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Huynh J, Ghoreschi FC, Werner RN, Ghoreschi K, Moritz RKC. Livid-erythematöse sukkulente Papeln und Plaques bei einer 54-jährigen Patientin: Livid-erythematous succulent papules and plaques in a 54-year-old female patient. J Dtsch Dermatol Ges 2024; 22:129-132. [PMID: 38212921 DOI: 10.1111/ddg.15309_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/04/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Julia Huynh
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Franziska C Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Ricardo Niklas Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Rose K C Moritz
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
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2
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Huynh J, Ghoreschi FC, Werner RN, Ghoreschi K, Moritz RKC. Livid-erythematous succulent papules and plaques in a 54-year-old female patient. J Dtsch Dermatol Ges 2024; 22:129-132. [PMID: 38115167 DOI: 10.1111/ddg.15309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/04/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Julia Huynh
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Franziska C Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Ricardo Niklas Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Rose K C Moritz
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
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3
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Whiting C, Schwartzman G, Khachemoune A. Syphilis in Dermatology: Recognition and Management. Am J Clin Dermatol 2023; 24:287-297. [PMID: 36689103 PMCID: PMC9869822 DOI: 10.1007/s40257-022-00755-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 01/24/2023]
Abstract
The incidence of syphilis has been increasing in the USA since 2000. Notably, the coronavirus disease 2019 pandemic negatively impacted the public health efforts to contain the spread of sexually transmitted diseases including syphilis and congenital syphilis. Clinical manifestations of syphilis are predominantly mucocutaneous lesions, thus dermatologists are primed to recognize the myriad presentations of this disease. Primary syphilis is classically characterized by a painless transient chancre most often located in the genital area. Secondary syphilis typically manifests clinically as systemic symptoms in addition to a mucocutaneous eruption of which a variety of forms exist. Although less common in the era of effective penicillin treatment, late clinical manifestations of syphilis are described as well. In addition to recognition of syphilis on physical examination, several diagnostic tools may be used to confirm infection. Treponema pallidum spirochetes may be detected directly using histopathologic staining, darkfield microscopy, direct fluorescent antibody, and polymerase chain reaction assays. A table detailing the histopathologic features of syphilis is included in this article. Serologic testing, non-treponemal and treponemal tests, is the preferred method for screening and diagnosing syphilis infections. Two serologic testing algorithms exist to aid clinicians in diagnosing positive syphilis infection. Determining the correct stage of syphilis infection combines results of serologic tests, patient history, and physical examination findings. Using the current Centers for Disease Control and Prevention case definitions and treatment guidelines, a management algorithm is proposed here. Penicillin remains the pharmacological treatment of choice although specific clinical situations allow for alternative therapies. Syphilis is a reportable disease in every state and should be reported by stage according to individual state requirements. Screening recommendations are largely based upon risks encountered through sexual exposures. Likewise, sexual partner management includes evaluating and treating persons exposed to someone diagnosed with an infective stage of syphilis. Close clinical follow-up and repeat testing are recommended to ensure appropriate response to treatment. This guide will discuss the current epidemiology of syphilis and focus on practice aspects of diagnosis and management, including public health reporting.
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Affiliation(s)
- Cleo Whiting
- grid.253615.60000 0004 1936 9510School of Medicine and Health Sciences, George Washington University, Washington, DC USA
| | - Gabrielle Schwartzman
- grid.253615.60000 0004 1936 9510School of Medicine and Health Sciences, George Washington University, Washington, DC USA
| | - Amor Khachemoune
- Department of Dermatology, Veterans Affairs Medical Center, State University of New York Downstate, 800 Poly Place, Brooklyn, NY, 11209, USA. .,Department of Dermatology, Veterans Health Administration, Brooklyn, NY, USA.
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4
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Christmann CR, Figg WD, Chatterjee R, Lavere PF, Mehta N. Tertiary Syphilis Masquerading as Oropharyngeal Cancer. Cureus 2022; 14:e28912. [PMID: 36237821 PMCID: PMC9547047 DOI: 10.7759/cureus.28912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/23/2022] Open
Abstract
Syphilis is re-emerging in the United States. Treponema pallidum, the spirochete bacterium responsible for syphilis, has immunoevasive properties that facilitate pathogenesis and widespread tissue involvement. Host immune status, particularly the presence of HIV/AIDS, can influence the presentation and severity of the disease. Patients co-infected with HIV and syphilis may develop atypical lesions, including those involving the oropharynx. Any immunocompromised patient with tongue lesions and lymphadenopathy is presumed to have a wide differential diagnosis, and tissue sampling with histopathologic analysis is indicated. We present a patient with gumma of the tongue as the initial manifestation of tertiary syphilis.
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5
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Dimnik J, Benko M, Hosta V, Murnik Rauh A, Pagon A, Špik VC, Battelino S, Vozel D. Malignant Syphilis in a Female Patient: A Case Report and Mini-Review. Trop Med Infect Dis 2022; 7:tropicalmed7030047. [PMID: 35324594 PMCID: PMC8950934 DOI: 10.3390/tropicalmed7030047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022] Open
Abstract
Malignant syphilis (MS) is a rare form of secondary syphilis with grotesque skin lesions, systemic manifestation and life-threatening complications. This article presents a case of MS in an immunocompetent 41-year-old female, who initially manifested with a generalized nonpruritic erythematous rash and systemic symptoms. She was mistreated for generalized impetigo and hepatitis attributed to chronic alcoholism. After partial recovery and a 3-month latent period, she developed infiltrated plaques with crusts on the trunk, head and neck; pharyngitis and laryngeal lesions; generalized lymphadenopathy and nonspecific systemic symptoms. Serologic tests confirmed syphilis, and cerebrospinal fluid analyses indicated the presence of anti-treponemal antibodies. Urine drug screening was positive for cannabinoids. The polymerase chain reaction from skin biopsy samples identified T. pallidum, confirmed with Warthin-Starry staining. Immunohistochemical analysis was uncharacteristic. Tertiary syphilis, neurosyphilis, ocular syphilis and otosyphilis were excluded. However, the patient was treated for neurosyphilis with benzylpenicillin (18 million IU intravenously daily, 14 days) and corticosteroids. No Jarisch-Herxheimer reaction occurred. Ten months after treatment, residual scars were visible, and 1 year later, she attempted suicide. Since MS can resemble other diseases, it should be suspected in a mentally ill patient with chronic drug abuse, systemic nonspecific manifestations and dermatological abnormalities, including the head and neck region.
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Affiliation(s)
- Julija Dimnik
- Department of Dermatovenereology, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia; (J.D.); (M.B.); (V.H.); (A.M.R.); (A.P.)
| | - Maja Benko
- Department of Dermatovenereology, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia; (J.D.); (M.B.); (V.H.); (A.M.R.); (A.P.)
| | - Violeta Hosta
- Department of Dermatovenereology, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia; (J.D.); (M.B.); (V.H.); (A.M.R.); (A.P.)
| | - Andreja Murnik Rauh
- Department of Dermatovenereology, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia; (J.D.); (M.B.); (V.H.); (A.M.R.); (A.P.)
| | - Andreja Pagon
- Department of Dermatovenereology, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia; (J.D.); (M.B.); (V.H.); (A.M.R.); (A.P.)
| | - Vesna Cvitković Špik
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, SI-1000 Ljubljana, Slovenia;
| | - Saba Battelino
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Domen Vozel
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, SI-1000 Ljubljana, Slovenia
- Correspondence:
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6
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Li W, Han J, Zhao P, Wang D, Sun T, Guo J, He Y, Qu P, Liu Y, Shen C, Wang Y. Predicting asymptomatic neurosyphilis using peripheral blood indicators. BMC Infect Dis 2021; 21:1191. [PMID: 34836501 PMCID: PMC8626879 DOI: 10.1186/s12879-021-06846-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background The high misdiagnosis rate of asymptomatic neurosyphilis (ANS) has long challenged infectious disease clinicians. We aim to develop a model for diagnosing ANS in asymptomatic syphilis (AS) patients without CSF indicators. Results 277 AS patients with HIV-negative and underwent lumbar puncture were enrolled in this horizontal study.The area under the curve for predicting ANS by CSF leukocytes and protein was 0.643 and 0.675 [95% CI, 0.583–0.699VS.0.616–0.729]. Through LRM, the AUC increased to 0.806 [95% CI, 0.732–0.832], and the Youden's index was 0.430. If the score is ≤ 0.159, ANS can be excluded with a predictive value of 92.9%; we can identify ANS while the score is over 0.819, with a predictive value of 91.7% and a specificity of 99.25%. This study showed that the LRM can diagnose ANS in AS patients effectively. Conclusion Given a large number of misdiagnosis ANS patients and CSF results' insufficiency, the model is more practical. Our research will help clinicians track suspected syphilis, especially those who cannot accept the CSF test.
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Affiliation(s)
- Weijie Li
- Department of Clinical Laboratory, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Jiaqi Han
- ICU, The First Hospital of Tsinghua University, Beijing, China
| | - Pan Zhao
- Department of Infectious Diseases, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Dagang Wang
- Department of Clinical Laboratory, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Tianhao Sun
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jie Guo
- Department of Clinical Laboratory, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Yanqun He
- Department of Clinical Laboratory, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Pei Qu
- Department of Clinical Laboratory, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Ying Liu
- Department of Clinical Laboratory, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Congle Shen
- Department of Clinical Laboratory, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Yajie Wang
- Department of Clinical Laboratory, Beijing Ditan Hospital Capital Medical University, Beijing, China.
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7
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Cozzani E, Gasparini G, Ciccarese G, Drago F, Trave I, Vellone V, Biatta CM, Cabiddu F, Ribizzi G, Parodi A. Concurrent benign tertiary syphilis and asymptomatic neurosyphilis in an immunocompetent patient. J Eur Acad Dermatol Venereol 2020; 35:e151-e152. [PMID: 32810327 DOI: 10.1111/jdv.16882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/30/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- E Cozzani
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Dermatology Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - G Gasparini
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Dermatology Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.,Department of Experimental Sciences (DIMES), University of Genoa, Genoa, Italy
| | - G Ciccarese
- Dermatology Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - F Drago
- Dermatology Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - I Trave
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Dermatology Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - V Vellone
- Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - C M Biatta
- Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - F Cabiddu
- Pathology Unit, Policlinico San Martino IRCCS, Genoa, Italy
| | - G Ribizzi
- Division of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - A Parodi
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Dermatology Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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8
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Bittencourt MDJS, Brito ACD, Nascimento BAM, Carvalho AH, Drago MG. Nodular tertiary syphilis in an immunocompetent patient. An Bras Dermatol 2017; 91:528-30. [PMID: 27579755 PMCID: PMC4999118 DOI: 10.1590/abd1806-4841.20163837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/09/2015] [Indexed: 11/25/2022] Open
Abstract
Acquired syphilis can be divided into primary, secondary, latent, and tertiary
stages. About 25% of patients with untreated primary syphilis will develop late
signs that generally occur after three to five years, with involvement of
several organs. The authors present an immunocompetent female who developed a
tertiary stage syphilis presenting with long-standing nodular plaques.
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9
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Krasnoselskikh TV, Mikheev GN, Grigorian AE, Yastrebov VV, Sokolovskiy EV. A case of tertiary syphilis manifested with multiple skin gummas. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-2-84-93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The tertiary cutaneous syphilis has become extremely rare as a result of the effective treatment of early syphilis with penicillin and occasional antibiotic therapy for concomitant infections. We report a case of tertiary gummatous syphilis associated with asymptomatic neurosyphilis that was initially misdiagnosed as basal cell carcinoma of the skin. A 67-year-old woman presented with the 18-month history of multiple, firm, bluish-red asymptomatic nodes on the parietal scalp, chin and lateral part of the trunk that had developed without preceding trauma. One node on the trunk had small central ulceration covered with dry yellowish crust. On the left retroauricular area the brownish-purple atrophic scar was observed. Blood tests revealed reactive VDRL, ELISA and TPHA assays. Skin biopsy has showed endarteritis with endothelial swelling and caseating granulomas along with plasmocytic infiltrate in the dermis and subcutaneous tissue. Increased lymphocyte count and the positive VDRL test with cerebrospinal fluid have confirmed the diagnosis of asymptomatic syphilitic meningitis in this patient. The treatment with aqueous penicillin intravenously has lead to resolution of the skin infiltrates and progressive more than 4-fold reduction of follow-up serum VDRL titers. This case is reported as a reminder of the possibility of tertiary syphilis with misleading clinical patterns in patients infected during the epidemics of 1995-2000. We would like to emphasize the necessity to perform timely serological and pathomorphological study to prevent misdiagnosis and mistreatment.
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10
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Middelveen MJ, Bandoski C, Burke J, Sapi E, Filush KR, Wang Y, Franco A, Mayne PJ, Stricker RB. Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients. BMC DERMATOLOGY 2015; 15:1. [PMID: 25879673 PMCID: PMC4328066 DOI: 10.1186/s12895-015-0023-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/28/2015] [Indexed: 11/10/2022]
Abstract
Background Morgellons disease (MD) is a complex skin disorder characterized by ulcerating lesions that have protruding or embedded filaments. Many clinicians refer to this condition as delusional parasitosis or delusional infestation and consider the filaments to be introduced textile fibers. In contrast, recent studies indicate that MD is a true somatic illness associated with tickborne infection, that the filaments are keratin and collagen in composition and that they result from proliferation and activation of keratinocytes and fibroblasts in the skin. Previously, spirochetes have been detected in the dermatological specimens from four MD patients, thus providing evidence of an infectious process. Methods & Results Based on culture, histology, immunohistochemistry, electron microscopy and molecular testing, we present corroborating evidence of spirochetal infection in a larger group of 25 MD patients. Irrespective of Lyme serological reactivity, all patients in our study group demonstrated histological evidence of epithelial spirochetal infection. Strength of evidence based on other testing varied among patients. Spirochetes identified as Borrelia strains by polymerase chain reaction (PCR) and/or in-situ DNA hybridization were detected in 24/25 of our study patients. Skin cultures containing Borrelia spirochetes were obtained from four patients, thus demonstrating that the organisms present in dermatological specimens were viable. Spirochetes identified by PCR as Borrelia burgdorferi were cultured from blood in seven patients and from vaginal secretions in three patients, demonstrating systemic infection. Based on these observations, a clinical classification system for MD is proposed. Conclusions Our study using multiple detection methods confirms that MD is a true somatic illness associated with Borrelia spirochetes that cause Lyme disease. Further studies are needed to determine the optimal treatment for this spirochete-associated dermopathy.
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Affiliation(s)
| | - Cheryl Bandoski
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA.
| | | | - Eva Sapi
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA.
| | - Katherine R Filush
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA.
| | - Yean Wang
- Australian Biologics, Sydney, NSW, Australia.
| | | | - Peter J Mayne
- International Lyme and Associated Diseases Society, Bethesda, MD, USA.
| | - Raphael B Stricker
- International Lyme and Associated Diseases Society, Bethesda, MD, USA. .,, 450 Sutter Street, Suite 1504, San Francisco, CA, 94108, USA.
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11
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Xu XG, Li YH, Gao XH, Chen HD, Zhang YQ. A case of tertiary neurosyphilis presenting with moth-eaten bone lesions. Dermatol Ther 2014; 26:486-8. [PMID: 24552413 DOI: 10.1111/dth.12020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Syphilis, the "great imitator," with regard to skin diseases, is a chronic systemic infectious disease with a clinical course that waxes and wanes. The incidence of tertiary syphilis had decreased drastically these decades. We report a case of tertiary neurosyphilis presenting with moth-eaten bone lesions of the lower extremities. To the best of our knowledge, we have not seen such reports.
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Affiliation(s)
- Xue-Gang Xu
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, China; Department of Dermatology, No.1 Hospital of China Medical University, Shenyang, China
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12
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Bekkali N, Oumakhir S, Marcil T, Ghfir M, Sedrati O. An annular patch of the scalp reveals tertiary syphilis. Int J Dermatol 2013; 53:e185-7. [PMID: 23675919 DOI: 10.1111/ijd.12183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nihal Bekkali
- Department of Dermatology, Mohammed V Military Hospital of Instruction, Rabat, Morocco
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13
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Middelveen MJ, Burugu D, Poruri A, Burke J, Mayne PJ, Sapi E, Kahn DG, Stricker RB. Association of spirochetal infection with Morgellons disease. F1000Res 2013; 2:25. [PMID: 24715950 PMCID: PMC3954163 DOI: 10.12688/f1000research.2-25.v1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 12/04/2022] Open
Abstract
Morgellons disease (MD) is an emerging multisystem illness characterized by skin lesions with unusual filaments embedded in or projecting from epithelial tissue. Filament formation results from abnormal keratin and collagen expression by epithelial-based keratinocytes and fibroblasts. Recent research comparing MD to bovine digital dermatitis, an animal infectious disease with similar skin features, provided clues that spirochetal infection could play an important role in the human disease as it does in the animal illness. Based on histological staining, immunofluorescent staining, electron microscopic imaging and polymerase chain reaction, we report the detection of
Borrelia spirochetes in dermatological tissue of four randomly-selected MD patients. The association of MD with spirochetal infection provides evidence that this infection may be a significant factor in the illness and refutes claims that MD lesions are self-inflicted and that people suffering from this disorder are delusional. Molecular characterization of the
Borrelia spirochetes found in MD patients is warranted.
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Affiliation(s)
| | - Divya Burugu
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA
| | - Akhila Poruri
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA
| | | | - Peter J Mayne
- International Lyme and Associated Diseases Society, Bethesda, MD, 20827, USA
| | - Eva Sapi
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, 06516, USA
| | - Douglas G Kahn
- Department of Pathology, Olive View-UCLA Medical Center, Sylmar, CA, 91342, USA
| | - Raphael B Stricker
- International Lyme and Associated Diseases Society, Bethesda, MD, 20827, USA
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14
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The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. Am J Dermatopathol 2011; 33:433-60. [PMID: 21694502 DOI: 10.1097/dad.0b013e3181e8b587] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Syphilis has plagued mankind for centuries and is currently resurgent in the Western hemisphere. Although there has been a significant reduction of tertiary disease and recognition of facilitative interactions with human immunodeficiency virus infection, the natural history of syphilis has remained largely unchanged; thus, new strategies are required to more effectively combat this pathogen. The immunopathologic features of experimental syphilis in the rabbit; the course, stages, and pathology of human syphilis; and a comparison of human syphilis with leprosy suggest that the clinical course of syphilis and its tissue manifestations are determined by the balance between delayed-type hypersensitivity (DTH) and humoral immunity to the causative agent, Treponema pallidum. A strong DTH response is associated with clearance of the infecting organisms in a well-developed chancre, whereas a cytotoxic T-cell response or strong humoral antibody response is associated with prolonged infection and progression to tertiary disease. Many of the protean symptoms/appearances of secondary and tertiary human syphilis are manifestations of immune reactions that fail to clear the organism, due to a lack of recruitment and, more importantly, activation of macrophages by sensitized CD4 T cells. The Bacillus Calmette-Guerin vaccination can enhance DTH and has been shown to produce a low, but measurable, beneficial effect in the prevention of leprosy, a disease that shows a disease spectrum with characteristics in common with syphilis. In the prevention of syphilis, a potential vaccine protective against syphilis should be designed to augment the DTH response.
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15
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