A shepherd named Syphilus

• 56 year old male presenting with a progressive cognitive decline

• Onset of the memory impairments was slow

• Exhibiting euphoria and logorrhea; patient’s previous personality being usually sober and reserved

• Lost his previous professional efficiency, becoming slow and erratic.

• Headaches that had become more frequent and intense in the past few months

• Many short-term relations with promiscuous sexual partners

• Had not previously been tested for syphilis

Patient History

Diagnostic Results

• Neurological examination was completely normal, with no neurological signs

• The blood cells count, the chemistry profile and the transaminase levels were normal

• (CSF) analysis revealed a moderate cellularity, with small lymphocytes and rare neutrophyl granulocytes.– The Venereal Disease Research Laboratory test (VDRL) serology was positive

(titer 1/4), and the treponemal pallidum hemagglutination test index (THPA) was positive (titer 1/10,240)

• Blood serology– the VDRL was positive (titer 1/512). THPA was also positive (titer 1/20,480)

– the diagnosis of neurosyphilis being confirmed.

• Primary stage– Multiplication of the organisms at the initial site of entry

– Superficial ulcer with a firm base called a hard chancre

• Secondary stage– Dissemination of treponemes to other tissues

– slight fever, generalized lymphadenopathy, malaise, and a mucocutaneousrash

• Tertiary or late stage– Cardiovascular involvement (80%)

– Neurologic involvement

– Gummas

Clinical Manifestations

• Congenital spread– Bacteria can cross the placenta

– Still birth/ miscarriage

– mucocutaneous lesions, osteochondritis, anemia, and hepatosplenomegaly

• Hutchinson's triad– late congenital syphilis, three commonly observed manifestations, interstitial

keratitis, notched incisors, and eighth-nerve deafness.

Clinical Manifestations

• Structure– helically coiled, corkscrew-shaped organisms 6 to 15 μm long and 0.1 to 0.2 μm

wide

• Environment– Fastidious

– pH (7.2 to 7.4), and temperature (30 to 37°C)

– Microaerophilic

– Inactivated by mild heat, cold, desiccation, and most disinfectants

Treponema pallidum

Cultural Characteristics??

• None– This organism has not been successfully cultured in vitro

– Preservation media

– 18-21 days

• Staining– Gram

– Stain does not take

– Non Acid Fast

– Dieterle stain?

– Can be used to visualize T. pallidum

• Clinical manifestations are highly characteristic

• Treponema in lesion material

• Serologic reactions are often used for diagnosis– “nontreponemal”

– Detect antibodies to nonspecific antigens, such as cardiolipin, that are produced in most patients with syphilis

– Venereal Disease Research Laboratory (VDRL) test

– Rapid Plasma Reagin (RPR) tests

– “treponemal”

– Detect antibodies directed against protein constituents of T pallidum

– Fluorescent T pallidum Antibody-Absorption (FTA-ABS)

– Microhemagglutination for T pallidum (MHA-Tp)

ID

• Humans are the only natural host

• Infection occurs through sexual contact

• Mucosal membranes and small breaks in skin

• Virulence– Several hemolysins

– A membrane protein that allows for permeability of nutrients but inaccessible to antibody

– Ligands that allow cytoadhesion

Pathogenic Mechanism

• World wide

• 18-30 years old

• Peak incidence in 1946

• Treatment– Penicillin

Epidemiology and Treatment

ANY QUESTIONS?

• http://www.mayomedicallaboratories.com/interpretive-guide/?alpha=S&unit_code=32184

• http://www.ncbi.nlm.nih.gov/books/NBK7716/

• http://www.tmj.ro/article.php?art=5468744642124430

• http://microbiologyglossary.wikispaces.com/Treponema+pallidum

• http://www.antimicrobe.org/new/b242.asp

• http://phil.cdc.gov/phil/details.asp?pid=10179

References