(Student)Spirochetal disease.pptx

Spirochetal Disease Dr. Abbey Baus DMSc, PA-C, AAHIVS (she/her) Instructional Objectives 48. Differentiate spirochetal diseases by epidemiology, etiologies, risk factors, genetic influences, pathophysiology, signs/symptoms, physical examination. (CO1, CO2) 49. Distinguish spirochetal diseases as...

Spirochetal Disease Dr. Abbey Baus DMSc, PA-C, AAHIVS (she/her) Instructional Objectives 48. Differentiate spirochetal diseases by epidemiology, etiologies, risk factors, genetic influences, pathophysiology, signs/symptoms, physical examination. (CO1, CO2) 49. Distinguish spirochetal diseases as acute, chronic, urgent, or emergent. (CO3, CO4) 50. Select the most appropriate clinical criteria and diagnostic tests available to classify the types of spirochetal diseases. (CO3) 52. Apply the current and emerging pharmacologic and other nonpharmacologic evidence-based practices used in the treatment of spirochetal diseases. (CO4) 53. Formulate an age appropriate, comprehensive treatment plan for individual patient with spirochetal diseases. (CO4) 54. Identify the age appropriate health screening and health promotion/disease prevention strategies of spirochetal diseases. (CO5) 51. Interpret the results of diagnostic tests to establish the diagnosis of spirochetal diseases. (CO3) Spirochetal Disease • Spirochetes are gramnegative, motile, spiral bacteria, from 3 to 500 m (1 m = 0.001 mm) long. • Spirochetes are unique in that they have endocellular flagella (axial fibrils, or axial filaments), which number between 2 and more than 100 per organism, depending upon the species Lyme Disease • Borrelia burgdorferi is transmitted to humans by the Ixodide tick • The tick must feed for more than 24-36 hours in order to transmit the spirochete • The most common vector-borne disease in the US • Up to 75% of patients with Lyme disease do not recall being bitten by a tick Lyme Disease • Stage 1: Early localized infection (7-10 days after bite) • Erythema migrans • A painless expanding annular rash • Stage 2 : Early disseminated infection (days to weeks later) Lyme Disease • Typically involves the skin, CNS, and musculoskeletal system • Headache, stiff neck, fatigue, malaise, and intermittent musculoskeletal symptoms are present • Cardiac or neurologic manifestations occur in up to 20% of cases • Stage 3: late persistent infection (months to years later) Lyme Disease • Musculoskeletal disease includes joint pain without objective findings. • CNS and PNS manifestations • Acrodermatitis chronicum atrophicans Lyme Disease • Diagnostic Studies • Antibodies can be detected by immunofluorescent assay or ELISA techniques. • A Western blot assay is used as a confirmatory test. • Immunoglobulin M wanes after 6-8 weeks • Immunoglobulin G may persist indefinitely • Early disease should be diagnosed based on clinical findings • Late disease is diagnosed by objective evidence of clinical manifestations and laboratory evidence of disease • Further lab tests such as CSF analysis, synovial fluid analysis, aspirations or biopsies may be helpful in discrete manifestations Lyme Disease-Treatment • Early localized disease • Doxycycline 100mg bid x 10 days for patients with erythema migrans or suspicion of Lyme disease based on clinical findings and a history of a tick present on the skin for more than 24 hours • Alternatives include amoxicillin, cefuroxime, cetriaxone, or cefotaxime • Symptomatic treatment with NSAIDs for analgesia • Prevention by proper clothing, tick repellent and a search for ticks after outdoor exposure • Prophylactic antibiotic therapy with doxycycline 200mg as a single dose after a tick bite is not recommended unless all of the following criteria: • Ixodes spp. tick attached for ≥36 hours • Prophylaxis can be given within 72 hours of tick removal • and local rate of Ixodes spp. tick infection with Borrelia burgdorferi is ≥20% Lyme Disease-Treatment • Acute neurologic disease • Isolated facial nerve palsy, meningitis or radiculomyelopathy • Doxycycline 100mg bid for 14-21 days • Arthritis without neurological involvement • 100mg bid for 28 days Syphilis • Treponema pallidum affects almost any tissue or organ • Transmission most frequently during sexual contact with direct contact of primary sores and sexual fluids • Vertical transmission in pregnancy Source: STD Facts - Syphilis (cdc.gov) Darkened micrograph of treponema Syphilis-Primary Infection • Clinical Findings • Primary syphilis is characterized by a painless chancre with clean base and firm, indurated margins approximately 10-90 days (average 21 days) after acquired infection. • It develops at the site of the inoculation. Associated with regional lymphadenopathy and lasts 3-6 weeks, resolving without treatment. Syphilis-Secondary Infection • Clinical Findings • Secondary lesions may involve skin, mucous membranes, eyes, bones, kidneys, CNS, or liver. There may be a relapsing rash during early latency • Can appear when the primary chancre is healing or several weeks after the chancre heals. • Usually does not cause itching. • May appear as rough, red, or reddish-brown spots on the palm of the hands and bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body. Source: STD Facts - Syphilis ( cdc.gov) Syphilis-Secondary Infection • Early Latent Stage= A syphilis infection has occurred within the past 12 months • Condyloma lata • Large, raised, gray or white lesions. • They may develop in warm, moist areas like the mouth, underarm or groin region. • In addition to rashes, signs and symptoms of secondary syphilis may include: • fever • swollen lymph nodes • sore throat • patchy hair loss • headaches • weight loss • muscle aches • fatigue Source: National STD curriculum, The University of Washington Source: National STD curriculum, The University of Washington Syphilis-Late Latent and Tertiary • Late latent has occurred more than 12 months ago • Tertiary syphilis includes gummatous lesions involving skin, bones, and viscera; cardiovascular disease, nervous system and ophthalmic lesions • Neurosyphilis can result in • • • • • • • • • Asymptotic disease, Meningovascular syphilis/Headache Generalized paresis Confusion Nausea, vomiting Stiff neck Visual acuity impairment Tinnitus Tabes dorsalis • Tabes dosalis manifests with impaired proprioception, loss of vibratory sense, Argyll Robertson pupil, or tabes dosalis crises Source: Gumma_of_nose_due_to_a_long_s tand.2e16d0ba.fill-1280x720.jpg ( 1280×720) (prod-dovemed.s3.am azonaws.com) Syphilis-Diagnostic Studies • Serologic testing is the recommend method for diagnosis • Nontreponemal antigen tests detect nonspecific antibodies to lipoidal antigens • VDRL and RPR tests become positive 4-6 weeks post infection • Treponemal antibody tests use live or killed T.pallidum as antigen to detect specific antibodies • The fluorescent treponemal antibody absorption (FTA-ABS) test is the most widely used. It is useful in determining whether a positive nontreponemal antigen test is a true positive. • FTA-ABS antibody will remain positive after acute infection is treated and for the rest of the patient's life Syphilis Source: Soreng, K., Levy, R., & Fakile, Y. (2014). Serologic testing for syphilis: Benefits and challenges of a reverse algorithm. Clinical Microbiology Newsletter, 36(24), 195– 202. https://doi.org/10.1016/j.clinmicnews.2014.12.001 Syphilis Source: Soreng, K., Levy, R., & Fakile, Y. (2014). Serologic testing for syphilis: Benefits and challenges of a reverse algorithm. Clinical Microbiology Newsletter, 36(24), 195– 202. https://doi.org/10.1016/j.clinmicnews.2014.12.001 Nontreponemal Titers that Indicate a Clinicallysignificant change Syphilis-Treatment • All cases of syphilis, regardless of stage, must be reported to the state public health agency • Sexual partners who may have been exposed in the last 90 days should be treated • Importance of monitoring the effectiveness of treatment to identify treatment failures • Early syphilis (primary, secondary, and early latent syphilis) without evidence of neurosyphilis: • Benzathine penicillin G, 2.4 million U IM in a single dose, is the treatment of choice. • Late latent and tertiary syphilis without evidence of neurosyphilis • IM injection of 2.4 million units penicillin G benzathine given one time each week x 3 weeks • If a patient misses a dose, and if more than 14 days have elapse since the prior dose, the course she be reinitiated Syphilis-Treatment Neurosyphilis, ocular, or otic syphilis is treated with IV penicillin G administered 3-4 million units every 4 hours for 10-14 days • Consider Jarisch-Herxheimer reaction secondary the sudden massive destruction of spirochetes Source: https://healthjade.net/jarisc h-herxheimer/ Congenital Syphilis • Transmitted via the placenta from mother to fetus and can result in severe defects • Leads to abnormalities in the skin or mucous membranes, nasal discharge (snuffles) hepatosplenomegaly, anemia, and osteochondritis • For children remained untreated, they may develop interstitial keratitis, Hutchinson teeth, saddle nose, deafness, and/or CNS abnormalities Source: Congenital-Syphilis-Pi cture-200x300.jpg (2 00×300) (hxbenefit.c om) Source: Marquette University School of Medicine