Syphilis

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Author:
ehamm
ID:
117711
Filename:
Syphilis
Updated:
2011-11-18 12:33:47
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Syphilis
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Description:
Syphilis
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  1. Spirochetes: overview
    • Flexible, peptidoglycan wall
    • endoflagella
    • Motile - rotationa nd flexion
    • Gram negative-stain poorly
    • Darkfield/ IF
    • Grow slowly
  2. Organism
    • T. pallidum
    • regular spirals, like a corkscrew
    • Seen by IF or dark field
    • Slow rotating motility
    • Susceptible to many disinfectants
  3. Epidemiology
    • Exclusivily human
    • Direct sexual contact with primary or secondary syphilis
    • Non-genital contact with lesion, needle sharing, transplacentally
    • tertiary not infectious
  4. Pathogenesis
    • Subepi tissues via breaks in skin
    • Slowly multiplies
    • Endarteritis
    • swelling and proliferation of arteriolar endothelial cells-> necrotic ulceration
    • Spreads via lymph nodes
    • Silent until secondary stage
    • Bind Ig and complement
    • Granulomatous lesions in late stage syphilis
    • No toxins
  5. Immunity
    • Slow and imperfect
    • Doesn't appear until early latency
    • 1/3 progress to secondary stage
    • 1/3 progress to late stage
    • humoral and cell mediated
    • CD4/8 primary cells in lesions
  6. Primary syphilis
    • Papule which evolves into ulcer
    • site of infection
    • indurate and painless-> chancre
    • enlargement of lymph nodes
    • heals spontaneously in 3-6 weeks
    • 1/3 -> secondary
  7. Secondary syphilis
    • 2-8 weeks post chancre
    • symmetric maculopapular rash on palms, soles, face; generalized enlarged nodes
    • Lesions are teeming with organisms, highly infectious
    • 40% develop CNS involvement
    • Multiple organ systems involved = the great imposter
    • Resolves sponateously
    • 1/3 -> tertiary
  8. Latent syphilis
    • No clinical manifestations
    • May be interrupted by relapses
  9. Tertiary syphlis
    • 15-20 years
    • Neurosyphilis: chronic meningitis with fever, headache, focal neurological findings; cortical degeneration -> mental changesl tabes doraslis via demyelination of posterior columns
    • CVsyphilis: arteritis of vasovasorum of aorta; medial necrosis; dilatation of aorta, aneurysms of aorta
    • Gumma in skins, bones, joints
  10. Congenital syphilis
    • After 4th month of gestation
    • Untreated maternal infection -> fetal loss, congenital syphilis
    • rhinitis and maculopapular rash
    • Bane involvement -> saddle nose, saber shins
    • Anemia, thrombocytopenia, liver failure
  11. Diagnosis
    • Dark-field microscopy -> need experienced lab tech
    • Non-treponemal tests: measure Ab against cardiolipin; RPR, VDRL; positive during primary chancre, repeat in two weeks if negative; uniformly positive in secondary syphilis; used for screening; autoimmune/ pregnancy -> false positives;
    • Treponemal tests: confirmation test; direct detection of Ab; more specific than VDRL; not useful for screening, remain positive for life; IgM test for congenital syphilis
  12. Treatment and prevention
    • Pencillin
    • Safe sex

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