Borrelia

Order: Spirochaetales
Family:: Spirochaetaceae Genus:: Treponema Borrelia Family: Leptospiraceae Genus:: Leptospira

General Overview
Gram-negative spirochetes Spirochete from Greek for coiled hair Extremely thin and can be very long Tightly coiled helical cells with tapered ends

Motile by periplasmic flagella (endoflagella)

Endoflagella

Borrelia
Large, 5-30 um long & 0.3-.7 um wide Motile with endoflagella Readily stained by ordinary methods Gram negative Irregular, wide open coils.

Commensals in buccal & genital mucosa

Treponema

Leptospira

Borrelia

Spirochaetales Associated Human Diseases

Genus Species Syphilis Bejel Yaws Pinta Lyme disease (borreliosis) Epidemic relapsing fever Endemic relapsing fever Vincents angina Disease Treponema pallidum ssp. pallidum pallidum ssp. endemicum pallidum ssp. pertenue carateum Borrelia burgdorferi recurrentis Many species vincenti

Leptospira

interrogans

Leptospirosis (Weils Disease)

Lyme Disease

History
Lyme, Connecticut, USA. in 1975 In a cluster of suspected Juvenile Rheumatoid arthritis. Five years later, Burgdoofer identified the

organism.

Epidemiology
Causative organism: B.burgdorferi Vector : Ixodid ticks Reservoir: Deer & small mammals

Morphology
4-5 Flexible, helical Gram negative

0.2-0.25 um

Species
B.burgdorferi B.garinii B.afzelii

Culture
Fastidious Modified Kellys (BSK) medium Incubation at 33 degree for > 2 wks.

Clinical features
Incubation period: 3-30 days Three stages 1. Erythema migrans 2. Disseminated infection 3. Persistent infection

Erythema migrans

1.ERYTHEMA MIGRANS Localised infection Expanding annular skin lesion Bulls eye appearance.

1.ERYTHEMA MIGRANS

2. DISSEMINATED INFECTION
Fever Headache Myalgia Arthralgia Lymphadenopathy Meningeal & Cardiac involvement

3. PERSISTENT INFECTION
Chronic arthritis Polyneuropathy Encephalopathy Acrodermatitis

Lab Diagnosis
1. Isolation 1. 2. 2. Serology 1. 2.

Ticks Patients Skin, CSF & Blood

ELISA IF

Treatment
Doxycycline Amoxycillin Cefuroxime

Relapsing fever

Introduction
Arthropod-borne infection Two types 1. Epidemic RF 2. Endemic RF

Epidemic RF
B.recurrentis

Louse-borne
Pediculus humanus corporis (body lice) No extra-human reservoir.

Endemic RF
Causative agents: 1. B.duttonii 2. B.hermsii 3. B.parkeri Tick-borne Reservoir Rodents & other mammals

Morphology
8-20 um

0.2-0.4 um

Irregular spirals with one or both ends pointed 5-10 loose spiral coils Gram negative

Giemsa staining

Cultural characteristics
Microaerophilic

Cultivation is difficult in medias

Egg inoculation in chick embryos Chorioallantoic membrane Animal inoculation - intraperitoneal Rat Mice

Antigenic variation
Readily undergoes antigenic variations in vivo DNA rearrangement in linear plasmids Ultimate recovery development of immunity to all the antigenic variants.

Clinical features
Incubation period: 2-10 days Sudden onset of fever (3-5 days)

Afebrile period for 4-10 days

Another bout of fever Subsides after 3-10 relapses.

Relapsing fever

Epidemiology - Epidemic Relapsing Fever

Transmitted person-to-person by human body lice

(vectors) from infected human reservoir

Infect host only when louse is injured, e.g., during

scratching
A single louse can only infect a single person

Lice leave host that develops a fever and seek

normal temperature host

Epidemiology - Endemic Relapsing Fever

Sporadic cases Transmitted by soft body ticks (vectors) from small mammal reservoir Ticks can multiply and infect new human hosts

Lab Diagnosis
Wet film Lashing motility Blood smears Giemsa stain Leishman stain Dilute carbol fuchsin During pyrexial period

Giemsa Stain of Borrelia recurrentis in Blood

Light Microscopy

Phase Contrast Microscopy

Lab Diagnosis
Animal inoculation - White mice - Intraperitoneal Serology - Agglutinins for Proteus OXK

Treatment
Tetracyclines Chloramphenicol Penicillin Erythromycin

Borrelia vincenti

 Fusospirochetosis B.vincenti Fusobacterium fusiforme Ulcerative gingivostomatitis Oropharyngitis (Vincents angina) Lung abscess Gangrenous balanitis

Vincents angina

Summary
Borrelia recurrentis

Borrelia spp.

Borrelia burgdorferi