SPIROCHAETES
By DR ARSHEYA
Morphology
• Spirochaetes are structurally more complex than other bacteria.
• A characteristic feature is the presence of varying number of
endoflagella.
• The spiral shape and the motility of the spirochaetes depend on
integrity of these endoflagella.
• Motility of spirochaetes is of three types: flexion and extension of the
cellscorkscrew-like rotatory movement.
• The members of three genera of spirochaetes namely, Treponema,
Borrelia and Leptospira are pathogenic to man.
Spirochetes (order)
(Family)
Spirochetaceae Leptospiraceae
Genus Genus
Treponema Leptospira
Borrelia
Spirochaeta
Cristispira
DISEASES
Treponema
• Pathogenic Treponemes
1. T. pallidum - venereal syphilis
2. T. pertenue – yaws (Irradicated from INDIA in 2016)
3. T. carateum - pinta
4. T. endemicum - endemic syphilis
Treponema Pallidum
Morphology
• It is thin, delicate spirochaete with tapering ends, having about ten
regular spirals.
• It is about 10 µm long and 0.1-0.2 µm wide.
• It is actively motile, showing rotation round the long axis, backward
and forward movements and flexion of the whole body.
• Because of thinness of the spirals, T.pallidum cannot be seen by light
microscope. However, its morphology and motility can be seen by
dark ground microscopy or phase contrast microscopy.
• Three or four endoflagella are present.
Culture
• Pathogenic treponemes cannot be grown in artificial culture media but
are maintained by subculture in susceptible animals.
RESISTANCE
• T .pallidum is very delicate, being readily inactivated by drying or by
heat (41-42°C in one hour).
• Hence fomites are of little importance in the transmission of infection
• It is killed in 1 – 3 days at 0 – 4°C, so transfusion syphilis can be
prevented by storing blood for atleast four days in the refrigerator
before transfusion.
PATHOGENICITY
• Natural infection with Treponema Pallidum occurs only in human
beings
DISEASE - SYPHILIS
• Syphilis can be acquired by the venereal or non-venereal route or be
congenital or acquired
• Venereal syphilis is acquired by sexual contact.
Incubation period is about a month (range 10-90 days). There are three
clinical stages of the disease in an untreated case - primary, secondary
and tertiary.
• The treponemes can cross the placental barrier. Thus congenital
syphilis may occur.
Venereal syphilis
PRIMARY LESION SECONDARY SYPHILIS LATENT SYPHILIS LATE TERTIARY
SYPHILIS
• The primary lesion in • Sets in 1-3 months after the • After the secondary • In a few cases, a
syphilis is the chancre at the primary lesion heals. lesions disappear, late tertiary stage
site of entry of the spirochete • During this interval, the patient there is a period of may develop,
• The chancre is genital but is asymptomatic. quiescence known as presenting with
other common sites are • The secondary lesions are due latent syphilis. neurological
mouth and nipples to widespread multiplication of • In many cases, this is manifestations such
• It is known as a HARD the spirochetes and their folllowed by natural as tabes dorsalis, or
CHANCRE (painless, dissemination through the cure but in others, general paralysis
avascular, indurated, blood after several years, may develop
superficially ulcerated) • Spirochetes are abundant in the manifestations of several decades
• The chancre is covered by a lesions and thus the patient is tertiary syphilis after the initial
thick, glairy exudate rich in most infectious during the appear infection.
spirochetes. secondary stage.
• It heals in 10-40 days even • They usually undergo
without treatment , leaving a spontaneous healing, in some
thin scar. instances taking as long as four
or five years.
• Non-venereal (as occupationally in doctors or nurses)
The natural evolution is as in venereal syphilis, except
that the primary chancre is extragenital, usually on the
fingers. In the rare instances where syphilis is
transmitted by blood transfusion, the primary chancre
does not occur.
• Congenital syphilis, where infection is transmitted from
mother to fetus transplacentally.
LABORATORY DIAGNOSIS
• Laboratory diagnosis consists of demonstration of the spirochetes
under the microscope and of antibodies in serum or CSF.
1. Specimen :
Specimens should be collected with care as the lesions are highly
infectious.
Serum is collected for serology.
CSF can be collected for neurosyphilis.
2. Microscopy
• Dark ground microscopy : Treponema pallidum
appears as a slender, spiral organism showing
rotational as well as flexion and
extension movements
• Direct Fluorescent Antibody Staining for
T.pallidum (DFA-TP) : Smear is stained with
fluorescent-labelled monoclonal antibody
against T.pallidum. The treponemes exhibit
an apple green fluorescence.
• SEROLOGICAL TESTS :
These tests form the mainstay of laboratory diagnosis.
A. Non treponemal tests
1. VDRL (Venereal Disease Research Laboratory )
2. Rapid Plasma Reagin (RPR)
B. Specific Treponemal tests
1. Treponema pallidum immobilisation (TPI)
TPI was the most specific test available for the diagnosis of syphilis and
was considered the gold standard in syphilis serology. However, because
of its extreme complexity, it was available only in a few laboratories.
2. Fluorescent treponemal antibody (FTA)
The currently used modification of the test is the PTA-absorption (FTA-
ABS)
3. T.pallidum hemagglutination assay (TPHA)
• Non-Treponemal Tests : These tests detect non-specific
antibodies (reagin antibodies) produced in response to cellular
damage caused by Treponema pallidum.
1. VDRL : Detects reagin antibodies that react with cardiolipin (a
lipid antigen released from damaged host cells and T. pallidum).
Serum or cerebrospinal fluid (CSF) is mixed with a cardiolipin-
lecithin-cholesterol antigen. If antibodies are present, flocculation
(clumping) occurs.
2. RPR : Similar to VDRL, but uses charcoal particles for
macroscopic observation of flocculation. A drop of plasma is
mixed with antigen containing cardiolipin, lecithin, and cholesterol
coated on charcoal particles. A visible black clumping indicates a
positive test.
• Specific Treponemal Tests : These tests detect antibodies specific to Treponema
pallidum antigens, used for confirming syphilis after a positive non-treponemal test.
1. TPI (Treponema Pallidum Immobilization Test)
Directly detects live T. pallidum by determining whether the patient's serum
contains antibodies that immobilize the bacteria in the presence of complement.
2. TPHA (Treponema Pallidum Hemagglutination Assay)
Detects T. pallidum-specific antibodies by causing agglutination of sensitized red
blood cells (RBCs).
Patient serum is incubated with RBCs coated with T. pallidum antigens.
Agglutination indicates the presence of specific antibodies.
3. FTA (Fluorescent Treponemal Antibody Test)
Detects T. pallidum-specific antibodies using fluorescent-labeled anti-human
antibodies. T. pallidum organisms are fixed onto a slide and incubated with patient
serum. If antibodies are present, they bind to the organisms. A secondary fluorescent
antibody highlights these complexes.
FTA-ABS reduces non-specific reactions by pre-absorbing the serum with non-T.
pallidum antigens.
PROPHYLAXIS
• As transmission is by direct contact, it is possible to protect
against syphilis by avoiding sexual contact with an infected
individual.
• The use of physical barriers (such as condoms), antiseptics
(potassium permanganate) or antibiotics may minimise the risk.
• The use of prophylactic penicillin carries the danger that it may
suppress the primary lesion without eliminating the infection, so
that recognition and treatment of the disease may become more
difficult.
• No vaccine is available.
TREATMENT
• Penicillin is uniformly effective in syphilis but it is necessary to
give an adequate dose and maintain the drug level for a
sufficiently long period to establish cure.
• A single injection of 2.4 million units of benzathine penicillin G
is adequate in early cases. For late syphilis, this amount may be
repeated weekly for three weeks.
• In patients allergic to penicillin, doxycycline may be used.
• Ceftriaxone is effective, particularly in neurosyphilis
LEPTOSPIRA
• Members of the genus Leptospira are actively motile, delicate
spirochaetes possessing numerous closely wound spirals and
characteristic hooked ends.
• They do not stain readily.
• Pathogenic leptospires of man belong to the
species Leptospira interrogans.
Leptospira Interrogans
• MORPHOLOGY : These are spiral bacteria, 5-20 µm x 0.1 µm with
numerous closely set coils and hooked ends. They are actively motile.
Leptospires rotate rapidly about their long axis and bending or flexing
sharply.
• CULTURE : They are aerobic and microaerophilic.
Several media, such as Korthof's, Stuart's and Fletcher's media have
been described. Semisynthetic medium, such as EMJH (Ellinghausen,
McCullough, Johnson, Harris) is now commonly used.
Disease - leptospirosis
• L. interrogans causes a zoonotic disease named leptospirosis in
rodents.
• It is transmitted to humans by direct or indirect contact with water
contaminated by urine of carrier animals.
• Aseptic meningitis
• Weil's disease
Laboratory Diagnosis
1. SPECIMEN : Demonstration of Leptospires in the Blood or Urine
2. MICROSCOPY :
Examination of blood: leptospires disappear from blood after the first
week, blood examination is helpful only in the early stages of the disease.
Examination of urine: Leptospires appear in urine in the second week of
the disease and intermittently thereafter for 4-6 weeks. The urine should
be examined immediately after voiding leptospires
3. Culture: Specimens can be cultured in modified Korthof's medium or
Fletcher's semisolid medium.
4. Serological diagnosis:
Haemagglutination test, enzyme-linked immunosorbent assay (ELISA),
sensitised erythrocyte lysis (SEL), agglutination test and indirect
immunofluorescence.
• Treatment :
Leptospires are sensitive to penicillin, tetracycline and
erythromycin.
• Prophylaxis :
Preventive measures include
(i) rodent control
(ii) disinfection of water
(iii) the wearing of protective clothing
