Treponema Pallidum

SPIROCHETES
Dr. Aqsa Aslam

AP Pathology
Learning Objectives
 Describe the salient features & transmission of
Treponema pallidum.
 Explain the clinical manifestations of primary,

secondary & tertiary syphilis.
 Discuss the lab approaches to diagnose

syphilis with their pros and cons.
Spiral shaped organisms having a characteristic motility
pattern ( spin around longitudinal axis in a corkscrew
type manner), cannot be stained with Gram’s stain
 Treponema pallidum
 Borrelia burgdorferi
 Leptospira
TREPONEMA
PALLIDUM
DISEASE: Syphilis
 Has not been grown on bacteriologic

media or in cell culture
 Grows very slowly
 Produces no toxins or enzymes

 Infects the endothelium of small blood
vessels, causing endarteritis inflammation of inner
lining of artery
TRANSMISSION
 Intimate contact fluid

 Perinatal across the placenta, typically
after the third month of pregnancy
 Blood transfusion
Primary syphilis
• Chancre ----10-90 days after infection
• Localized , painless, indurated tough& highly infectious

lesion, which heal in 3-6 wks
• Regional lymphadenitis
Lymph nodes have a typical rubbery appearance
Secondary Syphilis
High bacteremia during secondary
syphilis
 Low-grade fever
 Malaise unknown reason of illness
 Anorexia imbalance diet pattern
 Weight loss
 Headache
 Myalgias muscles pain
 Generalized lymphadenopathy swelling in lymph
nodes
 Patchy alopecia Patchy baldness

 Internal organ involvement (meningitis,
nephritis, swelling in nephrons hepatitis etc)
After Primary/Secondary
Syphilis
About 1/3rd About Remaining
of cases get 1/3rd 1/3rd the
cured without remain disease enters
treatment latent tertiary stage ,
spreads to the
skin, bones,
CNS and CVS
cardiovascular systm
Latent Stage
 No lesion appears, but serological tests are positive indicating continuing
infection.
The latent period has;
Early Stage Late Stage

Symptoms of secondary Last for many years,
syphilis reappear No symptoms
Pts can infect others Pts are non- infectious
Tertiary or Late (Gummatous) Syphilis
•Treponemes are rarely seen

in this stage
•Highly destructive phase
•Untreatable
•Non -contiguous stage
Tertiary Syphilis Gumma
Tertiary syphilis with gumma destruction

A gumma (granuloma) is a soft, non-cancerous growth resulting from the
tertiary stage of syphilis. They have a firm, necrotic center surrounded
by inflamed tissue, which forms an amorphous proteinaceous mass. The
center may become partly hyalinized.
Gummas
 Characterized by
granulomatous
inflammation
Nodular lesions
can form in any

organ
Trichrome stain of liver shows gumma (also

known as hepar lobatum)=== stained blue
CONGENITAL
SYPHILIS
 Abortion or Stillbirth
 Deafness
 Keratitis inflammation of the cornea
 Hepatosplenomegaly
 Clutton's joints: Symmetrical
swelling of knee joint
DIAGNOSIS
Evaluation of presenting signs & symptoms

as well as contact history
MICROSCOPY
Dark field examination or direct fluorescent
antibody (DFA) test
Histologic stains such as silver stain for gummas
Treponema pallidum (dark-field microscopy) showing several spirochetes in
scrapings from the base of a chancre.
SPECIFIC SEROLOGIC TESTS
 T. pallidum reacts with specific treponemal

antibodies in the patient's serum
 These antibodies arise within 2–3 weeks of

infection; therefore, the test results are
positive in most patients with primary
syphilis
ADVANTAGES:
 More specific
DISADVANTAGES:
 Expensive
 More difficult to perform
 Cannot be used for screening the population
 These tests remain positive for life after effective

treatment and cannot be used to determine the
response to treatment or reinfection
TREATMENT
 Penicillin
 More than half of patients who are treated

with penicillin experience fever, chills,
myalgias and other influenzalike
symptoms a few hours after receiving the
antibiotic (Jarisch-Herxheimer reaction)
PREVENTION
 Early diagnosis and adequate treatment
 Use of barrier precautions
 Administration of antibiotic after suspected
exposure
 Serologic follow-up of infected individuals &
their contacts
 Presence of any STD makes testing for
SYPHILIS mandatory

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SPIROCHETES

Dr. Aqsa Aslam

 Explain the clinical manifestations of primary,

 Discuss the lab approaches to diagnose

 Has not been grown on bacteriologic

 Produces no toxins or enzymes

 Intimate contact fluid

• Chancre ----10-90 days after infection

• Localized , painless, indurated tough& highly infectious

 Patchy alopecia Patchy baldness

The latent period has;

Early Stage Late Stage

•Treponemes are rarely seen

Tertiary syphilis with gumma destruction

can form in any

Trichrome stain of liver shows gumma (also

Evaluation of presenting signs & symptoms

 T. pallidum reacts with specific treponemal

 These antibodies arise within 2–3 weeks of

 More difficult to perform

 Cannot be used for screening the population

 These tests remain positive for life after effective

 More than half of patients who are treated

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