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Gani AH, Saleh NA, Selvam SB, Azwa I. Prevalence, risk factors and treatment outcomes of syphilis among people living with human immunodeficiency virus at primary care clinics in Malaysia: A retrospective study. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2024; 19:13. [PMID: 38496768 PMCID: PMC10944645 DOI: 10.51866/oa.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Introduction Syphilis and human immunodeficiency virus (HIV) coinfection is a common clinical problem with a significant rising trend worldwide. In Malaysia, the burden of care is shared between hospitals and primary care clinics. This study aimed to determine the prevalence of syphilis among people living with HIV (PLHIV) at primary care clinics in Malaysia and assess its association with sociodemographic characteristics, risk factors and treatment outcomes. Methods This retrospective study included 750 PLHIV aged ≥18 years who attended primary care clinics in three different locations in Malaysia from 1 January 2017 to 31 December 2019. Data were obtained from the patients' clinical notes using a structured questionnaire evaluating the sociodemographic characteristics, history of sexual and lifestyle behaviours, diagnosis and management. Results The patients' age ranged from 18 to 78 years (mean=34.7, standard deviation=10.2). The prevalence of syphilis among the PLHIV at the three primary care clinics was 33.8% (n=254). Syphilis was significantly associated with gender (P=0.038) as well as sexual activity (P<0.001), substance use (P=0.038), history of chemsex (P=0.001) and history of sexually transmitted infections (STIs) (P<0.001) within the past 12 months. The majority of the PLHIV with syphilis received treatment at the primary care clinics (n=248, 97.3%), and up to 96.1% (n=245) had completed such treatment. Conclusion Syphilis is prevalent among PLHIV at primary care clinics, and most patients receive standard treatment. Therefore, primary care doctors must enhance their knowledge to effectively manage STIs, especially syphilis.
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Affiliation(s)
- Abdul Hafiz Gani
- MBBS, MFamMed, MRCGP, MSc, CMID, Klinik Kesihatan Mahmoodiah, Jalan Mahmoodiah, Johor Bahru, Johor, Malaysia.
| | - Narul Aida Saleh
- MBBS, MFamMed, Klinik Kesihatan Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Sheela Bai Selvam
- MBBS, MFamMed, Klinik Kesihatan Cheras, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- MBChB, FRCP, Dip GUM, Dip HIV, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Wu H, Xue M, Wu C, Lu Q, Ding Z, Wang X, Fu T, Yang K, Lin J. Scaling law characteristics and spatiotemporal multicomponent analysis of syphilis from 2016 to 2022 in Zhejiang Province, China. Front Public Health 2023; 11:1275551. [PMID: 37965512 PMCID: PMC10642232 DOI: 10.3389/fpubh.2023.1275551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023] Open
Abstract
Background Syphilis has caused epidemics for hundreds of years, and the global syphilis situation remains serious. The reported incidence rate of syphilis in Zhejiang Province has ranked first in the province in terms of notifiable infectious diseases for many years and is the highest in China. This study attempts to use the scaling law theory to study the relationship between population size and different types of syphilis epidemics, while also exploring the main driving factors affecting the incidence of syphilis in different regions. Methods Data on syphilis cases and affected populations at the county level were obtained from the China Disease Control and Prevention Information System. The scaling relationship between different stages of syphilis and population size was explained by scaling law. The trend of the incidence from 2016 to 2022 was tested by the joinpoint regression. The index of distance between indices of simulation and observation (DISO) was applied to evaluate the overall performance of joinpoint regression model. Furthermore, a multivariate time series model was employed to identify the main driving components that affected the occurrence of syphilis at the county level. The p value less than 0.05 or confidence interval (CI) does not include 0 represented statistical significance for all the tests. Results From 2016 to 2022, a total of 204,719 cases of syphilis were reported in Zhejiang Province, including 2 deaths, all of which were congenital syphilis. Latent syphilis accounted for 79.47% of total syphilis cases. The annual percent change (APCs) of all types of syphilis, including primary syphilis, secondary syphilis, tertiary syphilis, congenital syphilis and latent syphilis, were - 21.70% (p < 0.001, 95% CI: -26.70 to -16.30), -16.80% (p < 0.001, 95% CI: -20.30 to -13.30), -8.70% (p < 0.001, 95% CI: -11.30 to -6.00), -39.00% (p = 0.001, 95% CI: -49.30 to -26.60) and - 7.10% (p = 0.008, 95% CI: -11.20 to -2.80), respectively. The combined scaling exponents of primary syphilis, secondary syphilis, tertiary syphilis, congenital syphilis and latent syphilis based on the random effects model were 0.95 (95% CI: 0.88 to 1.01), 1.14 (95% CI: 1.12 to 1.16), 0.43 (95% CI: 0.37 to 0.49), 0.0264 (95% CI: -0.0047 to 0.0575) and 0.88 (95% CI: 0.82 to 0.93), respectively. The overall average effect values of the endemic component, spatiotemporal component and autoregressive component for all counties were 0.24, 0.035 and 0.72, respectively. The values of the autoregressive component for most counties were greater than 0.7. The endemic component of the top 10 counties with the highest values was greater than 0.34. Two counties with value of the spatiotemporal component higher than 0.1 were Xihu landscape county and Shengsi county. From 2016 to 2022, the endemic and autoregressive components of each county showed obvious seasonal changes. Conclusion The scaling exponent had both temporal trend characteristics and significant heterogeneity in the association between each type of syphilis and population size. Primary syphilis and latent syphilis exhibited a linear pattern, secondary syphilis presented a superlinear pattern, and tertiary syphilis exhibited a sublinear pattern. This suggested that further prevention of infection and transmission among high-risk populations and improvement of diagnostic accuracy in underdeveloped areas is needed. The autoregressive components and the endemic components were the main driving factors that affected the occurrence of syphilis. Targeted prevention and control strategies must be developed based on the main driving modes of the epidemic in each county.
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Affiliation(s)
- Haocheng Wu
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
- Key Laboratory for Vaccines and Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
| | - Ming Xue
- Hangzhou Centre for Disease Control and Prevention, Hangzhou, China
| | - Chen Wu
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
| | - Qinbao Lu
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
| | - Zheyuan Ding
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
| | - Xinyi Wang
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
| | - Tianyin Fu
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
| | - Ke Yang
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
| | - Junfen Lin
- Zhejiang Province Center for Disease Control and Prevention, Hangzhou, China
- Key Laboratory for Vaccines and Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
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Cabido LF, Romañach MJ. Bacterial Lesions of the Oral Mucosa. Oral Maxillofac Surg Clin North Am 2023; 35:159-173. [PMID: 37019503 DOI: 10.1016/j.coms.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Nonodontogenic bacterial infections of the oral cavity are not a common finding in the United States. Nevertheless, there has been an increase in prevalence of certain bacterial sexually transmitted diseases, such as syphilis and gonorrhea, and conditions such as tuberculosis still pose a serious threat to certain segments of the population. Finally, given the uncommon nature and pathophysiology of these diseases, diagnosis is often delayed, resulting in more clinically significant disease and potential contamination of individuals. Thus, it is prudent that clinicians be familiar with these uncommon but potentially serious infectious diseases, so treatment can be instituted promptly.
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Affiliation(s)
- Leticia Ferreira Cabido
- Department of Diagnosis and Oral Health, University of Louisville School of Dentistry 501 South Preston St. Louisville, KY 40202, USA.
| | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro (UFRJ), Brazil
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Corrêa DG, de Souza SR, Freddi TDAL, Fonseca APA, Dos Santos RQ, Hygino da Cruz LC. Imaging features of neurosyphilis. J Neuroradiol 2023; 50:241-252. [PMID: 36641134 DOI: 10.1016/j.neurad.2023.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/09/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Abstract
Syphilis is an infectious disease caused by the spirochete Treponema pallidum, subspecies pallidum. Although its incidence has declined after the widespread availability of penicillin, it has recently re-emerged, especially in men who have sex with men and in people living with human immunodeficiency virus (HIV). The neurological manifestations of syphilis, generally known as neurosyphilis, may appear at any time during the infection, including the initial years after the primary infection. Neurosyphilis can be asymptomatic, only with cerebrospinal fluid abnormalities, or symptomatic, characterized by several different clinical syndromes, such as meningitis, gumma, meningovascular, brain parenchyma involvement, meningomyelitis, tabes dorsalis, and peripheral nervous system involvement. However, these syndromes may simulate several other diseases, making the diagnosis often a challenge. In addition, syphilis can also be vertically transmitted from mother to child during pregnancy, leading to neurological manifestations. Neuroimaging is essential to demonstrate abnormal brain or spinal cord findings in patients with neurosyphilis, aiding in the diagnosis, treatment, and follow-up of these patients. This article aims to review the imaging features of neurosyphilis, including the early and late stages of the infection.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ 2640-102, Brazil; Department of Radiology, Federal Fluminense University, Rua Marquês de Paraná, 303, Centro, Niterói, RJ 24070-035, Brazil.
| | - Simone Rachid de Souza
- Department of Pathology, Federal University of Rio de Janeiro, Cidade Universitária da Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, Rio de Janeiro, RJ 21941-617, Brazil
| | | | - Ana Paula Alves Fonseca
- Department of Radiology, UnitedHealth Group, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | - Roberto Queiroz Dos Santos
- Department of Radiology, Hospital dos Servidores do Estado, Rua Sacadura Cabral, 178, Saúde, Rio de Janeiro, RJ 20221-903, Brazil; Department of Radiology, Hospital das Américas, United Health Group, Avenida Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, RJ 22775-001, Brazil
| | - Luiz Celso Hygino da Cruz
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ 2640-102, Brazil
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Ruiz de Villa A, Haider AA, Frimer L, Lleshi A, Bazikian Y. A Rare Presentation of Undiagnosed Systemic Syphilis: A Case Report and Review of Literature. Cureus 2022; 14:e27911. [PMID: 36110468 PMCID: PMC9464350 DOI: 10.7759/cureus.27911] [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: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Within the specialties of infectious diseases and dermatology, few rashes involve the palms and soles. The syphilitic rash has a pathognomonic association with these body surfaces and signals physicians to investigate this disease. However, the distinct presentations and symptoms associated with syphilis and the various stages of the disease make it diagnostically challenging. We herein report a rather intricate and unusual case of a patient who presented with a new-onset headache and blurred vision and a two-month history of diffuse pruritic maculopapular rash sparing the palms and soles. Several physicians had not established a diagnosis in the outpatient setting. Inpatient workup eventually revealed that the patient was suffering from secondary syphilis with neurological and ocular involvement. Management included a prolonged course of intravenous penicillin G leading to a complete recovery. We share images of the skin findings and the details of the intricate workup and hospital course, as well as a review of the literature.
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van Ruitenbeek N, van Kasteren M, Bouma-de Krijger A. Neurosyphilis mimicking giant cell arteritis both clinically and microscopically. BMJ Case Rep 2022; 15:e247642. [PMID: 35641087 PMCID: PMC9157360 DOI: 10.1136/bcr-2021-247642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/03/2022] Open
Abstract
Temporal arteritis is usually caused by giant cell arteritis (GCA). However, inflammation of the temporal artery can also occur secondary to autoimmune diseases or infections.We present a remarkable case of a man in his 70s with biopsy proven temporal arteritis, who was later diagnosed with meningovascular neurosyphilis. The presentation of an acute onset monocular vision loss with inflammation of the temporal artery on biopsy appeared a GCA, misleading the physicians, as it turned out to be a manifestation of neurosyphilis.
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Affiliation(s)
| | - Marjo van Kasteren
- Internal Medicine, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
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Michaels A, Hughes R, Capone A, Smith KL. Diffuse lymphadenopathy and fever without a rash: an atypical presentation of secondary syphilis. BMJ Case Rep 2022; 15:e248968. [PMID: 35584858 PMCID: PMC9119134 DOI: 10.1136/bcr-2022-248968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/04/2022] Open
Abstract
A woman in her 30s presented to the emergency department with 4 days of fever, headache and back pain. The patient was admitted for pain control, inability to tolerate oral intake and intravenous antibiotics for presumed diagnosis of pyelonephritis. Following admission, CT of the abdomen/pelvis showed multiple prominent pelvic and inguinal lymph nodes, and the patient was noted to have anterior and posterior cervical and submandibular lymphadenopathy on examination. The differential diagnosis was broadened to infectious, haematological, malignant and autoimmune aetiologies of diffuse lymphadenopathy. Workup included serum studies, imaging, lumbar puncture and lymph node biopsy. Rapid plasma reagin (RPR) returned positive with titre 1:16 and confirmatory reactive Treponema pallidum particle agglutination. With an otherwise unrevealing workup, the diagnosis of secondary syphilis was confirmed. This case highlights the differential and diagnostic approach for diffuse lymphadenopathy and an unusual presentation of secondary syphilis. Additionally, it indicates that secondary syphilis can be present even with a relatively low RPR titre.
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Affiliation(s)
- Arianna Michaels
- Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Rachel Hughes
- Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Alia Capone
- Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Kelly Lacy Smith
- Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Aung ET, Chow EP, Fairley CK, Phillips TR, Chen MY, Tran J, Maddaford K, Rodriguez ER, Ong JJ. Preferences of men who have sex with men for performing anal self-examination for the detection of anal syphilis in Australia: A discrete choice experiment. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 21:100401. [PMID: 35243457 PMCID: PMC8873922 DOI: 10.1016/j.lanwpc.2022.100401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Regular anal self-examination could potentially reduce syphilis transmission by detecting anal syphilis earlier among men who have sex with men (MSM). This study aimed to examine the preferences of MSM on performing anal self-examination to detect anal syphilis. METHODS An online survey with a discrete choice experiment (DCE) was distributed to MSM attending a sexual health clinic and through social media in Australia between June and November 2020. The DCE examined the preferred attributes of anal self-examination that would encourage MSM to perform anal self-examination. Data were analysed using a random parameters logit (RPL) model. FINDINGS The median age of 557 MSM who completed the survey was 35 (inter quartile range, 27-45). The choice to perform anal self-examination was most influenced by two attributes: the accuracy of anal self-examination to diagnose anal syphilis, and the frequency of anal self-examination, followed by the type of instruction materials to perform anal self-examination, waiting time for medical review, and type of support received if abnormalities were found. Using the most preferred attributes, 98% of people would conduct anal self-examination compared with 35% when the least preferred anal self-examination attributes were offered. INTERPRETATION If anal self-examination were recommended for anal syphilis screening, it will be important to consider preferences of MSM: men were more likely to undertake anal self-examination if the frequency was once a month and there was higher accuracy of detecting anal syphilis. FUNDING Australian National Health And Medical Research Council.
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Affiliation(s)
- Ei T. Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric P.F. Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Tiffany R. Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y. Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Julien Tran
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Elena R. Rodriguez
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Jason J. Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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9
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Begaj T, Sobrin L. Ophthalmic Consequences of Syphilis. Int Ophthalmol Clin 2022; 62:251-268. [PMID: 35325922 DOI: 10.1097/iio.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Forouzan P, Fell D, Jones FR. Ocular Syphilis as a Cause of Chronic Postoperative Uveitis Followed by a Localized Ocular Jarisch-Herxheimer-like Reaction. Ocul Immunol Inflamm 2022; 31:649-652. [PMID: 35226593 DOI: 10.1080/09273948.2022.2042321] [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: 10/19/2022]
Abstract
OBJECTIVE The case draws attention to syphilis as a cause of chronic postoperative uveitis following cataract surgery and is the first to document transient worsening of ocular inflammation without systemic symptoms after initiation of treatment, suggesting a localized Jarisch-Herxheimer-like reaction. DESIGN Case report. RESULTS The average thickness of the retinal nerve fiber layer was used as an objective measure of intraocular inflammation. The patient's nerve edema worsened during a standard neurosyphilis treatment course and returned to normal several weeks after completion of therapy. CONCLUSION Syphilis serologic testing should be strongly considered in the work-up for chronic postoperative uveitis. A localized ocular Jarisch-Herxheimer-like reaction may occur and should not detract from completion of neurosyphilis treatment.
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Affiliation(s)
- Parsha Forouzan
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David Fell
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Freddie R Jones
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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11
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Ha-Bu-Lie-Ti XEBT, Wang LL, Zhu YL. An unusual case of tertiary syphilis. Clin Exp Dermatol 2021; 47:785-787. [PMID: 34905227 DOI: 10.1111/ced.15066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/28/2022]
Abstract
We report a rare case of tertiary syphilis in a middle aged man who presented with a 6-month history of ulceration of his left eye with extreme pain. Physical examination revealed fistulas, granuloma with ulcer, and corneal opacity with granulomatous conjunctivitis in the left eye. Based on the patient's clinical manifestations and auxiliary examination results, neurosyphilis was diagnosed.
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Affiliation(s)
| | - Ling-Ling Wang
- The First Affiliated Hospital of XinJiang Medical University, Urumqi City, China
| | - Ya-Lin Zhu
- The First Affiliated Hospital of XinJiang Medical University, Urumqi City, China
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12
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Jedwab R, Khan AM, Russ J, Zaveri ED. Epidemics, pandemics, and social conflict: Lessons from the past and possible scenarios for COVID-19. WORLD DEVELOPMENT 2021; 147:105629. [PMID: 34866756 PMCID: PMC8633882 DOI: 10.1016/j.worlddev.2021.105629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 06/02/2023]
Abstract
Since COVID-19 broke out, there has been renewed interest in understanding the economic and social dynamics of historical and more recent epidemics and pandemics, from the plagues of Antiquity to modern-day outbreaks like Ebola. These events can have significant impacts on the interplay between poverty and social cohesion, i.e. how different groups in society interact and cooperate to survive and prosper. To that effect, this paper provides a theory-driven overview of how social responses to past epidemics and pandemics were determined by the epidemiological and non-epidemiological characteristics of these outbreaks, with a particular focus on the conditions giving rise to scapegoating and persecution of minority groups, including migrants. We discuss existing theories as well as historical and quantitative studies, and highlight the cases where epidemics and pandemics may lead to milder or more severe forms of scapegoating. Finally, we conclude with a summary of priorities for future research on epidemics, pandemics and social conflict and discuss the possible effects and policy implications of COVID-19.
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Affiliation(s)
- Remi Jedwab
- George Washington University, Elliott School of International Affairs, 603 North Henry St, Alexandria, VA 22314, USA
| | - Amjad M Khan
- George Washington University, Elliott School of International Affairs, 603 North Henry St, Alexandria, VA 22314, USA
| | - Jason Russ
- George Washington University, Elliott School of International Affairs, 603 North Henry St, Alexandria, VA 22314, USA
| | - Esha D Zaveri
- George Washington University, Elliott School of International Affairs, 603 North Henry St, Alexandria, VA 22314, USA
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Duncan A, Zingas N, Ahmed A, Shih R. The Great Imitator: Latent Neurosyphilis Revealed After Initiation of the Immunosuppressive Drug Secukinumab. Cureus 2021; 13:e18462. [PMID: 34650839 PMCID: PMC8489801 DOI: 10.7759/cureus.18462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 11/05/2022] Open
Abstract
Syphilis is a multi-organ system bacterial infection caused by the bacterium Treponema pallidum. Syphilis can advance through four clinical stages: primary, secondary, latent, and tertiary. Once in the tertiary stage, mortality is seen in up to 58% of individuals. Here, we present a case of latent neurosyphilis manifesting after initiation of the immunosuppressive medication secukinumab, a monoclonal antibody that antagonizes interleukin-17A. A 66-year-old male with type II diabetes mellitus, hyperlipidemia, and rheumatoid arthritis presented to the emergency department for a right lower quadrant abdominal cellulitis at the site of his insulin pump. On examination, a non-blanching papular rash on the palms and soles with several scaling papules was discovered. No visible pustules, oral lesions, or perirectal lesions were seen. Neurological examination was noncontributory. His past medical history revealed initiation of secukinumab for the management of rheumatoid arthritis two months prior to presentation. The rash developed six weeks after starting secukinumab. Basic laboratory tests, including a complete blood count, thyroid panel, renal function panel, fasting blood glucose, electrolytes, and C-reactive protein, were within normal limits. A hepatic panel revealed mildly elevated alkaline phosphatase, alanine transaminase, and erythrocyte sedimentation rate Westergren level. Laboratory tests for hepatitis B, hepatitis C, HIV-1, Chlamydia trachomatis, and Neisseria gonorrhoeae all returned negative. A rapid plasma reagin (RPR) titer returned positive at 1:128, and a serum Treponema pallidum Ab returned reactive. Lumbar puncture serologies demonstrated a positive Venereal Disease Research Laboratory (VDRL) test. The patient was diagnosed with latent neurosyphilis and started on intravenous crystalline penicillin G for three weeks. A thorough history, comprehensive physical examination, and basic workup should be performed in any individual prior to immunosuppressive medication initiation. On initial presentation, our patient had an isolated rash on the palms and soles, which is classical for secondary syphilis. The specific manifestations seen in syphilis depend upon the timing, site, and immune status of the individual. Due to its ability to have a variety of presentations, syphilis should always remain on the differential for any physician caring for immunocompromised individuals. Again, initiation of immunosuppressive medications, such as the monoclonal antibody secukinumab, can result in the reactivation of previously dormant infections. As physicians, we must carefully screen our patients prior to initiating immunosuppressive agents to prevent disease reactivation.
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Affiliation(s)
- Allison Duncan
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Nicholas Zingas
- Internal Medicine Residency Program, Wright State University, Dayton, USA
| | - Anas Ahmed
- Internal Medicine Residency Program, Wright State University, Dayton, USA
| | - Roger Shih
- Department of Internal Medicine/Infectious Disease, Wright-Patterson Medical Center, Wright-Patterson AFB, USA
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Krothapalli N, Desai N, Tunguturi A, Hou Y, Patel SD. Neurosyphilis presenting with a large vessel occlusion: A case report. Brain Circ 2021; 7:285-288. [PMID: 35071847 PMCID: PMC8757502 DOI: 10.4103/bc.bc_39_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/21/2021] [Accepted: 07/15/2021] [Indexed: 12/03/2022] Open
Abstract
We describe a case of a 36-year-old man who presented with stroke in the right paramedian pons in the pontine perforator territory, manifesting as intermittent headache, slurred speech, left-sided weakness, and paresthesia. This case highlights the diagnostic challenge in identifying neurosyphilis as a cause of stroke in young individuals. Clinicians should maintain vigilance for this uncommon etiology through conducting a detailed history and investigation in susceptible patients with key risk factors. Once the diagnosis was confirmed in our case, a multidisciplinary approach was used for management with neurologists, infectious disease specialists, and the neurointerventional team. Our patient ultimately underwent successful therapy with mechanical thrombectomy for basilar artery thrombosis from meningovascular syphilis.
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Affiliation(s)
| | - Ninad Desai
- Department of Neurology, St. Vincent's Medical Center, Hartford Healthcare, Hartford, Connecticut, USA
| | - Ajay Tunguturi
- Department of Neurology, Hartford Hospital, Hartford, Connecticut, USA
| | - Yan Hou
- Department of Neurology, Hartford Hospital, Hartford, Connecticut, USA
| | - Smit D Patel
- Department of Neurology, UCONN School of Medicine, Connecticut, USA
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15
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The effect of public health awareness and behaviors on the transmission dynamics of syphilis in Northwest China, 2006-2018, based on a multiple-stages mathematical model. Infect Dis Model 2021; 6:1092-1109. [PMID: 34585031 PMCID: PMC8455652 DOI: 10.1016/j.idm.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022] Open
Abstract
Syphilis, a sexually transmitted infectious disease caused by the bacterium treponema pallidum, has re-emerged as a global public health issue with an estimated 12 million people infected each year. Understanding the impacts of health awareness and behaviors on transmission dynamics of syphilis can help to establish optimal control strategy in different regions. In this paper, we develop a multiple-stage SIRS epidemic model taking into account the public health awareness and behaviors of syphilis. First, the basic reproduction number R0 is obtained, which determines the global dynamics behaviors of the model. We derive the necessary conditions for implementing optimal control and the corresponding optimal solution for mitigation syphilis by using Pontryagin's Maximum Principle. Based on the data of syphilis in Ningxia from 2006 to 2018, the parameterizations and model calibration are carried out. The fitting results are in good agreement with the data. Moreover, sensitivity analysis shows that the public awareness induced protective behaviors Ce, compliance of condom-induced preventability ε and treatment for the primary syphilis m1 play an important role in mitigating the risk of syphilis outbreaks. These results can help us gain insights into the epidemiology of syphilis and provide guidance for the public health authorities to implement health education programs.
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16
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Dong H, Liu Z, Duan Y, Li D, Qiu Z, Liu Y, Huang J, Wang C. Syphilitic meningomyelitis misdiagnosed as spinal cord tumor: Case and review. J Spinal Cord Med 2021; 44:789-793. [PMID: 31603731 PMCID: PMC8477965 DOI: 10.1080/10790268.2019.1658283] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Context: Syphilitic meningomyelitis is a rare manifestation of neurosyphilis, not well described in the literature.Methods: We reported a rare case of a 29-year-old female with syphilitic meningomyelitis. Her clinical manifestations and imaging findings were discussed with the related literatures reviewed.Results: The patient presented with progressive bilateral lower extremities numbness and weakness for months. Laboratory tests revealed positive serum Treponema pallidum Hemagglutinin Test (TPHA) and rapid plasma reagin test (RPR). The cerebral spinal fluid (CSF) was positive with TPHA but negative for RPR with lymphocytic pleocytosis and elevated protein. Spinal MRI showed swelling and high-signal intensity of thoracic spinal cord except T6-7 level with associated gadolinium enhancement ("flip-flop sign") and peripheral strip-like enhancement on T1WI ("candle guttering appearance"). She was initially diagnosed as spinal cord tumor due to the chronic clinical onset and cord swelling with central enhancement found on thoracic MRI. After dramatic clinical and radiographic improvement with dexamethosone and serological tests of syphilis, she was diagnosed as probable syphilitic meningomyelitis. Till now, there are 12 cases of syphilitic myelitis reported with spinal cord MR images. Thoracic cord is the predominant involved segment (10/12), "candle guttering appearance" is the most common enhancing characteristics of the lesion (7/12), "flip-flop sign" may be seen in the stage with significant inflammation (3/12).Conclusion: Syphilitic meningomyelitis can occur at early or late stage of syphilis, the onset may be acute, subacute or chronic. The imaging findings suggested focal inflammation of the spinal cord. Prognosis is relatively good after proper treatment.
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Affiliation(s)
- Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zheng Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence to: Zheng Liu, Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing100053, People’s Republic of China; Ph: 008613910320552; 0086-10-83198899 ext 8701.
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Dawei Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhandong Qiu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jing Huang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chaodong Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
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17
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Majander K, Pfrengle S, Kocher A, Neukamm J, du Plessis L, Pla-Díaz M, Arora N, Akgül G, Salo K, Schats R, Inskip S, Oinonen M, Valk H, Malve M, Kriiska A, Onkamo P, González-Candelas F, Kühnert D, Krause J, Schuenemann VJ. Ancient Bacterial Genomes Reveal a High Diversity of Treponema pallidum Strains in Early Modern Europe. Curr Biol 2020; 30:3788-3803.e10. [PMID: 32795443 DOI: 10.1016/j.cub.2020.07.058] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/24/2020] [Accepted: 07/16/2020] [Indexed: 12/30/2022]
Abstract
Syphilis is a globally re-emerging disease, which has marked European history with a devastating epidemic at the end of the 15th century. Together with non-venereal treponemal diseases, like bejel and yaws, which are found today in subtropical and tropical regions, it currently poses a substantial health threat worldwide. The origins and spread of treponemal diseases remain unresolved, including syphilis' potential introduction into Europe from the Americas. Here, we present the first genetic data from archaeological human remains reflecting a high diversity of Treponema pallidum in early modern Europe. Our study demonstrates that a variety of strains related to both venereal syphilis and yaws-causing T. pallidum subspecies were already present in Northern Europe in the early modern period. We also discovered a previously unknown T. pallidum lineage recovered as a sister group to yaws- and bejel-causing lineages. These findings imply a more complex pattern of geographical distribution and etiology of early treponemal epidemics than previously understood.
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Affiliation(s)
- Kerttu Majander
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Institute for Archaeological Sciences, University of Tübingen, Rümelinstrasse 19-23, 72070 Tübingen, Germany; Department of Archaeogenetics, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, 07745 Jena, Germany; Department of Biosciences, University of Helsinki, Viikinkaari 9, 00014 Helsinki, Finland.
| | - Saskia Pfrengle
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Institute for Archaeological Sciences, University of Tübingen, Rümelinstrasse 19-23, 72070 Tübingen, Germany
| | - Arthur Kocher
- Transmission, Infection, Diversification and Evolution Group, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, 07745 Jena, Germany
| | - Judith Neukamm
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Institute for Archaeological Sciences, University of Tübingen, Rümelinstrasse 19-23, 72070 Tübingen, Germany; Institute for Bioinformatics and Medical Informatics, University of Tübingen, Sand 14, 72076 Tübingen, Germany
| | | | - Marta Pla-Díaz
- Joint Research Unit "Infection and Public Health" FISABIO-University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Natasha Arora
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland
| | - Gülfirde Akgül
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Kati Salo
- Department of Biosciences, University of Helsinki, Viikinkaari 9, 00014 Helsinki, Finland; Archaeology, Faculty of Arts, University of Helsinki, Unioninkatu 38F, 00014 Helsinki, Finland
| | - Rachel Schats
- Laboratory for Human Osteoarchaeology, Faculty of Archaeology, Leiden University, Einsteinweg 2, 2333CC Leiden, the Netherlands
| | - Sarah Inskip
- McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge CB2 3ER, UK
| | - Markku Oinonen
- Laboratory of Chronology, Finnish Museum of Natural History, University of Helsinki, Gustaf Hällströmin katu 2, 00560 Helsinki, Finland
| | - Heiki Valk
- Institute of History and Archaeology, University of Tartu, Jakobi 2, 51005 Tartu, Tartumaa, Estonia
| | - Martin Malve
- Institute of History and Archaeology, University of Tartu, Jakobi 2, 51005 Tartu, Tartumaa, Estonia
| | - Aivar Kriiska
- Institute of History and Archaeology, University of Tartu, Jakobi 2, 51005 Tartu, Tartumaa, Estonia
| | - Päivi Onkamo
- Department of Biosciences, University of Helsinki, Viikinkaari 9, 00014 Helsinki, Finland; Department of Biology, University of Turku, Vesilinnantie 5, 20500 Turku, Finland
| | - Fernando González-Candelas
- Joint Research Unit "Infection and Public Health" FISABIO-University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Denise Kühnert
- Transmission, Infection, Diversification and Evolution Group, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, 07745 Jena, Germany
| | - Johannes Krause
- Institute for Archaeological Sciences, University of Tübingen, Rümelinstrasse 19-23, 72070 Tübingen, Germany; Department of Archaeogenetics, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, 07745 Jena, Germany; Senckenberg Centre for Human Evolution and Palaeoenvironment (S-HEP), University of Tübingen, Tübingen, Germany.
| | - Verena J Schuenemann
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Institute for Archaeological Sciences, University of Tübingen, Rümelinstrasse 19-23, 72070 Tübingen, Germany; Senckenberg Centre for Human Evolution and Palaeoenvironment (S-HEP), University of Tübingen, Tübingen, Germany.
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18
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Masouris I, Klein M, Ködel U. The potential for CXCL13 in CSF as a differential diagnostic tool in central nervous system infection. Expert Rev Anti Infect Ther 2020; 18:875-885. [PMID: 32479125 DOI: 10.1080/14787210.2020.1770596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Central nervous system (CNS) infections can be life-threatening and are often associated with disabling sequelae. One important factor in most CNS infections is a timely pathogen-specific treatment. The diagnostic methods available, however, do not always reach a satisfying sensitivity and specificity. In these cases, there is need for additional diagnostic biomarkers. Chemokines represent potential candidates as biomarkers, since they are an important pillar of the host immune response. The aim of this review is to discuss the diagnostic potential of cerebrospinal fluid (CSF) CXCL13 in patients with CNS infections. Areas covered: Data were obtained from a literature search in PubMed up to October 2019. This review focusses on articles on the potential of CXCL13 as a diagnostic tool. The majority of identified studies aimed to characterize its role in two diseases, namely Lyme neuroborreliosis and neurosyphilis. Expert opinion: CSF CXCL13 has a significant potential as a diagnostic and monitoring add-on marker in Lyme neuroborreliosis. Differences in study design, control groups and clinical parameters between studies, however, affect sensitivity, specificity and cutoff values, underlining the need of further studies to address these issues and pave the way for a generalized clinical practice.
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Affiliation(s)
- Ilias Masouris
- Department of Neurology, University Hospital, Ludwig Maximilian University , Munich, Germany
| | - Matthias Klein
- Department of Neurology, University Hospital, Ludwig Maximilian University , Munich, Germany
| | - Uwe Ködel
- Department of Neurology, University Hospital, Ludwig Maximilian University , Munich, Germany
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19
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Daey Ouwens IM, Fiolet ATL, Thijs RD, Koehler PJ, Verhoeven WMA. Neurosyphilis Mimicking Autoimmune Encephalitis: A Case Report and Review of the Literature. CLINICAL NEUROPSYCHIATRY 2020; 17:175-180. [PMID: 34908989 PMCID: PMC8650208 DOI: 10.36131/cnfioritieditore20200305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Neurosyphilis may imitate a wide range of neurological and psychiatric diseases, including autoimmune encephalitis. To avoid further cognitive decline and morbidity, early recognition and adequate treatment are of particular importance in both neurosyphilis and autoimmune encephalitis. In case of a strong clinical suspicion of a diagnosis of autoimmune encephalitis, guidelines recommend initiating immunotherapy even in the absence of immunological confirmation. Here, a case of neurosyphilis is reported in which the potential overlap in clinical presentation of autoimmune encephalitis and parenchymatous neurosyphilis is discussed. The here reported data suggest that, in cases presenting with new onset focal epilepsy, slowing of electroencephalographic activity over the temporal regions and magnetic resonance imaging suggestive of swelling of the amygdala, neurosyphilis should be excluded prior to initiation of immunotherapy for suspected autoimmune encephalitis.
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Affiliation(s)
- Ingrid M Daey Ouwens
- Stichting Epilepsie Instellingen Nederland, PO Box 540, 2130 AM Hoofddorp, The Netherlands.
| | - Aernoud T L Fiolet
- Stichting Epilepsie Instellingen Nederland, PO Box 540, 2130 AM Hoofddorp, The Netherlands.
| | - Roland D Thijs
- Stichting Epilepsie Instellingen Nederland, PO Box 540, 2130 AM Hoofddorp, The Netherlands.
- Stichting Epilepsie Instellingen Nederland, PO Box 540, 2130 AM Hoofddorp, The Netherlands.
| | - Peter J Koehler
- Department of Neurology, Zuyderland Ziekenhuis, Sittard-Geleen, The Netherlands.
| | - Willem M A Verhoeven
- Erasmus Medical Centre, Department of psychiatry, Rotterdam, The Netherlands
- Stichting Epilepsie Instellingen Nederland, PO Box 540, 2130 AM Hoofddorp, The Netherlands.
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20
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Rizza S, Mistrangelo M, Ribaldone DG, Morino M, Astegiano M, Saracco GM, Pellicano R. Proctitis: a glance beyond inflammatory bowel diseases. MINERVA GASTROENTERO 2020; 66:252-266. [PMID: 32218425 DOI: 10.23736/s1121-421x.20.02670-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Proctitis is an inflammation involving the anus and the distal part of the rectum, frequently diagnosed in the context of inflammatory bowel diseases (IBD). Nevertheless, when the standard therapy for IBD is ineffective, it becomes necessary for the clinician to review alternative etiologies, beginning from the broad chapter of infectious causes up to rare causes such as radiation, ischemia, diversion and traumatisms. While it is possible to find infectious proctitides caused by pathogens generally inducing extensive colitis, the growing incidence of both sexually transmitted infections and isolated proctitis reported in the recent years require a lot of attention. The risk appears to be higher in individuals participating in anal intercourse, especially men having sex with men (MSM) or subjects who use sex toys and participate to sex parties, dark rooms and so on. The commonest implicated pathogens are Neysseria gonorrhoeae, Chlamydia trachomatis, Herpes Simplex virus and Treponema pallidum. Herpes and Chlamydia infections mainly occur in HIV-positive MSM patients. Since symptoms and signs are common independently from etiology, performing a differential diagnosis based on clinical manifestations is complicated. Therefore, the diagnosis is supported by the combination of clinical history and physical examination and, secondly, by endoscopic, serologic and microbiologic findings. Particular emphasis should be given to simultaneous infections by multiple organisms. The involvement of experts in infectious diseases and in sexual health is crucial for the diagnostic and therapeutic management. The available therapies, empirically initiated or specific, in many cases are able to guarantee a good prognosis and to prevent relapses.
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Affiliation(s)
- Stefano Rizza
- Unit of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Davide G Ribaldone
- Unit of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Marco Astegiano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giorgio M Saracco
- Unit of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy.,Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
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21
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Lu Y, Ke W, Yang L, Wang Z, Lv P, Gu J, Hao C, Li J, Cai Y, Gu M, Liu H, Chen W, Zhang X, Wang L, Liu Y, Yang B, Zou H, Zheng H. Clinical prediction and diagnosis of neurosyphilis in HIV-negative patients: a case-control study. BMC Infect Dis 2019; 19:1017. [PMID: 31791265 PMCID: PMC6886180 DOI: 10.1186/s12879-019-4582-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early diagnosis and treatment of neurosyphilis is of great significance for regression. There is no gold standard for the diagnosis of neurosyphilis. We did this study to explore the factors associated with the clinical diagnosis of neurosyphilis and assess their accuracy for the diagnosis of neurosyphilis. METHODS We retrospectively reviewed 100 cases of syphilis patients who underwent lumbar puncture at a major dermatology hospital in Guangzhou, China between April 2013 and November 2016. Fifty patients who were clinically diagnosed with neurosyphilis were selected as case group. Control group consisted of 50 general syphilis patients who were matched with age and gender. The records of patients were reviewed to collect data of socio-demographic information, clinical symptom, and laboratory indicators. Multivariable logistic regression was used to explore diagnostic indictors, and ROC analysis was used to assess diagnostic accuracy. RESULTS Neurological symptoms (odds ratio (OR) = 59.281, 95% CI:5.215-662.910, P = 0.001), cerebrospinal fluid (CSF) Treponema pallidum particle agglutination (TPPA) titer (OR = 1.004, 95% CI:1.002-1.006, P < 0.001), CSF protein (OR = 1.005, 95% CI:1.000-1.009, P = 0.041), and CSF white blood cell (WBC) (OR = 1.120, 95% CI:1.017-1.233, P = 0.021) were found to be statistically associated with neurosyphilis. In ROC analysis, CSF TPPA titer had a sensitivity of 90%, a specificity of 84%, and an area under curve (AUC) of 0.941. CONCLUSION CSF TPPA can potentially be considered as an alternative test for diagnosis of neurosyphilis. Combining with neurological symptoms, CSF protein, CSF WBC, the diagnosis would have a higher sensitivity.
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Affiliation(s)
- Yong Lu
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 518107, Guangdong, China
| | - Wujian Ke
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Ligang Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Zhenyu Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 518107, Guangdong, China
| | - Ping Lv
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Jinghua Li
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Yumao Cai
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Mei Gu
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Hongfang Liu
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Wenjing Chen
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Xiaohui Zhang
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Liuyuan Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China
| | - Yahui Liu
- Qingyuan Chronic Disease Prevention Hospital, Qingyuan, 511500, Guangdong, China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 518107, Guangdong, China. .,Kirby Institute, The University of New South Wales, Sydney, Australia.
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, 510091, Guangdong, China.
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22
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Bandara HMHN, Samaranayake LP. Viral, bacterial, and fungal infections of the oral mucosa: Types, incidence, predisposing factors, diagnostic algorithms, and management. Periodontol 2000 2019; 80:148-176. [PMID: 31090135 DOI: 10.1111/prd.12273] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
For millions of years, microbiota residing within us, including those in the oral cavity, coexisted in a harmonious symbiotic fashion that provided a quintessential foundation for human health. It is now clear that disruption of such a healthy relationship leading to microbial dysbiosis causes a wide array of infections, ranging from localized, mild, superficial infections to deep, disseminated life-threatening diseases. With recent advances in research, diagnostics, and improved surveillance we are witnessing an array of emerging and re-emerging oral infections and orofacial manifestations of systemic infections. Orofacial infections may cause significant discomfort to the patients and unnecessary economic burden. Thus, the early recognition of such infections is paramount for holistic patient management, and oral clinicians have a critical role in recognizing, diagnosing, managing, and preventing either new or old orofacial infections. This paper aims to provide an update on current understanding of well-established and emerging viral, bacterial, and fungal infections manifesting in the human oral cavity.
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Affiliation(s)
| | - Lakshman P Samaranayake
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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23
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Landry T, Smyczek P, Cooper R, Gratrix J, Bertholet L, Read R, Romanowski B, Singh AE. Retrospective review of tertiary and neurosyphilis cases in Alberta, 1973-2017. BMJ Open 2019; 9:e025995. [PMID: 31230001 PMCID: PMC6596972 DOI: 10.1136/bmjopen-2018-025995] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To review the notification rate and characteristics of tertiary and neurosyphilis cases in Alberta, Canada in the postantibiotic era. METHODS A retrospective review of all neurosyphilis and tertiary syphilis cases reported in Alberta from 1973 to March 2017 was undertaken and cases classified into early neurosyphilis, late neurosyphilis and cardiovascular (CV) syphilis. Variables collected included demographics, sexual partners, HIV status, clinical parameters, symptoms and treatment and distributions were compared between early versus late neurosyphilis and asymptomatic versus symptomatic cases (stratified by early versus late stage). Data were analysed using IBM SPSS Statistics V.19.0. RESULTS 254 cases were identified; 251 were neurosyphilis and 3 were CV. No cases of gummatous syphilis were reported. Early neurosyphilis accounted for 52.4% (n=133) and 46.1% (n=117) were late neurosyphilis cases; one (0.4%) case with unknown duration. Three outbreaks of infectious syphilis were identified during the study period and a concurrent rise in both early and late neurosyphilis was observed during the outbreak periods. The most common manifestation of symptomatic neurosyphilis was ocular involvement which was more likely in early neurosyphilis. Relative to late neurosyphilis cases, early neurosyphilis cases were more likely to be younger, Caucasian, born in Canada, HIV positive and reporting same sex partners. CONCLUSIONS Our review of tertiary and neurosyphilis cases found that early and late neurosyphilis cases continue to occur in the context of cycling syphilis outbreaks. CV syphilis cases were extremely rare. Ongoing identification of new cases of syphilis and clinical evaluation of cases for complications continues to be important in the context of global resurgence of syphilis.
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Affiliation(s)
- Takaaki Landry
- Immunology and Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Petra Smyczek
- Department of Medicine/Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Ryan Cooper
- Department of Medicine/Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Ron Read
- Alberta Health Services, Calgary, Alberta, Canada
| | - Barbara Romanowski
- Department of Medicine/Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Ameeta E Singh
- Department of Medicine/Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
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24
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Buitrago‐Garcia D, Martí‐Carvajal AJ, Jimenez A, Conterno LO, Pardo R. Antibiotic therapy for adults with neurosyphilis. Cochrane Database Syst Rev 2019; 5:CD011399. [PMID: 31132142 PMCID: PMC6536092 DOI: 10.1002/14651858.cd011399.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neurosyphilis is an infection of the central nervous system, caused by Treponema pallidum, a spirochete capable of infecting almost any organ or tissue in the body causing neurological complications due to the infection. This disease is a tertiary manifestation of syphilis. The first-line treatment for neurosyphilis is aqueous crystalline penicillin. However, in cases such as penicillin allergy, other regimes of antibiotic therapy can be used. OBJECTIVES To assess the clinical effectiveness and safety of antibiotic therapy for adults with neurosyphilis. SEARCH METHODS We searched the Cochrane Library, CENTRAL, MEDLINE, Embase, LILACS, World Health Organization International Clinical Trials Registry Platform and Opengrey up to April 2019. We also searched proceedings of eight congresses to a maximum of 10 years, and we contacted trial authors for additional information. SELECTION CRITERIA We included randomised clinical trials that included men and women, regardless of age, with definitive diagnoses of neurosyphilis, including HIV-seropositive patients. We compared any antibiotic regime (concentration, dose, frequency, duration), compared to any other antibiotic regime for the treatment for neurosyphilis in adults. DATA COLLECTION AND ANALYSIS Two review authors independently selected eligible trials, extracted data, and evaluated risk of bias. We resolved disagreements by involving a third review author. For dichotomous data (serological cure, clinical cure, adverse events), we presented results as summary risk ratios (RR) with 95% confidence intervals (CI). We assessed the quality of evidence using the GRADE approach. MAIN RESULTS We identified one trial, with 36 participants diagnosed with syphilis and HIV. The participants were mainly men, with a median age of 34 years. This trial, funded by a pharmaceutical company, compared ceftriaxone in 18 participants (2 g daily for 10 days), with penicillin G, also in 18 participants (4 million/Units (MU)/intravenous (IV) every 4 hours for 10 days). The trial reported incomplete and inconclusive results. Three of 18 (16%) participants receiving ceftriaxone versus 2 of 18 (11%) receiving penicillin G achieved serological cure (RR 1.50; 95% CI: 0.28 to 7.93; 1 trial, 36 participants very low-quality evidence); and 8 of 18 (44%) participants receiving ceftriaxone versus 2 of 18 (18%) participants receiving penicillin G achieved clinical cure (RR 4.00; 95% CI: 0.98 to 16.30; 1 trial, 36 participants very low-quality evidence). Although more participants who received ceftriaxone achieved serological and clinical cure compared to those who received penicillin G, the evidence from this trial was insufficient to determine whether there was a difference between treatment with ceftriaxone or penicillin G.In this trial, the authors reported what would usually be adverse events as symptoms and signs in the follow-up of participants. Furthermore, this trial did not evaluate recurrence of neurosyphilis, time to recovery nor quality of life. We judged risk of bias in this clinical trial to be unclear for random sequence generation, allocation, and blinding of participants, and high for incomplete outcome data, potential conflicts of interest (funding bias), and other bias, due to the lack of a sample size calculation. We rated the quality of evidence as very low. AUTHORS' CONCLUSIONS Due to low quality and insufficient evidence, it was not possible to determine whether there was a difference between treatment with ceftriaxone or Penicillin G. Also, the benefits to people without HIV and neurosyphilis are unknown, as is the ceftriaxone safety profile.Therefore, these results should be interpreted with caution. This conclusion does not mean that antibiotics should not be used for treating this clinical entity. This Cochrane Review has identified the need of adequately powered trials, which should be planned according to Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) recommendations, conducted and reported as recommended by the CONSORT statement. Furthermore, the outcomes should be based on patients' perspectives taking into account Patient-Centered Outcomes Research Institute (PCORI) recommendations.
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Affiliation(s)
- Diana Buitrago‐Garcia
- Universidad Tecnológica EquinoccialCochrane Ecuador. Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio EspejoQuitoEcuador
- Fundación Universitaria de Ciencias de la Salud‐FUCSClinical EpidemiologyCra 49 95‐79BogotáColombia
| | | | - Adriana Jimenez
- Fundación Universitaria de Ciencias de la Salud‐Hospital de San JoséMicrobiology‐Infectious DiseasesCalle 10 # 18‐35BogotaColombia
| | - Lucieni O Conterno
- University of CampinasDivision of Infectious Diseases, Department of Internal Medicine,School of Medicine,Rua Tessália Vieira de Camargo, 126Cidade Universitária "Zeferino Vaz"Distrito de Barão GeraldoSão PauloBrazil13083‐887
| | - Rodrigo Pardo
- Faculty of Medicine, Universidad Nacional de ColombiaClinical Research InstituteBogotaColombia
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Matias MDP, Jesus AOD, Resende RG, Caldeira PC, Aguiar MCFD. Diagnosing acquired syphilis through oral lesions: the 12 year experience of an Oral Medicine Center. Braz J Otorhinolaryngol 2019; 86:358-363. [PMID: 30956150 PMCID: PMC9422386 DOI: 10.1016/j.bjorl.2018.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/29/2018] [Accepted: 12/19/2018] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION A resurgence of syphilis in Brazil has been reported in recent years. OBJECTIVE With this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital. METHODS A retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected. RESULTS A total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%). CONCLUSION The frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis.
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Affiliation(s)
- Michelle Danielle Porto Matias
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Odontologia, Departamento de Cirurgia Oral e Patologia Oral, Belo Horizonte, MG, Brazil
| | - Alessandro Oliveira de Jesus
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Odontologia, Departamento de Cirurgia Oral e Patologia Oral, Belo Horizonte, MG, Brazil
| | | | - Patrícia Carlos Caldeira
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Odontologia, Departamento de Cirurgia Oral e Patologia Oral, Belo Horizonte, MG, Brazil
| | - Maria Cássia Ferreira de Aguiar
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Odontologia, Departamento de Cirurgia Oral e Patologia Oral, Belo Horizonte, MG, Brazil.
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Plagens-Rotman K, Przybylska R, Gerke K, Piskorz-Szymendera M, Tomaszewska M, Sadowska-Przytocka A, Adamski Z, Czarnecka-Operacz M. Syphilis and a pregnant woman: a real danger for the woman and the child. Postepy Dermatol Alergol 2019; 36:119-124. [PMID: 30858792 PMCID: PMC6409870 DOI: 10.5114/ada.2019.82833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/13/2017] [Indexed: 02/06/2023] Open
Affiliation(s)
- Katarzyna Plagens-Rotman
- Department of Mother’s and Child’s Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Renata Przybylska
- Department of Neurological Nursing, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Gerke
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Magdalena Tomaszewska
- Department of Mother’s and Child’s Health, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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Kondo T, Takahashi M, Kuse A, Morichika M, Nakagawa K, Sakurada M, Asano M, Ueno Y. Autopsy case of acute pulmonary thromboembolism with neurosyphilis. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2018. [DOI: 10.1186/s41935-018-0080-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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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.
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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
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Leng T, Keeling MJ. Concurrency of partnerships, consistency with data, and control of sexually transmitted infections. Epidemics 2018; 25:35-46. [PMID: 29798812 DOI: 10.1016/j.epidem.2018.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/18/2018] [Accepted: 05/13/2018] [Indexed: 11/28/2022] Open
Abstract
Sexually transmitted infections (STIs) are a globally increasing public health problem. Mathematical models, carefully matched to available epidemiological and behavioural data, have an important role to play in predicting the action of control measures. Here, we explore the effect of concurrent sexual partnerships on the control of a generic STI with susceptible-infected-susceptible dynamics. Concurrency refers to being in more than one sexual partnership at the same time, and is difficult to measure accurately. We assess the impact of concurrency through the development of three nested pair-formation models: one where infection can only be transmitted via stable sexual partnerships, one where infection can also be transmitted via casual partnerships between single individuals, and one where those individuals in stable partnerships can also acquire infection from casual partnerships. For each model, we include the action of vaccination before sexual debut to inform about the ability to control. As expected, for a fixed transmission rate, concurrency increases both the endemic prevalence of infection and critical level of vaccination required to eliminate the disease significantly. However, when the transmission rate is scaled to maintain a fixed endemic prevalence across models, concurrency has a far smaller impact upon the critical level of vaccination required. Further, when we also constrain the models to have a fixed number of new partnerships over time (both long-term and casual), then increasing concurrency can slightly decrease the critical level of vaccination. These results highlight that accurate measures and models of concurrency may not always be needed for reliable forecasts when models are closely matched to prevalence data. We find that, while increases in concurrency within a population are likely to generate public-health problems, the inclusion of concurrency may be unnecessary when constructing models to determine the efficacy of the control of STIs by vaccination.
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Affiliation(s)
- Trystan Leng
- EPSRC & MRC Centre for Doctoral Training in Mathematics for Real-World Systems, University of Warwick, United Kingdom.
| | - Matt J Keeling
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, Mathematics Institute and School of Life Sciences, University of Warwick, United Kingdom
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Gadiwalla Y, Patel V. Osteonecrosis of the jaw unrelated to medication or radiotherapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:446-453. [DOI: 10.1016/j.oooo.2017.12.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/04/2017] [Accepted: 12/20/2017] [Indexed: 01/02/2023]
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Yan Y, Wang J, Qu B, Zhang Y, Wei Y, Liu H, Wu C. CXCL13 and TH1/Th2 cytokines in the serum and cerebrospinal fluid of neurosyphilis patients. Medicine (Baltimore) 2017; 96:e8850. [PMID: 29381995 PMCID: PMC5708994 DOI: 10.1097/md.0000000000008850] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/29/2017] [Accepted: 11/02/2017] [Indexed: 11/30/2022] Open
Abstract
Neurosyphilis is a chronic infectious disease with involvement of central nervous system infection by Treponema pallidum. This study was to investigate the contents of B lymphocyte chemokine 1 (BLC-1/chemokine [C-X-C motif] ligand 13), Th1 cytokines (Interleukin [IL]-2, IL-12, and Interferon [IFN]-γ), and Th2 cytokines (IL-6 and IL-10) in serum and cerebrospinal fluid (CSF) of HIV-negative patients with neurosyphilis before and after treatment, aiming to elucidate roles of CXCL13 and Th1/Th2 cytokines in immune response to and pathogenesis of neurosyphilis.Enzyme-linked immunosorbent assay was employed to detect the contents of CXCL13, IL-2, IL-12, IFN-γ, IL-6, and IL-10 in serum and CSF of 47 HIV-negative patients with neurosyphilis, 36 syphilis patients without neurological involvement and 23 controls (noninfectious intracranial disease) before, 3 and 12 months after treatment with high dose penicillin.Results showed that there was no significant difference in blood CXCL13 content among 3 groups (P > .05); CSF CXCL13 content in neurosyphilis patients was significantly higher than in other 2 groups (P < .001), and positively related to leucocyte count, protein concentration, and IgG index. IL-6 and IL-10 contents of the serum and CSF in neurosyphilis patients were markedly higher than in other 2 groups (P < .05 or .01), but IL-2, IL-12, and IFN-γ of the serum and CSF were significantly lower than in other 2 groups (P < .05 or .01). The IL-6, IL-10, IL-2, IL-12, and IFN-γ contents of the serum and CSF were comparable between control group and syphilis group (P > .05). CSF CXCL13 content was positively related with IL-6 and IL-10 content, while negatively related to IL-12 content in neurosyphilis patients. CSF IL-6 content was negatively related with IL-12 content. In neurosyphilis patients, the CSF CXCL13 content reduced significantly at 3 and 12 months (P < .001), the CSF IL-2 and IL-12 contents increased significantly at 12 months, and CSF IL-6 contents reduced significantly at 12 months after treatment (P < .05 or .01).It is concluded that neurosyphilis patients did not have normal immune function. CXCL13 and Th1/Th2 cytokines are involved in the immune response of neurosyphilis patients. CSF CXCL13 and Th1/Th2 cytokines contents may be used for the diagnosis and evaluation of therapeutic efficacy of neurosyphilis.
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Affiliation(s)
| | | | - Bin Qu
- Department of Dermatology, Hangzhou Clinical College of Medical University of Anhui, Hangzhou Third Hospital, Hangzhou, Zhejiang, P. R. China
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Zhang W, Du Z, Huang S, Chen L, Tang W, Zheng H, Yang B, Hao Y. The association between human perceived heat and early-stage syphilis and its variance: Results from a case-report system. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 593-594:773-778. [PMID: 28364611 PMCID: PMC5748342 DOI: 10.1016/j.scitotenv.2017.03.194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND The relationship between temperature and syphilis is poorly understood despite clues and suggestions from previous studies. We examined the association between human perceived temperature (humidex) and the relative risk of early-stage syphilis in the most affected area of China, as well as its variance across social-economic status and age groups. METHODS Information regarding early-stage (primary and secondary) syphilis cases reported to the China Case Report System between 2005-2013 from Guangdong province was analyzed in this study. Weather data were obtained from the National Meteorological Information Center. Distributed lag nonlinear models were applied to assess the relationship between humidex and the relative risk of early-stage syphilis. Results were further stratified by social-economic status and age groups. RESULTS The relative risks of early-stage syphilis mainly increased with increased humidex, and were elevated when the humidex was around 30 or greater than 38. The humidex-RR association for the 15-40 age group was similar to the scenario pooled across the age groups, particularly in the Pearl-River Delta Region. The relative risk of syphilis in the elderly for the non-Pearl-River Delta Region did not show a clear change with humidex, whereas that in the Pearl-River Delta Region substantially increased, particularly when humidex was above 25. CONCLUSIONS Human perceived temperature was positively related to the relative risk of early-stage syphilis. People in the Pearl-River Delta Region tended to be more sensitive, with relative risk elevated at potential comfortable times or under excessively hot conditions. The vulnerability of the elderly in the Pearl-River Delta Region is concerning.
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Affiliation(s)
- Wangjian Zhang
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine & Sun Yat-sen Global Health Institute, School of Public Health, Sun Yat-sen University, Guangdong Province 510080, China.
| | - Zhicheng Du
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine & Sun Yat-sen Global Health Institute, School of Public Health, Sun Yat-sen University, Guangdong Province 510080, China.
| | - Shujie Huang
- Southern Medical University Dermatology Hospital, Guangdong Province 510081, China.
| | - Lei Chen
- Southern Medical University Dermatology Hospital, Guangdong Province 510081, China.
| | - Weiming Tang
- Southern Medical University Dermatology Hospital, Guangdong Province 510081, China; University of North Carolina at Chapel Hill, NC 27599, USA
| | - Heping Zheng
- Southern Medical University Dermatology Hospital, Guangdong Province 510081, China.
| | - Bin Yang
- Southern Medical University Dermatology Hospital, Guangdong Province 510081, China.
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine & Sun Yat-sen Global Health Institute, School of Public Health, Sun Yat-sen University, Guangdong Province 510080, China.
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Bai Y, Niu F, Liu L, Sha H, Wang Y, Zhao S. Tertiary syphilis in the lumbar spine: a case report. BMC Infect Dis 2017; 17:513. [PMID: 28738852 PMCID: PMC5525220 DOI: 10.1186/s12879-017-2620-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/18/2017] [Indexed: 11/25/2022] Open
Abstract
Background The incidence of tertiary syphilis involvement in the spinal column with destructive bone lesions is very rare. It is difficult to establish the correct diagnosis from radiographs and histological examination alone. Limited data are available on surgical treatment to tertiary syphilitic spinal lesions. In this article, we report a case of tertiary syphilis in the lumbar spine with osteolytic lesions causing cauda equina compression. Case presentation A 44-year-old man who suffered with low back pain for 6 months and progressive radiating pain at lower extremity for 1 week. Radiologic findings showed osteolytic lesion and new bone formation in the parts of the bodies of L4 and L5. Serum treponema pallidum hemagglutination (TPHA) test was positive. A surgery of posterior debridement, interbody and posterolateral allograft bone fusion with instrumentation from L3 to S1 was performed. The low back pain and numbness abated after operation. But the follow-up radiographs showed absorption of the bone grafts and failure of instrumentation. A Charcot’s arthropathy was formed between L4 and L5. Conclusion It is challenging to diagnose the tertiary syphilis in the spine. Surgery is a reasonable auxiliary method to antibiotic therapy for patients who suffered with neuropathy. Charcot’s arthropathy should be considered as an operative complication.
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Affiliation(s)
- Yang Bai
- Department of Cardiac Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Feng Niu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Lidi Liu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Hui Sha
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Yimei Wang
- Department of Pathology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Song Zhao
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, 130021, China.
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Cerchione C, Maraolo AE, Marano L, Pugliese N, Nappi D, Tosone G, Cimmino I, Cozzolino I, Martinelli V, Pane F, Picardi M. Secondary syphilis mimicking malignancy: A case report and review of literature. J Infect Chemother 2017; 23:576-578. [PMID: 28456488 DOI: 10.1016/j.jiac.2017.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/27/2017] [Accepted: 03/08/2017] [Indexed: 11/30/2022]
Abstract
A 56-year-old man developed disseminate lymphadenopathies, associated with hepato-splenomegaly, fever, nocturnal sweating and weight loss. Imaging studies in particular FDG-PET/CT raised the suspicion of a malignant disease. But blood flow cytometry assay for B/T cell clonality was negative and fine-needle biopsy of enlarged laterocervical lymph node showed a not specific "reactive hyperplasia". Four months later, the patient developed a non-itching rash; since a further anamnestic investigation revealed an history of high-risk sexual intercourse, the patient underwent serological tests for Treponema pallidum that were positive at high titer, after a first negative screening. Made the diagnosis of secondary syphilis, the patient responded to the treatment with benzyl penicillin with complete resolution of symptoms. This case highlights the importance of carefully screening the patients with suspected lymphoadenopathies also for lue, particularly in presence of behavioral risk factors.
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Affiliation(s)
- Claudio Cerchione
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy.
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples "Federico II", Italy
| | - Luana Marano
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Davide Nappi
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Grazia Tosone
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples "Federico II", Italy
| | - Ilaria Cimmino
- Department of Translational Medical Sciences, University of Naples "Federico II", Italy
| | - Imma Cozzolino
- Department of Translational Medical Sciences, University of Naples "Federico II", Italy
| | - Vincenzo Martinelli
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Marco Picardi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Italy
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Goulenok T, Benali K, Cazes A, Castier Y, Papo T. A 55-Year-Old Traveller With Chest Pain. Clin Infect Dis 2017. [DOI: 10.1093/cid/ciw859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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de Vries PJ, Caumes E. Western Europe. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Peter J. de Vries
- Department of Internal Medicine; Tergooi Hospital; Hilversum The Netherlands
| | - Eric Caumes
- Department of Infectious and Tropical Diseases, Hôpital Pitié-Salpêtrière; Université Pierre et Marie Curie; Paris France
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Hernandez I, Johnson A, Reina-Ortiz M, Rosas C, Sharma V, Teran S, Naik E, Salihu HM, Teran E, Izurieta R. Syphilis and HIV/Syphilis Co-infection Among Men Who Have Sex With Men (MSM) in Ecuador. Am J Mens Health 2016; 11:823-833. [PMID: 27923971 PMCID: PMC5675307 DOI: 10.1177/1557988316680928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is a reemergence of syphilis in the Latin American and Caribbean region. There is also very little information about HIV/Syphilis co-infection and its determinants. The aim of this study is to investigate knowledge, attitudes, and practices regarding sexually transmitted infections (STIs), in particular syphilis infection and HIV/Syphilis co-infection, as well as to estimate the prevalence of syphilis among men who have sex with men (MSM) in a city with one of the highest HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 291 adult MSM. Questions included knowledge about STIs and their sexual practices. Blood samples were taken from participants to estimate the prevalence of syphilis and HIV/syphilis co-infection. In this population, the prevalence of HIV/syphilis co-infection was 4.8%, while the prevalence of syphilis as mono-infection was 6.5%. Participants who had syphilis mono-infection and HIV/syphilis co-infection were older. Men who had multiple partners and those who were forced to have sex had increased odds of syphilis and HIV/syphilis co-infection. A high prevalence of syphilis and self-reported STI was observed, which warrants targeted behavioral interventions. Co-infections are a cause for concern when treating a secondary infection in a person who is immunocompromised. These data suggest that specific knowledge, attitudes, and behaviors among MSM are associated with increased odds of STIs (including HIV/syphilis co-infections) in this region of Ecuador.
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Affiliation(s)
| | | | - Miguel Reina-Ortiz
- 2 University of South Florida, Tampa, FL, USA.,3 Fundación Raíces, Esmeraldas, Ecuador
| | - Carlos Rosas
- 4 Universidad San Francisco de Quito, Quito, Ecuador
| | | | | | - Eknath Naik
- 2 University of South Florida, Tampa, FL, USA
| | | | - Enrique Teran
- 4 Universidad San Francisco de Quito, Quito, Ecuador
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Role of microbial flora in female genital tract: A comprehensive review. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2016. [DOI: 10.1016/s2222-1808(16)61155-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Drago F, Ciccarese G, Tomasini CF, Calamaro P, Boggio M, Rebora A, Parodi A. First report of tertiary syphilis presenting as lipoatrophic panniculitis in an immunocompetent patient. Int J STD AIDS 2016; 28:408-410. [PMID: 27558164 DOI: 10.1177/0956462416665973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe herein a woman who developed subcutaneous gummas in her trochanteric regions, bilaterally, although she had been treated for syphilis two decades earlier. Evidence of Treponema pallidum latent late infection was the presence of IgG antibodies against T. pallidum and the positive non-treponemal and treponemal tests. Moreover, immunohistochemical staining for T. pallidum detected some spirochetes close to the atrophic adipocytes allowing the diagnosis of lypo-atrophic panniculitis tertiary syphilis. This is the first case of tertiary syphilis presenting as panniculitis in an immunocompetent patient, demonstrating that subcutaneous fat may be another organ infected in tertiary syphilis.
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Affiliation(s)
- Francesco Drago
- 1 DISSAL, Section of Dermatology, IRCCS Azienda, Universitaria Ospedaliera San Martino-IST, Genoa, Italy
| | - Giulia Ciccarese
- 1 DISSAL, Section of Dermatology, IRCCS Azienda, Universitaria Ospedaliera San Martino-IST, Genoa, Italy
| | - Carlo F Tomasini
- 2 City of Health and Science of Turin, University of Turin, Turin, Italy
| | - Paola Calamaro
- 3 Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy.,4 Department of Anatomical Pathology, University of Genoa, Genoa, Italy
| | - Maurizio Boggio
- 3 Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy.,4 Department of Anatomical Pathology, University of Genoa, Genoa, Italy
| | - Alfredo Rebora
- 1 DISSAL, Section of Dermatology, IRCCS Azienda, Universitaria Ospedaliera San Martino-IST, Genoa, Italy
| | - Aurora Parodi
- 1 DISSAL, Section of Dermatology, IRCCS Azienda, Universitaria Ospedaliera San Martino-IST, Genoa, Italy
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Yanhua W, Haishan S, Le H, Xiaomei Z, Xinru C, Ling L, Zhangying W, Dong Z, Yuefen Z, Yan T, Xinni L, Sha L, Yuping N. Clinical and neuropsychological characteristics of general paresis misdiagnosed as primary psychiatric disease. BMC Psychiatry 2016; 16:230. [PMID: 27400713 PMCID: PMC4940705 DOI: 10.1186/s12888-016-0925-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/15/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Neurosyphilis is caused by the invasion of Treponema pallidum into the central nervous system. General paresis (GP) is a type of neurosyphilis. The main manifestation of general paresis is dementia; however, this is different from the other types of dementia, which can be cured by adequate doses of penicillin in the early stage. Neurosyphilis is the "great imitator" because it can mimic many types of medical disorders. In addition, the manifestations of neurosyphilis are not typical. Psychiatric disorders as a cause of general paresis have become more common due to the use of antibiotics. Patients with a psychiatric manifestation are often misdiagnosed. The purpose of this study was to explore the differences in the clinical and neuropsychological characteristics of general paresis between patients misdiagnosed as having a primary psychiatric disease and patients diagnosed correctly upon seeing a doctor. The results may assist clinicians in the early identification of neurosyphilis with a mental disorder. METHOD The demographic and clinical manifestations, laboratory tests, and neuroimaging and neuropsychological characteristics were analysed in 55 general paresis patients with psychiatric disorders, including 29 patients misdiagnosed as primary psychiatric disease and 26 patients diagnosed as having general paresis after being seen once by a doctor. RESULT All of the patients had positive assay results for cerebral spinal fluid (CSF) Treponema pallidum hemagglutination (TPHA). Only 43.3 % of misdiagnosed patients and 30.8 % of general paresis patients had positive results for the CSF rapid plasma reagin (RPR) test; 96.4 % patients had abnormal neuroimaging. Mood disturbances were the most common psychiatric disorder in the general paresis patients, especially agitation, between the two groups (patients with general paresis who were misdiagnosed as having primary psychiatric disease and patients who had never been misdiagnosed) (p = 0.011). CONCLUSION Our findings reinforce the importance of performing serologic testing for syphilis. This should be a part of the evaluation of patients with psychiatric disorders, especially patients with cognitive impairment. When the syphilis serology is positive, the patient should be examined thoroughly for neurosyphilis by lumbar puncture. Brain imaging could also aid the physician in discriminating these patients from those with a functional mental disorder.
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Affiliation(s)
- Wang Yanhua
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Shi Haishan
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Hou Le
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Zhong Xiaomei
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Chen Xinru
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Li Ling
- Department of Psychiatry, Sun Yat-sen University, Guangzhou Brain Hospital, Guangdong, China
| | - Wu Zhangying
- Department of Psychiatry, Guangzhou Medical University, Guangzhou Brain Hospital, Guangdong, China
| | - Zheng Dong
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Zhang Yuefen
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Tan Yan
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Luo Xinni
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Liu Sha
- Department of Radiology, Guangzhou Brain Hospital, Guangdong, China
| | - Ning Yuping
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China.
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Gall GEC, Lautenschlager S, Bagheri HC. Quarantine as a public health measure against an emerging infectious disease: syphilis in Zurich at the dawn of the modern era (1496-1585). GMS HYGIENE AND INFECTION CONTROL 2016; 11:Doc13. [PMID: 27303653 PMCID: PMC4899769 DOI: 10.3205/dgkh000273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Syphilis is considered as one of the most devastating sexually transmitted diseases in human history. Based on historical records, the "Böse Blattern" (German for "Evil Pocks") spread through Europe after 1495 and shared symptoms with what we know today as syphilis. Many cities took measures to protect their population. Here, transliterations of archival documents from the 15(th) and 16(th) century (provided in the appendix) are used to trace the steps taken by the governing authorities in Zurich to deal with this emerging infectious disease. One of the central measures taken by the city was to establish a quarantine facility referred to as the "Blatternhaus". The city doctors, including the well-known physician and naturalist Conrad Gessner, oversaw the obligatory quarantine and treatment of patients with symptoms. Treatment could range from better nutrition, herbal remedies and skin ointments to aggressive heat therapy and "smoking". Furthermore, the affliction was suspected as a sexually acquired disease, hence prostitutes and infected foreigners were extradited from the city. Meanwhile, the church used its social influence to promote a more "Christian" behavior. In several respects, the public health measures taken in the 16(th) century against a new and menacing epidemic do not diverge in their basic rationale from approaches used during the 20(th) century and today.
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Affiliation(s)
| | | | - Homayoun C. Bagheri
- Department of Evolutionary Biology and Environmental Studies, University of Zurich, Switzerland
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Tutelyan AV, Gaponov AM, Pisarev VM, El-Registan GI. [Microbial dormancy and prevention of healthcare-associated infections]. TERAPEVT ARKH 2016; 87:103-108. [PMID: 26821426 DOI: 10.17116/terarkh20158711103-109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Healthcare-associated infections (HCAI) remain one of the most challenges of modern health care and assume increasing social and medical significance. The specific features of HCAI are frequent recurrences and inefficiency of antibiotic therapy, a reason for which is antibiotic resistance in microorganisms. The review discusses antibiotic resistance, a form of antibiotic tolerance (AT), and its role in the development of HCAI. It also describes essential differences between AT and antibiotic tolerance at the cellular and molecular genetic levels. Relationships between AT and dormancy of microorganisms, pathogens of HCAI, are discussed. The paper gives the data available in the literature on how AT occurs in HCAI pathogens and discusses the diagnosis of this condition. It also analyzes the literature data on pharmacological attempts to overcome AT and discusses novel approaches to antibiotic therapy for HCAI.
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Affiliation(s)
- A V Tutelyan
- Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia; Dmitry Rogachev Federal Research-and-Clinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - A M Gaponov
- Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia; Dmitry Rogachev Federal Research-and-Clinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia, Moscow, Russia; V.A.Negovsky Research Institute of General Reanimatology, Federal Agency of Research Organizations of Russia, Moscow, Russia
| | - V M Pisarev
- Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia; Dmitry Rogachev Federal Research-and-Clinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia, Moscow, Russia; V.A.Negovsky Research Institute of General Reanimatology, Federal Agency of Research Organizations of Russia, Moscow, Russia
| | - G I El-Registan
- S.N. Vinogradsky Institute of Microbiology, Russian Academy of Sciences, Moscow, Russia
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Zhang X, Zhang T, Pei J, Liu Y, Li X, Medrano-Gracia P. Time Series Modelling of Syphilis Incidence in China from 2005 to 2012. PLoS One 2016; 11:e0149401. [PMID: 26901682 PMCID: PMC4763154 DOI: 10.1371/journal.pone.0149401] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The infection rate of syphilis in China has increased dramatically in recent decades, becoming a serious public health concern. Early prediction of syphilis is therefore of great importance for heath planning and management. METHODS In this paper, we analyzed surveillance time series data for primary, secondary, tertiary, congenital and latent syphilis in mainland China from 2005 to 2012. Seasonality and long-term trend were explored with decomposition methods. Autoregressive integrated moving average (ARIMA) was used to fit a univariate time series model of syphilis incidence. A separate multi-variable time series for each syphilis type was also tested using an autoregressive integrated moving average model with exogenous variables (ARIMAX). RESULTS The syphilis incidence rates have increased three-fold from 2005 to 2012. All syphilis time series showed strong seasonality and increasing long-term trend. Both ARIMA and ARIMAX models fitted and estimated syphilis incidence well. All univariate time series showed highest goodness-of-fit results with the ARIMA(0,0,1)×(0,1,1) model. CONCLUSION Time series analysis was an effective tool for modelling the historical and future incidence of syphilis in China. The ARIMAX model showed superior performance than the ARIMA model for the modelling of syphilis incidence. Time series correlations existed between the models for primary, secondary, tertiary, congenital and latent syphilis.
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Affiliation(s)
- Xingyu Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R.China
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
| | - Tao Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R.China
| | - Jiao Pei
- Department of Science and Education, Sichuan Cancer Hospital & Institute, Sichuan, China
| | - Yuanyuan Liu
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R.China
| | - Xiaosong Li
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R.China
- * E-mail:
| | - Pau Medrano-Gracia
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
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Keshtkar-Jahromi M, Rassaei N, Bruno MA, Maneval ML, Whitener CJ. A 59-Year-Old Man With Multiple Liver Lesions, Rash, and Uveitis. Clin Infect Dis 2016. [DOI: 10.1093/cid/civ761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pinto VM, Tancredi MV, De Alencar HDR, Camolesi E, Holcman MM, Grecco JP, Grangeiro A, Grecco ETO. Prevalence of syphilis and associated factors in homeless people of Sao Paulo, Brazil, using a Rapid Test. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 17:341-54. [PMID: 24918408 DOI: 10.1590/1809-4503201400020005eng] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 09/13/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Homeless people are a vulnerable group to sexually transmitted diseases (STD) with high prevalence of syphilis and hepatitis. OBJECTIVES To estimate the prevalence of syphilis infection and its association with risky behaviors for STDs in a sample of homeless people, and to assess the feasibility of the use of rapid syphilis test (RST) in this population. METHODS Cross-sectional study, in a convenience sample of homeless people assisted in social support services of São Paulo, between 2006 and 2007. A structured questionnaire was applied and RST was performed. In addition, a blood sample for syphilis detection was also collected. The sensitivity and specificity of the RST was estimated using conventional laboratory diagnosis (VDRL + TPHA) as reference. RESULTS 1,405 volunteers were included in the study. The prevalence rate of syphilis was 7.0%, and was associated with homosexual practices (OR(adj) 4.9; 95%CI 2.6 - 9.4), prior history of STD (OR(adj) 2.6; 95%CI 1.7 - 4.0) and with self-referred non-white race (OR(adj) 1.9; 95%CI 1.1 - 3.4). The sensitivity and specificity of the RST for syphilis were, respectively, 81.4 and 92.1%. CONCLUSION The high prevalence of syphilis infection among homeless people shows the need for actions for its control and the utilization of RST that can be considered an efficient strategy due to its sensitivity and specificity. Public Health policymakers must strengthen actions for syphilis control, with screening tests for syphilis and early treatment, decreasing morbidity with the improvement of sexual and reproductive health of the population in general and especially the most vulnerable.
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Sahin O, Ziaei A. Clinical and laboratory characteristics of ocular syphilis, co-infection, and therapy response. Clin Ophthalmol 2015; 10:13-28. [PMID: 26730177 PMCID: PMC4694667 DOI: 10.2147/opth.s94376] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the clinical presentation of patients diagnosed with presumed latent ocular syphilis and congenital ocular syphilis at tertiary referral center in Turkey, and to compare the clinical findings with patients described in other studies, specifically focusing on demographics and co-infections. Methods This is a retrospective study reviewing the medical records of patients diagnosed with ocular inflammation between January 2012 and June 2014 at a tertiary referral center in Turkey. Ocular syphilis was diagnosed on the basis of non-treponemal and treponemal antibody tests, and cerebrospinal fluid analysis. All the patients diagnosed with ocular syphilis were tested for human immunodeficiency virus (HIV), Toxoplasma gondii, rubella, cytomegalovirus, and herpes. Results A total of 1,115 patients were evaluated between January 2012 and June 2014, and 12 patients (1.07%) were diagnosed with ocular syphilis based on the inclusion criteria. None of the patients were seropositive for HIV. Two patients were seropositive for T. gondii-specific IgG. Clinical presentations include non-necrotizing anterior scleritis, non-necrotizing sclerokeratitis, anterior uveitis, intermediate uveitis, posterior uveitis, panuveitis, and optic neuritis. All of the patients showed clinical improvement in the level of ocular inflammation with intravenous penicillin 24 million U/day for 10 days. Three patients received additional oral methotrexate as an adjunctive therapy. Two cases received low-dose trimethoprim–sulfamethoxazole. Conclusion Ocular syphilis is an uncommon cause of ocular inflammation in HIV-negative patients. Central retinochoroiditis is the most common ocular manifestation, and it is the most common cause of visual impairment. Ocular syphilis might present associated with co-infections such as T. gondii in developing countries. Oral methotrexate might be beneficial as an adjunctive therapy for ocular syphilis in resolving the residual intraocular inflammation and cystoid macular edema after specific therapy with intravenous penicillin.
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Affiliation(s)
- Ozlem Sahin
- Department of Ophthalmology/Uveitis, Dunya Goz Hospital, Ankara, Turkey
| | - Alireza Ziaei
- Department of Ophthalmology/Uveitis, Dunya Goz Hospital, Ankara, Turkey; Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA; Department of Ophthalmology, Dunya Eye Hospital Ltd, Ankara, Turkey
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Merins V, Hahn K. Syphilis and neurosyphilis: HIV-coinfection and value of diagnostic parameters in cerebrospinal fluid. Eur J Med Res 2015; 20:81. [PMID: 26445822 PMCID: PMC4596308 DOI: 10.1186/s40001-015-0175-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/17/2015] [Indexed: 11/20/2022] Open
Abstract
Background Neurosyphilis might be difficult to diagnose particularly in asymptomatic patients and patients with HIV-coinfection. The objective of this study was to evaluate current diagnostic standards for neurosyphilis in HIV-positive and -negative patients. Methods We studied retrospectively patients with an active syphilis infection who had additionally undergone lumbar puncture. Patients where the criteria for the diagnosis of a definite or probable neurosyphilis were applicable were further analyzed for clinical symptoms, CSF, HIV-status as well as Treponema pallidum testing in serum and CSF. Correlation analysis of categorical variables was done by using the Chi-square test or in cases of small sample sizes the exact test of Fisher. p values ≤0.05 were considered significant. Results Eighty-nine patients were diagnosed with syphilis. All necessary criteria for the diagnosis of a neurosyphilis were available in 67 of them including 35 HIV-positive and 32 HIV-negative patients. A definite neurosyphilis could be retrospectively diagnosed in 13 and a probable in another 25 cases. Normal CSF results were more likely in HIV-negatives (p = 0.016). A neurosyphilis was correlated to a CSF pleocytosis > 5 cells/µl and to an albumin quotient >7.8 mg/dl regardless of a parallel HIV infection. HIV-positives had more frequently a CSF-RPR titre >1:4 than HIV-negatives (p = 0.031). However, the RPR test in CSF in definite or probable neurosyphilis had a sensitivity of only 21 %. Discussion Our data show that a pleocytosis and an elevated albumin quotient correlate with neurosyphilis. However, the CSF-RPR test as gold standard in neurosyphilis diagnostics has a very low sensitivity.
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Affiliation(s)
- V Merins
- Group Practice Family Physicians, Alt-Buckow 9-11, 12349, Berlin, Germany.
| | - K Hahn
- Department of Neurology, Universitätsmedizin Charité, Charitéplatz 1, 10117, Berlin, Germany.
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Abstract
In the postantibiotic era, neurosyphilis continues to have a significant incidence, especially in certain subpopulations. We report, for the first time, neurosyphilis presenting as parkinsonism without more typical neurosyphilitic clinical features. A 53-year-old man developed clinical features of gradual onset consistent with idiopathic Parkinson's disease but was found to have positive treponemal serology and cerebrospinal fluid Venereal Disease Research Laboratory (VRDL) reaction. Antibiotic treatment dramatically improved all the parkinsonian symptoms. However, over the subsequent 15 years, the patient slowly deteriorated again in a manner typical of idiopathic Parkinson's disease. A dopaminergic deficit was demonstrated on ((123)I)FP-CIT SPECT. This is the first report in the postantibiotic era of neurosyphilis presenting as relatively pure parkinsonism. Blood test screening for syphilis is therefore appropriate if there is any clinical doubt about an idiopathic parkinsonian presentation. The patient's late second deterioration may suggest that the neurosyphilitic basal ganglial insult primed or accelerated development of idiopathic-like disease.
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Affiliation(s)
- John McAuley
- Department of Neurology, Barking Havering and Redbridge University Hospitals, Essex, UK
| | - Gaenor Hughes
- Department of Radiology, Barking Havering and Redbridge University Hospitals, Essex, UK
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Lim G, Hudacek K, Lodha S, Chung CL, Cusack CA. JAAD Grand Rounds. Pink scaling papules and plaques on the palms, soles, chest, abdomen, and extremities. J Am Acad Dermatol 2015; 72:926-8. [PMID: 25890468 DOI: 10.1016/j.jaad.2013.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/25/2013] [Indexed: 11/29/2022]
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Rosa G, Bennett D, Piliang MP. Eosinophil-rich syphilis: a report of four cases. J Cutan Pathol 2015; 42:554-8. [PMID: 25997023 DOI: 10.1111/cup.12540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 12/06/2014] [Accepted: 01/11/2015] [Indexed: 11/28/2022]
Abstract
The differential diagnosis for eosinophil-rich skin lesions often includes a drug reaction, allergic contact dermatitis and rarely, response to a helminth infection. However, many unrelated entities, such as infections, neoplasms and inflammatory dermatoses, can have a prominent eosinophilic infiltrate. Syphilis is classically associated with plasma cells, but other patterns of inflammation have been reported, including ulcerative, granulomatous and eosinophil-rich. Classic teaching might indicate that the presence of eosinophils argues against a diagnosis of syphilis. We present four cases of secondary syphilis with increased eosinophils, ranging from 8 to >200 eosinophils per 10 high-power fields (×400 magnification). Patient 1 had lesions on the penis and scrotum, with greater than 200 eosinophils per 10 high-power fields. Patient 2 had lesions on the back, with 150 eosinophils per 10 high-power fields. Patient 3 had lesions on the bilateral arms, with 8 eosinophils per 10 high-power fields. Patient 4 had lesions involving the anus, with 17 eosinophils per 10 high-power fields. These cases highlight that the presence of an eosinophil-rich infiltrate on skin biopsy should not exclude syphilis from the differential diagnosis.
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Affiliation(s)
- Gabriela Rosa
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dan Bennett
- Department of Dermatology, University of Wisconsin, Madison, WI, USA
| | - Melissa P Piliang
- Sections of the Departments of Dermatology and Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
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