SPIROCHETES AND NEISSERIA

Faculty: Dr. Alvin Fox

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 Key Words
• Spirochete
• Axial filament
• Treponema pallidum
Syphilis
•
• Chancre
• Primary lesion
• Darkfield microscopy
• Secondary Lesion
• Tertiary Lesion
• Anti-cardiolipin antibodies
• Borrelia burgdorferi
• Lyme disease
• Relapsing fever (other borrelia)
• Leptospira (leptospirosis)
• Neisseria
• Thayer Martin agar
• Oxidase test
• N. gonorrhoeae
• Gonorrhea
• N. meningitidis
• Meningitis 2
SPIROCHETES
Treponema, Borrelia and
Leptospira

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 Spirochetes
• Gram negative
• long, thin, helical, motile

• axial filaments
– locomotion
– between peptidoglycan layer/outer membrane
* runs parallel

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 Histology: Treponema pallidum
- testis infected rabbit 5
 Treponema pallidum

• transmission
– genital/genital
– in utero or during birth

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 Syphilis
• chronic
• slowly progressive

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• primary lesion - chancre
– 10 to 60 days
– area of ulceration/inflammation
– many organisms

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• Secondary (2-10 weeks later)
– systemic spread
– flu-like symptoms
– skin, particularly
– many organisms

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mouth muosa
• Tertiary
– several years later
– rare
– skin,
– central nervous system
– delayed hypersensitivity
– few organisms
* control by immune response

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Microbiological diagnosis
• not culturable
• dark field microscopy
– actively motile organisms
– brightly lit against dark backdrop
– light shines at an angle
– reflected from thin organisms
– enters objective
• conventional light microsrcopy
– light shines through
– NOT visualized
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• fluorescence microscopy
– antibody staining

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Secondary and Tertiary Syphilis
- serology
• screening method
• antibodies to cardiolipin

• specific diagnosis
• antibodies to treponemal antigen

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 Autoimminty
• cardiolipin
– self antigen

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• no vaccine

• antibiotics (e.g. penicillin)

– effective

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 Other treponemal diseases
• bejel, yaws and pinta
– extremely rare in US

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Borrelia burgdorferi and Lyme
disease

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Ixodes scapularis, tick vector for Lyme disease.
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Also known as Ixodes dammini. CDC
Lyme Disease
erythematous rash
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 A tick bite leads to transmission of
B. burgdorferi

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Lyme disease - symptoms
• bacteremia
– acute

• arthritis
• cardiac
• neurologic
– chronic
* weeks, months later

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 Therapy
• early antibiotic therapy
– curable
* penicillin
* tetracycline

• late antibiotic administration

– ineffective
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 Diagnosis
• serum antibodies to B. burgdorferi.
burgdorferi

• laboratory strains
– grow extremely slowly
– tissue culture media
– not bacteriological media
• patient body fluids/tissue sample
– almost never growth

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A physicians dilemma
• acute
– responds to antibiotic
–antibodies not detectable
• late diagnosis
– not curable
– antibodies detectable

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 Lyme Disease -etiology

• reactive arthritis similar to

– Reiter's syndrome
– rheumatic fever

• resembles rheumatoid arthritis.

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 Relapsing fever
• <100/ per year in US
• transmission
–tick-B. hermsii
* rodent, primary host

– lice-B. recurrentis
* human, primary host

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“Relapsing” fever
• immune response develops
– disease relapses

• new antigens expressed

– no immunity
– disease reappears

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 Diagnosis
• no culture
• no serological test
• detected - blood smear

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Leptospirosis

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 Leptospirosis

• <100 cases per year in US

• symptoms
–flu-like
–severe systemic disease
* kidney
* brain
* eye
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 Transmission
• infected urine
– rodents
– farm animals

• water

• through broken skin.

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 Laboratory Diagnosis
• serology
• most readily culturable of spirochetes
– culture still extremely difficult

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 NEISSERIA

Neisseria gonorrhoeae
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 Neisseria
• Gram negative
• diplococci (pairs of cocci)
• oxidase positive

• culture
• Thayer Martin.
– selective
– chocolate agar
* heated blood (brown)

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 N. gonorrhoeae
the “Gonococcus"

• found only in man

• gonorrhea
• second most common venereal disease

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 Smear
• polymorphonuclear cell
• Gram negative cocci
– many in cells

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Dissemination -gonococci

• gonoccocal arthritis
– “septic” arthritis

• dermatitis

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 Antibiotic therapy
• β lactamase-resistant cephalosporin
– e.g. ceftriaxone

• resistant strains
– common
– produce β lactamases
– destroy penicillin

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 Pathogensis
• adhesion to genital epithelium
– outer membrane
– pili
*Antigenicity
highly variable among strains
• no vaccine

• IgA protease
– also N. meningitidis
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N. gonorrhoeae

• Tissue injury
– lipopolysaccharide
– peptidoglycan

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N. meningitidis
(the “Meningococcus")

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 N. meningitidis
• resides in man only

• usually sporadic cases

– mostly young children

• outbreaks
– adults
– crowded conditions
*e.g. army barracks, dorms
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Neisseria meningitidis
upper respiratory tract infection
– adhesion pili

bloodstream

brain
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 Meningococcal meninigitis
• second most common meningitis
– pneumococcus, most common

• fatal if untreated

• responds well to antibiotic therapy

– penicillin

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 Laboratory Diagnosis

• spinal fluid
– Gram negative diplococci
within polymorphonuclear cells
– meningococcal antigens

• Culture
– Thayer Martin agar

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 Capsule
• capsule
– inhibit phagocytosis

• anti-capsular antibodies
– stop infection

•antigenic variation
– sero-groups

• vaccine
–multiple sero-groups 48