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Chapter 24. Spirochetes: Treponema, Borrelia, and Leptospira

A 28-year-old woman who is 10 weeks pregnant presents to the obstetrics clinic for prenatal care. She has a history of treatment for syphilis 7 years previously. The results of serologic tests for syphilis are as follows: nontreponemal test, RPR, nonreactive; treponemal test (TP-PA), reactive. Which of the following statements is most correct?

(A) The mother’s previous treatment for syphilis was effective.

(B) The baby is at high risk for congenital syphilis.

(C) The mother needs to be treated again for syphilis.

(D) The mother needs a lumbar puncture and a VDRL test of her CSF for neurosyphilis.

A 12-year-old Boy Scout went to summer camp for 2 weeks in late August at a site located just outside Mystic, Connecticut. When he returned home, his mother noticed a bull’s-eye-shaped rash on the back of her son’s left calf. Shortly after Labor Day, the boy developed a flulike illness that resolved after 4 days of bed rest. Three weeks later, the boy complained to his mother that his body hurt all over whenever he moved. This prompted a visit to the pediatrician, who ordered an infectious disease workup. What is the most likely source of the boy’s infection?

(A) Respiratory transmission from another sick camper

(B) Ingestion of urine-contaminated water from a stream

(C) The bite of a mosquito harboring a parasite

(D) Ingestion of fecally contaminated food

(E) The bite of a spirochete-infected tick

Nontreponemal serological tests:

(A) Are useful in definitively identifying a T. pallidum infection.

(B) Measure antibodies against T. pallidum.

(C) Can be used to monitor antibiotic treatment of primary or secondary syphilis.

(D) Measure antibodies against lipids released from damaged cells.

(E) Are useful in diagnosing a disseminated gonococcal infection.

A 42-year-old woman went camping in the Sierra Nevada Mountains, where she slept for two nights in an abandoned log cabin. After the second night, a tick was found on her shoulder. Six days later, she developed fever to 38°C, which lasted for 4 days. Ten days later, she had another similar episode of fever. Examination of a blood smear stained with Wright stain showed spirochetes suggestive of Borrelia species. Which of the following ...

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