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Treponema

Treponema

Treponema is a gram-negative, microaerophilic Microaerophilic Helicobacter spirochete. Owing to its very thin structure, it is not easily seen on Gram stain Gram stain Klebsiella, 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 are able to avoid immune recognition Immune Recognition Yaws, Bejel, and Pinta and phagocytosis Phagocytosis The engulfing and degradation of microorganisms; other cells that are dead, dying, or pathogenic; and foreign particles by phagocytic cells (phagocytes). Innate Immunity: Phagocytes and Antigen Presentation by forming a protective coating with fibronectin Fibronectin Glycoproteins found on the surfaces of cells, particularly in fibrillar structures. The proteins are lost or reduced when these cells undergo viral or chemical transformation. They are highly susceptible to proteolysis and are substrates for activated blood coagulation factor VIII. The forms present in plasma are called cold-insoluble globulins. Connective Tissue: Histology. Humans are the only reservoir Reservoir Animate or inanimate sources which normally harbor disease-causing organisms and thus serve as potential sources of disease outbreaks. Reservoirs are distinguished from vectors (disease vectors) and carriers, which are agents of disease transmission rather than continuing sources of potential disease outbreaks. Humans may serve both as disease reservoirs and carriers. Escherichia coli 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 A systemic non-venereal infection of the tropics caused by treponema pallidum subspecies pertenue. 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 An infectious disease of the skin caused by treponema carateum that occurs only in the Western hemisphere. Age of onset is between 10 and 20 years of age. This condition is characterized by marked changes in the skin color and is believed to be transmitted by direct person-to-person contact. Yaws, Bejel, and Pinta, respectively.

Last updated: Jul 6, 2023

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Contents

Classification

Gram negative bacteria classification flowchart

Gram-negative bacteria:
Most bacteria 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 do, however, retain the safranin counterstain and thus appear as pinkish-red on the stain, making them gram negative. These bacteria 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 can be more narrowly identified by growing them on specific media (triple sugar iron (TSI) agar) where their 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 Spiral Computed tomography where there is continuous x-ray exposure to the patient while being transported in a spiral or helical pattern through the beam of irradiation. This provides improved three-dimensional contrast and spatial resolution compared to conventional computed tomography, where data is obtained and computed from individual sequential exposures. Computed Tomography (CT) shaped)
  • Gram negative Gram negative Bacteria which lose crystal violet stain but are stained pink when treated by gram’s method. Yersinia spp./Yersiniosis
  • Microaerophilic Microaerophilic Helicobacter
  • Endoflagellated
    • 3 flagella Flagella A whiplike motility appendage present on the surface cells. Prokaryote flagella are composed of a protein called flagellin. Bacteria can have a single flagellum, a tuft at one pole, or multiple flagella covering the entire surface. In eukaryotes, flagella are threadlike protoplasmic extensions used to propel flagellates and sperm. Flagella have the same basic structure as cilia but are longer in proportion to the cell bearing them and present in much smaller numbers. Helicobacter originate from each end.
    • Located in the periplasmic space
  • Classic motility Motility The motor activity of the gastrointestinal tract. Gastrointestinal 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 Giemsa stain Borrelia
  • Cannot be grown in culture
  • The pathogenic species are morphologically and antigenically indistinguishable.
Treponema pallidum spirochetes

Treponema pallidum spirochetes in a sample using a modified Steiner silver stain

Image: “Treponema pallidum 01” by Dr. Edwin P. Ewing, Jr. License: Public Domain
Treponema carateum

A tissue sample showing numerous thin, spiral-shaped Treponema carateum.

Image: “2900” by CDC. License: Public Domain

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 A systemic non-venereal infection of the tropics caused by treponema pallidum subspecies pertenue. Yaws, Bejel, and Pinta)
  • T. carateum ( pinta Pinta An infectious disease of the skin caused by treponema carateum that occurs only in the Western hemisphere. Age of onset is between 10 and 20 years of age. This condition is characterized by marked changes in the skin color and is believed to be transmitted by direct person-to-person contact. Yaws, Bejel, and Pinta)

Related videos

8:29
Treponema

Pathogenesis

Pathogenesis of treponema infections

Pathogenesis of Treponema infections
The pathogen adheres to 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 Reservoir Animate or inanimate sources which normally harbor disease-causing organisms and thus serve as potential sources of disease outbreaks. Reservoirs are distinguished from vectors (disease vectors) and carriers, which are agents of disease transmission rather than continuing sources of potential disease outbreaks. Humans may serve both as disease reservoirs and carriers. Escherichia coli.
  • 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 A systemic non-venereal infection of the tropics caused by treponema pallidum subspecies pertenue. 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 An infectious disease of the skin caused by treponema carateum that occurs only in the Western hemisphere. Age of onset is between 10 and 20 years of age. This condition is characterized by marked changes in the skin color and is believed to be transmitted by direct person-to-person contact. Yaws, Bejel, and Pinta)

Virulence Virulence The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. The pathogenic capacity of an organism is determined by its virulence factors. Proteus

  • Hyaluronidase Hyaluronidase Bacteroides
    • Allows tissue invasion
    • Facilitates dissemination
  • Corkscrew motility Motility The motor activity of the gastrointestinal tract. Gastrointestinal 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: Histology)
    • Assists with dissemination
  • Fibronectin Fibronectin Glycoproteins found on the surfaces of cells, particularly in fibrillar structures. The proteins are lost or reduced when these cells undergo viral or chemical transformation. They are highly susceptible to proteolysis and are substrates for activated blood coagulation factor VIII. The forms present in plasma are called cold-insoluble globulins. Connective Tissue: Histology

Diseases Caused by Treponema

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

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

Table: 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
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 Congenital syphilis Syphilis acquired in utero and manifested by any of several characteristic tooth (Hutchinson’s teeth) or bone malformations and by active mucocutaneous syphilis at birth or shortly thereafter. Ocular and neurologic changes may also occur. Syphilis
Transmission Sexual contact 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. Skin: Structure and Functions contact with disseminated rash Rash Rocky Mountain Spotted Fever Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship are not contagious at this stage Placental, during the first trimester
Symptoms Localized disease:
  • Painless chancre Chancre The primary sore of syphilis, a painless indurated, eroded papule, occurring at the site of entry of the infection. Syphilis
  • Painless buboes Buboes Chancroid after chancre Chancre The primary sore of syphilis, a painless indurated, eroded papule, occurring at the site of entry of the infection. Syphilis resolution
 Systemic disease: Systemic disease: Neurosyphilis Neurosyphilis Infections of the central nervous system caused by treponema pallidum which present with a variety of clinical syndromes. The initial phase of infection usually causes a mild or asymptomatic meningeal reaction. The meningovascular form may present acutely as brain infarction. The infection may also remain subclinical for several years. Late syndromes include general paresis; tabes dorsalis; meningeal syphilis; syphilitic optic atrophy; and spinal syphilis. General paresis is characterized by progressive dementia; dysarthria; tremor; myoclonus; seizures; and argyll-robertson pupils. Syphilis:
  • Tabes dorsalis Tabes dorsalis Parenchymatous neurosyphilis marked by slowly progressive degeneration of the posterior columns, posterior roots, and ganglia of the spinal cord. The condition tends to present 15 to 20 years after the initial infection and is characterized by lightning-like pains in the lower extremities, urinary incontinence; ataxia; severely impaired position and vibratory sense, abnormal gait, optic atrophy; Argyll-Robertson pupils, hypotonia, hyperreflexia, and trophic joint degeneration. Syphilis
  • 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. Pupil: Physiology and Abnormalities
  • 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 Meningoencephalitis Encephalitis
  • 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. Nose and Nasal Cavity: Anatomy
  • 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: Anatomy
  • Saber shins Shins Erythema Nodosum
  • CN VIII deafness
  • Rhagades
  • Mulberry molars Molars The most posterior teeth on either side of the jaw, totaling eight in the deciduous dentition (2 on each side, upper and lower), and usually 12 in the permanent dentition (three on each side, upper and lower). They are grinding teeth, having large crowns and broad chewing surfaces. Teeth: Anatomy
  • Nasal discharge
  • Short maxilla Maxilla One of a pair of irregularly shaped bones that form the upper jaw. A maxillary bone provides tooth sockets for the superior teeth, forms part of the orbit, and contains the maxillary sinus. Skull: Anatomy
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 Neurosyphilis Infections of the central nervous system caused by treponema pallidum which present with a variety of clinical syndromes. The initial phase of infection usually causes a mild or asymptomatic meningeal reaction. The meningovascular form may present acutely as brain infarction. The infection may also remain subclinical for several years. Late syndromes include general paresis; tabes dorsalis; meningeal syphilis; syphilitic optic atrophy; and spinal syphilis. General paresis is characterized by progressive dementia; dysarthria; tremor; myoclonus; seizures; and argyll-robertson pupils. Syphilis)
Management
Prevention Mothers are tested and treated during pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care.
CN: cranial nerve
VDRL: Venereal Disease Research Laboratories test
RPR: rapid plasma reagin test
FTA-ABS: fluorescent treponemal antibody absorption test
MHA-TP: microhemagglutination test
PCR: polymerase chain reaction
CSF: cerebrospinal fluid
1560px chancres on the penile shaft due to a primary syphilitic infection caused by treponema pallidum 6803 lores

Primary, painless chancre of syphilis (Treponema pallidum pallidum infection)

Image: “Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores” by M. Rein. License: Public Domain

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 Yaws A systemic non-venereal infection of the tropics caused by treponema pallidum subspecies pertenue. 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 (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 Pinta An infectious disease of the skin caused by treponema carateum that occurs only in the Western hemisphere. Age of onset is between 10 and 20 years of age. This condition is characterized by marked changes in the skin color and is believed to be transmitted by direct person-to-person contact. Yaws, Bejel, and 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. Skin: Structure and Functions 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. Skin: Structure and Functions 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 Papilloma A circumscribed benign epithelial tumor projecting from the surrounding surface; more precisely, a benign epithelial neoplasm consisting of villous or arborescent outgrowths of fibrovascular stroma covered by neoplastic cells. Cowden Syndrome 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. Skin: Structure and Functions lesions
  • Palms and soles may be involved.
  • Osteoperiostitis Osteoperiostitis Yaws, Bejel, and Pinta
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. Bones: Structure and Types 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. Skin: Structure and Functions ulcerations, particularly those of the face
 Primary phase: small, primary papule Papule Elevated lesion < 1 cm in diameter Generalized and Localized Rashes on the oral mucosa Oral mucosa Lining of the oral cavity, including mucosa on the gums; the palate; the lip; the cheek; floor of the mouth; and other structures. The mucosa is generally a nonkeratinized stratified squamous epithelium covering muscle, bone, or glands but can show varying degree of keratinization at specific locations. Stomatitis
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. Skin: Structure and Functions
  • Lesions become condylomatous before eventually healing.
  • Periostitis Periostitis Inflammation of the periosteum. The condition is generally chronic, and is marked by tenderness and swelling of the bone and an aching pain. Acute periostitis is due to infection, is characterized by diffuse suppuration, severe pain, and constitutional symptoms, and usually results in necrosis. Reactive Arthritis
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. Bones: Structure and Types 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. Skin: Structure and Functions 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. Skin: Structure and Functions lesions ( pintids Pintids Yaws, Bejel, and Pinta)
Tertiary phase:
  • 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. Skin: Structure and Functions discoloration
  • Depigmentation Depigmentation Vitiligo
  • Atrophy Atrophy Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. Cellular Adaptation
Diagnosis Since these treponemal species are morphologically indistinguishable, the diagnosis is based on:
  • Clinical manifestations
  • Geographic region
  • Demographics
Supporting evidence:
  • VDRL
  • FTA-ABS
Management
VDRL: Venereal Disease Research Laboratories test
FTA-ABS: fluorescent treponemal antibody absorption test
Cutaneous manifestation of yaws

Cutaneous manifestation of yaws
(A) A patient with lesions on the face due to Treponema pallidum pertenue
(B) Resolution of the lesions after treatment with penicillin

Image: “Yaws treatment” by PLOS. License: CC BY 2.5
Cutaneous manifestation of yaws

Cutaneous manifestation of yaws
Juxta-articular skin lesions and nodules on the elbow resulting from a Treponema pallidum pertenue infection

Image: “Yaws 01” by Dr. Peter Perine. License: Public Domain
Mucocutaneous lesions of bejel

Mucocutaneous lesions of bejel (endemic syphilis)
A: An oral lesion of primary bejel resulting from Treponema pallidum endemicum infection
B: Chronic skin lesion of secondary bejel

Image: “Endemic treponemal diseases” by Marks M, Solomon AW, Mabey DC. License: CC BY 4.0
Gummatous lesions in late-stage bejel

Gummatous lesions in late-stage bejel (Treponema pallidum endemicum infection)

Image: “Infiltration of skin due to endemic syphilis” by Alireza Abdolrasouli, Adam Croucher, Yahya Hemmati, and David Mabey. License: Public Domain
Cutaneous lesions of pinta

Cutaneous lesions of pinta (Treponema carateum infection)
(A) Erythematous plaque of early pinta
(B) Skin discoloration of late pinta

Image: “Endemic treponemal diseases” by Marks M, Solomon AW, Mabey DC. License: CC BY 4.0

Related videos

17:07
Syphilis – Treponema pallidum
2:42
Yaws and Pinta – Treponema pallidum

Comparison of Spirochetes

Spirochetes are gram negative Gram negative Bacteria which lose crystal violet stain but are stained pink when treated by gram’s method. Yersinia spp./Yersiniosis, spiral Spiral Computed tomography where there is continuous x-ray exposure to the patient while being transported in a spiral or helical pattern through the beam of irradiation. This provides improved three-dimensional contrast and spatial resolution compared to conventional computed tomography, where data is obtained and computed from individual sequential exposures. Computed Tomography (CT) 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 interrogans Leptospira interrogans A genus of question mark-shaped bacteria spirochetes which is found in freshwater that is contaminated by animal urine. It causes leptospirosis. Leptospira/Leptospirosis
Micro
  • Microaero
  • Seen using Giemsa and Wright stain
  • Microaero
  • Seen using Giemsa and Wright stain
  • Aerobic
  • Hooked ends
Virulence Virulence The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. The pathogenic capacity of an organism is determined by its virulence factors. Proteus
  • Hyaluronidase Hyaluronidase Bacteroides
  • Fibronectin Fibronectin Glycoproteins found on the surfaces of cells, particularly in fibrillar structures. The proteins are lost or reduced when these cells undergo viral or chemical transformation. They are highly susceptible to proteolysis and are substrates for activated blood coagulation factor VIII. The forms present in plasma are called cold-insoluble globulins. Connective Tissue: Histology coating
  • Hyaluronidase Hyaluronidase Bacteroides
  • Fibronectin Fibronectin Glycoproteins found on the surfaces of cells, particularly in fibrillar structures. The proteins are lost or reduced when these cells undergo viral or chemical transformation. They are highly susceptible to proteolysis and are substrates for activated blood coagulation factor VIII. The forms present in plasma are called cold-insoluble globulins. Connective Tissue: Histology coating
  • Hyaluronidase Hyaluronidase Bacteroides
  • Fibronectin Fibronectin Glycoproteins found on the surfaces of cells, particularly in fibrillar structures. The proteins are lost or reduced when these cells undergo viral or chemical transformation. They are highly susceptible to proteolysis and are substrates for activated blood coagulation factor VIII. The forms present in plasma are called cold-insoluble globulins. Connective Tissue: Histology coating
  • Antigenic variation
  • Osp regulation
 Antigenic variation
  • LPS
  • Hemolysins Hemolysins Proteins from bacteria and fungi that are soluble enough to be secreted to target erythrocytes and insert into the membrane to form beta-barrel pores. Biosynthesis may be regulated by hemolysin factors. Leptospira/Leptospirosis
  • 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 Reservoir Animate or inanimate sources which normally harbor disease-causing organisms and thus serve as potential sources of disease outbreaks. Reservoirs are distinguished from vectors (disease vectors) and carriers, which are agents of disease transmission rather than continuing sources of potential disease outbreaks. Humans may serve both as disease reservoirs and carriers. Escherichia coli Humans Humans Humans
  • Rodents
  • Deer
 Humans
  • Wild animals Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, animalia was one of the kingdoms. Under the modern three domain model, animalia represents one of the many groups in the domain eukaryota. Cell Types: Eukaryotic versus Prokaryotic
  • Livestock
  • Domesticated animals Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, animalia was one of the kingdoms. Under the modern three domain model, animalia represents one of the many groups in the domain eukaryota. Cell Types: Eukaryotic versus Prokaryotic
Transmission Sexual contact P2P contact P2P contact Ixodes tick Louse Direct contact with animal tissue or fluids
Clinical 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
  • Yaws Yaws A systemic non-venereal infection of the tropics caused by treponema pallidum subspecies pertenue. 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
 Pinta Pinta An infectious disease of the skin caused by treponema carateum that occurs only in the Western hemisphere. Age of onset is between 10 and 20 years of age. This condition is characterized by marked changes in the skin color and is believed to be transmitted by direct person-to-person contact. Yaws, Bejel, and 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 Weil’s disease Leptospira/Leptospirosis
Diagnosis
  • VDRL
  • FTA-ABS
  • Direct visualization
  • Clinical
  • VDRL
  • FTA-ABS
  • Clinical
  • VDRL
  • FTA-ABS
  • Clinical
  • ELISA ELISA An immunoassay utilizing an antibody labeled with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed. St. Louis Encephalitis Virus
  • Western blot
 Blood-smear analysis
  • Blood culture
  • Urine culture Urine culture Urinary tract infections (UTIs)
  • ELISA ELISA An immunoassay utilizing an antibody labeled with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed. St. Louis Encephalitis Virus
  • 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
  • Doxycycline
  • Amoxicillin Amoxicillin A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. Penicillins
  • Ceftriaxone Ceftriaxone A broad-spectrum cephalosporin antibiotic and cefotaxime derivative with a very long half-life and high penetrability to meninges, eyes and inner ears. Cephalosporins
Osp: outer surface protein
LPS: lipopolysaccharide
P2P: person-to-person
Microaero: microaerophilic
VDRL: Venereal Disease Research Laboratory test
FTA-ABS: fluorescent treponemal antibody absorption
ELISA: enzyme-linked immunosorbent assay
PCR: polymerase chain reaction
Thick spirals of treponema

Visual comparison of spirochetes on electron micrograph: thick spirals of Treponema

Image: “Treponema pallidum” by Dr. David Cox. License: Public Domain
Borrelia

Visual comparison of spirochetes on electron micrograph: Borrelia, which are larger than Treponema

Image: “Lyme disease parasite Borrelia burgdorferi” by Claudia Molins. License: Public Domain
Hooked ends of leptospira

Visual comparison of spirochetes on electron micrograph: hooked ends of Leptospira

Image: “A filtration-based technique for simultaneous SEM and TEM sample preparation for the rapid detection of pathogens” by Beniac DR, Siemens CG, Wright CJ, Booth TF. License: CC BY 3.0, edited by Lecturio.

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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