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Dos Santos ES, Rocha AFL, Leite AA, Gallagher KPD, Penafort PVM, Cintra ML, Vargas PA. A crateriform lesion on the upper lip. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:446-450. [PMID: 38519297 DOI: 10.1016/j.oooo.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/09/2024] [Accepted: 02/26/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Erison Santana Dos Santos
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Audrey Foster Lefort Rocha
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, Universidade Estadual Paulista (UNESP), São Paulo, Brazil
| | - Amanda Almeida Leite
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | | | | | - Maria Letícia Cintra
- Pathology Department, Dermatopathology Division, School of Medical Sciences, UNICAMP, Sao Paulo, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.
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2
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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.
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Vieira Granja B, Amoroso Canão P, Mota A. Not Always a Malignant Tumour: A Quiz. Acta Derm Venereol 2024; 104:adv34750. [PMID: 38334068 PMCID: PMC10865891 DOI: 10.2340/actadv.v104.34750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
Abstract missing (Quiz)
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Affiliation(s)
- Bárbara Vieira Granja
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Pedro Amoroso Canão
- Department of Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal, 3Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - Alberto Mota
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal
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4
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Olandt CA, Sloane S, Campbell C, Subramony R. The Great Masquerader Strikes Again. J Emerg Med 2024; 66:232-234. [PMID: 38262783 DOI: 10.1016/j.jemermed.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 01/25/2024]
Affiliation(s)
| | - Skyler Sloane
- University of California, San Diego School of Medicine, San Diego, California.
| | - Colleen Campbell
- Department of Emergency Medicine, University of California, San Diego, San Diego, California.
| | - Rachna Subramony
- Department of Emergency Medicine, University of California, San Diego, San Diego, California.
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5
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Sun L, Yin X, Lu X, Zhou M, Ji W, Liu W. A Case of Oropharyngeal Syphilis. EAR, NOSE & THROAT JOURNAL 2024:1455613231218142. [PMID: 38279792 DOI: 10.1177/01455613231218142] [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: 01/29/2024] Open
Abstract
We present a case of a 50-year-old male who complained of a sore throat persisting for 2 months. Upon physical examination, multiple mucous patches were observed in the oropharynx region, but no skin lesions were found. Fiberoptic laryngoscopy confirmed these findings. The Treponema pallidum particle agglutination test and toluidine red unheated serum test (TRUST) were positive with a titer of TRUST 1:64. The patient admitted to engaging in extramarital sexual activities with several females but no males. Based on the clinical manifestations and laboratory test results, a diagnosis of secondary syphilis of the oropharynx was established. He was treated with 2.4 million units of benzathine penicillin G by intramuscular injection once a week for 3 weeks. After 1 month, the lesions completely disappeared without any symptoms. The titer of TRUST reduced to 1:2 in 1-year follow-up. This report aims to enhance physicians' understanding and recognition of oropharyngeal syphilis, enabling timely diagnosis and effective management.
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Affiliation(s)
- Linan Sun
- Department of Dermatology, People's Hospital of SND, Suzhou, Jiangsu, China
| | - Xingping Yin
- Department of Dermatology, People's Hospital of SND, Suzhou, Jiangsu, China
| | - Xiaojun Lu
- Department of Dermatology, People's Hospital of SND, Suzhou, Jiangsu, China
| | - Mingyu Zhou
- Department of Otolaryngology, People's Hospital of SND, Suzhou, Jiangsu, China
| | - Wenjun Ji
- Department of Otolaryngology, People's Hospital of SND, Suzhou, Jiangsu, China
| | - Wei Liu
- Department of Dermatology, People's Hospital of SND, Suzhou, Jiangsu, China
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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.
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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
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Ying S, Li S, Qiao J. A Man With Asymptomatic Ulcerated White Plaques on the Soft Palate. JAMA 2023; 329:680-681. [PMID: 36729464 DOI: 10.1001/jama.2023.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A man in his 60s had irregular gray-white ulcers with a surrounding erythema on the soft palate, uvula, and tonsils that did not improve with oral cefuroxime. He reported sexual contact with 1 male partner over the prior 6 months; history and physical examination findings were otherwise unremarkable. What is the diagnosis and what would you do next?
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Affiliation(s)
- Shuni Ying
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Victor M, Vavinskaya V, Guo T. A Young Man Presenting With Tongue Lesions. JAMA Otolaryngol Head Neck Surg 2023; 149:89-90. [PMID: 36416858 DOI: 10.1001/jamaoto.2022.3799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A 19-year-old man presented with tongue pain of 3 months’ duration and a raised tongue lesion with slightly hairy appearance. What is your diagnosis?
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Affiliation(s)
- Mitchell Victor
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego School of Medicine, La Jolla
| | - Vera Vavinskaya
- Department of Pathology, University of California San Diego School of Medicine, La Jolla
| | - Theresa Guo
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego School of Medicine, La Jolla
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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.
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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.
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10
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de Andrade BAB, de Arruda JAA, Gilligan G, Piemonte E, Panico R, Molina Ávila I, Pimentel Sola JM, Carmona Lorduy MC, Pupo Marrugo S, Sánchez Tatis AS, Werner LC, Abrahão AC, Agostini M, Buoro L, Israel MS, Freire NDA, Lima LA, Abrantes TDC, Cunha JLS, Pérez-de-Oliveira ME, Roza ALOC, Vargas PA, Lopes MA, Santos-Silva AR, de Almeida OP, Pontes FSC, Pontes HAR, Rondanelli BM, Villarroel-Dorrego M, Bologna-Molina R, Derderian N, Sánchez-Romero C, Abreu LG, Fonseca FP, Mesquita RA, Gomez RS, Martínez-Flores R, Delgado-Azañero W, Alves ATNN, Lourenço SDQC, Coimbra C, Polignano GAC, Assunção Júnior JNR, Souto GR, Souza PEA, Horta MCR, González-Arriagada WA, Romañach MJ. Acquired oral syphilis: A multicenter study of 339 patients from South America. Oral Dis 2022; 28:1561-1572. [PMID: 34263964 DOI: 10.1111/odi.13963] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/01/2021] [Accepted: 07/11/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To report the clinicopathologic features of acquired oral syphilis cases in South American countries. MATERIALS AND METHODS Clinical data were retrospectively collected from the records of 18 oral diagnostic services in Argentina, Brazil, Chile, Colombia, Venezuela, Uruguay, and Peru. Serologies of nontreponemal and treponemal tests were used for diagnosis. RESULTS The series comprised 339 cases of acquired oral syphilis. Secondary syphilis ranked as the most common stage (86.7%). Lesions were more frequent among males (58.0%) and young adults with a mean age of 33.3 years. Individuals aged 20-29 years were most affected (35.3%). The most commonly involved sites were the tongue (31.6%), lip/labial commissure (25.1%), and hard/soft palate (20.4%). Clinically, acquired oral syphilis usually presented as mucous patches (28.4%), papules (25.7%), and ulcers (18.1%). Skin manifestations occurred in 67.7% of individuals, while lymphadenopathy and fever were observed in 61.3% and 11.6% of all subjects, respectively. Most patients were treated with the benzathine penicillin G antibiotic. CONCLUSION This report validates the spread of acquired oral syphilis infection among young adults in South America. Our directives include accessible diagnostic tools for proper disease screening, surveillance, and counselling of affected individuals, especially in low- and middle-income countries.
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Affiliation(s)
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gerardo Gilligan
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Eduardo Piemonte
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - René Panico
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | | | | | | | | | | | - Aline Corrêa Abrahão
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luisa Buoro
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica Simões Israel
- Department of Diagnosis and Therapeutics, School of Dentistry, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Postgraduate Program of Oral Medicine, Faculdade São Leopoldo Mandic, Rio de Janeiro, Brazil
| | | | - Lucas Ambrósio Lima
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thamiris de Castro Abrantes
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - John Lennon Silva Cunha
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | | | | | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | - Marcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | | | | | | | | | - Ronell Bologna-Molina
- Molecular Pathology Area, Faculty of Dentistry, Universidad de la República, Montevidéu, Uruguay
| | - Nathalie Derderian
- Molecular Pathology Area, Faculty of Dentistry, Universidad de la República, Montevidéu, Uruguay
| | - Celeste Sánchez-Romero
- Molecular Pathology Area, Faculty of Dentistry, Universidad de la República, Montevidéu, Uruguay
| | - Lucas Guimarães Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - René Martínez-Flores
- Department of Oral Medicine and Oral Pathology, School of Dentistry, Universidad Andrés Bello, Viña del Mar, Chile
| | - Wilson Delgado-Azañero
- Department of Oral Pathology, Oral Medicine and Oral Surgery, School of Dentistry, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | | | | | | | - Giovanna Ribeiro Souto
- Graduate Program in Dentistry, School of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Eduardo Alencar Souza
- Graduate Program in Dentistry, School of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Jaa DA, Bab DA, Lg A, Mj R, Ra M, Ta S. Impact of data scarcity on the evaluation of risk factors associated with acquired oral syphilis in South America. Int J STD AIDS 2021; 32:1374-1375. [PMID: 34546115 DOI: 10.1177/09564624211042312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- de Arruda Jaa
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, 28114Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - de Andrade Bab
- Department of Oral Diagnosis and Pathology, School of Dentistry, 28125Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Abreu Lg
- Department of Child's and Adolescent's Oral Health, School of Dentistry, 28114Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Romañach Mj
- Department of Oral Diagnosis and Pathology, School of Dentistry, 28125Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mesquita Ra
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, 28114Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Silva Ta
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, 28114Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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12
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Normando AGC, Rodrigues-Fernandes CI, de Pauli Paglioni M, Arboleda LPA, de Franceschi L, Vargas PA, Lopes MA, Santos-Silva AR. An ulcerated nodule on the tip of the tongue of a patient with skin lesions. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:363-368. [PMID: 34511354 DOI: 10.1016/j.oooo.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Ana Gabriela Costa Normando
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (Unicamp), Piracicaba, São Paulo, Brazil.
| | | | - Mariana de Pauli Paglioni
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (Unicamp), Piracicaba, São Paulo, Brazil
| | | | - Leticia de Franceschi
- Centro de Oncologia, Hospital dos Fornecedores de Cana de Piracicaba, Piracicaba, São Paulo, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (Unicamp), Piracicaba, São Paulo, Brazil
| | - Márcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (Unicamp), Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (Unicamp), Piracicaba, São Paulo, Brazil
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Abstract
Syphilis is a sexually transmitted disease caused by Treponema pallidum. The primary stage of the disease (the chancre) mainly involves the genital areas. Extragenital areas are involved in 5%-14% of cases, many of which occur in the oral cavity. Among the extragenital locations, the lip is the most frequent; however, despite this, published cases of the chancre of the lip are few. We present a case of a chancre presenting on the lip of a nonimmunocompromised 55-year-old male patient with immunohistochemical confirmation.
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14
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Barguil S, Sousa Alves A, Christen JR, De Jerphanion C, Valero J, Gaillard T, Karkowski L. Pharyngeal abscess complicated by Lemierre's syndrome: Identification of an atypical germ. IDCases 2021; 25:e01180. [PMID: 34235050 PMCID: PMC8246386 DOI: 10.1016/j.idcr.2021.e01180] [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: 11/29/2020] [Revised: 01/07/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Lemierre's syndrome is a rare but serious complication of an oral infection mostly related to Fusobacterium necrophorum. This condition combines jugular vein thrombosis and septic emboli to the lungs or other organs. CASE PRESENTATION We report here an original case of a pharyngeal abscess complicated by Lemierre's syndrome in a young healthy male patient. Samples taken from the pus of the pharyngeal abscess showed the presence of Gardnerella vaginalis associated with Fusobacterium necrophorum. The patient was treated by draining the abscess, antibiotic therapy and preventive anticoagulation for 1 month. The evolution was good with a resolution of the thrombosis. CONCLUSIONS This case highlights the need for bacterial identification to adapt antibiotic therapy in Lemierre's syndrome. It also shows the possibility of extragenital localization of Gardnerella vaginalis in a male patient having oral sex with women. In contrast to sexually transmitted infections such as syphilis and pharyngeal gonococcus, this oral localization of Gardnerella vaginalis has not been described previously in the literature.
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Affiliation(s)
- Solène Barguil
- Hôpital d’Instruction des Armées Desgenettes, Lyon, France
| | | | | | | | - Joris Valero
- Hôpital d’Instruction des Armées Desgenettes, Lyon, France
| | - Tiphaine Gaillard
- Laboratoire de Biologie Médicale, HIA Desgenettes, Lyon, France
- Laboratoire de Biologie Médicale, CH Croix-Rousse, Lyon, France
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15
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Thums MA, Koth VS, de Figueiredo M, Cherubini K, Salum FG. Oral manifestations of syphilis: an epidemiological study in southern Brazil. Aust Dent J 2021; 66:289-294. [PMID: 33656756 DOI: 10.1111/adj.12834] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Syphilis is an infectious, sexually transmitted disease with varied oral manifestations, that can mimic other lesions. This study aimed to conduct an epidemiological survey of cases of syphilis, diagnosed from oral manifestations, establishing the sociodemographic profile of patients and clinical characteristics of oral lesions. METHODS The medical records of patients with oral lesions of syphilis acquired were reviewed, and 109 cases were selected. RESULTS The mean age of the patients was 34.4 years and, of these, 51% were male. In 105 cases, the disease was diagnosed in the secondary stage; in three cases, in the primary stage; and, in one case, in the tertiary stage. The cases of primary syphilis presented as single and ulcerated nodules, and the case of tertiary syphilis, as a necrotic lesion in the palate. In 86% of cases of secondary syphilis, there were multicentric lesions, presenting as grayish-white plaques (85%), associated or not with erosive and/or ulcerated lesions (33%), mostly affecting the labial mucosa and tongue. In 91.7% of cases painful symptoms were reported. CONCLUSION Considering the increase in syphilis, it is extremely important that dentists recognize its oral manifestations, because early diagnosis and treatment can minimize the risks of complications and transmission.
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Affiliation(s)
- M A Thums
- Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - V S Koth
- Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maz de Figueiredo
- Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - K Cherubini
- Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - F G Salum
- Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
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Smith MH, Vargo RJ, Bilodeau EA, Anderson KM, Trzcinska A, Canterbury CR, Fantasia JE, Rawal YB. Oral Manifestations of Syphilis: a Review of the Clinical and Histopathologic Characteristics of a Reemerging Entity with Report of 19 New Cases. Head Neck Pathol 2021; 15:787-795. [PMID: 33459991 PMCID: PMC8384985 DOI: 10.1007/s12105-020-01283-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syphilis is a sexually-transmitted infectious disease caused by Treponema pallidum. Cases of primary and secondary syphilis are on the rise in the United States, with a 14.4% increase in new cases noted from 2017 to 2018 and an escalation of 71% between the years 2014 and 2018. Fulfilling its nickname of "the great imitator," oral manifestations of syphilis may mimic a variety of infectious, neoplastic, or immune-mediated processes, both clinically and histopathologically. This large spectrum of appearances can create a diagnostic challenge to the clinician and/or pathologist, leading to delay in diagnosis or misdiagnosis. METHODS A database of oral syphilis cases was created from archives at the University of Kentucky, University of Pittsburgh, LIJMC, Columbia University MC, and University of Tennessee. The age, sex, race, location, duration, and clinical description were recorded. Cases without positive reaction upon immunohistochemistry or serologic tests were excluded. RESULTS We identified 19 new cases of oral syphilis (17 males, one female, and one case unknown sex) and described the clinical and histopathological features of this re-emerging and potentially fatal disease. All cases demonstrated dense lymphoplasmacytic inflammation, often with inflammatory exocytosis or ulceration at the surface, and perivascular inflammation. CONCLUSIONS Early recognition of the histopathologic and clinical manifestations of oral syphilis is imperative for prompt diagnosis, improved patient outcomes, and disease prevention.
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Affiliation(s)
- Molly Housley Smith
- Division of Oral and Maxillofacial Pathology, University of Kentucky College of Dentistry, 800 Rose Street, Rm. 530, Lexington, KY, 40536, USA.
| | - Richard J Vargo
- Oral and Maxillofacial Pathology Specialty Care Unit, A.T. Still University-Missouri School of Dentistry & Oral Health, St. Louis, MO, USA
| | - Elizabeth Ann Bilodeau
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, G-135 Salk Hall, 3501 Terrace St., Pittsburgh, PA, USA
| | - K Mark Anderson
- Department of Diagnostic Sciences, The University of Tennessee College of Dentistry, Memphis, TN, USA
| | - Anna Trzcinska
- Head and Neck Pathology Fellow, Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Carleigh R Canterbury
- Division of Oral and Maxillofacial Pathology, Columbia University Medical Center, New York, NY, USA
| | - John E Fantasia
- Department of Dental Medicine, Division of Oral and Maxillofacial Pathology, Long Island Jewish Medical Center, Zucker School of Medicine At Hofstra Northwell Health, New Hyde Park, NY, USA
| | - Yeshwant B Rawal
- Department of Surgical Sciences, Marquette University School of Dentistry, Milwaukee, WI, USA
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de Arruda JAA, do Valle IB, Mesquita RA, Silva TA. Oral syphilis. J Am Acad Dermatol 2020; 84:e101-e102. [PMID: 33011314 DOI: 10.1016/j.jaad.2020.09.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 01/26/2023]
Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Isabella Bittencourt do Valle
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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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.
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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
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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.
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20
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Sexual behavior and its association with persistent oral lesions: analysis of the POP-Brazil study. Clin Oral Investig 2020; 25:1107-1116. [PMID: 32583241 PMCID: PMC7878220 DOI: 10.1007/s00784-020-03407-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
Objectives To investigate whether the presence of persistent self-reported oral lesions (PSOLs) is associated with sexual behaviors and with the presence of sexually transmitted infections (STIs) in individuals aged 16–25 years in the state capitals of Brazil. Materials and Methods Data from the POP-Brazil study were analyzed. An association analysis was performed by Poisson regression with the presence of PSOLs as the outcome. The exposure variables were the age at first sexual intercourse, the number of partners, oral sex practice, and aspects of condom use for model 1, and the presence of a self-reported STI or a positive rapid test for HIV/syphilis and the presence of genital human papillomavirus (HPV) for model 2. The results were adjusted for socioeconomic variables. Results The prevalence of PSOLs was 76% higher among individuals who had two or more sexual partners in the past year (p = 0.046) and 68% higher in those who reported not using condoms for contraception (p = 0.032). The group with HIV/syphilis or self-reported STI had a 140% higher PSOL prevalence (p = 0.003). Conclusions The self-report of oral lesions in adolescents and young adults may suggest risky sexual behavior and the presence of STI. Clinical relevance It is necessary to contextualize the reality of the young person to optimize oral health care.
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Lampros A, Seta V, Gerhardt P, Isnard C, Husson C, Dupin N. Oral forms of secondary syphilis: An illustration of the pitfalls set by the great imitator. J Am Acad Dermatol 2020; 84:348-353. [PMID: 32339705 DOI: 10.1016/j.jaad.2020.04.089] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/31/2020] [Accepted: 04/17/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Syphilis is reemerging in certain populations, such as in men who have sex with men in particular. Oral manifestations are not uncommon and can render diagnosis difficult, particularly if occurring in isolation. MATERIALS AND METHODS We recovered clinical data for all patients receiving a diagnosis of secondary syphilis who were referred to the National Reference Center for Syphilis in Paris, France, from January 2000 to July 2019. We selected patients presenting oral symptoms only and analyzed their general characteristics, time to diagnosis, and clinical presentations. RESULTS Secondary syphilis was diagnosed in 206 patients, 38 of whom (18%) presented oral manifestations, which were isolated in 14 patients (37%). The main oral manifestations were subacute erosive or ulcerative lesions (55%), mucous patches on the tongue (53%), and nodular (10%) and leukokeratotic lesions (5%). Mean time to diagnosis was 4.5 months, but was significantly longer for patients with isolated oral symptoms (8.8 vs 1.8 months; P = .02). CONCLUSION Oral presentations of secondary syphilis are frequent and challenging for diagnosis, even in patients with epidemiologic risk factors. Clinicians confronted with subacute oral lesions in such patients should bear in mind the possibility of this contagious, curable, and sometimes severe disease.
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Affiliation(s)
- Alexandre Lampros
- Service de Dermatologie, Hôpital Cochin, Assistance Publique des Hôpitaux, Paris, France; Sorbone University, Paris
| | - Vannina Seta
- Service de Dermatologie, Hôpital Cochin, Assistance Publique des Hôpitaux, Paris, France
| | - Phillippe Gerhardt
- CeGIDD, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux, Paris, France
| | - Camille Isnard
- Service de Dermatologie, Hôpital Cochin, Assistance Publique des Hôpitaux, Paris, France
| | | | - Nicolas Dupin
- Service de Dermatologie, Hôpital Cochin, Assistance Publique des Hôpitaux, Paris, France; CeGIDD, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux, Paris, France; Centre National de Référence des infections sexuellement transmissibles, Laboratoire associé Syphilis, Paris, France; Institut Cochin, Inserm 1016, Université de Paris, Paris, France.
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Affiliation(s)
- Lester D R Thompson
- Department of Pathology, Woodland Hills Medical Center, 158530Southern California Permanente Medical Group, Woodland Hills, CA, USA
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