Medical Microbiology

Treponema(Syphilis,Yaws,Pinta) 321

becauseofdirectcontactwithlesionscontainingthepathogens,whichthen

invadethehostthroughmicrotraumataintheskinormucosa.Theincubation

periodistwotofourweeks.Leftuntreated,thediseasemanifestsinseveral

stages:

&StageI(primarysyphilis).Hard,indolent(painless)lesion,laterinfiltra-

tionandulcerousdisintegration,calledhardchancre.Accompaniedbyregio-

nallymphadenitis,alsopainless.Treponemescanbedetectedintheulcer.

&StageII(secondarysyphilis).Generalizationofthediseaseoccursfourto

eightweeksafterprimarysyphilis.Frequentclinicalsymptomsincludemi-

cropolylymphadenopathyandmacularorpapulosquamousexanthem,broad

condylomas,andenanthem.Numerousorganismscanbedetectedinseeping

surfaceefflorescences.

&Latentsyphilis.Stageofthediseaseinwhichnoclinicalsymptomsare

manifested,butthepathogensarepresentinthebodyandserumantibody

testsarepositive.Dividedintoearlylatency(lessthanfouryears)andlate

latency(morethanfouryears).

&StageIII(tertiaryorlatesyphilis).Lategummatoussyphilis:manifesta-

tionsinskin,mucosa,andvariousorgans.Tissuedisintegrationisfrequent.

Lesionsarehardlyinfectiousornotatall.Cardiovascularsyphilis:endarteritis

obliterans,syphiliticaortitis.Neurosyphilis:twomajorclinicalcategoriesare

observed:meningovascularsyphilis,i.e.,endarteritisobliteransofsmall

bloodvesselsofthemeninges,brain,andspinalcord;parenchymatoussy-

philis,i.e.,destructionofnervecellsinthecerebralcortex(paresis)andspinal

cord(tabesdorsalis).Agreatdealofoverlapoccurs.

&Syphilisconnata.Transmissionofthepathogenfrommothertofetus

afterthefourthmonthofpregnancy.Leadstomiscarriageorbirthofseverely

diseasedinfantwithnumeroustreponemesinitsorgans.

Diagnosis.Laboratorydiagnosisincludesbothisolationandidentificationof

thepathogenandantibodyassays.

Pathogenidentification.Onlydetectableinfluidpressedoutofprimary

chancre,inthesecretionsofseepingstageIIefflorescencesorinlymph

nodebiopsies.Methods:darkfieldmicroscopy,directimmunofluorescence

(Fig.4. 23 ).

Antibodyassays.Twoantibodygroupscanbeidentified:

&Antilipoidalantibodies(reaginicantibodies).Probablyproducedin

responsetothephospholipidsfromthemitochondriaofdisintegratingso-

maticcells.Theantigenusediscardiolipin,alipidextractfromtheheart

muscleofcattle.Thisserologicaltestisperformedaccordingtothestandards

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Kayser, Medical Microbiology © 2005 Thieme