1 / 56

Group B6

Syphilis , Chlamydia and Gonorrhea : Bacteriology, Epidemiology, Pathogenesis, Clinical Manifestations, Diagnosis and Treatment. Group B6. Epidemiology - Syphilis. Epidemiology - Syphilis. Epidemiology - Syphilis. Epidemiology - Syphilis. Epidemiology - Syphilis. Epidemiology - Syphilis.

onofre
Download Presentation

Group B6

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Syphilis, Chlamydia and Gonorrhea: Bacteriology, Epidemiology, Pathogenesis, Clinical Manifestations, Diagnosis and Treatment Group B6

  2. Epidemiology - Syphilis

  3. Epidemiology - Syphilis

  4. Epidemiology - Syphilis

  5. Epidemiology - Syphilis

  6. Epidemiology - Syphilis

  7. Epidemiology - Syphilis

  8. Epidemiology - Syphilis

  9. Transmission - T. pallidum • “teeming with spirochetes” • Transmission • Sexually engaging a person with lesions • Mother  Baby • In utero • Congenital syphilis

  10. Pathogensis – T. pallidum 3-6 wks post-incubation

  11. Pathogensis – T. pallidum Chancres resolve w/in wks even w/o treatment Some move directly to 2 syphilis Period in which organism replicates & spreads throughout body 4-10 wks after first signs of primary lesions If left untreated, can move to 3 syphilis Latent Period

  12. 2 Syphilis Sites of replication Lymph nodes, mucous membranes, liver, joints, muscle, skin • Spirochete replication  dissemination • Manifestations(variable) • Malaise & Fever • Myalgias & Arthralgias • Lymphadenopathy • Rash & Lesions • Rash present on ENTIRE body (inc. palms & soles) • Lesions present in different stages (macular, papular, pustular) • Contains treponemes Condylomatalata gray/white lesions painless highly infectious warm/moist areas 2 syphilis will heal w/in weeks w/o treatment; if left untreated  latent &/or 3 syphilis

  13. Latent Syphilis • Early Latent Syphilis • Less than 1 yr after 2 syphilis • Relapse possible • PT may have relapse of 2 syphilis lesions/symptoms • CONTAGIOUS • Late Latent Syphilis • Less than 1 yr after 2 syphilis • No symptoms • Not as contagious PT is seropositive during latent phase, thus blood test is required for diagnoses. Latent stage may persist for years (10-20yrs); if left untreated  3 syphilis

  14. 3 Syphilis • Rare  ~1/3 of untreated PTs • Slow, chronic inflammatory damage d/t to reaction of spirochetes in tissue • 3 categories • Gummatous syphilis • Cardiovascular syphilis • Neurosyphilis • Gummatous syphilis • Granulomatous lesions • Center = necrotic tissue • Form in (but not limited to) liver, bones, ski • Cardiovascular syphilis • Aneurysm formation in ascending aorta • Neurosyphilis • CNS invasion  syphilitic meningitis • Damage to blood vessels in CNS  meningovascular syphilis • Parenchymalneurosyphilis tabesdorsalis & general paresis

  15. Clinical - Syphilis • Aka The Great Imitator • Primary syphilis characterized by a firm, round, small, PAINLESS, chancre • Usually a single lesion but there may be multiple • Occurs at the site where the treponeme invaded • The chancre lasts 3 to 6 weeks

  16. Clinical - Syphilis • Secondary syphilis is characterized via a skin rash and mucous membrane lesions • Presents as rough, red/brownish spots on palms and soles • Other symptoms are fever, lymphadenopathy, myalgias, weight loss, and fatigue • These symptoms will disappear with or without treatment

  17. Clinical - Syphyilis • Tertiary syphilis occurs many years after the secondary phase • Treponemes damage the brain, eyes, heart, vessels, bones, joints, and many internal organs • Patients may develop aortitis, hoarseness, Argyll Robertson’s pupil, gummas, and TabesDorsalis

  18. Diagnosis – T. pallidum • Dark Field microscopy serology tests: • Fluorescent Treponemal Antibody Absorption (FTA-ABS) • Specific • Veneral Disease Research Lab (VDRL) • Nonspecific • detects reaginAb against cardiolipin

  19. Diagnosis – T. pallidum • Serology • Non-treponemal antibodies • VDRL & PRP • Serology • Treponemal antibodies • FTA-ABS & MHA-TP

  20. Treatment – T. pallidum • Drugs: • Benzathine penicillin G

  21. Epidemiology - Chlamydia

  22. Epidemiology - Chlamydia

  23. Epidemiology - Chlamydia

  24. Epidemiology - Chlamydia

  25. Epidemiology - Chlamydia

  26. Pathogenesis – Chlamydia

  27. Virulence Factors – Chlamydia • Intracellular organism • Downregulates MHC-I • LPS • Promotes inflammation via TLR-4 activation (inducing IL-1 & -8 secretion) • Prevents fusion of endosome with lysosome • Provides a “home” • Persistent state • Allows Chlamydia to persist in face of IFN-gamma • Nutrient up-take • Via Type 3 secretion system which serves as a “transport channel”

  28. Clinical - Chlamydia • Clamydia trachomatis • A,B,C serotypes induce chronic infections and blindness due to follicular conjunctivitis • D,K serotypes cause urethritis/PID, ectopic pregnancy, neonatal pneumonia(staccato cough), or neonatal conjunctivitis • L1,L2,L3 result in lymphogranulomavenereum

  29. Clinical - Chlamydia • Known as the silent STD since many are asymptomatic • Women may have burning upon urination or vaginal discharge • Untreated infections may lead to PID or ectopic pregnancy • Leading cause of pneumoniae and conjunctivitis in neonates

  30. Clinical - Chlamydia • Men may have discharge from penis or burning upon urination • Rarely, Reiter’s syndrome may occur including arthritis, skin lesions, and inflammation of the eye and urethra

  31. Diagnosis – C. trachomatis • Cell culture • Non-culture Direct Detection methods: • Direct Fluorescent Antibody tests (DFA) test) – direct at elementary bodies • Enzyme Immunoassays (EIA) • Nucleic Acid Hybridization Tests • Nucleic Acid Amplification Tests – most sensitive • Serologic Tests

  32. Treatment – C. trachomatis • Drugs • Azithromycin • Ceftriaxone + Doxycycline = concurrent N. gonorrhea • Erythromycin (oral) = Neonates

  33. Epidemiology - Gonorrhea

  34. Epidemiology - Gonorrhea

  35. Epidemiology - Gonorrhea

  36. Epidemiology - Gonorrhea

  37. Epidemiology - Gonorrhea

  38. Epidemiology - Gonorrhea

  39. Virulence Factors – N. gonorrhea • Adherence/Uptake • Pili • Opa proteins • Antigen variation/antigen phase variation • Porin 1 • Enzymes/Toxins • LOS • IgA protease

  40. Pathogenesis – N. gonorrhea • Virulence Factors • Adherence/Uptake • Pili • Opa proteins • Antigen variation • Movement across cell • Porin 1 • Enzymes/Toxins • LOS • IgA protease

  41. Clinical - Gonorrhea • Men may have burning upon urination and white, yellow, or green discharge • Painful or swollen testes may also occur as well as epidydimitis leading to infertility • Women are often asymptomatic but could experience burning upon urination • Untreated infections lead to PID in women and septic arthritis in both sexes • Pregnant women may also transmit gonorrhea to their baby via passage through birth canal resulting in blindness and joint infections

  42. Diagnosis – N. gonorrhoeae • Nucleic acid amplification tests (NAAT) – most sensitive (PCR) • Nucleic acid hybridization test (co-infection Chlamydia) • Culture: Thayer Martin agar / chocolate agar • Gram stain: diplococci within neutrophils

  43. Treatment – N. gonorrhoeae • Drugs: • Ceftriaxone + Azithromycin • Ceftriaxone + Doxycycline = concurrent Chlamydia • Erythromycin (eye gtts) = prophylaxis in neonates • Resistance: • Penicillin • Fluoroquinolones – Ciprofloxacin or Levofloxacin (Levaquin) • Vaccines: • NONE (varied pili antigens)

  44. Antibiotic Resistance – N. gonorrhoeae • Beta-lactamases • Efflux pumps • Mutations: • Penicillin-binding proteins • DNA gyrase and topoisomerase • Porins

  45. Q1 A 34-year-old male presents to your ofice with a painless penile ulcer several weeks after an episode of unprotected sexual intercourse.(bad luck?!) Which of the following is most useful in diagnosing Treponemapallidum infection in this patient? • Ulcer exudate microscopy after Gram staining • Ulcer exudate microscopy with darkfield illumination • Ulcer eudate cultures on enrichment media • Blood culture on differential media • Antitoxin detection in the serum

More Related