BACTERIOLOGY: SPIROCHETES

LEPTOSPIRES

General Characteristics:
 Tightly coiled, thin, flexible spirochetes
 Obligately aerobic
 Can be grown in artificial media such as Fletcher’s semisolid, Stuart liquid or
Ellinghausen-McCullough-Johnson-Harris (EMJH) semisolid media

Virulence Factors and Pathogenicity:

 Reduced phagocytosis in the host
 A soluble hemolysin produced by some virulent strains
 Cell-mediated sensitivity to leptospiral antigen by the host
 Small amounts of endotoxin

Infections Caused by Leptospires:

 Leptospires enter through small breaks in the skin or intact mucosa
 Incubation period is usually 10-12 days, but ranges from 3 to 30 days
 Onset of clinical illness is usually abrupt, with nonspecific, influenza-like symptoms
 Subsequent course is protean, frequently biphasic, and often results in hepatic, renal, and
CNS involvement
 Most characteristic physical finding
 Weil’s Disease
o Severe systemic diseases
o Renal failure, Hepatic failure, and intravascular disease and can result in death
 Late manifestation can be caused by the host’s immunologic response to the infection

Laboratory Diagnosis:
 Specimen Collection and Handling:
o During the acute phase (first week), blood or CSF should be collected
o After acute phase, urine can also be collected (higher yield of leptospires)
 Isolation and Identification:
o Accomplished by direct inoculation of 1-2 drops of freshly drawn blood/CSF into
laboratory media such as Fletcher, Stuart, or EMJH, and incubation at the dark at
room temperature
o Urine can also be cultured
 Serologic Tests:
o IgM antibodies are detected within 1 week after onset of disease
o Macroscopic slide agglutination
 Rapid screening test
o Microscopic agglutination
 Gold standard

Antimicrobial Susceptibility:
 Susceptible in vitro to streptomycin, tetracycline, doxycycline, and macrolides

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 Doxycycline appears to shorten the course of illness in adults and reduce incidence of
leptospiruria

BORRELIAE

General Characteristics:
 Most species cause relapsing fever, with the notable exception of Lyme borreliosis,
which is caused by Borrelia burgdorferi sensu lato complex.
 Highly flexible organisms
 Stain easily and can be visualized by bright field microscopy

Clinically Significant Species:

 Borrelia recurrentis and similar Borrelia
o Clinical Manifestations:
 Incubation period of 2 to 15 days
 Massive spirochetemia develops and remains at varying levels of severity
during the entire course
 Infection is accompanied by sudden high temperatures, rigors, severe
headache, muscle pains, and weakness
 Febrile period lasts about 3 to 7 days and ends abruptly with the
development of an adequate immune response
o Epidemiology
 Can be tick-borne (endemic relapsing fever)
 Ornithodoros ticks
 Or louse-borne (epidemic relapsing fever)
 Body louse, Pediculus humanus
 Humans are the only reservoir
o Laboratory Diagnosis:
 Microscopic Examination
 Giemsa- or Wright-stained blood smears taken during the febrile
period
 Isolation and Identification
 Can be recovered using Kelly medium or animal inoculation
(suckling Swiss mice or suckling rats), but rarely attempted
o Antimicrobial Susceptibility:
 Susceptible to many antimicrobial agents
 Tetracyclines are drug of choice
 Jarisch-Herxheimer reaction
 Sudden release of endotoxin form of spirochetes following
antimicrobial treatment
 Borrelia burgdorferi
o Virulence Factors
 Ability to bind plasminogen and urokinase-type plasminogen activator
 Could convert plasminogen to plasmin, which is a potent protease
that could facilitate tissue invasion

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 Binding factor H allows for complement evasion

o Clinical Manifestations:
 A complex disease that can generally be divided into 3 stages:
 Stage 1
o Localized stage
o About 60% of patients exhibit erythema migrans (EM)
o Regional lymphadenopathy is common with minor
constitutional symptoms
 Stage 2
o Early disseminated and produces widely variable symptoms
 Secondary skin lesions, migratory joint and bone
pain, alarming neurologic and cardiac pathology,
splenomegaly, and severe malaise and fatigue
 Stage 3
o Late manifestation or late persistent infection
 Cardiac, musculoskeletal and neurologic system
involvement
 Arthritis is the most common symptom, occurring
weeks to years later
o Epidemiology
 Transmitted via bite of infected Ixodes ticks
 At least 3 species of B. burgdorferi sensu lato complex causes Lyme
Disease
 B. burgdorferi sensu stricto
 B. garinii
 B. afzelii
o Laboratory Diagnosis:
 Specimen Collection and Handling
 Serum for serology
 Serologic Tests
 Immunofluorescent antibody (IFA) or Enzyme Immunoassay
(EIA) to screen
 Confirmation via western blot
o Antimicrobial Susceptibility:
 Doxycycline and amoxicillin are equally effective in treating early stages
 Ceftriaxone has been effective

TREPONEMES
General Characteristics:
 Thin, spiral organisms
 Three periplasmic flagella inserted into each end of the cell
 Graceful flexuous movements in liquid

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Clinically Significant Species

 Treponema pallidum subsp. pallidum
o Virulence Factors:
 Ability to cross intact mucous membranes and the placenta
 Antigenic variation of the cell surface proteins contributes to the ability to
evade the immune system
o Clinical Manifestations:
 Syphilis
 Transmission normally occurs during direct sexual contact with an
individual who has an active or secondary syphilis
 Primary Stage of Syphilis:
o Spirochetes multiply rapidly and disseminate to local
lymph nodes and other organs via bloodstream
o Primary lesion develops 10 to 90 days after infection and is
a result of an inflammatory response to the infection site
o Lesion is also known as the chancre
 Typically a single erythematous lesion that is
nontender but firm
 Extremely infectious
 Secondary Stage of Syphilis:
o Approximately 2 to 12 weeks after development of lesion
o Clinical symptoms of fever, sore throat, generalized
lymphadenopathy, headache, lesions of the mucous
membranes, and rash
o All secondary lesions are infectious
 Tertiary Stage of Syphilis
o Individuals are not contagious
o Relapses occur in about 25% of patients
o Symptoms include development of granulomatous lesions
(gummas) in skin bones and liver, degenerative changes in
CNS (neurosyphilis), and syphilityic cardiovascular lesions
 Congenital Syphilis
o Treponemes can be transmitted from an infected mother to
her fetus by crossing the placenta
o Early-onset syphilis
 Onset at less than 2 years of age
 Characterized by mucocutaneous lesions,
osteochondritis, anemia, hepatosplenomegaly, and
CNS involvement
o Late-onset syphilis
 Occur after 2years of age
 Symptoms include interstitial keratitis, bone and
tooth deformities, eight nerve deafness,
neurosyphilis, and other tertiary manifestations

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 BACTERIOLOGY: SPIROCHETES

o Epidemiology:
 Exclusive human pathogen under natural conditions
o Laboratory Diagnosis:
 Specimen collection and handling
 Lesions of primary and secondary syphilis typically contain large
numbers of spirochetes
 Culture methods are not available
 Serology is normal basis of diagnosis
 Microscopic Examination
 Dark field microscopy
 Serologic Test
 Non-treponemal
o VDRL
o RPR
 Treponemal
o Treponema pallidum-particulate agglutination (TP-PA)
o Fluorescent treponemal antibody absorption assay (FTA-
ABS)
o Antimicrobial Susceptibility:
 Penicillin is drug of choice
 Long acting penicillin such as benzathine penicillin is preferred

 Other Treponemal Diseases

o Yaws
 Caused by T. pallidum subsp. pertenue
 Course of yaws is similar to syphilis
 Early stage lesions are elevated, granulomatous nodules
o Endemic Syphilis
 Caused by T. pallidum subsp. endemicum
 Closely resembles yaws in clinical manifestations
 Primary and secondary lesions are usually papules
 Progress to form gummas of the skin, bones, and nasopharynx
 Transmitted by direct contact or sharing contaminated eating utensils
o Pinta
 Caused by T. carateum
 Found in tropical regions of Central and South America
 Rarely transmitted by sexual intercourse
 Lesions begin as scaling, painless papules and are followed by
erythematous rash that becomes hypopigmented with time

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