 Welcome back to our meds smarter lecture series where we're taking a smarter approach to preparing future physician Before we get started if you'll take just a quick minute and click that like button and also Subscribe and turn the bell on so that you'll be notified when we post new videos Continuing on discussing more spirokeets leptospira and terragans is a spirokeet with hook shaped ends that we see in Water that's contaminated with animal urine. So as you can see on the right here This is a electron microscope view of this very very small Spirokeet and it has those hook shaped ends at the end of the particular bacteria And it can cause two different kind of diseases Leptospirosis, which is a flu like disease. They get myalgias classically seen in the calves jaundice Photophobia with conjunctival Sefusion which is an erythema without any exudate coming through and then it can also be prevalent among surfers and those in the tropics because they're exposed to Those contaminated waters that have the animal urine in them The other disease that it can cause is wheels disease Which is also known as an ecter hemorrhagic leptospirosis and this here particularly causes is the most severe form Which gives us jaundice Azotemia all this from a liver and kidney dysfunction We can see fever hemorrhage and then anemia also associated with wheels disease And then finally our third spirokeet here is going to be syphilis. So once again spirokeets here gram negative This is caused by trepanema pallidum and We're gonna jump ahead real quick here and discuss the treatment before we discuss the various types of syphilis here So the treatment is penicillin G very very simple and straightforward treat syphilis with penicillin G The big key is as recognizing it and recognizing it early before it becomes more disseminated So let's talk about those different stages that we do have with syphilis So primary syphilis is the initial infection where it's localized at the very location that it entered the body It's gonna have a painless shanker associated with that at its local Lies point at its localized point and we can see the syphilis Microbacteria by using a fluorescent or dark field microscope and actually see those trepanemes in that shanker It's a painless shanker So a lot of times people might ignore it because it's not causing any pain or problems But it is there typically on the genitals secondary syphilis. However is where we have that primary syphilis being More migratory throughout the body. It's disseminated with constitutional symptoms like immaculapapular rash condylo malatas Lympho adenopathy patchy hair loss, and it's also confirmed with our dark field microscopy We can do testing for secondary syphilis using the VDR L RPR VDR L stands for venereal disease research laboratory, and then the RPR is the rapid plasma reagent And that is going to be more nonspecific where we can confirm that diagnosis using the specific FTA ABS test and the FTA is the fluorescent trepanemal antibody absorption test So remember primary syphilis is localized to one location secondary syphilis is going to be systemic and then you can't even potentially follow that with a latent syphilis as well Continuing on in our discussion of syphilis We will discuss tertiary syphilis tertiary syphilis is even further down the road where we can see gummas Which are chronic granulomas aortitis or vasovasorum destruction then Neurosyphilis, which is tabes dorsalis a general peresis of the body and our goal Robinson pupil are present in tertiary syphilis Signs associated with tertiary syphilis is going to be a broad-based ataxia with a positive rhomburg sign Charcode joints and strokes without hypertension In patients that have neuro syphilis We need to test the spinal fluid and we test that spinal fluid with the spinal tap check it with the VDRL RPR the FTA ABS and the PCR test We want to confirm if there is neuro syphilis to be able to treat it appropriately Another form of syphilis that we can have is congenital syphilis and this basically is where we get facial abnormalities and in the Newborn babies with regaids which are linear cracks or fissures in the skin Typically seen like in the angles of the mouth, which you can kind of see here in this patient's photo snuffles Saddle nose notched teeth Mulberry molars short maxilla saber shins and cranial nerve 8 deafness Those are our presentation for congenital syphilis To prevent this we want to treat the mother early in pregnancy to keep this from potentially crossing the placental barrier and Transmitting itself to the infant during the first trimester Mothers with syphilis need to be treated ASAP with that penicillin G to decrease the risk of transmitting it to her baby So following up that discussion on syphilis. We're going to talk about VDRL false positives So VDRL or venereal disease Research Lab is the test that we use for syphilis And it's going to detect nonspecific antibodies that react with a beef cardiolipan Specifically here the reason we use this is because it's very inexpensive and widely available to test for syphilis But the problem is we can get false positives Here specifically we see false positives often occurring alongside of viral infections Specifically like chicken pox and measles So if you see some of those things even lymphomas tuberculosis malaria Endocarditis connective tissue disease pregnancy all of those can cause some false positives So we need to be aware of the patient's current condition to determine could we have a false positive for VDRL And also that helps us know that we need to continue on checking if we do have that a positive test That that's not a confirmation But just an indication that we need to go to a confirmatory test that is more expensive that particular beef cardiolipan basically is what the basis here is that the antibodies that our body produces against the syphilis spirochete will actually react to an extract from an ox heart So that's that beef cardiolipan, and it's actually dye phosphatidyl glycerol So what they're looking for here during this test is checking for either IgG IgM or IgA Antibodies against that cardiolipan, and you can actually see that in this test here on the right by Having some foaming of the test tube or flocculation. So if we see one of these Windows that have foaming in it, then that is going to be a positive VDRL test So you can remember the false positives with VDRL using positive VDRL as your Memorization tool in the P stands for pregnancy V viral infection D drugs our rheumatic fever and L lupus or leprosy Like we said, there are some other things, but those are going to be your most common ones Viral infection most likely measles or chicken pox If you found this material helpful for your studying, please like and consider subscribing to the channel Also share this video so that more people can benefit from it like you have