1
|
Barreto MEZ, Soares CD, de Andrade MMP, de Oliveira Sales A, Fonseca FP, Abreu LG, Tenório JR, de Arruda JAA, de Andrade BAB. Immunohistochemistry and RT-PCR as ancillary tools in the diagnosis of acquired oral syphilis. Oral Dis 2024. [PMID: 39155473 DOI: 10.1111/odi.15107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 08/05/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE To investigate Treponema pallidum detection using immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR) assays in acquired oral syphilis (AOS). MATERIALS AND METHODS Thirty-seven paraffin-embedded tissue specimens of AOS (32 secondary and five primary) were analyzed, integrating double-positive serological results with clinicodemographic and histopathological data. T. pallidum presence was semiquantitatively assessed by IHC, while RT-PCR targeted T. pallidum DNA. Sensitivity, specificity, and the area under the curve (AUC) were calculated with 95% confidence intervals (CI). RESULTS The study included mostly females (62.2%) with a mean age of 27.1 years. T. pallidum was detected in all samples by IHC, predominantly in the epithelium across all layers (43.2%). RT-PCR identified T. pallidum DNA in 32 cases, with negative results observed in cases of secondary AOS. The AUC for IHC versus disease stage was 62.5% (95% CI: 45.1-77.8), and for RT-PCR, it was 57.8% (95% CI: 40.5-73.8). The AUC comparing IHC to RT-PCR was 83.8% (95% CI: 67.9-93.8). CONCLUSION This study represents the first attempt to evaluate the proposed direct detection algorithm for AOS. IHC and RT-PCR serve as ancillary tools for detecting T. pallidum in both primary and secondary stages of AOS.
Collapse
Affiliation(s)
- Maria Eduarda Zeraik Barreto
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Felipe Paiva Fonseca
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jefferson R Tenório
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Alcides Almeida de Arruda
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | |
Collapse
|
2
|
de Lima Medeiros Y, Guimarães IC, de Melo FA, de Souza Chandretti PC, Leite ICG, Vilela EM. Oral manifestations of syphilis: Knowledge and skills of senior dental students and newly graduated dentists. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:497-503. [PMID: 37950520 DOI: 10.1111/eje.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/15/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES To evaluate the knowledge of senior dental students and newly graduated dentists about the prevention, diagnosis and treatment of oral manifestations of syphilis. MATERIALS AND METHODS A 32-question questionnaire was designed with three domains: (I) demographic, academic and professional data of the participants, (II) attitudes, practices and self-perception regarding training about syphilis and (III) knowledge about syphilis. All knowledge responses were classified as correct or incorrect. Scores ranging from 1 to 14 were calculated, and grades were assigned to each participant according to their level of knowledge. RESULTS The sample comprised 408 dental students and 339 newly graduated dentists. The mean score was 7.70 ± 3.35 for undergraduates and 9.09 ± 3265 for dentists. The highest frequency of correct answers (>70%) was attributed to questions about the aetiology, transmission and treatment of syphilis. The questions with the lowest frequency of correct answers (<50%) were about the identification of oral manifestations and stages of syphilis. CONCLUSIONS The knowledge of dental practitioners and academics about the oral manifestations of syphilis was unsatisfactory. The lack of understanding of these aspects can delay the diagnosis and treatment of patients with this disease, which is concerning given the steady increase in cases in recent years.
Collapse
|
3
|
Mauceri R, Coppini M, Cascio A, Trizzino M, Crivello V, Florena AM, Campisi G. Oral Secondary Syphilis in an HIV-Positive Transgender Patient: A Case Report and Review of the Literature. Dent J (Basel) 2023; 11:231. [PMID: 37886916 PMCID: PMC10605375 DOI: 10.3390/dj11100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Syphilis is a worldwide sexually transmitted infection caused by Treponema pallidum. In most cases, the oral manifestations of syphilis infection are associated with cutaneous involvement. However, the present case report is noteworthy since the oral lesions are the sole clinical sign in an HIV-positive transgender patient. CASE PRESENTATIONS We reported an uncommon case of secondary syphilis in a 37-year-old seropositive transgender male, whose diagnostic suspect was based only on oral mucosal lesions. The patient was referred to the Oral Medicine Unit for the presence of multiple undiagnosed painful oral lesions. The intraoral examination revealed the presence of white and red plaques on the right and the left buccal mucosa and several painful lesions localized on the upper and lower labial mucosa. No cutaneous lesions were observed. Considering the sexual history of the patient and clinical findings, secondary syphilis infection was suspected. The serologic analysis was conducted, and the diagnosis of syphilis was confirmed. Moreover, to exclude the presence of oral epithelial dysplasia or malignant disease, an incisional biopsy was performed. DISCUSSION Compared to the literature data, oral lesions as lone signs of secondary syphilis infection are uncommon, especially in HIV-positive patients. Syphilis and HIV coinfection create a concerning situation as they interact synergistically, leading to an increased risk of transmission and faster disease progression. CONCLUSIONS This case report emphasizes the importance of considering syphilis as a diagnostic possibility, even when oral lesions are the only clinical manifestations, especially in HIV-positive patients. Comprehensive evaluation, including a detailed sexual history and careful oral examination, is essential for accurate diagnosis and appropriate management in such cases.
Collapse
Affiliation(s)
- Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences (DiChirOnS), University of Palermo, 90127 Palermo, Italy; (R.M.); (G.C.)
- Unit of Oral Medicine and Dentistry for Fragile Patients, Department of Rehabilitation, Fragility, and Continuity of Care, University Hospital Palermo, 90127 Palermo, Italy
| | - Martina Coppini
- Department of Surgical, Oncological and Oral Sciences (DiChirOnS), University of Palermo, 90127 Palermo, Italy; (R.M.); (G.C.)
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90127 Palermo, Italy; (A.C.); (M.T.); (V.C.); (A.M.F.)
| | - Marcello Trizzino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90127 Palermo, Italy; (A.C.); (M.T.); (V.C.); (A.M.F.)
| | - Valentina Crivello
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90127 Palermo, Italy; (A.C.); (M.T.); (V.C.); (A.M.F.)
| | - Ada Maria Florena
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90127 Palermo, Italy; (A.C.); (M.T.); (V.C.); (A.M.F.)
| | - Giuseppina Campisi
- Department of Surgical, Oncological and Oral Sciences (DiChirOnS), University of Palermo, 90127 Palermo, Italy; (R.M.); (G.C.)
- Unit of Oral Medicine and Dentistry for Fragile Patients, Department of Rehabilitation, Fragility, and Continuity of Care, University Hospital Palermo, 90127 Palermo, Italy
| |
Collapse
|
4
|
de Souza VG, Carvalho ADL, Angeloni MB, Siqueira Miranda CS. Oral Eosinophil-Rich Syphilis: An Unusual Presentation. Int J Surg Pathol 2023; 31:1119-1121. [PMID: 36317295 DOI: 10.1177/10668969221126106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
| | | | - Mariana Bodini Angeloni
- PhD in Applied Immunology and Parasitology, Medicine Course, Federal University of Jataí, Jataí, Brazil
| | | |
Collapse
|
5
|
Khan M, Sharma A, Hathorn T, Sandhu M, Rosen R, Riddle N, Mifsud M. The Mucosal Manifestations of Syphilis in the Head and Neck. EAR, NOSE & THROAT JOURNAL 2023:1455613231165159. [PMID: 37129418 DOI: 10.1177/01455613231165159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Objectives: Syphilis is a resurging disease which can present itself in many ways, including lesions within the head and neck mucosa. Some of these lesions may clinically mimic oral malignancies. This literature review aims to better characterize the mucosal presentations of syphilis. Methods: PubMed, EMBASE, and clinicaltrials.gov were searched for full-text, English articles published from 1950 to 2022 that reported patients with head and neck mucosal manifestations of syphilis. Articles were screened according to PRISMA guidelines. Results: One hundred forty-three manuscripts documenting 236 individual patients were included in the review. Patients with secondary syphilis accounted for 62% of patients presenting with head and neck mucosal lesions. The most common lesions found in primary and secondary syphilis were ulcerations, primarily found on the tongue, lips, and palate. While serologic studies are the gold standard for diagnosing syphilis, biopsy of these lesions have characteristic syphilitic changes. Conclusions: Syphilis' nickname of "The great imitator" remains to be true, and the head and neck mucosal manifestations of this disease can resemble commonly seen malignancies. Awareness of this disease and its lesions is prudent given the rising incidence of syphilis within the United States.
Collapse
Affiliation(s)
- Mahnoor Khan
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Abhay Sharma
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Travis Hathorn
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Mannat Sandhu
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Ross Rosen
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Nicole Riddle
- Department of Pathology and Cell Biology, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Matthew Mifsud
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| |
Collapse
|
6
|
Ramírez-Amador V, Castillejos-García I, Maldonado-Mendoza J, Saeb-Lima M, Aguilar-León D, Anaya-Saavedra G. Exposing the Great Imitator: Proposal for a Holistic Diagnosis of Oral Secondary Syphilis in People Living with HIV. Head Neck Pathol 2022; 16:773-784. [PMID: 35334094 PMCID: PMC9424447 DOI: 10.1007/s12105-022-01446-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/05/2022] [Indexed: 10/18/2022]
Abstract
Oral secondary syphilis may mimic various infectious, neoplastic, or immune-mediated processes; hence, its diagnosis may represent a challenge. Early diagnosis of syphilis, a disease that has increased in recent decades, is essential for adequate management, particularly in people living with HIV (PLWH). This study aimed to comprehensively characterize oral secondary syphilis in a group of 47 PLWH. A group of PLWH with oral secondary syphilis attending four HIV-referral centers in Mexico City was included (2004-2021). Clinical and laboratory data were retrieved, and an exhaustive oral examination was performed following the established criteria. Demographic, clinicopathological, immunohistochemical, and serological features of the patients were analyzed. Approximately 11% of PLWH with oral secondary syphilis demonstrated negative Venereal Disease Research Laboratory tests. A noticeable feature was the absence of symptoms in 95.7% of cases, despite the clinically evident appearance of the lesions. In contrast to previous results, 18% of ulcerations were detected to be deep, crateriform, and infiltrative, and 22% of the mucous patches were highly keratotic lesions. Most samples (77.3%) showed superficial lymphoplasmacytic infiltrates in the superficial lamina propria, with perivascular and perineural patterns, and immunohistochemistry was positive in 66.7% of the cases. The "great imitator" appears not only clinically but also histopathologically and immunohistochemically, where features may be comparable with those of chronic inflammatory processes, deep infections, or malignant processes. Although not recommended as a routine assay, IHC could be a critical tool, particularly in PLWH with atypical clinical features or with negative and/or dubious serology.
Collapse
Affiliation(s)
- Velia Ramírez-Amador
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Calzada del Hueso 1100, col. Villa Quietud, 04960, Mexico City, Mexico
| | - Itzel Castillejos-García
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Calzada del Hueso 1100, col. Villa Quietud, 04960, Mexico City, Mexico
| | - Jessica Maldonado-Mendoza
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Calzada del Hueso 1100, col. Villa Quietud, 04960, Mexico City, Mexico
| | - Marcela Saeb-Lima
- Pathology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Diana Aguilar-León
- Pathology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Gabriela Anaya-Saavedra
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Calzada del Hueso 1100, col. Villa Quietud, 04960, Mexico City, Mexico.
| |
Collapse
|
7
|
Magnaterra E, Grandi V, Pisano L. The Great Imitator: Primary Syphilis Clinically Mimicking Oral Squamous Cell Carcinoma. Am J Med 2022; 135:1078-1079. [PMID: 35307358 DOI: 10.1016/j.amjmed.2022.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 11/01/2022]
Affiliation(s)
| | - Vieri Grandi
- Dermatology Unit, Department of Health Sciences, University of Florence, Italy
| | - Luigi Pisano
- Dermatology Unit, Department of Health Sciences, University of Florence, Italy
| |
Collapse
|
8
|
Oumarou Hama H, Aboudharam G, Barbieri R, Lepidi H, Drancourt M. Immunohistochemical diagnosis of human infectious diseases: a review. Diagn Pathol 2022; 17:17. [PMID: 35094696 PMCID: PMC8801197 DOI: 10.1186/s13000-022-01197-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/18/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Immunohistochemistry (IHC) using monoclonal and polyclonal antibodies is a useful diagnostic method for detecting pathogen antigens in fixed tissues, complementing the direct diagnosis of infectious diseases by PCR and culture on fresh tissues. It was first implemented in a seminal publication by Albert Coons in 1941. MAIN BODY Of 14,198 publications retrieved from the PubMed, Google, Google Scholar and Science Direct databases up to December 2021, 230 were selected for a review of IHC techniques, protocols and results. The methodological evolutions of IHC and its application to the diagnosis of infectious diseases, more specifically lice-borne diseases, sexually transmitted diseases and skin infections, were critically examined. A total of 59 different pathogens have been detected once in 22 different tissues and organs; and yet non-cultured, fastidious and intracellular pathogens accounted for the vast majority of pathogens detected by IHC. Auto-IHC, incorporating patient serum as the primary antibody, applied to diseased heart valves surgically collected from blood culture-negative endocarditis patients, detected unidentified Gram-positive cocci and microorganisms which were subsequently identified as Coxiella burnetii, Bartonella quintana, Bartonella henselae and Tropheryma whipplei. The application of IHC to ancient tissues dated between the ends of the Ptolemaic period to over 70 years ago, have also contributed to paleomicrobiology diagnoses. CONCLUSION IHC plays an important role in diagnostic of infectious diseases in tissue samples. Paleo-auto-IHC derived from auto-IHC, is under development for detecting non-identified pathogens from ancient specimens.
Collapse
Affiliation(s)
- Hamadou Oumarou Hama
- IHU Méditerranée Infection, Marseille, France
- Aix-Marseille-Univ., IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
| | - Gérard Aboudharam
- Aix-Marseille-Univ., IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
- Aix-Marseille-Univ., Ecole de Médecine Dentaire, Marseille, France
| | - Rémi Barbieri
- IHU Méditerranée Infection, Marseille, France
- Aix-Marseille-Univ., IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
| | - Hubert Lepidi
- Aix-Marseille-Univ., IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
- Laboratoire d'Histologie, Faculté de Médecine, Université de la Méditerranée, Marseille, France
| | - Michel Drancourt
- IHU Méditerranée Infection, Marseille, France.
- Aix-Marseille-Univ., IRD, MEPHI, IHU Méditerranée Infection, Marseille, France.
| |
Collapse
|
9
|
Jain A, Maheshwari K, Gupta K, Meena S. Mucous patch of secondary syphilis masquerading as leukokeratosis: An atypical presentation. Indian J Sex Transm Dis AIDS 2021; 42:153-155. [PMID: 34909621 PMCID: PMC8628090 DOI: 10.4103/ijstd.ijstd_85_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/22/2019] [Accepted: 02/04/2021] [Indexed: 12/03/2022] Open
Abstract
Syphilis is known to inflict human being since long. It has varied clinical presentations. Atypical presentations are not uncommon and may jeopardize the clinical acumen of experienced clinician. Here, we are reporting a case of syphilis presenting as a sole manifestation in oral cavity.
Collapse
Affiliation(s)
- Arushi Jain
- Department of Dermatology, Venereology and Leprology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Kriti Maheshwari
- Department of Dermatology, Venereology and Leprology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Kalpana Gupta
- Department of Dermatology, Venereology and Leprology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Sanjay Meena
- Department of Dermatology, Venereology and Leprology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| |
Collapse
|
10
|
Ramírez-Amador V, Anaya-Saavedra G, Calva-Mercado JJ. The challenging diagnosis of overlapping oral primary/secondary syphilis with nonreactive serology. J Cutan Pathol 2020; 47:1058-1062. [PMID: 32666536 DOI: 10.1111/cup.13811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 11/28/2022]
Abstract
The prevalence of oral syphilis, known as "the great imitator" because of its diagnostic complexity and varied clinical manifestations, is increasing worldwide, particularly in people living with HIV (PLWH), who could present false-negative serological results. Although some studies have described the variable presentation of oral syphilis in the context of HIV infection, the difficulty in distinguishing between the primary and secondary stages, clinically and histopathologically, underscores the need to describe atypical cases. We report the case of a 28-year-old HIV-positive man presenting with a 3-month history of painless white/red ulcerated lesion on the soft palate. Physical examination revealed an ulcerated lesion with local signs of inflammation. Initial biopsy revealed a nonspecific inflammatory process and immunohistochemistry (IHC) using anti-Treponema pallidum antibodies showed negative results. The results of serological tests for syphilis (Venereal Disease Research Laboratory and fluorescent treponemal antibody-absorption test) were negative on repeated occasions. Nonetheless, polymerase chain reaction (PCR) assay and subsequent IHC for T. pallidum showed positive results, confirming the diagnosis of oral syphilis. This case illustrates that the diagnosis of oral syphilis is challenging in the absence of serological evidence, and specific tests such as PCR and IHC are useful complementary diagnostic tools.
Collapse
Affiliation(s)
- Velia Ramírez-Amador
- Oral Pathology and Medicine Postgraduate Program, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
| | - Gabriela Anaya-Saavedra
- Oral Pathology and Medicine Postgraduate Program, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
| | | |
Collapse
|
11
|
A nonspecific ulcer on upper lip presented as the first and sole sign of syphilis. J Infect Chemother 2020; 26:1309-1312. [PMID: 32768339 DOI: 10.1016/j.jiac.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/04/2020] [Accepted: 07/20/2020] [Indexed: 01/25/2023]
Abstract
Syphilis, a sexually transmitted disease, can be categorized as acquired syphilis and congenital syphilis, manifesting diverse lesions involving multiple sites. Oral manifestations at the primary stage of acquired syphilis are usually characterized by its short period and non-specific varied presentations. And oral ulcers as initial and the only presentation of syphilis oral lesions are infrequent and occur in less than 2% of patients. Because of its transient nature and variable manifestations which could mimic other oral ulcerative lesions, oral syphilis presenting as sole ulceration at early stage can be easily neglected and rather difficult to diagnose. Herein, we report a 35-year-old female patient manifested a sole atypical ulceration on her upper lip for approximately 1 month. We highlighted the importance of early and accurate diagnosis, focused on the characteristics of oral chancre, and gave an insight to the differential diagnoses, which would be enlightening and useful in clinical practice.
Collapse
|
12
|
Atypical ulceration of the hard palate. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:347-352. [PMID: 31270011 DOI: 10.1016/j.oooo.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 11/22/2022]
|
13
|
Schuch LF, da Silva KD, de Arruda JAA, Etges A, Gomes APN, Mesquita RA, Vasconcelos ACU, Tarquinio SBC. Forty cases of acquired oral syphilis and a review of the literature. Int J Oral Maxillofac Surg 2018; 48:635-643. [PMID: 30459066 DOI: 10.1016/j.ijom.2018.10.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/20/2018] [Accepted: 10/31/2018] [Indexed: 12/31/2022]
Abstract
The aim of this study was to describe 40 cases of acquired oral syphilis (AOS) and to discuss the distribution of demographic characteristics, clinical features, and differential diagnosis of the disease. A retrospective study was conducted covering a 17-year period at a single institution in southern Brazil. Moreover, a literature review was performed through a search of the PubMed database for articles on AOS published between 1955 and March 2018. Data were analyzed descriptively. The predominant group within the case series was male patients in their twenties. The vast majority of cases (92.5%) were in the secondary stage of the disease. The lips were the most commonly affected site, with greyish-white mucous patches and reddish ulcers. In the literature review, the largest number of reported cases came from North America. Male patients in the third and fourth decades of life were most affected. AOS occurred more commonly as mucous patches and ulcers on the tongue and palate. Similarities regarding the distribution by sex, age, and anatomical location were found in the present study when compared to cases reported elsewhere. Clinicians, oral pathologists, and maxillofacial surgeons should familiarize themselves with the variable spectrum of signs and symptoms of AOS in their clinical practice to improve diagnosis and management.
Collapse
Affiliation(s)
- L F Schuch
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - K D da Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - J A A de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - A Etges
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - A P N Gomes
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - R A Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - A C U Vasconcelos
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - S B C Tarquinio
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| |
Collapse
|
14
|
Gondivkar S, Gadbail A, Sarode GS, Sarode SC, Patil S, Awan KH. Infectious diseases of oral cavity. Dis Mon 2018; 65:164-184. [PMID: 30681961 DOI: 10.1016/j.disamonth.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Shailesh Gondivkar
- Department of Oral Medicine and Radiology, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Amol Gadbail
- Department of Dentistry, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Gargi S Sarode
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram nagar, Pimpri, Pune 411018, Maharashtra, India
| | - Sachin C Sarode
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram nagar, Pimpri, Pune 411018, Maharashtra, India.
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Kamran H Awan
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, United States
| |
Collapse
|
15
|
Thakrar P, Aclimandos W, Goldmeier D, Setterfield JF. Oral ulcers as a presentation of secondary syphilis. Clin Exp Dermatol 2018; 43:868-875. [PMID: 30039628 DOI: 10.1111/ced.13640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 12/01/2022]
Abstract
The incidence of syphilis is increasing, and it typically presents in patients with known risk factors, often to genitourinary physicians. Patients presenting to a dermatologist or ophthalmologist will more likely have secondary syphilis, with the potential for having the associated complications. Early recognition is therefore vital to limit both the disease and risk of further contact spread. In this review, we include two case histories demonstrating the value of recognizing oral signs. Additionally, we review the currently accepted diagnostic and therapeutic recommendations.
Collapse
Affiliation(s)
- P Thakrar
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - W Aclimandos
- Department of Ophthalmology, King's College Hospital, London, UK
| | - D Goldmeier
- Department of Genitourinary medicine, Imperial College NHS Healthcare Trust, London, UK
| | - J F Setterfield
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Mucosal and Salivary Division, Dental Institute, King's College, London, UK
| |
Collapse
|
16
|
Sugaya N, Braz-Silva PH, Bergamini ML, Migliari D. Primary syphilis occurring as an extensive ulceration on the palatal gingival mucosa diagnosed by immunohistochemical staining. J Eur Acad Dermatol Venereol 2018; 32:e461-e462. [PMID: 29730886 DOI: 10.1111/jdv.15058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N Sugaya
- Department of Stomatology, Oral Medicine Division, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
| | - P H Braz-Silva
- Department of Stomatology, Oral Pathology Division, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
| | - M L Bergamini
- Department of Stomatology, Oral Pathology Division, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
| | - D Migliari
- Department of Stomatology, Oral Medicine Division, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
| |
Collapse
|
17
|
NAVAZO-EGUÍA AI, RIOJA-PEÑARANDA E, ECHEVARRIA-ITURBE C, TERÁN-MUÑOZ D, CORDERO-CIVANTOS C, IBAÑEZ-MUÑOZ C. Manifestaciones orales de la sífilis. Caso clínico. REVISTA ORL 2017. [DOI: 10.14201/orl.16751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
18
|
Irani S. Orofacial Bacterial Infectious Diseases: An Update. J Int Soc Prev Community Dent 2017; 7:S61-S67. [PMID: 29184830 PMCID: PMC5682706 DOI: 10.4103/jispcd.jispcd_290_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/22/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Most of the oral infections with odontogenic origin are very common and can be treated by tooth extraction, endodontic therapy, or surgical treatment. Other infectious lesions are the manifestations of systemic diseases such as tuberculosis and syphilis. Skin and underlying subcutaneous tissue, fascia, or muscle is also involved with infectious diseases which range from superficial epidermal infections to very serious necrotizing fasciitis. MATERIALS AND METHODS An extensive literature in PubMed, Google Scholar, and Scopus search was performed from 1980 to 2017. All related articles were analyzed. RESULTS Most oral infections have odontogenic origin. Skin and the underlying subcutaneous tissue, fascia, or muscles are also involved with infectious diseases which range from superficial epidermal infections to very serious necrotizing fasciitis. CONCLUSIONS These facts prove that the interaction between the oral cavity, face skin, and the other organs can risk the people's life. The establishment of a correct diagnosis and recognition of clinical findings are the crucial steps to support and improve professional orofacial health status.
Collapse
Affiliation(s)
- Soussan Irani
- Department of Oral Pathology, Dental Research Center, Research Centre for Molecular Medicine, Dental Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
19
|
Secondary Syphilis Presenting as Glossodynia, Plaques en Prairie Fauchée, and a Split Papule at the Oral Commissure: Case Report and Review. Case Rep Med 2017; 2017:1980798. [PMID: 28785283 PMCID: PMC5529628 DOI: 10.1155/2017/1980798] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/31/2017] [Indexed: 11/18/2022] Open
Abstract
Syphilis has been coined "the great imitator" due to its extreme heterogeneity of presentation and mimicry of other conditions. Therefore, it is essential that physicians be familiar with the full spectrum of its manifestations. Syphilis may also lead to oral lesions that, occasionally, are unaccompanied by concomitant tegumentary findings. Such patients will pose unique diagnostic challenges. We report the case of a 45-year-old HIV-infected male patient in whom secondary syphilis presented with burning mouth and dysgeusia that progressed to glossodynia and odynophagia. Examination revealed painful, shallow erosions on the posterior aspect of the tongue, in a pattern of plaques en prairie fauchée. A painful split papule (fausse perlèche or false angular cheilitis) was also present in the left commissure. There were no cutaneous lesions. The oral lesions were considered highly suggestive of secondary syphilis. A novel VDRL assay (which was previously negative) yielded a titer of 1/128. Complete clinical remission was rapidly achieved after initiation of penicillin therapy. A comprehensive review of the literature on oral manifestations of syphilis is offered.
Collapse
|
20
|
Magliocca KR, Fitzpatrick SG. Autoimmune Disease Manifestations in the Oral Cavity. Surg Pathol Clin 2016; 10:57-88. [PMID: 28153136 DOI: 10.1016/j.path.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Immune-related disorders of the oral cavity may occur as primary disease process, secondary to systemic disease or neoplasm, or as a reaction to medications and other agents. The entities represented within this group may vary significantly by severity, clinical presentation, microscopic presentation, and special testing results. The selected immune-related conditions of the oral cavity in this article are categorized and presented by their prototypical tissue reaction patterns: vesiculobullous, including acantholytic and subepithelial separation; psoriasiform; spongiotic; and lichenoid reaction patterns.
Collapse
Affiliation(s)
- Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University, 500 Peachtree Street Northeast, Atlanta, GA 30308, USA.
| | - Sarah G Fitzpatrick
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida, 1395 Center Drive, Gainesville, FL 32610, USA
| |
Collapse
|
21
|
Secondary Syphilis Presenting as Oral Lesions and Posterior Placoid Chorioretinitis in an Immunocompetent Patient. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
22
|
Secondary Syphilis Presenting as Oral Lesions and Posterior Placoid Chorioretinitis in an Immunocompetent Patient. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:783-784. [PMID: 27340116 DOI: 10.1016/j.ad.2016.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 11/20/2022] Open
|
23
|
Campana F, Carvelli J, Fricain JC, Vergier B, Boralevi F, Kaplanski G. [Reached multifocal secondary syphilis: A case presentation]. ACTA ACUST UNITED AC 2016; 117:104-7. [PMID: 26964840 DOI: 10.1016/j.revsto.2016.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/27/2015] [Accepted: 01/22/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Syphilis is a sexually transmitted infection (STI) related to Treponema pallidum. Secondary syphilis is the blood-borne systemic spread of Treponema. OBSERVATION We report the case of secondary syphilis in a patient without risk of STIs factor. The clinical picture began with a genital affection followed by oral erosions and ulcers and an anterior and then posterior uveitis. Serology established the diagnosis and intravenous penicillin G treatment allowed for healing. DISCUSSION Called the "great pretender" because of its clinical polymorphism, secondary syphilis can lead to formidable neurological and ophthalmological complications. Serological diagnosis is based on the use of treponemal and a nontreponemal tests. Penicillin G remains the treatment of choice and must be adapted according to the clinical damage.
Collapse
Affiliation(s)
- F Campana
- Centre Massilien de la face, 24, avenue du Prado, 13006 Marseille, France.
| | - J Carvelli
- Service de médecine interne, Assistance publique-Hôpitaux de Marseille, hôpital de la Conception, 13005 Marseille, France
| | - J C Fricain
- Service d'odontologie, CHU de Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - B Vergier
- Service d'anatomopathologie, CHU de Bordeaux, avenue de Magellan, 33604 Bordeaux cedex, France
| | - F Boralevi
- Service de dermatologie, CHU de Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - G Kaplanski
- Service de médecine interne, Assistance publique-Hôpitaux de Marseille, hôpital de la Conception, 13005 Marseille, France
| |
Collapse
|
24
|
Fluorescence in situ hybridization for the identification of Treponema pallidum in tissue sections. Int J Med Microbiol 2015; 305:709-18. [PMID: 26365167 DOI: 10.1016/j.ijmm.2015.08.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Syphilis is often called the great imitator because of its frequent atypical clinical manifestations that make the disease difficult to recognize. Because Treponema pallidum subsp. pallidum, the infectious agent of syphilis, is yet uncultivated in vitro, diagnosis is usually made using serology; however, in cases where serology is inconclusive or in patients with immunosuppression where these tests may be difficult to interpret, the availability of a molecular tool for direct diagnosis may be of pivotal importance. Here we present a fluorescence in situ hybridization (FISH) assay that simultaneously identifies and analyzes spatial distribution of T. pallidum in histological tissue sections. For this assay the species-specific FISH probe TPALL targeting the 16S rRNA of T. pallidum was designed in silico and evaluated using T. pallidum infected rabbit testicular tissue and a panel of non-syphilis spirochetes as positive and negative controls, respectively, before application to samples from four syphilis-patients. In a HIV positive patient, FISH showed the presence of T. pallidum in inguinal lymph node tissue. In a patient not suspected to suffer from syphilis but underwent surgery for phimosis, numerous T. pallidum cells were found in preputial tissue. In two cases with oral involvement, FISH was able to differentiate T. pallidum from oral treponemes and showed infection of the oral mucosa and tonsils, respectively. The TPALL FISH probe is now readily available for in situ identification of T. pallidum in selected clinical samples as well as T. pallidum research applications and animal models.
Collapse
|
25
|
de Paulo LFB, Servato JPS, Oliveira MTF, Durighetto AF, Zanetta-Barbosa D. Oral Manifestations of Secondary Syphilis. Int J Infect Dis 2015; 35:40-2. [DOI: 10.1016/j.ijid.2015.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/06/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022] Open
|