Treponema

Treponema is a gram-negative, microaerophilic spirochete. Owing to its very thin structure, it is not easily seen on Gram stain, but can be visualized using dark-field microscopy. This spirochete contains endoflagella, which allow for a characteristic corkscrew movement. The bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview are able to avoid immune recognition and phagocytosis by forming a protective coating with fibronectin. Humans are the only reservoir and transmission is through human-to-human contact. The most common species involved in human disease is Treponema pallidum subspecies pallidum, which is the causative agent of syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis. Other clinically relevant species include T. pallidum pertenue, T. pallidum endemicum, and T. carateum. These are the causative organisms for yaws Yaws Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta, bejel Bejel Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta, and pinta Pinta Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta, respectively.

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Classification

Gram negative bacteria classification flowchart

Gram-negative bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview:
Most bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview can be classified according to a lab procedure called Gram staining.
Bacteria with cell walls that have a thin layer of peptidoglycan do not retain the crystal violet stain utilized in Gram staining. These bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview do, however, retain the safranin counterstain and thus appear as pinkish-red on the stain, making them gram negative. These bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview can be further classified according to morphology (diplococci, curved rods, bacilli, and coccobacilli) and their ability to grow in the presence of oxygen (aerobic versus anaerobic). The bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology: Overview can be more narrowly identified by growing them on specific media (triple sugar iron (TSI) agar) where their enzymes Enzymes Enzymes are complex protein biocatalysts that accelerate chemical reactions without being consumed by them. Due to the body's constant metabolic needs, the absence of enzymes would make life unsustainable, as reactions would occur too slowly without these molecules. Basics of Enzymes can be identified (urease, oxidase) and their ability to ferment lactose can be tested.
* Stains poorly on Gram stain
** Pleomorphic rod/coccobacillus
*** Require special transport media

Image by Lecturio. License: CC BY-NC-SA 4.0

General Characteristics of Treponema

Basic features of Treponema species

  • Spirochete (spiral shaped)
  • Gram negative
  • Microaerophilic
  • Endoflagellated
    • 3 flagella originate from each end.
    • Located in the periplasmic space
  • Classic motility:
    • Rotates rapidly about its longitudinal axis
    • Bends, flexes, and snaps
  • Visualization:
    • Dark-field microscopy
    • Too slender to be visualized using Gram or Giemsa stain
  • Cannot be grown in culture
  • The pathogenic species are morphologically and antigenically indistinguishable.

Clinically relevant species

  • T. pallidum subspecies:
    • T. pallidum subspecies pallidum ( syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis)
    • T. pallidum subspecies endemicum ( bejel Bejel Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta)
    • T. pallidum subspecies pertenue ( yaws Yaws Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta)
  • T. carateum ( pinta Pinta Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta)

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Pathogenesis

Pathogenesis of treponema infections

Pathogenesis of Treponema infections
The pathogen adheres to the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin or mucosal membranes, leading to the production of hyaluronidase which allows for tissue invasion. The pathogen coats itself in the host’s fibronectin, which prevents its phagocytosis and recognition by the immune system. Consequently, the pathogen disseminates through the bloodstream. A host immune response ultimately occurs, which causes disease manifestations.

Image by Lecturio. License: CC BY-NC-SA 4.0

Reservoirs and transmission

  • Humans are the only reservoir.
  • Transmission is human-to-human:
    • Sexual contact ( syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis)
    • Vertical ( syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis)
    • Contact with infected lesions ( yaws Yaws Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta, bejel Bejel Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta, and pinta Pinta Yaws, bejel, and pinta are endemic, nonvenereal treponematoses. The causative organisms are Treponema pallidum pertenue (yaws), T. pallidum endemicum (bejel), and T. carateum (pinta). These treponematoses are generally transmitted by direct skin-to-skin contact with infected skin lesions. Yaws, Bejel, and Pinta)

Virulence

  • Hyaluronidase
    • Allows tissue invasion
    • Facilitates dissemination
  • Corkscrew motility
    • Able to move in thick substances (e.g., connective tissue Connective tissue Connective tissues originate from embryonic mesenchyme and are present throughout the body except inside the brain and spinal cord. The main function of connective tissues is to provide structural support to organs. Connective tissues consist of cells and an extracellular matrix. Connective Tissue)
    • Assists with dissemination
  • Fibronectin
    • Protective coating
    • Comes from the host
    • Prevents phagocytosis and immune recognition

Diseases Caused by Treponema

Syphilis

The most common treponemal disease caused by T. pallidum pallidum:

Table: Syphilis
Stage Primary syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis Secondary syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis Tertiary syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis Congenital syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis
Transmission Sexual contact Skin contact with disseminated rash Patients are not contagious at this stage Placental, during the first trimester
Symptoms Localized disease:
  • Painless chancre
  • Painless buboes after chancre resolution
Systemic disease:
  • Maculopapular rash (including palms and soles)
  • Condylomata lata
  • Lymphadenopathy Lymphadenopathy Lymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease. Lymphadenopathy
  • Flu-like symptoms
Systemic disease:
  • Gummas
  • Destructive bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Structure of Bones lesions
  • Aortitis
  • Neurogenic arthropathy
Neurosyphilis:
  • Tabes dorsalis
  • Argyll Robertson pupil Pupil The pupil is the space within the eye that permits light to project onto the retina. Anatomically located in front of the lens, the pupil's size is controlled by the surrounding iris. The pupil provides insight into the function of the central and autonomic nervous systems. Physiology and Abnormalities of the Pupil
  • Meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis or meningoencephalitis
  • Stroke
  • Saddle nose Nose The nose is the human body's primary organ of smell and functions as part of the upper respiratory system. The nose may be best known for inhaling oxygen and exhaling carbon dioxide, but it also contributes to other important functions, such as tasting. The anatomy of the nose can be divided into the external nose and the nasal cavity. Anatomy of the Nose
  • Hutchinson’s teeth Teeth Normally, an adult has 32 teeth: 16 maxillary and 16 mandibular. These teeth are divided into 4 quadrants with 8 teeth each. Each quadrant consists of 2 incisors (dentes incisivi), 1 canine (dens caninus), 2 premolars (dentes premolares), and 3 molars (dentes molares). Teeth are composed of enamel, dentin, and dental cement. Teeth
  • Saber shins
  • CN VIII deafness
  • Rhagades
  • Mulberry molars
  • Nasal discharge
  • Short maxilla
Diagnosis
  • RPR
  • VDRL
  • FTA-ABS
  • Dark-field microscopy
  • MHA-TP
  • PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR) of CSF (neurosyphilis)
Management
  • Penicillin G
  • Ceftriaxone
  • Doxycycline
Prevention
  • Safe sex practices
  • Penicillin prophylaxis (if known exposure)
Mothers are tested and treated during pregnancy Pregnancy Pregnancy is the time period between fertilization of an oocyte and delivery of a fetus approximately 9 months later. The 1st sign of pregnancy is typically a missed menstrual period, after which, pregnancy should be confirmed clinically based on a positive β-HCG test (typically a qualitative urine test) and pelvic ultrasound. Pregnancy: Diagnosis, Maternal Physiology, and Routine Care.

CN: cranial nerve

VDRL: Venereal Disease Research Laboratories test

RPR: rapid plasma reagin test

FTA-ABS: fluorescent treponemal antibody absorption Absorption Absorption involves the uptake of nutrient molecules and their transfer from the lumen of the GI tract across the enterocytes and into the interstitial space, where they can be taken up in the venous or lymphatic circulation. Digestion and Absorption test

MHA-TP: microhemagglutination test

PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR): polymerase chain reaction Polymerase chain reaction Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR)

CSF: cerebrospinal fluid

Non-venereal diseases

The less-common species of Treponema and their diseases are summarized below:

Table: Less-common species of Treponema and their diseases
Disease Yaws Bejel (endemic syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis) Pinta
Associated species T. pallidum pertenue T. pallidum endemicum T. carateum
Transmission
  • Human-to-human
  • Direct contact with skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin lesions
  • Human-to-human
  • Direct contact with mucosal lesions
  • Utensils
  • Human-to-human
  • Direct contact with skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin lesions
Predominant locations Tropical regions:
  • Africa
  • South America
  • India
  • Indonesia
  • Pacific Islands
Desert regions:
  • Middle East
  • Central and South Africa
Tropical regions: Central and South America
Primary demographic Children Children Adults
Clinical manifestations Primary phase: painless, yellow papilloma lesion on lower extremities
Secondary phase:
  • Solitary or disseminated papilloma-like skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin lesions
  • Palms and soles may be involved.
  • Osteoperiostitis
Tertiary phase:
  • Gummas
  • Destructive bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Structure of Bones lesions and skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin ulcerations, particularly those of the face
Primary phase: small, primary papule on the oral mucosa
Secondary phase:
  • Plaques on mucous membranes and skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin
  • Lesions become condylomatous before eventually healing.
  • Periostitis
Tertiary phase:
  • Gummas
  • Destructive bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Structure of Bones lesions and skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin ulcerations, particularly those of the face
Primary phase:
  • Initial small, red, pruritic papules
  • Commonly on lower extremities
Secondary phase: diffuse, flat skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin lesions (pintids)
Tertiary phase:
  • Skin discoloration
  • Depigmentation
  • Atrophy
Diagnosis Since these treponemal species are morphologically indistinguishable, the diagnosis is based on:
  • Clinical manifestations
  • Geographic region
  • Demographics
Supporting evidence:
  • VDRL
  • FTA-ABS
Management
  • Penicillin G
  • Azithromycin

VDRL: Venereal Disease Research Laboratories test

FTA-ABS: fluorescent treponemal antibody absorption Absorption Absorption involves the uptake of nutrient molecules and their transfer from the lumen of the GI tract across the enterocytes and into the interstitial space, where they can be taken up in the venous or lymphatic circulation. Digestion and Absorption test

Comparison of Spirochetes

Spirochetes are gram negative, spiral shaped, and motile. The following table briefly compares some clinically relevant spirochetes:

Table: Comparison of clinically relevant spirochetes
Organism Treponema pallidum pallidum Other T. pallidum subspecies Treponema carateum Borrelia Borrelia Borrelia are gram-negative microaerophilic spirochetes. Owing to their small size, they are not easily seen on Gram stain but can be visualized using dark-field microscopy, Giemsa, or Wright stain. Spirochetes are motile and move in a characteristic spinning fashion due to axial filaments in the periplasmic space. Borrelia burgdorfi Borrelia Borrelia Borrelia are gram-negative microaerophilic spirochetes. Owing to their small size, they are not easily seen on Gram stain but can be visualized using dark-field microscopy, Giemsa, or Wright stain. Spirochetes are motile and move in a characteristic spinning fashion due to axial filaments in the periplasmic space. Borrelia recurrentis Leptospira Leptospira Leptospira is a spiral or question mark-shaped, gram-negative spirochete with hook-shaped ends. The disease, leptospirosis, is a zoonosis, infecting animals. Rodents are the most important reservoir. Bacteria shed in the urine of rodents and other animals can be transmitted to humans via contaminated water. Leptospira/Leptospirosis interrogans
Micro
  • Microaero
  • Not seen using Gram or Giemsa stain
  • Microaero
  • Not seen using Gram or Giemsa stain
  • Microaero
  • Not seen using Gram or Giemsa stain
  • Microaero
  • Seen using Giemsa and Wright stain
  • Microaero
  • Seen using Giemsa and Wright stain
  • Aerobic
  • Hooked ends
Virulence
  • Hyaluronidase
  • Fibronectin coating
  • Hyaluronidase
  • Fibronectin coating
  • Hyaluronidase
  • Fibronectin coating
  • Antigenic variation
  • Osp regulation
Antigenic variation
  • LPS
  • Hemolysins
  • Complement regulators and enzymes Enzymes Enzymes are complex protein biocatalysts that accelerate chemical reactions without being consumed by them. Due to the body's constant metabolic needs, the absence of enzymes would make life unsustainable, as reactions would occur too slowly without these molecules. Basics of Enzymes
Reservoir Humans Humans Humans
  • Rodents
  • Deer
Humans
  • Wild animals
  • Livestock
  • Domesticated animals
Transmission Sexual contact P2P contact P2P contact Ixodes tick Louse Direct contact with animal tissue or fluids
Clinical Syphilis
  • Yaws
  • Bejel
Pinta Lyme disease Lyme disease Lyme disease is a tick-borne infection caused by the gram-negative spirochete Borrelia burgdorferi. Lyme disease is transmitted by the black-legged Ixodes tick (known as a deer tick), which is only found in specific geographic regions. Patient presentation can vary depending on the stage of the disease and may include a characteristic erythema migrans rash. Lyme Disease Relapsing fever Relapsing fever Relapsing fever is a vector-borne disease caused by multiple species of the spirochete Borrelia. There are 2 major forms of relapsing fever: tick-borne relapsing fever (caused by multiple species, such as B. hermsii, B. miyamotoi, and B. turicatae) and louse-borne relapsing fever (caused by B. recurrentis). Patients go through recurrent stages of fever, crisis phase, and afebrile periods. Relapsing Fever
  • Leptospirosis Leptospirosis Leptospira is a spiral or question mark-shaped, gram-negative spirochete with hook-shaped ends. The major clinical species is Leptospira interrogans, which causes a mild flu-like illness in a majority of cases. The manifestations are biphasic, with Leptospira found in the blood initially. Leptospira/Leptospirosis
  • Weil’s disease
Diagnosis
  • VDRL
  • FTA-ABS
  • Direct visualization
  • Clinical
  • VDRL
  • FTA-ABS
  • Clinical
  • VDRL
  • FTA-ABS
  • Clinical
  • ELISA
  • Western blot
Blood-smear analysis
  • Blood culture
  • Urine culture
  • ELISA
  • PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR)
Management
  • Penicillin G
  • Ceftriaxone
  • Doxycycline
  • Penicillin G
  • Azithromycin
  • Penicillin G
  • Azithromycin
  • Doxycycline
  • Amoxicillin
  • Ceftriaxone
  • Penicillin G
  • Doxycycline
  • Penicillin G
  • Doxycycline

Osp: outer surface protein

LPS: lipopolysaccharide

P2P: person-to-person

Microaero: microaerophilic

VDRL: Venereal Disease Research Laboratory test

FTA-ABS: fluorescent treponemal antibody absorption Absorption Absorption involves the uptake of nutrient molecules and their transfer from the lumen of the GI tract across the enterocytes and into the interstitial space, where they can be taken up in the venous or lymphatic circulation. Digestion and Absorption

ELISA: enzyme-linked immunosorbent assay

PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR): polymerase chain reaction Polymerase chain reaction Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR)

References

  1. Fine, S.M., and Fine, L.S. (2019). Treponematosis (endemic syphilis, yaws, and pinta). In Brusch, J.L. (Ed.), Medscape. Retrieved January 5, 2021, from https://emedicine.medscape.com/article/230403-overview
  2. Chandrasekar, P.H. (2017). Syphilis. In Bronze, M.S. (Ed.), Medscape. Retrieved January 5, 2020, from https://emedicine.medscape.com/article/229461-overview
  3. Gladwin, M., & Trattler, B. (2008). Clinical microbiology made ridiculously simple (4th edition). Miami: MedMaster.
  4. Radolf, J.D. (1996). Treponema. In: Baron S., (Ed.), Medical Microbiology. (4th edition). Galveston (TX): University of Texas Medical Branch at Galveston. Available from: https://www.ncbi.nlm.nih.gov/books/NBK7716/

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