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Chapter 57 : and , Human Host-Associated Spirochetes

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Abstract:

Researcher demonstrated using 16S rRNA sequences that spirochetes can be grouped into a phylum of five clusters, , , , now , and . The four members of the genus that cause venereal syphilis, endemic syphilis, yaws, and pinta are morphologically identical and, despite advances in molecular differentiation, are distinguished primarily by differences in geographic distribution, epidemiology, clinical manifestations, and host range in experimental animals. In the early 1950s, the WHO and United Nations Children's Fund launched an extremely successful program that decreased the global prevalence of endemic treponematoses by more than 95% over an approximately 10-year period. The frequency of spirochetal colonization of the intestinal tract has declined dramatically in developed countries during the 20th century but remains high in the developing world. Polymerase chain reaction (PCR) can be performed on either fixed or unfixed tissue, although unfixed tissue is recommended. Routine antimicrobial susceptibility testing of is not practical due to the lack of a suitable in vitro cultivation system. Researchers confirmed that the serologic response to therapy is slow and often incomplete. This study, as well as anecdotal experience, brought about a substantial loosening in the accepted criteria for an adequate therapeutic response, currently defined as a fourfold decrease in nontreponemal titer by 1 year.

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57

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Restriction Fragment Length Polymorphism
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Herpes simplex virus 1
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Herpes simplex virus 2
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Figures

Image of FIGURE 1
FIGURE 1

Morphology of . (A) Scanning electron micrograph showing spiral shape. (B) Negatively stained view of the tips of two organisms. Note the insertion points (I) of periplasmic flagella (PF) near the ends. (C to E) Electron micrographs of ultrathin sections, showing the outer membrane (OM), the cytoplasmic membrane (CM), periplasmic flagella (PF), and the location of the cytoplasmic filaments (CF). Reprinted from reference with permission of Kluwer.

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
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Image of FIGURE 2
FIGURE 2

Human intestinal spirochetosis. (Top) H&E staining of a colonic biopsy sample showing a false brush border covering the luminal surface of the colon as observed by light microscopy. Reproduced from reference with permission from Blackwell Publishing Asia Pty Ltd. (Bottom) TEM showing attached end-on to the colonic mucosa, forming a false brush border. Magnification, ×11,000. Reproduced from reference with permission from the American Society for Microbiology.

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
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Image of FIGURE 3
FIGURE 3

The course of untreated syphilis. The presence of treponemes in mucocutaneous lesions and serologic responses (top) are juxtaposed with disease stage and manifestations (bottom). Reprinted with permission from reference .

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
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Image of FIGURE 4
FIGURE 4

PCR-based molecular typing of “street strains.” (Top) Schematic representation of all gene MseI RFLP patterns identified to date. (Bottom) Schematic showing different repeat sizes obtained by PCR. The size of each repeat is indicated above the amplicon. mw, molecular weight.

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
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Tables

Generic image for table
TABLE 1

Characteristics and major clinical features of the treponematoses

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
Generic image for table
TABLE 2

Criteria for diagnosis of syphilis

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
Generic image for table
TABLE 3

Laboratory tests used for direct detection of in clinical samples obtained during the various stages of syphilis

Applicable to all except oral lesions.

There is no commercial kit for this test, but FITC-conjugated polyclonal or monoclonal antibody can be purchased commercially.

not applicable.

CDC recommends against routine lumbar puncture, but it needs to be done for neurologic symptoms.

Nasal discharge or autopsy material can also be examined for

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
Generic image for table
TABLE 4

Oligonucleotide primers and probes used for real-time multiplex PCR for GUD

Indicates final concentration of primer or probe in multiplex reaction.

Glycoprotein D gene.

Hemolysin A gene.

47-kDa immunogen gene.

Human ribonuclease P gene target is used as an internal control.

Fluorescent dyes.

Black hole quencher.

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
Generic image for table
TABLE 5

Oligonucleotide primers and probes used for conventional multiplex PCR for GUD

Adapted from reference .

Glycoprotein B gene.

47-kDa immunogen gene.

Used as an internal control.

Envelope gene.

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
Generic image for table
TABLE 6

Primers and thermocycling conditions for - and -specific PCR

Adapted from references and .

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
Generic image for table
TABLE 7

Nontreponemal tests for syphilis serodiagnosis

Point-of-care test; FDA license in progress; trials in North and South America and Europe.

S, serum; C, CSF; P, plasma; B, blood.

For technical details, see (http://www.cdc.gov/std/syphilis/manual-1998/).

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
Generic image for table
TABLE 8

Conventional treponemal tests for syphilis

S, serum; C, CSF

Some authorities use FTA-ABS on CSF as a means of ruling out neurosyphilis (see the text).

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
Generic image for table
TABLE 9

Treponemal EIAs for syphilis

S, serum; P, plasma: r, recombinant antigen; Ag, antigen; Ab, antibody, HRP, horseradish peroxidase.

See reference .

Different conjugates required.

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
Generic image for table
TABLE 10

Treponemal immunoblots and rapid tests for syphilis

Recombinant antigen.

S, serum; C, CSF; P, plasma; B, blood.

AlkP, alkaline phosphatase.

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57
Generic image for table
TABLE 11

Treponemal light-based tests for syphilis

Recombinant antigen.

S, serum; P, plasma.

Citation: Radolf J, Pillay A, Cox D. 2011. and , Human Host-Associated Spirochetes, p 941-963. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch57

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