1 / 86

Syphilis

Syphilis. Terry Kotrla, MS, MT(ASCP)BB Fall 2007. Introduction to Spirochetes. Long, slender, helically tightly coiled bacteria Gram-negative Aerobic, microaerophilic or anaerobic . Corkscrew motility Can be free living or parasitic

cjeff
Download Presentation

Syphilis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Syphilis Terry Kotrla, MS, MT(ASCP)BB Fall 2007

  2. Introduction to Spirochetes • Long, slender, helically tightly coiled bacteria • Gram-negative • Aerobic, microaerophilic or anaerobic . • Corkscrew motility • Can be free living or parasitic • Best-known are those which cause disease: Syphilis and Lyme’s disease

  3. Morphology • Have axial filaments, which are otherwise similar to bacterial flagella • Filaments enable movement of bacterium by rotating in place

  4. Spirochete Diseases • Localized skin infection disseminates to other organs. • Latent stage, no signs/symptoms apparent. • Cardiac and neurological involvement in untreated cases.

  5. Serological Testing • Important in diagnosis • Isolation of organism very difficult • Clinical symptoms not always apparent.

  6. Syphilis • Most commonly acquired spirochete disease in the U.S. • Complex sexually transmitted disease that has a highly variable clinical course. • Between 2005 and 2006, the number of cases of early latent syphilis reported to CDC increased 12.4% (from 8,176 to 9,186), while the number of cases of late and late latent syphilis increased 9.9% (from 16,049 to 17,644).

  7. Primary and secondary syphilis — Rates by county: United States, 2006

  8. http://www.cdc.gov/std/stats/tables/table28.htm

  9. http://www.cdc.gov/std/stats/tables/table32.htm

  10. Characteristic of the Organism • Causative agent is Treponema pallidum • Member of the family Spirochaetaceae. • No natural reservoir in the environment, requires living host. • Organism cannot be cultured from clinical specimens

  11. Morphology • Spiral shaped and motile due to periplasmic flagella. • Variable length.

  12. Scanning Electron Micrograph ofT. pallidum

  13. Other Treponemes • Three other pathogens in the group: Treponema which are morphologically and antigenically similar to T. Pallidum • Differences are in: • characteristics of lesions, • Amount of systemic involvement and • course of the disease.

  14. T. pertenue • Found in tropics, causes disease Yaws. • Non-venereal transmission, transmitted by direct contact. • Disease of bone and skin, rarely viscera • Persistent lesions, wart-like, occur primarily in children, causes and ulcerative necrosis, scar formation, disfiguring. • Untreated disease not as severe as syphilis, but lesions are more persistent. • Treat with penicillin • Serologic syphilis test will be reactive.

  15. T. pertenue • Occurs mainly in equatorial regions and can be found in South America, Central America, the Caribbean, Africa, and Southeast Asia. • It is associated with high humidity and rainfall. • Fifty years ago, the WHO recognized that endemic treponematoses—yaws in particular—were a major cause of disfigurement and disability and a significant economic burden in poor countries.

  16. T. Pertenue - Lesions

  17. Infection with Treponema pallidum pertenue. Notice the deformed tibiae, the so-called sabre tibiae.

  18. T. endemicum • Causes non-venereal syphilis known as bejel or endemic syphilis • Typically spread among children, most commonly in the Middle East and the southern Sahara desert regions. • Bejel is completely curable with penicillin. • Serologic syphilis test will be reactive.

  19. T. endemicum • Bejel affects the skin, bones, and mucous membranes of the mouth. • Transmission is by direct contact, with broken skin or contaminated hands, or indirectly by sharing drinking vessels and eating utensils. • Symptoms begin with a slimy patch on the inside of the mouth followed by blisters on the trunk, arms, and legs. • Bone infection develops later, mainly in the legs. • Also in later stages, soft, gummy lumps may appear in the nose and on the roof of the mouth (soft palate).

  20. Bejel

  21. T. caroteum • Pinta (T carateum) occurs in Central and South America and the Caribbean. • More common in young adults. • Non-venereal, direct contact, disease of skin. • Lesion is initially a scaly patch, becomes red-blue, later becomedepigmented and atrophy. • Treat with penicillin • Serologic syphilis test will be reactive.

  22. Pinta • Depigmented skin lesions.

  23. T. cuniculi • Not pathogenic for humans. • Causes rabbit syphilis.

  24. Mode of Transmission • Organism is very fragile, destroyed rapidly by heat, cold and drying. • Sexual transmission most common, occurs when abraded skin or mucous membranescome in contact with open lesion. • Can be transmitted to fetus. • Rare transmission from needle stick and blood transfusion.

  25. Stages of Disease • Primary • Secondary • Latent • Tertiary • Congenital Syphilis

  26. Primary Syphilis • Organism enters directly through skin or through mucosal tissue. • Carried by blood throughout the body. • Organisms remaining at the site begin to multiply. • Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.

  27. Primary Syphilis - Chancre • Variable incubation period of 10 days to several months, a primary lesion, chancre, forms at the entrance site. • Chancre begins as a small, usually singular nodule; as it enlarges, the overlying epithelial tissues begins to necrose, resulting in a relatively painless ulcer. • Unlike other bacterial infections, there is no formation of pus unless a secondary bacterial infection sets in.

  28. Primary - Chancre • Chancre is most frequently seen on the external genitalia • In women the lesions may form in the vagina or on the cervix. • In men it may be inside the urethra, resulting in a serous discharge. • The lesion heals spontaneously after 1-5 weeks. • Swab of chancre smeared on slide, examined under dark-field microscope, spirochetes will be present. • Thirty percent become serologically positive one week after appearance of chancre, 90% positive after three weeks.

  29. Primary Syphilis - Chancre

  30. Primary Syphilis - Chancre

  31. Darkfield Microscopy

  32. Fluid From Chancre

  33. Spirochetes in Blood

  34. Intact Spirochetes in Umbilical Cord

  35. Secondary Syphilis • Occurs 6-8 weeks after initial chancre, becomes systemic, patient highly infectious. • Characterized by localized or diffuse mucocutaneous lesions, often with generalized lymphadenopathy. • Primary chancre may still be present. • Secondary lesions subside in about 2-6 weeks. • Serology tests nearly 100% positive.

  36. Secondary Syphilis • A widespread eruption resembling psoriasis or pityriasis rosea which prominently involves the hands should always include the differential diagnosis of secondary syphilis.

  37. Secondary Syphilis • Secondary syphilis lesions on back

  38. Latent Syphilis • Stage of infection in which organisms persist in the body of the infected person without causing symptoms or signs (asymptomatic). • This stage may last for years. • One-third of untreated latent stage individuals develop signs of tertiary syphilis. • After four years it is rarely communicable sexually but can be passed from mother to fetus.

  39. Latent Syphilis • This stage may be further subdivided. • Early latent, initial infection occurred within previous 12 months. • Late latent, initial infection occurred greater than 12 months. • Latent of unknown duration, date of initial infection cannot be established as having occurred in the previous year.

  40. Tertiary Syphilis • Divided into three manifestations: • Gummatous syphilis • Cardiovascular syphilis • Neurosyphilis

  41. Tertiary Syphilis - Gummatous • Gummas are localized areas of granulomatous inflammation found on bones, skin and subcutaneous tissue. • Cutaneous gummas may be single or multiple, generally asymmetric and grouped together. • Visceral lesions often cause local destruction of the affected organ. • Contain lymphocytes, plasma cells and perivascular inflammation.

  42. Tertiary Syphilis Buboe of Neck

  43. Tertiary Syphilis

  44. Tertiary Syphilis - Gumma

  45. Tertiary - Cardiovascular • This condition appears 20 or more years post-infection. • Usually involves the aorta. • Invading treponemes cause scarring of the tunica media. • Over many years, the inflammatory scarring weakens the aortic wall, leading to aneurysm formation, which causes incompetence of the aortic valve and narrowing of the coronary ostia.

  46. Tertiary - Cardiovascular • Antibiotic treatment cures the syphilis infection and stops the progress of cardiovascular syphilis. • The damage that has already occurred may not be reversed.

  47. Neurosyphilis • Caused by invasion of organisms into the CNS. • Manifests as an insidious but progressive loss of mental and physical functions and is accompanied by mood alterations. • General paresis of the insane: • forgetful, • personality change, • psychiatric symptoms. • Onset usually 10-20 years after primary infection. • Treatment may not improve symptoms.

  48. Neurosyphilis • Neurological complications at this stage include generalized paresis of the insane which results in personality changes, changes in emotional affect, hyperactive reflexes. • Tabes dorsalis, degeneration of lower spinal cord, general paresis and chronic progressive dementia often results in a characteristic shuffling gait. • Can only be diagnosed serologically by VDRL.

  49. Neurosyphilis • Cerebral atrophy, most prominent in frontal lobes seen in general paresis.

More Related