pallidum Laboratory diagnosis Serologic testing Treponemal Tests (uses syphilitic tissue as complement-fixing antigen) Reiter Protein Complement Fixation Antigen is an extract from nonvirulent treponeme (Reiter strain) Nonreactive in late stages of syphilis Dr.T.V.Rao MD 79 Specific serological tests of syphilis : A. Reiter protein complement fixation test. B . Fluorescent Treponemal antibody/absorption test, FTA/ABS. the most specific and most sensitiv e . C. Treponema pallidum haemagglutination test- TPHA- D. Treponema pallidum immobilization test- TPI Specific serological tests of syphilis Dr.T.V.Rao MD 80Treponema pallidum haemagglutination (TPHA): Treponema pallidum haemagglutination (TPHA) Adapted to micro techniques (MHA-TP) Tanned sheep RBCs are coated with T. pallidum antigen from Nichol’s strain. Agglutination of the RBCs is a positive result. Dr.T.V.Rao MD 81Specific serological tests of syphilis : Specific serological tests of syphilis A. Reiter protein complement fixation test. B. Fluorescent Treponemal antibody/absorption test, FTA/ABS. the most specific and most sensitive . C. Treponema pallidum Haemagglutination test- TPHA- D. Treponema pallidum immobilization test- TPI Dr.T.V.Rao MD 82Treponema pallidum: Treponema pallidum Laboratory diagnosis Serologic testing Treponemal Tests (uses syphilitic tissue as complement-fixing antigen) Fluorescent Antibody Tests / Fluorescent Treponemal Antibody Absorption (FTA-ABS) Test Uses lyophilized Nichols strain organisms as antigen mixed with antitreponemal antibody (from test serum) in a slide flourescein isothiocyanate-labeled antihuman Ig –> presence of antibody determined by darkfield microscopy Used to diagnosed congenital syphilis & late stage syphilis, confirmation of nontreponemal tests Dr.T.V.Rao MD 83Fluorescent Treponemal Antibody Absorption Test (FTA-ABS): Diluted, heat inactivated serum added to Reiter’s strain of T. pallidum to remove cross reactivity due to other Treponeme s. Slides are coated with Nichol’s strain of T. pallidum and add absorbed patient serum. Slides are washed, and incubated with antibody bound to a fluorescent tag. After washing the slides are examined for fluorescence. Requires experienced personnel to read. Highly sensitive and specific, but time consuming to perform. Fluorescent Treponemal Antibody Absorption Test (FTA-ABS) Dr.T.V.Rao MD 84Positive FTA Test for Syphilis Viewed with a Fluorescent Microscope : Positive FTA Test for Syphilis Viewed with a Fluorescent Microscope Dr.T.V.Rao MD 85Serologic Tests: Serologic Tests To improve sensitivity and specificity tests using a specific treponemal antigen devised MHA-TP: microhemagglutination assay for T. pallidum FTA-ABS: fluorescent treponemal antibody absorption test All positive nontreponemal test results should be confirmed with a specific treponemal test Dr.T.V.Rao MD 86Treponema pallidum: Treponema pallidum Laboratory diagnosis Serologic testing Treponemal Tests (uses syphilitic tissue as complement-fixing antigen) Haemagglutination Tests Microhemagglutination assay –T. pallidum (MHA-TP) Dr.T.V.Rao MD 87Every Pregnant women Needs Screening: Every Pregnant women Needs Screening Dr.T.V.Rao MD 88Biologic False-Positive Test Results : Biologic False-Positive Test Results Positive STS in persons with no history or clinical evidence of syphilis Acute BFP: those that revert to negative in less than 6 months Chronic BFP: persist > 6 months Dr.T.V.Rao MD 89BFP Test Results in Syphilis: BFP Test Results in Syphilis Acute BFP Vaccinations Infections pregnancy Chronic BFP Connective tissue disease (SLE) Liver disease Blood transfusions IVDA Dr.T.V.Rao MD 90PowerPoint Presentation: Advantage of VDRL : cheap, easy to perform quantitative, screen test monitor disease course trace theraputic effect, become “ - ” in 6-18 m after effective treatment. Dr.T.V.Rao MD 91Treatment of Late Syphilis: Late syphilis: benzathine penicillin 2.4 million units intramuscularly weekly for 3 weeks. procaine penicillin 1.2 million units intramuscularly daily for 21 days Tetracycline or erythromycin 500 mg 4 times a day – or doxycycline 100 mg x2- by mouth for 30 days Jarrisch-Herxheimer reaction Follow-up Treatment of Late Syphilis Dr.T.V.Rao MD 92PowerPoint Presentation: Prevention & Treatment of Syphilis Penicillin remains drug of choice WHO monitors treatment recommendations 7-10 days continuously for early stage At least 21 days continuously beyond the early stage Prevention with barrier methods (e.g., condoms) Prophylactic treatment of contacts identified through epidemiological tracing Dr.T.V.Rao MD 93Treponema pallidum: Treponema pallidum Treatment & Prevention Antibiotic treatment DOC: Penicillin (complete recovery for stage I &II) streptomycin, tetracycline, erythromycin (poor passage to fetal circulation) Treatment of case contacts Barrier methods (condom); “safe sex” Dr.T.V.Rao MD 94Other Related to Treponemes : Dr.T.V.Rao MD 95 Other Related to Treponemes Related Treponemes cause the non-venereal treponematoses bejel , or endemic syphilis ( T. pallidum endemicum ), yaws ( T. pallidum pertenue ), and pinta ( T. carateum ).Treponema pallidum: Treponema pallidum Other treponemal diseases Yaws (Frambesia) - Treponema pertenue Resembles syphilis Acquired in childhood other than sexual contact Mother yaw (or framboise), a painless erythematous papule occurs a month after primary infection Secondary lesion resemble primary lesion occurs 1-3 months after Tertiary lesions involve the skin & bones, crab yaws DOC: Penicillin Dr.T.V.Rao MD 96Treponema pallidum: Treponema pallidum Other treponemal diseases Pinta - Treponema carateum Acquired by person-to-person contact & rarely by sexual contact Primary & secondary lesions are flat, erythematous & non-ulcerating; healing first becomes hyper pigmented and later depigmented scarring; occurs in hand, feet & scalp Tertiary lesions are uncommon DOC: Penicillin Dr.T.V.Rao MD 97Treponema pallidum: Treponema pallidum Other treponemal diseases Bejel - Treponema pallidum variant Endemic syphilis Acquired by direct contact during childhood Similar to syphilis DOC: Penicillin Dr.T.V.Rao MD 98PowerPoint Presentation: Programme created by Dr.T.V.Rao MD for Medical and Health Care Workers in the Developing World Email firstname.lastname@example.org Dr.T.V.Rao MD 99 You do not have the permission to view this presentation. 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