MICROBIOLOGY 2008/2009 PART II (PROBLEM)

A 28-year-old male came to your clinic with a hard penile lesion. The laboratory report of the performed VDRL test to this patient was reactive at a dilution of 1:4. 1. The most appropriate action (pg 193; part 1) a) Order a confirmatory test such as FTA-Abs 2. Three characteristics of the fluorescent treponemal antibody test-absorbed (FTA-Abs) (pg 193; part 1) a) The most sensitive and highly specific test the first to become +ve in early syphilis b) Remains positive for many years after effective treatment of early syphilis c) Cannot be used to follow therapy 3. Causative agent of this clinical presentation and its morphology, stain and culture (pg 190-191; part 1) y Causative agent : Treponema pallidum y Morphology : o slender delicate spiral filament with 6-12 coils that are small, sharp, of same size and regularly spaced and the ends of the spiral are tapering and pointed o actively motile be endoflagella o 2 types of motility : rotary cork screw-like motility & angulation y Stain : o immunofluorescent staining technique o differentiate T. pallidum specifically from other normal commensal spirochetes that exist in genital areas in females y Culture : o never been cultured on culture medium o only a certain non-pathogenic variant of T. pallidum termed Reiter strain has been cultured anaerobically and successfully on a special medium composed of serum albumin, several amino acids, vitamins & minerals (Smith-Noguchi medium) 4. Objectives of HIV testing (pg 187; part 2) : a) Transfusion/donation safety b) Surveillance c) Diagnosis of HIV infection d) Research e) To monitor disease progression and response to treatment

PART III (SHORT ESSAY QUESTIONS)

1. General properties of Chlamydiae and Rickettsiae (pg 205 & 217; part 1) Chlamydiae 200-1000 nm Obligate intracellular parasite Contains both DNA and RNA Cell wall resembles the cell wall of gram -ve bacteria, but does not contain a peptidoglycan layer Complicated cycle of reproduction with fission Contains ribosomes & metabolic enzymes Sensitive to sulphonamides & some antibiotics Rickettsiae Smaller : 500 x 300 nm Obligate intracellular parasite Contains both RNA and DNA in a ratio of (3.5:1) Typical cell wall of gram ve bacteria including peptidoglycan containing muramic acid & diaminopimelic acid Same mode of division like bacteria Produce enzymes concerned with metabolism Susceptible to tetracycline & chloramphenicol

2. Culture is done during acute stage of gonorrhea (pg 110; part 1) a) To confirm the diagnosis b) To isolate the organism to determine its sensitivity to the different antibiotics c) When medico-legal proceedings may be involved 3. Points to be considered in relation to cardiolipin antibody tests (pg 193; part1) a) Used as screening tests or first line procedures for routine diagnosis b) May be negative in early primary syphilis c) Quantitatively, the titre of regain will gradually increase with the progress of the diasease d) Occurrence of biological false positive results 4. Transmission of HIV (pg 187; part 2) Horizontal transmission a) sexual transmission  infection is facilitated by breaks in epithelial surfaces which provide direct access to the underlying tissues or blood stream  other sexually-transmitted diseases especially genital ulcer disease increases the risk of sexual transmission as much as a hundred-fold b) blood and blood products  transfusion of infectious blood or blood products is an effective route  transmission due to sharing of contaminated syringe needle occur mainly in IV drug abusers

Vertical transmission a) congenital  from mothers blood through the placenta to the foetus b) intranatal  during birth from transplacental bleeding  contact of abrasions with virus-containing fluids (cervical secretions and blood) during passage along the birth canal c) early postnatal  mainly through breast milk A regimen of AZT therapy of the mother during pregnancy, during the birth process and of the baby after birth reduced the risk of perinatal transmission by 60-70%.