bacteria

• spherical (cocci)

• rod (bacilli)

• spiral (spirilla)

• comma (vibrios)

• corkscrew (spirochaetes)

gram +

• staphylococcus

• streptococcus

• enterococcus

there are much more gram+ cocci, but the named ones are the most imortant for the human health

gram -

• neisseriae

  • gonococcus

  • meningococcus (both diplococci)

differentiation due to their coagulase activity

=> coagulase: crucial enzyme to differenciate staphylococci

• positive coagulase activity:

  staphylococcus aureus

  -> to use blood for energy production

  -> to perform hemolysis

• negative coagulase activity: staphylococcus epidermis

cogulase+

member of the normal microbiota in nose and skin

active in numerous diseases:

• skin: abscess, folliculitis

• nose: sinusitis

• gut: food poisoning

• bone/joint: osteomyelitis, septic arthritis

  (not 100% clear how bacteries come to the bone; often after surgery)

• bacteremia (sepsis) -> endocarditis!

  (live in the blood and replicate in high numbers)

virulence factors:

• enzymes: coagulase

• toxins:

  • superantigens (toxic shock syndrome)

  • exfoitative toxins

  • membrane toxins (alpha, beta, delta)

• type VII secretion system (one type of a very effective secretion for b. to defend/protect themselves)

• small RNA

• DNA repair (s.a. has the ability; antibiotics that affect (destroy+fragmentate) DNA are no longer effective

• post-transcripitonal regulation

PROBLEM:

-> due to ubiquitous presence adapted to a lot of conditions

• multiple resistancies (as it develops resistancy quite rapidly)

coagulase-

s.e. always present on healthy skin (within the cornea layer of the skin; each manipulation of the skin, like entering a needle, can lead to the entering of the bacterium into a deeper layer)

• skin microbiota (microbioma) memeber, and crucial for normal fct of the skin

• influences odor (foot)

• forms biofilms (resistance; protects the outer skin from the entering of fungi)

• Acne vulgaris (+ cutibacterium acnes) (as often resistancies against antibiotics, cleaning of the skin is more important than medic treatment)

• often antibiotic resistances

-> crucial memeber differenciating the content of the sweat glands

-> s.e. especially increased in conditions where is no free air around

differentiation due to their hemolytic activity:

• alpha hemolysis

  • streptococcus pneumoniae (vaccines due to its importance!!)

• beta hemolysis (hemolytic activity)

  • streptococcus pyogenes

  • streptococcus agalactiae

• gamma (no) hemolytic activity

  • enterococcus faecalis, faecium)

• a-hemolytic activity

• does not belong to the microbioma on the skin

• transduced via the air ways, can spread all over the mucous from the nose into the lungs

• affects very often the lungs themselves (name)

  -> dangerous, because oxygen exchange is disturbed by having liquid in the alveoli (empyema)

  -> as they can reach the heart region through the lungs, also the heart can be affected by an empyema in the pericardium

  -> from aleveoli can easily enter the blood system and lead to a scepticaemia

• can also lead to arthritis or osteomyelitis

• as spreading via the blood, can also affect the brain and form a meningitis

why is it so dangerous?

• is a bacterium with a capsule, so it is better protected and the IS has more difficulties to act against the bacterium

• produces enzymes which destroy alveolar tissue

• has choline-binding proteins present in the cell wall, so can affect the nervous system

beta hemolytic activity

found more frequently than other bacteria on the skin and in the mucous

active in numerous diseases

• streptococcal pharyngitis

• skin: folliculitis, cellulitis, impetigo (Eiterflechte, Grind)

• scarlet fever (Scharlach)

• rheumatic fever

• postinfectious glomerulonephritis

• Penicillin!!! (still sensitive to penicillin as it does not cover up plasmids for resistance)

  -> more important for avoiding the postinfectious diseases such as glomerolunephritis)

=> beta hemolytic activity of streptococci is always in combination with high virulence and dangerous conditions

beta hemolytic activity

first, intestinal colonization and destruction of the epithelium of the gut, from there via transcystosis into blood vessels, blood takes them to the brain

-> possible meningitis

=> beta hemolytic activity of streptococci is always in combination with high virulence and dangerous conditions

gamma hemolytic activity

possibly caused diseases:

• urinary tract infection

• sepsis

• meningitis

• endocarditis

WHO: bio-indicator for water quality in pools + ocean

gram-

only sexually transmitted (infection depends on where sexual contact occured):

• urethritis (proctitis / pharyngitis)

• arthritis

• dermatitis

prevention: latex barriers

treatment: single injection of ceftriaxone

newborn conjunctivitis (outer eye)

• can become so severe until occurance of blindness

• erythromycin gel prophylaxis (aggressive silver nitrate prophylaxis no longer used)

gram-

form a thick capsule in addition to the wall

-> immune system has difficulties to identify and act against them

-> only region is within the spleen (resectomy of

spleen is a problem!!!)

meningitis: lethality 10%!

-> normal adult immune system is stable enough to fight m. (bigger problem for children, small children and newborns)

-> healthy adults normally do not need vaccination

-> but for example, if spleen was resected

sepsis:

• purpural rush (Henoch-Schönlein)

  specific sign of condition seen on the skin -> small hematomas within the skin without mecanic causes

• Waterhouse-Friedrichsen syndrome (adrenal gland insufficiency)

• disseminated intravascular coagulation (DIC)

vaccination: very effective in forming antibodies

gram+:

- Listeria monocytogenes, Corynebacterium diphtheriae

-> aerob, no spores

- Bacillus anthracis

-> aerob, spores

- Lactobacillus, Bifidobacteria, Actinomyces

-> (non) aerob, no spores

- Clostridium botulinum, C. perfringens, C. tetani, C.

difficile

-> anaerob, spores

gram-:

- Pseudomonas aeruginosa

Bordetella, Legionella, Haemophilus

-> aerob

gram +

• most common type of rod bacteria

• great impact on human because of high mortality

  -> 70%!!!

• virulence factors

  -> does not live outside of cells, so not seen by IS (foreces the cells to take them up and can then live, act and replicate without being seen by IS)

  -> does not have to leave cell to infect a next one, but builds extrusion/extension to contact next cell

  => UNIQUE FEATURE

-> IS strictly limited to signals outside of cells:

• decreased production of MHC-I protein, which will lead to destruction of cell by IS

PROBLEMS:

• can affect neural cells which cannot be destroyed by IS; and inflammatory process is not effective as bacteria are inside the cells -> inflammation of brain can get very severe; only a few antibiotics for treatment as they have to enter the blood-brain-barrier, and treatment with chemicals within cells always means an affection of the metabolic activity of the cell itself

• can lead to a sepsis, when at a certain stage let out of cells into intracellular space; and when in the blood, again they can spread to the brain

-> mainly in animal products: raw milk and products made

out of it, therefore heating of milk and no use of raw milk

LIFE CYCLE

1) listeria enter the intestine

2) can penetrate through epithelium

3) then infects the lymphatic cells

4) and then reach the lymph nodes and enter the blood

-> thatwise able to reach organs - mainly liver and spleen -

unseen by IS

-> in spleen able to infect erythrocytes

-> spleen enlargement typical sign for listeria infection

-> most problematic tissue again is the brain tissue

BUT

-> pregnancy:

• can enter the placental barrier and reach the fetus

• within the fetal tissue it will destroy nervous system

  -> growth no longer possible and will lead to abortion

  (dead of fetus)

  => no consumption of raw food!!!

gram+

-> toxins lead to problems not bacterium itself, so only toxin producing bacteria of c.diphteriae is a problem for human condition

-> specific appearance, which allows differenciation from other rods by microscopy

-> as toxine has been major problem in the 19th century, vaccination already for over 100yrs!!! and diphteriae is no problem in the population

• first with another corynebacterium, nowadays with toxine)

WHAT DOES TOXINE DO?

• c.diphteriae enters airways and proliferates in the mucous

• extracellular bacterium, therefore IS can react

• at the moment, it produces toxins, a pseudo-membrane formation on the surface of the epithelium occurs, can extend to nasal region and airways + larynx (!) -> inflammation will start there which causes a swelling that can lead to severe problems with breathing and therefore also dead

• in a second step, the toxine can enter the blood from the epithelium -> secondary diseases of central nervous system, kidneys and heart

  -> necessity to react early, that these membranes will not spread and extend in more dangerous sites and to avoid toxemia (that the toxine does not reach the blood) (which the IS can do easily when having had contact with toxine before)

gram+

• spore forming, four sites where toxin can act

  1) skin: boil-like lesions, like a large burning

  2) injection: can reach the whole body via the blood, can perform these boil-like changes in the inside: most feared that changes reaches the lungs

  3) lungs (via breathing): not immediate but delayed reaction, so long period with just coughing and not feeling well (not linked to b.a., yet); can then lead to severe pneumonia, and leaving the lung tissue also mediastinitis (inflammation of CT between the lungs) -> crucial and dangerous condition

  4) GI tract (gut): symptoms such as diarrhea as main symptom

• spores easily to be spread; used for bioterrorism; rapid reaction as spores contain some toxin and one does not have to wait until the spores witch back to metabolic stage

• aerob bacterium, so easily reactivation of metabolic stage in sites with oxygen, which is everywhere with blood supply

WHAT DOES THE TOXIN MAKE?

• produces edema

• and too much fluid outside the cells in the extracellular part of the tissue -> interrupted nutrition

• or fluid in lumen of gut -> severe loss of liquid (diarrhea)

=> capsule protects from phagocytosis

gram+

• typical appearance of two large bacteria lie next to each other and form one entity -> name BI- comes from this aspect

• LACTO- -> mainly found in milk

• has specific feature that it interacts with sugar which it reduces to lactic acid -> oral cavity

• lactic acid can interact with extracellular material strcts in the teeth -> caries within the teeth

• in other areas we want to have acid situations to prevent spreading of other bacteria -> GI tract and vagina, are therefore seen as probitiotic bacteria

• are part of normal microbioma; able to proliferate when IS unstable

• involved in GI tryptophan metabolism -> transform it into 3 other elements:

  1) IPA -> protects the brain and its activity

  2) I3A -> stimulates the immune cells in the intestine

  3) indole -> helps the liver; protective against vascular diseases

group of gram+ rods

C. botulinum: botulinum toxin (neuromuscular blockage)

C. perfringens: food poisoning, fasciitis, gas gangrene

C. tetani: tetanus toxin (muscle spasms)

C. difficile: multiple toxins (diarrhea, colon cancer)

• bacteria mainly need aerobic conditions

• spore building

• all bacteria are able to produce toxins, which mainly interact with nervous system -> life threatening conditions possible!!!

• c.botulinum toxin and c.tetani toxin partly used as medication, with opposite mechanisms -> botulinum toxin (botox) relaxes muscles (neuromuscular blockage by blocking acetylcholine release and destroying adhesion element necessary for vesicles to attach to outer membrane), while tetani toxin leads to constant contraction as inhibiting transmitters are blocked (muscles can get damaged (until loss of muscle tissue) due to lack of relaxation which is crucial for nutrition and oxygen support)

c. perfringens taken up with food

• toxin is able to destroy epithelial lining of the gut

  -> inflammatory reaction with invasion of many immune cells

  -> activity of epithelium no longer possible => no reuptake of any substances; digestion severly affected, which makes poisoning with c.perfringens very critical

gram- rod

• ubiquitous present, but under normal health conditions not problematic:

  hospital-acquired infections -> pneumonia + sepsis

• predominant risks: cystic fibrosis, immunocompromised

• highly adapted to antibiotics

• does not produce toxin, but interaction with tissue problematic

gram- rod

• produces toxin

• affects mainly tissues with cynocilium-like appearance -> respiratory tract, the lungs, the trachea, the oral site

• only seen in humans -> vaccination very effective strategy to get rid of b.

gram- rod

• first identified 1976

• like to enter cell system and live within cellular condition (appropriate nutrition and energy support)

• live in amoebae (protozoa) which live in humid environments and get destroyed as soon as there is ‘moving’ water -> showers (if not used, amoebae spread, and when used again, amoebae get destroyed and legionella are free, and one can get into contact, and by inhaling, they can enter respiratory tract

  -> upper respiratory tract: pontiac fever

  -> lungs: atypical pneumonia: legionnaires disease

• with a strong IS, one will develop pontiac fever but no legionnaires disease (often in older people)

• prevention: no aerosolic contact with long-time stagnant water

gram- rod (red color in staining)

• form a capsule -> need specific immunological reaction (which is not so well developed in infants and children -> problem to defend these bacteria)

• as the name indicates, during infection it has similar symptoms as other flu performing microorganisms:

  -> sinusitis

  -> otitis media

  -> infection of the larynx, bronchi and lungs

• higher aggressivity, likes to invade the tissue, then can extend and form a bacteriemia -> leads to distribution all over the body, most feared if reaches the brain -> meningitis

  -> vaccination (most reasonable for children up to 5, then IS developed enough); only against type b (hib), so one can get infection with other hi type

• salmonella

• shigella

• escherichia

• yersinia

• helicobacter pylori

=> widely spread, not only as human pathogens, but in the whole environment (insects, water, vegetation, animals)

=> very important for the whole system, as they support the environment

=> can therefore not be erased and a strategy against them has to be individual on each human affected by them

=> erasing them would harm ourselves, e.g. with e.coli

• vibrio cholerae

Bild vor vibrio cholerae

• gram- rod

• intracellular (difficult for IS to react against it), non-spore forming, facultative anaerob

• fecal-oral transduction

• flagellated

• two species -> s.bongori + s.enterica

• two forms of disease -> typhoidal + non-typhoidal

• non-typhoidal salmonellosis spread worlwide

• usually food-borne, through oral consumption of non-cooked or -heated eggs, chicken, meat, raw vegetables and fruit

• can be spread person-person -> causes typhoid fever (Typhus)

• incubation time: 12-24hrs, but can be up to 72hrs

• symptoms: enteritis with diarrhea without any obvious cause, blood in the stool

• typhoid fever: stomach pain, general system diseases, pneumonia, joint arthritis, kidney failure

• usually spreading more due to contaminated excretions

• long-term problems: irritable bowel syndrome,

  inflammatory bowel disease

• prevention: clean environment, washing hands, washing the fruit, boiling the water, etc

• gram- rod bacterium

• non-motile, facultative anaerob, non-spore forming

• intracellular

• 4 subgroups

  s.dysenteriae

  s.flexneri

  s.boydii

  s.sonnei

  -> dependend on subgroups, different symptoms form, and different way of acting in the body

• pathophysiology

  -> transmitted via contaminated food or water, poor sanitary conditions or person-to-person contact

  -> only a small number (10-100) of shigellae needed to cause lifethreatening shigellose of high resistance to gastric acid

  -> enters the epithelium, and because of rapid renweal of epithelial cells (within 48hrs), normally infection does not last long

  -> has the ability to develop intracellular motility, which makes an infection last longer, as it remains hidden from the IS

  -> production of toxins as another virulent factor

• symptoms:

  -> usually manifest after 24-48hrs

  -> without treatment these can last 7-10 days

  -> fever

  -> watery diarrhea, in severe cases mucous-bloody dysentery (Durchfall/Ruhr)

  -> dehydration

  -> vomiting

  -> abdominal pain and tenderness

  -> arthritis

  -> HUS: hemolytic urine syndrome

• treatment:

  -> rehydration

  -> antibiotics

• Gram- rod, non-spore-forming, facultative anaerobic, motile (flagella)

• part of our microbioma in the intestines

• provide vitamin K for the body (can lead to need of oral supplementation of vit K, if e.coli is affected by antibiotics taken against other diseases

• most widely studied bacteria

• pathogenesis:

  3 known antigens, which interact with IS

  -> O-antigen: lipopolysaccharide on outer membrane

  -> K-antigen: capsular polysaccharide (protective

  element)

  -> H-antigen: flagella (reacts with it; finding niches for

  better survival)

• depending on symptoms, different pathogenic subtypes:

  -> more toxic activity: ENTEROTOXIGENIC e.coli (ETEC)

  -> hemorrhage: ENTEROHERMORRAHRGIC e.coli (EHEC)

  -> ENTEROAGGREGATIVE e.coli (EAEC)

  -> ENTEROINVASIVE e.coli (EIEC)

• patheogenicity:

  -> Gastrointestinal diseases (Diarrhea)

  -> Urinary tract infection (UPEC): bladder, kidneys, prostate

  -> Neonatal meningitis (NMEC)

• gram- coccobacilli

• facultative anaerob

• y. pestis -> bubonic or pneumonic plague

• y.enterocolitica -> gastroenterocolitis (yersiniosis) in

  humans

  -> food-borne as it has its reservoirs in animals, via contaminated milk or meat

  -> typical symptoms are abdominal pain, diarrhea, fever

• transmission of bubonic plague -> from rodents to fleas to humans

• typical symptoms of bubonic plague:

  -> high fever

  -> breathing constriction

  -> opening of swollen buboes

  -> seizures (Krämpfe)

  -> extreme exhaustion

• gram-

• spiral shape allows to move through the mucous lining of the human stomach

• its urease (enzyme) production enables it to survive in gastric acid (h.pylori-urease-test)

• widespread; half of the population may carry the bacterium although not everybody develops a disease such as gastritis

• transmission:

  -> primarily by person-person through close contact

  -> many remain asymptomatic, but linked to peptic ulcers (duodenum or stomach) or inflammation of stomach lining, which can lead to gastritis and increased risk of stomach cancer (long-term infection)

• diagnosis & treatments:

  -> endoscopy with taking samples of stomach lining

  -> treatment with combination of antibiotics and acid reducing medications

• prevention:

  -> good food hygiene, safety of water and food sources

  -> addressing potential risk factors such as crowded living

• gram- rod

• long flagellum

• pathogenic agent is a toxin produced by bacteriophage, which affects the channels of epithelium, which usually keep balance of the extracellular fluid towards the tissue, so it’s blocking the channels entering the water

• as toxin binds to the cell and is not able to move to another cell -> self-limiting disease (remember renewal of epithelial tissue within 48hrs)

• main symptom is severe loss of fluid (really huge loss) and therefore really severe dehydration -> until lifethreatening stage

• treatment therefore is only rehydration or oral or by additional infusions

• dehydration leads to a number of severe side effects

• natural source: brakish and salt water

  -> therefore worldwide issue, but especially in those countries with poor hygenic conditions (central america, africa, india, china)

• characterized by a very specific cell wall

• broad capsule, especially enriched with a number of proteins, which focus and build pores, where contact can occur between the inside (cytoplasm) and the outside of the cell

• very complex and highly structured

  -> long replication time!!!

  => very specific element of mycobacteria

• “old” bacterium from ancient times (such as myc lepromatosis) which didn’t became an epidemic stage before industrialization in 18th/19zh century -> many people crowded in poor living conditions

• affected mainly young people (those where working in the industrialization process)

• found by Robert Koch in 1882

• requires oxygen to grow -> therefore high affiliation to the lungs!

• nonmotile

• divides only every 18-24 hours (therefore primary examination was difficult as cultures were hard to grow over weeks)

• can easily survive for weeks without water, so still living after days; and transmission still possible!!!

• quite resistant to desinfectants due to its high developed capsule -> to erase it from surfaces, intense desinfection is needed!

• can not be identified with gram staining! (due to capsule and the whole strct) -> nowadays, analysis of antibodies (by staining of antibodies, which is available only since the late 20th century)

• still spreading in a number of countries, and due to high motility (travelling), one can easily catch up the myc tub

• 95% of carriers are asymptomatic; more than 1/4 of world population carry the myc

• not a problem with healthy IS -> additional risk factors: malnutrition, poverty, compromised IS

• BCG vaccination exists, but only 20% decrease of risk, so not a routine anymore

• onyl human-human transmission, and only with humans, who are in the stage of spreading the bacteria; which is not the case the whole time, but only with sneezing and coughing

  -> prevention of spreading by isolation!

  -> prevention by wearing a mask!

  -> prevention by good, intense desinfection and general hygenic standards

  
  

  
  

different stages (can be identified by x-ray examination):

-> latent infection: only small local activites, incapsulated process within the lungs

-> cavitary tuberculosis: highly infectious because of large cavities being formed due to distruction of lung tissue; bact can spread towards next person

-> miliary tuberculosis: with many little localisations, again not infectious; pure lung affected tuberculosis

=> PRIMARY TUBERCULOSIS

• around most of the cavities or small spots, a healing fibrosis or calcification is formed, so surrounded by fibrous tissue or CT and can therefore not spread to neighbouring regions

  -> effective tool of body to stop spreading (can be easily seen in xrays), but still living bact within these strcts!!!

-> reactivation is always possible, especially with additional issues, such as a decrease in IS fct (but also malnutrition and other stress factors), might allow the bacteria to reorganise, to leave the organised sheath and to enter the blood system (even after years!) where it can form a bacteriemia; but only 10% develop progressive primary tuberculosis

• can affect a number of organs:

  -> liver and spleen (mainly)

  -> the joints and the long bones

  -> the adrenal gland; causes hormonological disturbances

  -> can lead to immunological problems

  -> brain with meninges can be affected, too

-> immunological reaction:

1) macrophages in alveoli phagocyte myc tub, but as soon as inside, myc tub forms protein that inhibits interaction of macrophage with lysosome, why myc tub survives

2) a so called CASEATING GRANULOMA with involvement of neutrophil granulocytes -> problem, that bacteria are still alive and proliferate; if not calcified, which means, in this case bacteria are dead

-> two stages of IS system reaction:

• depending on the stage, we have different antibodies, and therefore one can identify, if it’s active and in a fresh active form, or if it’s chronic

-> complicated, long-lasting treatment

• also known for a long time

• quite an issue in middle ages

• diagnosis possible by vision as skin and joints get affected

• in the middle ages, affected people were excluded from social life and had to live in leprosories (poor and rich)

• highly developed cell wall and capsule (as myc tub)

• spreads human-human

• high modern hygenic standards led to decrease in numbers nowadays

• doubling time 12-14 days!!! -> cannot be cultured

  -> takes a long time until syptoms manifest

• myc lep is an intracellular parasite -> hard for IS to recognise

• nowadays two hotspots -> india, brasil (big cities)

• symptoms:

  -> skin: pale or reddish lesions or nodules in different sizes

  -> nervous system: numbness, which leads to secondary disturbances such as deformations of the hands and feet; hair loss due to interruption of innervation and cycle of the hair

• incubation time 5 yrs!!! -> problem, as it is difficult to link showing symptoms to an infection with myc lep 5 yrs ago

• treatment: in an early stage, antibiotic treatment quite effective

• very exception of bacterium!!!

  => does not have a capsule AND no cell wall!

  -> only double lipid layer membrane

• small and very agile

• adheres at the cell membrane or locates intracellular

  -> in both cases it is difficult for IS to act against it

• primarily in the respiratory tract, where it can climb inbetween the kinocilia

• macrophages start inflammation in response to the bacteria -> pneumonia;

  => mycoplasma pneumonia can evade the response as it can enter the intracellular space and therefore resist the immunological response for a long time

  => can eventually spread within the body and lead to many non-specific symptoms:

  • headaches

  • loss of appetite -> can reach chronic stage, anorexia-like

  • mood swings; depression

  • infection of the heart with high heart rate

  • gastric symptoms such as vomiting and nausea

  • affection of bones and joints -> pain

• treatment with antibiotics

• treponema pallidum

• borreliose

• leptospira

-> curled appearance due to high activity of axial filament

• 6-15 micrometers long, quite small but impressive length; highly curled

• usually sexually transmitted bacterium -> syphillis

• locally it is restricted to affect skin and bones

  -> pinta (only skin)

  -> bejel (includes bone)

  -> yaws (includes bone)

• first three weeks after infection no symptoms (bacteria needs time to start to grow and to invade in the tissue)

• primary syphillis -> local signs of skin affection: small lesions at the site where the contact with the other person has occured (sexual organs or e.g. mouth); often no pain, and therefore often overseen

• primary signs will heal out by themselves; problematic as bacteria continue to live and to replicate in the body

• silent period of up to 24 weeks

• secondary syphillis with different signs: often dermal changes such as rash on the skin in various places (sole or back of the foot); accompanied by hepatitis, meningitis or glomerulonephritis

  => signs will heal out themselves, too

  => last longer than during primary syphillis -> longer time frame to recognize

  => if recognized has to be treated to stop further growth of treponema pallidum

  => if not recognized -> latent syphillis

• latent syphillis can last 3 to 30 yrs; secondary syphillis can repeat; and if IS slows down, tertiary syphillis can occur

• tertiary syphillis with GUMMA of skin -> more deep inflammatory reaction with destroying of the whole skin; most problematic part:

  => affects a number of organs, mainly the nervous system -> lead to a degeneration of the neurons and mimic of all types of CNS diseases

  • can be more global and appear like parkinson syndrome

  • can appear like tardis dorsalis

  • can appear like general dementia (so it can change the behaviour of the people

  -> in this stage the bacteria are so widely distributed that it becomes difficult to perform effective treatment; and treatment is only stabilizing for no longer loss of fct (but if nervous cells started to degenerate, the degenerated aspects and parts can not be reestablished)

SECONDARY SYPHILLIS

-> mostly identified

-> dermal non-itchy rash

-> mucous lesions (condyloma latum)

-> non-specific symptoms: fever, sore throat, weight loss

-> 4-10 weeks after primary infection

-> symptoms resolve after 3-6 weeks

-> can be proofed serologically by drawing blood!!!

treatment:

at every stage a single dose penicillin injected is sufficient!

prevention:

condoms and abstinence most effective tools

CONGENITAL SYPHILLIS

• infected women can transduce tre pa towards the fetus

  -> deformations in the face, as saddle nose

  -> changes in the teeth

  -> other symptoms

  => has to be treated, otherwise newborns will suffer from bacteriosis and that shortens their life span

• zoonotic disease/infection (usually no human-human transmission) -> mostly infections occur in contact with ticks

• first sign: typical rush with ring-like appearance growing from the center to the periphery

  => ERYTHEMA MIRGRANS

  (while outer area grows, region where bacteria entered becomes normal again)

  -> first sign usually followed by a stage of silence during which skin reaction passes away

• secondary symptoms (occur months or even years later)

  -> arthritis

  -> peripheral neuropathy

  -> encephalopathy

  -> fibromyalgia

  -> psychic and neurologic symptoms

  (neuroborreliosis)

• problem: borrelia can enter the nerve cells

  -> IS can no longer respond and pure immunologic clearance no longer possible

  -> additional chemics/antibiotics neede, which can pass blood-brain-barrier

  • long-lasting therapy

  • not easy to check because of lacking of immunologic response which could be proofed by antibodies in the blood

• enters the body and distributes in the whole body with variety of possible diseases and symptoms; non-specific reaction can occur in almost any organ

• ACUTE PHASE (shortly after contact with the bact)

  -> fever with headache as an affection of the brain

  -> conjunctiva (eyes affected)

  -> coughing (lungs affected)

  -> abdominal pain and vomiting

  -> pancreatitis

  -> inflammation of liver and gallbladder

  -> diarrhea (small or large intestine involved)

  -> muscle pain

  -> skin rash (rare event as leptospira is mainly seen

  internal)

• IMMUNE PHASE (when IS starts to act against the bacteria and starts inflammatory process)

  -> meningitis (in sheath of brain)

  ->myocarditis (if heart is affected)

  -> in the features of the GI tract

  -> kidney failure…

• pathophysiology

  enters the epidermis -> dermal disease

  if skin has small breaches (Verletzungen)

  -> can enter the tissue and towards the blood system and then can spread throughout the the different organ sites

• well protected skin usually a sufficient barrier to avoid infection with leptospira

• transmission from environment (not human-human)

• bacterium lives in warm, humid conditions in the environment -> mainly at aquatorial zone, so very rare event in europe