S Y P H I L I S
36
S Y P H I L I S
description
S Y P H I L I S. Causative Organism – Treponema pallidum Characteristics of Treponema pallidum. Spirochaetes or spiral organisms, they are motile, slender. Do not grow in artificial medium ( some treponema are part of the normal oral flora e.g. T.denticulc ) - PowerPoint PPT Presentation
Transcript of S Y P H I L I S
S Y P H I L I S
Causative Organism – Treponema pallidum Causative Organism – Treponema pallidum Characteristics of Treponema pallidumCharacteristics of Treponema pallidum
Spirochaetes or spiral organisms, they are Spirochaetes or spiral organisms, they are motile, slender.motile, slender.
Do not grow in artificial medium (Do not grow in artificial medium (some some treponema are part of the normal oral flora e.g. treponema are part of the normal oral flora e.g. T.denticulcT.denticulc) )
Cannot be seen by light microscopy because they Cannot be seen by light microscopy because they are very thin (are very thin (0.15 0.15 μμmm), long ), long 5-15 5-15 μμm.m.Note: Does not stain with gram stainNote: Does not stain with gram stain
Causative Organism – Treponema pallidum Causative Organism – Treponema pallidum Characteristics of Treponema pallidum Characteristics of Treponema pallidum
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Can be seen by Can be seen by Dark field microscopy, by Dark field microscopy, by Phase contract techniquePhase contract technique
Can be stained by Can be stained by Silver impregnationSilver impregnation Fluorescent antibody techniqueFluorescent antibody technique
Sensitive to penicillinSensitive to penicillin They can be propagated by inoculation in rabbits They can be propagated by inoculation in rabbits
in testes and anterior chamber of eye.in testes and anterior chamber of eye.
Causative Organism – Treponema pallidum Causative Organism – Treponema pallidum Characteristics of Treponema pallidum Characteristics of Treponema pallidum
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TreponemaTreponema
PathogenicPathogenic Non-pathogenicNon-pathogenic
PathogenicPathogenic Oral commensalsOral commensalsNon-venereal disease Non-venereal disease by direct contactby direct contact
T.pallidumT.pallidum
T.Pertenue T. carateum T.pallidumT.Pertenue T. carateum T.pallidum
T. Denticula T. Denticula T.macrodentium T.macrodentium T.microdentiumT.microdentium
SyphilusSyphilus
A sexually A sexually transmitted diseasetransmitted disease
YawsYaws PintaPinta BejalBejal
Mode of TransmissionMode of Transmission Direct sexual contact (Direct sexual contact (90 – 96%90 – 96%)) Blood transfusionBlood transfusion Via placenta from infected pregnant mother Via placenta from infected pregnant mother faetus faetus
causes congenital syphilis.causes congenital syphilis. Contact Contact accidental contact E.g. accidental contact E.g. Medical Medical
personnelpersonnel..SourceSource of T. pallidum: Primary and secondary syphilis lesions of T. pallidum: Primary and secondary syphilis lesions..
Causative Organism:Causative Organism: Treponema pallidum is the Treponema pallidum is the causative organism of syphilis. causative organism of syphilis. Syphilis can be Syphilis can be Acquired Acquired
CongenitalCongenital
Clinical Features of Syphilis / Symptoms and signs of Acquired syphilClinical Features of Syphilis / Symptoms and signs of Acquired syphil Syphilis is a sexually transmitted disease / a venereal diseaseSyphilis is a sexually transmitted disease / a venereal diseaseIncubation PeriodIncubation Period:: 10 – 90 days ( 10 – 90 days (average – 21 daysaverage – 21 days))
3 Stage of Syphilis:3 Stage of Syphilis:
11-- Primary syphilisPrimary syphilis: Primary chancre develops after 2-10 : Primary chancre develops after 2-10 weeks a well defined indurated painless ulcer mainly on weeks a well defined indurated painless ulcer mainly on the genitalia (the genitalia (90%90%) and extra-genital on Lips () and extra-genital on Lips (5-10%5-10%). ). In female, chancre occurs in the cervix. The chancre is In female, chancre occurs in the cervix. The chancre is painless and exudate is formed in the centre. This fluid painless and exudate is formed in the centre. This fluid is highly infectious and examination by dark field is highly infectious and examination by dark field microscopes shows Spirochaetes. There is regional microscopes shows Spirochaetes. There is regional lymphadenopathy.lymphadenopathy. Primary chancre heals spontaneously without treatment within Primary chancre heals spontaneously without treatment within
3-8 weeks.3-8 weeks. Primary syphilis is highly infectious.Primary syphilis is highly infectious. Serological tests for Syphilis are positive in 80% cases.Serological tests for Syphilis are positive in 80% cases.
22-- Secondary SyphilisSecondary Syphilis: After 6-8 weeks of primary : After 6-8 weeks of primary chancre:chancre: Desseminated secondary stage develops. Muco-cutaneous Desseminated secondary stage develops. Muco-cutaneous
lesion occurs e.g. Skin rash, mucasal ulcers, condylomata on lesion occurs e.g. Skin rash, mucasal ulcers, condylomata on genitalia, Lymphadenopathy, fever headache malaise, alopecia.genitalia, Lymphadenopathy, fever headache malaise, alopecia.
Secondary syphilis is highly infectiousSecondary syphilis is highly infectious Snal – truck mucosal ulcers in the mouth Hepatitis, Snal – truck mucosal ulcers in the mouth Hepatitis,
glomerulonephritis, periostitis, iridocyclitis, choroidoretinitis, glomerulonephritis, periostitis, iridocyclitis, choroidoretinitis, arthritis.arthritis.
Serological tests for syphilis becomes almost uniformly positive.Serological tests for syphilis becomes almost uniformly positive.Secondary Stage may follows by the following:Secondary Stage may follows by the following:
a) Cured spontaneouslyb) Early latentc) Late Latentd) Tertiary stage
Latent Stage:Latent Stage:
After the secondary syphilis symptoms subsides, the After the secondary syphilis symptoms subsides, the disease enters a latent stage.disease enters a latent stage.
After about 2 years, the syphilis is NOT normally After about 2 years, the syphilis is NOT normally infectious, except from mother to the foetus.infectious, except from mother to the foetus.
3- Tertiary Syphilis: After 2-20 yrs, tertiary stage develops produces
Gummatous Lesions in perforation of the palate (Roof of the mouth) which interferes with speech
Skin
Bone
Joints Charcoat’s joints
Cardiovascular System
E.g. (a) Aortic aneurism
(b) Aortic valve incompetence
Central Nervous System: Neurosyphilis E.g. a) Tabes dorsalis
b) General paralysis of insane
c) Meningovascular sympilis Tertiary stage is not infectious.
Congenital Syphilis: most distressing and dangerous form of Syphilis.
Early Congenital syphilis:a) Skin: rash maculopapular rashb) Mucosal Lesion: Mucocutaneous lesionsc) Hepatospleenomegalyd) Lymphadenopathy
Late Congenital Syphilis:a) Hutchinson’s teeth (Notching of the incisor teeth)b) Mulberry molars, Moon’s molarsc) Sadle nosed) Sabre shin (tibia)d) Interstitial keralitis, blindness
f) Deafnessg) Bone sclerosis, Arthritish) Juvenile general paralysis of insanei) Damage of Mental development and other neurological symptoms.j) Stillbirths
Laboratory of SyphilisLaboratory of Syphilis
1-1- Dark ground microscopyDark ground microscopy to demonstrate, to demonstrate, Spirochaetes Spirochaetes T. pallidumT. pallidum in fluid or exudate from in fluid or exudate from lesions of primary and secondary syphilis.lesions of primary and secondary syphilis.a) Primary Syphilis exudate from chancre b) Secondary syphilis mucous path exudate taken for dark ground microscopy.
Direct immunofluorescent microscopy can be used.
Laboratory of Syphilis (Continued)Laboratory of Syphilis (Continued)
2- Serological tests for Syphilis for all stages
A. Non-specific Tests B. Specific Tests
(for non-treponemal or reagin antibody)
(for non-treponemal)
(Ag used is cardiolipin) (Ag used is Treponemal antigen)
1- VDRL (Venereal Disease
Research Laboratory)
1- FTA – ABS Test (Florescent
Treponemal Antibody Absorption)
2- TPHA (Treponema pallidum
Haemagglutination.
3- TPI (Treponema pallidum immobilization)
2- RPR (Rapid Plasma reagin)
3- WR (Wasserman Reaction)
Congenital Syphilis Congenital Syphilis Baby’s blood IgM –FTA-ABS TEST Baby’s blood IgM –FTA-ABS TEST
Serological Tests for Syphilis (With Interpretation)Serological Tests for Syphilis (With Interpretation)
Stage of disease VDRL TPHA FTA-ABS
No Past /present Infection
Primary (Early)
Primary (Late)
Secondary + Tertiary
Latent
No Past or Present Infec.
(Active Syphilis).
Or(Active Syphilis).
(Active Syphilis) in secondary syphilis.
Or
Treated syphilis (had infection before)
Serological Tests for Syphilis (With Interpretation) Serological Tests for Syphilis (With Interpretation) (Continued)(Continued)
Stage of disease VDRL TPHA FTA-ABS
Biological false positive
Congenital syphilis*
* After successful treatment – VDRL Negative
* Early primary syphilis – FTA – ABS Positive
Note: FTA – ABS after successful treatment remains positive for life
* V.D.R.L. is used to see efficacy (effect) of treatment . After successful treatment V.D.R.L. becomes negative.
(No Infection by T. pallidum)
But FTA – ABS + TPHA
Remain positive
Serological Tests for Syphilis (With Interpretation) Serological Tests for Syphilis (With Interpretation) (Continued)(Continued)
Treatment of syphilis : * Penicillin is the drug of choice
Primary: * Penicillin for 15 days.
Secondary and Tertiary syphilis : Penicillin for 21 days usually followed by 10 injection at weekly intervals.
Note:
Spirochetes are spiral motile bacteria. Their motility is due to contractile axial fibers run along the bacterial cell.
Spirochetes (spiral bacteria)Spirochetes (spiral bacteria)
Treponema Borrelia Leptospira
Borrelia recurrentis Borrelia vincentiPathogenic genera of spirochaetes are : * Borrelia, * Leptaspira, * TreponemaBorrelia
recurrentisSource : RodentsDisease : • Epidemic Louse borne relapsing fever
• Endemic Louse borne relapsing feverTreatment: Tetracycline
Spirochetes (Spiral bacteria) (Continued)Spirochetes (Spiral bacteria) (Continued)
Borrelia vincenti : Gram –ve irregular spiral bacteria Culture : Strict anaerobic bacteria, difficult to culture.
Laboratory diagnosis : Mainly by Microscopic Examination of Gram stained smear only Disease : Borrelia vincenti and Fusobacterium species together produce:
• Vincent’s angina (Pharynigitis)
• Gingivo - Stomatitis
* Serum enriched media used Anaerobic culture
orAcute necrotizing ulcerative gingivitis
• Sore ThroatTreatment :
• Penicillin or Metronidazole• Oral hygiene
