Pathogenesis OMP-outer membrane proteins promote adherence Hyaluronidase -facilitate perivascular infiltration Fibronectin - produced by Treponema pallidum coating phagoctes-anti phagocytal properties Immunopathology => tissue destruction and lesions are primarily result of hosts immune response
11 Pathogenesis OMP – outer membrane proteins – promote adherence; Hyaluronidase –facilitate perivascular infiltration Fibronectín – produced by Treponema pallidum -coating phagoctes – anti phagocytal properties Immunopathology=> tissue destruction and lesions are primarily result of host’s immune response
Primary lesion-chancre Clinics -3 phases (painless) (10 to 60 days 1)skin in the place of area of ulceration /inflammation penetration shedding of spirochetes ulcus durum-primary site of replication(multiple Tsp in Secondary(2-10 weeks later) ulcus ), endarteritis a systemic spread periarteritis, infiltration of ulcer disseminated mucocutaneous with PMnl and makrophages, rash phagocytosis -spirochets are highly contagious able to survive it Tertiary (several years later) 2)Disseminated disease rare generalised skin lesions -skin multiple Tsp in blood central nervous system 3)Plate manifestation delayed hypersensitivity in any organ or tissue few organisms control by immune response 12
12 • Primary lesion –chancre (painless) • (10 to 60 days) – area of ulceration/inflammation shedding of spirochetes • Secondary (2-10 weeks later) – systemic spread – disseminated mucocutaneous rash – highly contagious • Tertiary (several years later) – rare – skin, – central nervous system – delayed hypersensitivity – few organisms * control by immune response Clinics – 3 phases 1) Skin in the place of penetration ulcus durum –primary site of replication (multiple T.sp in ulcus ), endarteritis a periarteritis, infiltration of ulcer with PMNL and makrophages, phagocytosis – spirochets are able to survive it 2) Disseminated disease – generalised skin lesions multiple T.sp in blood 3) Plate manifestation in any organ or tissue
Primary Syphilis-Chancre t IL. Primary Syphilis of tbe Lewer Lip. A chancre appearing n the bwer ip a the ane dinna明对 Secondary syphilis lesions on back spirochete. WBC 13
13 Primary Syphilis - Chancre Secondary syphilis lesions on back
Progression of Untreated Syphilis Course of disease and blood tests Course of untreated disease (incidence-Oslo study) Primary Positive blood Second r Early relapse 24% …… Positive, doubtful, or negative Late benign >Gummas in skin and soft tissues Late ordO Central Denign vascular nervous 15 10% system Clinical ertiary stage orizon Infection with Treponema pallidum 5 10 15 20 25 30 Y ear
14 Progression of Untreated Syphilis Tertiary Stage Late benign Gummas in skin and soft tissues
Congenital Syphilis Congenital syphilis results from transplacental infection T pallidum septicemia in the developing fetus and widespread dissemination Abortion, neonatal mortality, and late mental or physical problems resulting from scars from the active disease and progression of the active disease state Neonatal death Deformed faces Bone deformities Dental deformities saddle nose Blindness Skin rashes Deafness
15 Congenital syphilis results from transplacental infection T. pallidum septicemia in the developing fetus and widespread dissemination Abortion, neonatal mortality, and late mental or physical problems resulting from scars from the active disease and progression of the active disease state Neonatal death Deformed faces Bone deformities Dental deformities,saddle nose Blindness Skin rashes Deafness Congenital Syphilis