ALEXMED pon ade sini pon ade..

T.Pallidum

i) Name serological test: CAT (cardiolipin) & TAT (treponemal) . BOTH USE FOR diagnosis and monitoring treatment and follow up.

Importance of CAT :

·          +ve 10-14 days after appearance of chancre

·         -ve in early primary syphilis

·         +ve screening test so..should be confirmed with TAT…and repeating the CAT

·         Quantitative (gradual increase with progress of disease)

·         Can be used to follow therapy

·         False +ve result

False +ve: malaria

            : measles

            : Infectious mononucleosis

            : leprosy

            : collagen vascular disease ( SLE )

            : drug addiction

TAT      -FTA Abs : most sensitive,1^st become +ve in early..remain +ve for many years..

                        Disadvantages : cannot be used to judge efficacy of treatment

            -TP-PA :  performed in microdilution plate.

ii) Test use to diagnose 1ry stage

§  Dark ground microscopy - for motility

§  Flourescein  labeled anti treponemal serum - for antigen

§  NA probes and PCR – for DNA

§  CAT –ve but TAT +ve

iii) Differences HARD and SOFT chancre.

HARD	SOFT
Produce by T.Pallidum	Produce by H.Ducreyi
Never be culture on culture media.	Grow on choc agar.

iv)Specime collection for EVERY STAGES.>

1ry STAGE	-Exudate from chancre (squeezed gently using gloves) BLEEDING should be avoided (RBC mask the spirochetes)
2ry STAGE	-Exudate from skin lesions, mucous patches or condyloma lata
LATENT SYPHILIS	-Serum sample
LATE SYPHILIS	-Serum sample -CSF sample (active neurosyphilis)

N.GONORRHOEA

i) Selective media used : THAYER MARTIN > consists of VCN

v  Vancomycin - Gram +ve bact

v  Colistin - Gram -ve bacilli

v  Nystatin - Fungi

ii) Specimen collection ( acute/chronic in males and females )

ACUTE	CHRONIC (org. very few in no. / totally absent)
Urethral discharge from men	Morning urethral drop Prostatic secretion
Urethral discharge from female Cervical secretion	Swab from cervix uteri

iii) Culture done in acute stages

ü  Confirm the diagnosis

ü  Isolate the organism to determine its sensitivity to different antibiotics

ü  Medico-legal proceeding

Repeated gonococcal infection common

ü  Protective immunity to reinfection does not appear

ü  Antigenic variation

MYCOPLASMA

i) General character:

Ø  Smallest – so can pass through bact filters

Ø  Lack of rigid wall, bounded by triple layered membrane

Ø  Complete resistant to penicillin, so inhibited by tetracycline or erythromycin

Ø  Reproduce in cell free media – grow on agar rich sterols

Ø  Inhibited by specific Ab

Ø  Do not revert to, or originate from bact parental forms

Ø  Affinity to mammalian cell membrane by special terminal adhesion proteins

ii) What are genital mycoplasma (urogenital mycoplasma) : Mycoplasma Hominis

                                                                                                : Ureaplasma urealyticum

Iii) Disease caused by genital mycoplasma

Mycoplasma Hominis	Ureaplasma urealyticum
In females: 3P -          Pyelonephritis -          Post abortal or Post partum fever -          Pelvic inflammatory disease -          Salphingitis In male not causing any..	In males : non gonococcal urethritis (10%) In females : lung disease in premature, low birth weight infants

iv) Differentiate urogenital mycoplasma from others :

GROWTH INHIBITORS with specific antisera            BUT     differentiate ureaplasma urealyticum to M.Hominis by UREASE TEST (+ve in ureaplasma –ve in Hominis)

v) Specimen collection in urogenital mycoplasma affection

o   ONLY UPPER GENITOURINARY specimens are value – because both species frequently colonize the lower genitourinary of both sexes.

o   Urethral swabs or urine after prostatic massage in males.

o   Fetal membrane swabs and semen – part of investigation infertility

ALL SPECIMENS….put in STUART’s TRANSPORT MEDIUM & sent to lab.

CHLAMYDIAE

i) General properties :

§  Coccoid shape

§  Obligatory intracellular – deficiency in energy producing metabolic pathways

§  Types of NA DNA & RNA

§  Resemble cell wall Gram –ve bact, but no peptidoglycan layer

§  Complicated life cycle of reproduction by fission

§  Sensitive to sulphonamides

§  Contain ribosome and metabolic enzymes

§  Lack mechanism for metabolic energy production

ii) Classification & disease caused

Sites of infection	Disease	Organism ( serovars )
Eyes	Trachoma Adult & neonatal conjunctivitis	C.T (A,B,Ba,C) C.T (D-K)
Genital tracts	Male Female LGV	C.T (D-K) C.T (D-K) C.T ( L1-L3)
Respiratory	Pneumonitis of infants Pharyngitis, pneumonia Psittacosis Pneumonia	C.T (D-K) C.Pneumonia C.Psittaci (avian) C.Psittaci (ovine)

iii) Modes of transmission

Trachoma : eye to eye, droplet, hands, contaminated cloth and flies

Adult inclusion conjunctivitis: anto-inoculation of genital secretion or oral- genital contact (sexually active)

Neonatal conjunctivitis (ophthalmia nenonatorum) : passage through infected maternal birth canal.

C.psittaci from bird to human : Inhalation of dried birds faeces or feathers

TWAR strain C.pneumoniae  : human contact

P/s : what we've study in practical class shoulh be read...hopefully this time would get us easily get 15/15...