Introduction to medical

Spirochaetales
Spirochaetales

 Classification Spirochetes are members of the order

Spirochaetales which contains 2 families
 Spirochaetaceae – contains 2 medically important
genera
 Treponema

 Borrelia

 Leptospiraceae – 1 medically important genus

 Leptospira

 Morphology and general characteristics

 Is composed of:
 A helical protplasmic cylinder with a peptidoglycan
layer similar to G-B, cytoplasmic membrane, and
cytoplasm
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 A multilayered outer membrane that surrounds the

cylinder
 Periplasmic flagella which are attached to each end of
the protoplasmic cylinder and extend toward the
opposite end.
 Are not typical flagella and are often called axial
filaments
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 None of the pathogenic Treponemes have been

successfully cultured on artificial media
 T. pallidum is usually cultured in the testes of rabbits,
although it has been grown in tissue culture for short
periods of time.
 T. pallidum does not survive for long outside the
host.
 Visualized by darkfield microscopy or iron staining

T. pallidum
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 Borrelia may be grown on a complex media called Kelly’s

media, but this is not usually done in diagnostic labs.
 Borrelia may be observed with darkfield microscopy
or be stained in a blood sample with a Giemsa stain
or Wright stain.

Borrelia sp. in blood smear

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 Leptospira can be grown on semi-solid media containing

peptone, beef extract supplemented with rabbit serum
or bovine serum albumin and tween 80.
 Incubation may be for as long as 28 days.

 Visualize using darkfield microscopy

 Identification
 Treponema
 Observation of organisms in lesions

 Detection of antibodies made in the host.

 Two types of tests may be used:

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 Nonspecific, nontreponemal tests – used for

screening purposes
 Very sensitive, but not specific
 Many diseases give positive results
 Is inexpensive and easy to do
 Detects non-treponemal antibodies, called
reagenic or Wasserman antibodies, that react
with a phospholipid (cardiolipin-lecithin) that
is a normal tissue constituent
 Tests include: VDRL test, rapid plasma reagin
card tests (RPR), and automated reagin test
(ART)
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 Specific, treponemal tests – used to confirm positive

nontreponemal results
 Very specific, expensive, and more difficult to perform
 Include T. pallidum immobilization tests, Fluorescent
Treponemal antibody absorption test, indirect
Treponemal hemagglutination test
 Borrelia
 Demonstration of Spirochetes in the blood

 Leptospira
 Isolate and culture

 Specific agglutination test or C’ fixation test – look for

4-fold rise in titer in patient’s antibodies against the
organism
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 Virulence factors
 Treponema
 Molecular mimicry – the outer sheath contains
molecules that resemble the molecules commonly
found on the surface of human cells.
 This allows the organism to resist host defenses.
 Hyaluronidase

 Borrelia
 Antigenic variation
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 Leptospira
 Unknown
 Clinical significance
 Treponema
 T. pallidum causes venereal (transmitted by sexual
contact) and non-venereal (transmitted by directly by
non-sexual contact, and indirectly by common usage
of eating and drinking utensils) syphilis.
 In venereal syphilis the primary lesion is on the
genitals
 In non-venereal syphilis it is on oral mucous
membranes.
 The normal untreated course of the disease
occurs in several stages:
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 Primary stage – following penetration of

the skin or mucous membranes, a
characteristic, painless hard chancre
develops at the site of entry within 3
weeks.
 The chancre is highly contagious and filled with
Treponemes.
 Simultaneously the organism enters the
lymphatics and becomes disseminated.
 The chancre heals without treatment in a few
weeks due to local immunity, but by that time
the organism has already disseminated.
Primary syphilis
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 Secondary stage – 4-8 weeks after the primary

stage, the secondary stage develops.
 Typically there are lesions (filled with
treponemes) throughout the body including
the skin, mucous membranes, organs, and
eyes.
 Most lesions are on the skin and mucous
membranes.
 The patient may also have a loss of hair, a
mild fever, and the development of malaise.
 This also heals without treatment and the
patient may either spontaneously get well or
develop a latent infection
Secondary syphilis
Secondary syphilis
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 Latent infection – during this stage there are no

symptoms, but specific anti-treponemal
antibodies are found.
 This stage may last 3-10 years.
 During this time these is a biological balance
between the organism and the host.
 1/3 to ½ may eventually progress to the next
stage.
 Tertiary syphilis – this stage is characterized by
granulomatous lesions, called gummas, of the
skin, internal organs, CNS, bones, eyes, and
cardiovascular system.
 They are cause by the body’s hyperimmune
reaction to remaining spirochetes.
 When lesions develop in the CNS it is called
neurosyphilis and it can lead to paralysis.
Tertiary syphilis - gummas
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 Congenital syphilis – occurs when the treponemes

cross the placenta during the fifth month to infect
the unborn fetus (occurs usually when mom is in
the latent stage).
 This can result in damage to mental
development or other neurological symptoms
or the child may be born with generalized
syphilis.
 In a pregnant woman who has a primary or
secondary stage of the disease, this usually
results in stillbirth.
 T. pertenue - causes Yaws or tropical syphilis which
transmitted by non-venereal direct contact.
 T. carateum – causes Pinta, a skin disease with
hyperpigmentation in patches.
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 Borrelia – are arthropod transmitted Spirochetes and

they cause:
 Relapsing fever – two types:

 Epidemic – is caused by B. recurrentis and is

transmitted by human lice.
 This is a more severe form of the disease than
the endemic form.
 Endemic – is caused by many Borrelia species and
is transmitted by ticks
 Both types of relapsing fever follow the same
clinical pattern.
 12-15 days after infection there is an abrupt
onset of fever, headache, and myalgia for 4-
10 days.
 Antibodies are formed and the number of
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 The fever then relapses because the organism has undergone

antigenic variation.
 The antibodies are no longer effective and the organism numbers
increase.
 Several relapses may occur with each one being less severe than
the previous one.
 Lyme disease – caused by Borrelia burgdorferi and
transmitted by ticks.
 This is a systemic illness that may begin with the
appearance of a red skin lesion called erythema
chronicum migrans (ECM) because the lesion expands
in a circular manner.
 The patient may also have a fever, headache, nausea,
vomiting, myalgia, and fatigue.
 If untreated, the patient may develop arthritis (acute
or chronic), and cardiac or neurologic complications
weeks or months later due to immune complexes.
Lyme disease

ECM – from Lyme disease

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 Leptospira – L. interrogans causes Weil’s disease or

leptospirosis
 This disease is acquired by contact with the urine of
an infected animal or ingestion of contaminated food
or water.
 It is more a disease of animals other than man.
 Infection can vary from asymptomatic to fulminant.

 The CNS, liver, and kidneys are most commonly

infected.
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 In most cases the incubation is 2-20 days followed by

fever, chills, severe headache, myalgia, malaise, nausea
and vomiting.
 Jaundice occurs in severe cases
 Death may occur due to renal failure.
 Antibiotic therapy/treatment
 Treponema – penicillin, tetracycline, or erythromycin

 Borrelia - for relapsing fever use tetracycline or

erythromycin; for Lyme disease use amoxicillin or
doxycycline
 Use protective clothing and repellents to prevent
infection
 Leptospirosis provide supportive care; antibiotics
(penicillin or erythromycin) are only effective if given
during the first 2-4 days of illness