Infections Caused By Leptospires Organisms in mud or water enter through breaks in the skin or intact mucosa. Symptoms Initial phase • Fever, headache, malaise, and severe myalgia • Conjunctival suffusion seen in less than half • Can involve hepatic, renal, and central nervous systems Renal lesions are interstitial nephritis with glomerular swelling and hyperplasia. Illness lasts from less than 1 week to 3 weeks.
Epidemiology Zoonotic disease Animal workers or in rat-infested surroundings • Dog, rats, and other rodents are principal hosts Excreted in urine Freshwater recreational exposure • Water contaminated by urine Can survive for months in water
Infection Enters by contact with infected urine
Laboratory Diagnosis Specimen collection Collect blood or cerebrospinal fluid (CSF) during first week of illness Collect urine: yield higher after first week • Direct microscopic detection is not recommended. Isolation and identification Culture: Fletcher’s, Stuart’s, or Ellinghausen-McCullough- Johnson-Harris (EMJH) medium • Use 1 to 2 drops of patient sample Serology: microscopic agglutination test (MAT) for serotyping Immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) test
Antimicrobial Susceptibility Susceptible to Streptomycin Tetracycline Doxycycline Penicillin • Some limited effectiveness if used early (before fourth day of illness)
Relapsing Fever Symptoms Incubation period is 2 to 15 days. High fever (104°F) with shaking chills • Periods of 3 to 7 days Delirium Severe muscle aches and pain in bones and joints • Followed by remission and subsequent repeat of symptoms • Sometimes hepatosplenomegaly and jaundice Neurologic symptoms • Lymphocytic meningitis and facial palsy Rarely fatal
Relapsing Fever (Cont.) Laboratory diagnosis Direct examination of spirochetes in blood • Thick and thin films of Giemsa or Wright-stained smears Culture • Kelly medium • Animal inoculation (rarely) • Serology is difficult and impractical. Antimicrobial susceptibility Tetracyclines are the drugs of choice. • Death of spirochetes can cause sudden endotoxin release (Jarisch-Herxheimer reaction). Fever, chills, headache, myalgia
B. burgdorferi Virulence Factors Bacterial spread Binds plasminogen and urokinase-type plasminogen activator to its surface • Could act as a protease to promote tissue invasion Complement evasion Binds factor H
B. burgdorferi Infections Treatment Antibiotics: early stages doxycycline Late stages show no usefulness of antibiotics. Detection Generally only screen those with symptoms and high-risk factors • Generally test by serology
Virulence Factors Penetrate intact mucous membranes Crosses placenta Dissemination throughout the body and organ systems Antigenic variation May help evade immune system
Syphilitic Infection Transmission Infection caused by sexual contact (mucous membranes) • Can enter via cuts, abrasions, or directly through intact mucous membranes Can enter other sites such as the lip or transplacentally Incubation period Disseminate throughout the body 10 to 90 days (usually about 3 weeks)
Syphilitic Infection (Cont.) Primary syphilis Chancre at infection site (usually one but sometimes several in human immunodeficiency virus (HIV)–positive patients) • Clean, smooth base, edge slightly raised and firm • Painless but may be tender • Heals in 3 to 6 weeks Base contains spirochetes that can be identified by dark field microscopy or immunofluorescence or serology.
Syphilitic Infection (Cont.) Secondary syphilis Begins 2 to 12 weeks after chancre appearance Widespread macular rash (syphilitic roseola), particularly palms and soles of feet Secondary lesions • Condylomata lata Moist, gray-white plaques teeming with spirochetes Systemic symptoms • Lymphadenopathy, headache, lesions of the mucous membranes and the skin, and rash
Syphilitic Infection (Cont.) Latent syphilis Early latent phase: initial 4 years relapses occur; patient is infectious Late latent phase: indefinite duration; sometimes no complications ever appear Detected only through serology
Late syphilis (tertiary)
Late complications of syphilis involving many organs
Tertiary (Late) Syphilis Complications Central nervous system (CNS) disease, cardiovascular abnormalities, aortitis and valve insufficiency, and granulomatous lesions (gummas) in any organ Asymptomatic CNS disease CSF abnormalities without symptoms • Pleocytosis, elevated protein levels, depressed glucose
Syphilis Epidemiology and Specimen Collection Transmission Sexual contact, direct injection, direct contact with lesions, transplacental transmission Specimen collection Primary or secondary lesion is cleaned with saline and gently abraded with dry, sterile gauze. • Transfer serous fluid to slide with saline Coverslip and examine using darkfield microscopy Usually use serology or direct exam Do not use oral lesions because of nonpathogenic oral flora
Detection Nontreponemal tests (primary or secondary stage only, later stages less than 1%) Venereal disease research laboratory (VDRL) • Cardiolipin antigen is mixed with patient serum or CSF. If positive, flocculation occurs and can be read microscopically. Rapid plasma reagin (RPR) • Black carbon particles are bound to cardiolipin and mixed with patient sera. Particles agglutinate, thus indicating a positive test.
Detection (Cont.) Treponemal tests (all stages, although more effective for secondary and late stages) Confirm nontreponemal tests Titers remain high despite treatment.
Detection (Cont.) Fluorescent treponemal antibody absorption test (FTA-ABS) Patient sera is absorbed against nonpallidum spirochetes. Absorbed serum is then placed with T. pallidum organisms, and secondary antihuman antibody conjugated to a fluorescein is added. T. pallidum–particulate agglutination test (TP-PA) Antigens to T. pallidum are absorbed to gelatin particles. Patient sera added, and gelatin agglutinates Enzyme immunoassay (EIA) test kits are not comparable.
Other Treponemal Diseases T. pallidum subsp. pertenue Yaws: chronic nonvenereal disease • Central Africa, South America, India, Indonesia, and Pacific Islands • Primary, secondary, and tertiary stages Lesions are elevated, granulomatous nodules.