okay so our next topic will be it will be spirochetes now spirochetes is a group of microorganisms composed of a large group of spiral now you knew in important terms they are spiral as the name implies spirochetes no so they are spiral they are motile bacteria no spirochetes are composed of three genera namely treponema bodega and leptospira so let us begin with treponema okay so let us begin with treponema now particularly the most important species is treponema palidum so this is a small this is a slender a flexible in corkscrew shape and aerobic microorganism now please take note it has a slow binding and rotating motility a singapore now please take note aside from treponema pallidum the following are species and subspecies that causes the infection of treponema uh now we have treponema pallidum subspecies protein wave please take note this is the causative agent of yours yosh is an endemic disease endemic disease that is popular or common in tropical countries or it is pathologically similar to syphilis but it differs in contiguous and non-venereal nature okay another one is treponema and once again it has a similar pathologic characteristics to that of syphilis but it is more endemic now in mexico in south america and here in the philippines and lastly we have treponema nicola which causes rabbit syphilis now in terms of morphology so it it it has an axial filament okay which are otherwise similar to a bacterial flagella okay so this basically mentioned okay filament no so this structure of the organism causes it to move or it causes the motility of the bacteria now in terms of disease caused by treponema once again they will have syphilis and syphilis has different categories or levels so the number one or the first one is primary syphilis okay please take note that the transmission of primary syphilis is by direct contact with lesions with body fluids or body secretions even with blood with seminal fluid and saliva and usually the transmission occurs during sexual contact okay another mode of transmission is by vertical transmission no meaning to say from other to fetus okay by placental transmission or transfer okay now please take note the clinical manifestations of primary syphilis is number one painless ulcer okay we call this chunker no painless ulcer or chunker so this chunker is a firm type of inflammation okay which is rich in fluids and please take note influence contains a lot of treponema or treponyms now please take note the onset of primary syphilis is two to four weeks about two to four weeks after the infection okay onset of primary syphilis is two to four weeks after the infection is young chance hindi lung of use this once again fluid filled bouillon okay and the new fluid okay within the chunker contains triponims in blood noman okay so as you can see here we have the rbc aw bcs and then you know structures the pattern corkscrew a spider so those are the spirochetes okay in addition to painless ulcer or chunker another clinical manifestation is adenopathy okay adenopathy is a term we use for swelling of the glands okay this pertains to the swelling of the lymph nodes adenopathy the lymph nodes are located in many parts of the body including the neck the armpit no the chest and even the groin please take note the importance of the lymph node is that it contains it releases immune cells that can help fight infection that's why in the presence of bacterial infection lymph nodes and because it is trying to fight back not that bacterial infection okay that's why one clinical manifestations not only for syphilis but in other bacterial infections as well is lymph adenopathy lymphadenopathy the next is secondary syphilis okay secondary syphilis occurs six to eight weeks after initial chunker so this can be categorized by localized however predating diffuse mucocotinous lesions okay often with generalized lymph adenopathy so the presentation of secondary syphilis may include skin eruptions okay it can even disseminate into blood then please take note now in secondary synthesis our patients they are highly okay highly infectious okay our patients are highly infectious okay on stage disease okay please take note no okay primary chunker may still be present for secondary syphilis though it is highly infectious it will be positive you know in several logic tests almost or nearly 100 percent it's a secondary syphilis the following are the clinical pictures of uh of of secondary syphilis once again we have mucou continuous lesions which can be found in in the back okay even in the hands participate and then this is often uh often accompanied by generalized lymph adenopathy okay the next stage of syphilis is sleet and syphilis [Music] latent syphilis is the asymptomatic stage of syphilis so after secondary syphilis dismissed age this teach me last a year so it may it is rarely communicable sexually however this is the stage that can be passed from the mother to the fetus to placental transfer now latent syphilis can be um further subdivided into early latent immediate early latent stage so this is the inactive stage following secondary syphilis the apu stage where in the patient is non-infectious he will not transfer the infection however the fetus they can be infected from the mother okay so we have early latent stage and the other one is the late latent stage now lately 10 stage so the onset number of this is matagal the onset is approximately three years about three years and after secondary stage or secondary syphilis okay okay and lastly okay is the the tertiary otherwise known as the late late stage of syphilis so this can be divided into three manifestations so inflammatory lesions may occur in any or in many organs of the body in many tissues of the body however the heart okay the the cardiovascular system as well as the cns now are mostly involved or affected my cardiovascular syphilis my neuroscience in addition okay one unique or one important feature of tertiary charissiphilis is the presence of gumma okay so we have gomato syphilis from its root word guma or gumas double m don't forget double m guma is a granuloma oma now granuloma meaning it is it is a small area of inflammation so the complication may include once again gumas or granuloma of skin or bones no inflammation of the skin or bones it may also include liver damage and eye impairment or ear dysfunction once again in this stage the patient is non-infectious indicia okay except of course for the mother to fetus transfer okay or placental transfer okay so in summary okay the following are the stages once again okay of syphilis so we have by marie okay so i'm featuring it is chunker and whole mark nito is chunker so other sites may include biannuals [Music] it will disappear about about two to eight weeks after the onset of the infection okay for the second direction okay the hallmark of this is savage so much lesion a pink to a pink to brown macules so it it will involve that the palms the soles okay even the oval cavity now with the presence of mucus patches you know okay so usually a medal being symptomatic early neuroscience okay with ocular syphilis manifestations okay with genito inguinal novash so this may include antinea mimicker or hip up work like missions called codilumalata now it resembles a fungal infection or lingworm infection okay less common manifestations include an internal organ manifestations like hepatitis or nephrotic syndrome okay so these are the manifestations of secondary syphilis and then we have lit elite and syphilis okay so this is the asymptomatic stage after primary and secondary so it can be noticed or sometimes unnoticed so once again we have early latent and lately then another difference one difference is in the medication and treatment so this this patients under early latent syphilis can can receive single dose of penicillin okay well for lately tentnaman yeah they have a positive zedologic test but do not meet criteria for the early latent stage okay thus because of this a patients will receive multiple doses of penicillin and of course sleep elite syphilis or tertiary syphilis so this may include infections to many organs particularly of the heart cardiovascular system as well as the cns however the hallmark of of late or tertiary stage syphilis is the presence of gumas so this is an ulcerating granuloma where the skin sub bones and even the internal organs so please take note of the stages of syphilis now aside from this like what was mentioned transfer is also possible so an infected mother can pass the infection to the fetus okay that's why we have congenital congenital syphilis please take note the fetus may be affected during the second day or third trimester forty percent know of patients of fetus with this may result in syphilitic stillbirth [Music] includes bone in dental deformities spreading blindness deafness and deformed face no skin rush maneuvers now please take note now for for syphilis the treatment or the drug of choice is penicillin okay penicillin how about the money for example the patient is allergic allergic penicillin okay so an alternative medication instead of penicillin is tetracycline mistake no tetracycline alternative medication or drug for patients with syphilis what are ways to prevent syphilis infection prevention how will we prevent this number one is early detection okay early detection especially for sexually active individuals but so the following are the different tests for syphilis i will not be discussing in detail to manga tests anyway introduction you will have a more detailed discussion of this once you reach no immunology and psychology essay among the tests for this is more of several logic tests okay so una is dark field microscopy so this is direct detection no via microscopy this this works reasonably well particularly in primary stage syphilis primary stage syphilis okay so usually it's a chunker or tissue sweet shrinker so as you can see the organism will appear white against a dark background as a dark filled microscopy okay the following are several logic tests for syphilis we can um we can categorize no several logic tests for syphilis as a treponemal test and non-triponimal test logic test for syphilis is vdrl okay vdrl stands for venetian disease research lab so this is a test designed to assess or to check whether a patient have have antibodies no forcibilis yes basically once infected by syphilis our body will produce or respond now by producing antibodies to that particular antigen for for cells that were damaged not by the organism okay so our specimen for this is blood a blood sample so we use these test cards against and the following will be the possible results we have non-reactive okay meaning negative we do not have antibodies not against meaning to say we were not infected with it a weak reactive minimal weak reactive and reactive okay once positive okay the sample will be tested for confirmatory test or for confirmation so vdrl serves as a screening test for syphilis another test for syphilis which is almost the same to that of vdrl is rpr the rpr stands for rapid plasma gene rapid plasma gene now please take note your rpr test uses the same antigen now it uses the same antigen as vdrl however the antigen for this is bound to a carbon particle now carbon particle for this reason it will allow visualization of the reaction to a long microscope okay compared to vdrl please take note an rprp is more sensitive that's why some laboratories prefers rpr as a screening test instead of vdrl okay so this is an anthropomorphic slide agglutination test okay for the quantitative and semi-quantitative detection of plasma regions in human serum procedure for this so we simply place 50 microliters of the sample and one drop of each positive and negative controls into separate circles in the test slide or test card okay and then swirl the rpr card and then we place no one drop approximately 20 microliters okay of our the agent okay to the test site and then once again mix stir spread them over the entire surface of the circle and then place the test card or the slide on a mechanical rotator with the paper or shaker at 80 to 100 rpm for eight minutes and then indeed the test results now four the presence of loculation okay a or the presence of flocculation will mean the activity is the active and once again once positive this will be confirmed our confirmatory test for cpl is don't worry during your immunozero the confirmatory test for syphilis is fta abs okay this stands for fluorescent treponemal absorption test once again this is used to detect antibodies to to to the bacteria to treponema pallidum in blood our our specimen is an antigen that contains steponemaphalidum so once again we are detecting the patient's antibody the specimen of the patient if the patient is infected obviously will contain antibody okay and with this there will be a complex between okay the agent the ponemah palidum okay and the antibody forming an antibody antigen complex like that a stage or step two so the treponem or teponym is coated with antibody okay and this antibody can be stained now with a conjugate conjugate if your full flow of descent microscopy so this conjugate will be covered okay with airflow odyssey it don't flow odyssey nato basically this will the one which will cause okay the material to flow this the under fluorescent microscopy you will notice fluorescence now particularly off the antigen surface antibodies insufficient specimens obviously well [Music] flow of sense negative or confirmatory testing okay so i hope uh clear in lecture nothing for next is bodega we have two important species for bodelia so we have varelia burgdorferi the positive agent of lyme disease and bodelia de codentics not the cause of the lapsing fever in terms of morphology please take note they are large no in motile spirochetes their caviar their vector is known as exodus or actually the identification is through several logic testing the immunofluorescence in enzyme immunosorbent assay so borrelia in blood will look something like this spiral then okay but they are quite larger compared to the spiral kits malala so lyme disease is an infection caused by bodelia burgdorferi complications includes neurologic and cardiac manifestations and of course arthritis and so once again lyme disease can be can be transferred or transmitted by an infected adult fix so it can infect an adult and then this will infect other hosts humans also so or [Music] exodus x so the clinical manifestation of this okay orovash in the body particularly silicone and of course your complication once again cns or neurologic manifestations like drooping eyes and drooping corner of the mouth these are the clinical manifestations of lyme disease okay and lastly is leptospira okay we have one important species under this we have leptospida integrogans occasionally leptospida are isolated from blood and urine culture however their main habitat is damp environments like stagnant water and wet soil the reservoir includes kidneys of rodents and domestic animals transmission is through udine of animals ayumangamahiligma swimming a swimming in contaminated water or consuming contaminated food or drinks a clinical manifestations includes mild febrile illness due to fatal attacks of jaundice and renal failure and the diagnosis is rise in igm antibody titers device in igm antibody titers so this is one clinical manifestation of leptospida infection so this is conjunctivitis so this is a manifestation an infection of the eyes caused by leptospira intelligence and so this is characterized by redness of the conjunctiva irritated inflamed and swelling by swelling a particularly the onshore corners of the eye and the specimen from this will of course show you know the organism so leptospida intelligence okay so that's it for this part of our lecture do you have any questions or clarifications