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Wu VCC, Yeh JK, Chen SW, Wu CL, Lin YS, Wu M, Wei KC, Chu PH, Chang SH, Huang YT. Syphilis and cardiovascular risk: a Taiwanese registry. Eur Heart J 2024; 45:1512-1520. [PMID: 38568209 DOI: 10.1093/eurheartj/ehae183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND AND AIMS Studies on the impact of syphilis on the cardiovascular system in large populations are limited. This study investigated the effects of syphilis on cardiovascular outcomes. METHODS Medical records from 2010 to 2015 were retrieved from the Taiwan National Health Insurance Research Database, linked to the Notifiable Infectious Diseases database from the Taiwan Centers for Disease Control. Patients with syphilis were identified, excluding those with missing information, under 20 years of age, or with a history of human immunodeficiency virus infection, acute myocardial infarction, heart failure, aortic regurgitation, replacement of the aortic valve, aneurysm and/or dissection of the aorta, atrial fibrillation, ischaemic stroke, haemorrhagic stroke, and venous thromboembolism. Primary outcomes included new-onset acute myocardial infarction, heart failure, aortic regurgitation, aneurysm and dissection of the aorta, atrial fibrillation, ischaemic stroke, haemorrhagic stroke, venous thromboembolism, cardiovascular death, and all-cause mortality. RESULTS A total of 28 796 patients with syphilis were identified from 2010 to 2015. After exclusions and frequency matching, 20 601 syphilis patients and 20 601 non-syphilis patients were analysed. The relative rate (RR) was utilized in the analysis, as the competing risk of death was not considered. Compared with patients without syphilis, patients with syphilis had increased risks of acute myocardial infarction (RR 38%, 95% confidence interval [CI] 1.19-1.60, P < .001), heart failure (RR 88%, 95% CI 1.64-2.14, P < .001), aortic regurgitation (RR 81%, 95% CI 1.18-2.75, P = .006), atrial fibrillation (RR 45%, 95% CI 1.20-1.76, P < .001), ischaemic stroke (RR 68%, 95% CI 1.52-1.87, P < .001), haemorrhagic stroke (RR 114%, 95% CI 1.74-2.64, P < .001), venous thromboembolism (RR 67%, 95% CI 1.23-2.26, P = .001), cardiovascular death (RR 155%, 95% CI 2.11-3.08, P < .001), and all-cause death (RR 196%, 95% CI 2.74-3.19, P < .001) but not for aneurysm and dissection of the aorta. CONCLUSIONS This study demonstrates that patients with syphilis have a higher risk of cardiovascular events and all-cause mortality compared with those without syphilis.
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Affiliation(s)
- Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City 33302, Taiwan
| | - Jih-Kai Yeh
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Chia-Ling Wu
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Yu-Sheng Lin
- Department of Cardiology, Chang Gung Memorial Hospital, No. 6, Sec. West, Jiapu Road, Puzi City, Chiayi County 61363, Taiwan
| | - Michael Wu
- Divison of Cardiovascular Medicine, Arrhythmia Services Section, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA
| | - Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City 813414, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, No. 155, Section 2, Li-Nong Street, Beitou District, Taipei 112304, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Shang-Hung Chang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
- Graduate Institute of Nursing, Chang Gung University of Science and Technology, No. 261, Wenhua 1st Road, Guishan District, Taoyuan City 33303, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
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Malyshev M, Safuanov A, Malyshev A, Rostovykh A, Sinyukov D, Rostovykh N, Trushina V. Surgery for Ascending Aortic Aneurysm and Aortic Valve Insufficiency in Conditions of Active Proceeding Syphilitic Aortitis and Valvulitis. Ann Thorac Cardiovasc Surg 2024; 30:n/a. [PMID: 36967122 PMCID: PMC10902664 DOI: 10.5761/atcs.cr.22-00236] [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] [Indexed: 03/28/2023] Open
Abstract
A syphilitic aortitis is a late cardiovascular lesion of tertiary syphilis that has become exceptionally rare in the antibiotic era but not eradicated completely. Syphilitic aortitis of ascending aorta complicates in ascending aortic aneurysm formation and aortic valve regurgitation, both requiring surgical treatment. After surgery, lifelong surveillance of the remainder of the aorta is recommended because of a priori supposed high incidence of delayed involvement of noninvolved aortic segments. A 3-year follow-up result of surgery of syphilitic ascending aortic aneurysm with aortic valve regurgitation in condition of active ongoing syphilitic aortitis and valvulitis is described with addressing the dimensions of remaining aortic segments. This case demonstrates that the dilatation of the remainder of the aorta does not occur during 3 years, at least when anti-syphilitic course of antibiotic is used just after operation without additional treatment during the follow-up period. A few reports on surgical treatment of syphilitic aneurysms of the ascending aorta are discussed.
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Affiliation(s)
| | | | - Anton Malyshev
- Center of Cardiac Surgery, Chelyabinsk, Russian Federation
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Muacevic A, Adler JR. Mycotic Thoracic Aortic Aneurysm: Epidemiology, Pathophysiology, Diagnosis, and Management. Cureus 2022; 14:e31010. [PMID: 36349070 PMCID: PMC9632233 DOI: 10.7759/cureus.31010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/30/2022] Open
Abstract
Mycotic thoracic aortic aneurysm (MTAA) is an aneurysm of the aorta caused by infection of the vessel tissue through microbial inoculation of the diseased aortic endothelium. It is most commonly caused by bacteria. Rarely, it can be caused by fungi. However, viral aortic aneurysm has never been reported. Depending on the area and time period investigated, the infections organism discovered may vary significantly. Little is known about the natural history of MTAA due to its rarity. It is not known if they follow the same pattern as other TAAs. However, it is unclear whether MTAA follows a similar clinical course. The combination of clinical presentation, laboratory results, and radiographic results are used to make the diagnosis of MTAA. Treatment of MTAA is complex since patients frequently present at a late stage, frequently with fulminant sepsis, as well as concomitant complications such as aneurysm rupture. While medical treatment, including antibiotics, is recommended, surgery is still the mainstay of management. Surgery to treat MTAA is complicated and carries a high risk of morbidity and mortality and includes both open repairs and endovascular ones. In this review, we explore the etiology, pathogenesis, clinical presentations, diagnostic modalities as well as treatment management available for MTAA.
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Hoffman MA, Ekladious A. Clinically isolated descending thoracic aortitis in a healthy older woman: a diagnostic challenge. BMJ Case Rep 2021; 14:e238009. [PMID: 33602759 PMCID: PMC7896571 DOI: 10.1136/bcr-2020-238009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 11/04/2022] Open
Abstract
A woman travelling to Australia in her early 70s presents to a regional emergency department with chest pain and associated shortness of breath. Her medical history was that of seasonal affective disorder treated with citalopram, and an allergy to ibuprofen. Subsequent CT imaging revealed aortic wall thickening and associated periaortic fluid, and a moderate pleural effusion. This was successfully treated with oral prednisolone, responding within 1 day. Further blood tests revealed a high CD4/CD8 T-cell ratio, which can be seen in autoimmune disease, sarcoidosis and haematological malignancies. Without evidence for other autoimmune processes, the patient was given a provisional diagnosis of descending thoracic aortitis secondary to sarcoidosis, prescribed a weaning regimen of prednisolone, and asked to seek further investigation and management in her home country. This is a case with several learning points; rare disease can cause common presentations/reports, and sometimes empirical therapy is the only therapy.
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Affiliation(s)
- Max Amos Hoffman
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Adel Ekladious
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
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Chen JH, Zheng X, Liu XQ. Usefulness of Positron Emission Tomography in Patients with Syphilis: A Systematic Review of Observational Studies. Chin Med J (Engl) 2018; 130:1100-1112. [PMID: 28469107 PMCID: PMC5421182 DOI: 10.4103/0366-6999.204940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Diagnosis of syphilis is difficult. Follow-up and therapy evaluation of syphilitic patients are poor. Little is known about positron emission tomography (PET) in syphilis. This review was to systematically review usefulness of PET for diagnosis, disease extent evaluation, follow-up, and treatment response assessment in patients with syphilis. Methods: We searched PubMed, EMBASE, SCOPUS, Cochrane Library, Web of Science, ClinicalTrials.gov, and three Chinese databases (SinoMed, Wanfang, and CNKI) for English and Chinese language articles from inception to September 2016. We also collected potentially relevant studies and reviews using a manual search. The search keywords included the combined text and MeSH terms “syphilis” and “positron emission tomography”. We included studies that reporting syphilis with a PET scan before and/or after antibiotic treatment. The diagnosis of syphilis was based on serological criteria or dark field microscopy. Outcomes include pre- and post-treatment PET scan, pre- and post-treatment computed tomography, and pre- and post-treatment magnetic resonance imaging. We excluded the articles not published in English or Chinese or not involving humans. Results: Of 258 identified articles, 34 observational studies were included. Thirty-three studies were single-patient case reports and one study was a small case series. All patients were adults. The mean age of patients was 48.3 ± 12.1 years. In primary syphilis, increased fluorodeoxyglucose (FDG) accumulation could be seen at the site of inoculation or in the regional lymph nodes. In secondary syphilis with lung, bone, gastrointestinal involvement, or generalized lymphadenopathy, increased FDG uptake was the most commonly detected changes. In tertiary syphilis, increased glucose metabolic activity, hypometabolic lesions, or normal glucose uptake might be seen on PET. There were five types of PET scans in neurosyphilis. A repeated PET scan after treatment revealed apparent or complete resolution of the asymmetry of radiotracer uptake. Conclusion: PET is helpful in targeting diagnostic interventions, characterizing disease extent, assessing nodal involvement, and treatment efficacy for syphilis.
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Affiliation(s)
- Jian-Hua Chen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xin Zheng
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiu-Qin Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Spaltenstein M, Humbert F, Vu DL, Uçkay I, John G. A case report of CT-diagnosed renal infarct secondary to syphilitic aortitis. BMC Infect Dis 2017; 17:520. [PMID: 28747159 PMCID: PMC5530486 DOI: 10.1186/s12879-017-2624-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/20/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Even though reported cases of syphilis have been increasing, cases of tertiary syphilis remain extremely rare. The majority of our knowledge with regard to complications of syphilis such as aortitis was acquired before the advent of relatively modern technologies such as CT, MRI and PET. This case report presents a rare case of syphilitic aortitis associated with a renal infarct caused by a peripheral arterial embolism diagnosed by CT. CASE PRESENTATION We present a young man with sudden abdominal pain and flank tenderness without fever. Blood tests showed acute kidney failure. Computed tomography showed a right renal infarct and a non-circular thickening of the descending thoracic aortic wall with intra-luminal thrombus. Serology confirmed the diagnosis of syphilis. Treatment with anticoagulant and penicillin resulted in a good outcome. Follow-up PET-MRI showed resolution of the thrombus with a metabolically inactive atheromatous plaque. CONCLUSION Technologies, such as CT, PET-CT and PET-MRI, that were not present during the pre-antibiotic era, can provide new insights into rare presentations of tertiary syphilis such as aortitis. These imaging modalities show promise for early radiological diagnosis of aortitis in syphilis and may be useful for determining the response to treatment in specific cases.
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Affiliation(s)
- Maaike Spaltenstein
- Division of Internal Medicine, Hôpital Neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Françoise Humbert
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Diem-Lan Vu
- Division of Infectious Diseases, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ilker Uçkay
- Division of Infectious Diseases, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gregor John
- Division of Internal Medicine, Hôpital Neuchâtelois, La Chaux-de-Fonds, Switzerland
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Li W, Yin XJ, Liu HY, Yang R. Syphilitic aortic aneurysm with a pulmonary lesion: a case report and literature view. SPRINGERPLUS 2016; 5:1725. [PMID: 27777861 PMCID: PMC5053956 DOI: 10.1186/s40064-016-3397-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/27/2016] [Indexed: 02/05/2023]
Abstract
Introduction Syphilitic aortic aneurysm (SAA) is caused by tertiary stage of syphilis infection. As the wide application of penicillin, this complication is becoming rarer than before. The SAA with lung cancer is a very rare disease in patient. Case description A 55-year-old male was admitted to the hospital complaining “progressive hoarseness for 3 months” and the patient has been diagnosed with syphilis after specific blood exams, computed tomography angiography (CTA) and 3dimensional (3D) reconstructions of cardiac vessels. Chest computed tomography displayed an anomalous soft tissue mass with slightly lobular borders in the peripheral segment of the left lower lobe. According to the aneurysm’s and lung neoplasm’s location, several procedures could be selected such as aneurysm resection with artificial graft replacement or endovascular stenting under angiography. Then, the lesion was removed by lobectomy using video-assisted thoracic surgery. Discussion and Evaluation Cardiovascular syphilis remains a major cause of ascending aortic aneurysm. The clinical manifestations of patients with syphilis aortic aneurysm could vary. Aortic imaging is necessary to confirm the diagnosis and to determine the anatomic extent of the aneurysm. The differential diagnosis of the lesion in the pulmonary is mostly the tumor like pulmonary lesion, Pulmonary syphilis. Some studies showed that thoracic aortic aneurysm has been reduced by using penicillin. However, penicillin therapy alone is not always sufficient in recent years. The serologic response to treatment is more significant and faster in patients treated with the enhanced regimen compared to patients treated with the standard penicillin regimen.
Conclusions Syphilitic aortic aneurysm with lung cancer is a rare disease in patient. Chest CT and CTA scans are able to indicate the presence of SAA. Pathological analysis is an effective method to clarify the diagnosis of the lung lesion. The interventional therapy and surgery are regular treatment method for SAA and pulmonary neoplasm.
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Affiliation(s)
- Wei Li
- Intervention Treatment Center, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Xiu-Jun Yin
- Department of Infectious Disease, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Hua-Ying Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Rong Yang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, GuoxueAlley, Chengdu, 610041 China
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Chadwick JA, MacNab A, Sarma J, Ray S, Kadir I, Muldoon EG. Secondary syphilis presenting with aortitis and coronary ostial occlusion. Sex Transm Infect 2015; 92:108-9. [PMID: 26670911 DOI: 10.1136/sextrans-2015-052247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/07/2015] [Indexed: 11/03/2022] Open
Abstract
Aortitis is an established manifestation of tertiary syphilis. We report a rare case of aortitis with ostial occlusion and left ventricular failure in secondary syphilis. Her management required a true multidisciplinary approach from multiple specialities due to complications of concomitant psychosis and a history of anaphylaxis to penicillin. This case illustrates the complexities of diagnosing and managing a rare presentation of this increasingly prevalent infection.
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Affiliation(s)
- John A Chadwick
- Department of Cardiology, University Hospital of South Manchester, UK
| | - Anita MacNab
- Department of Cardiology, University Hospital of South Manchester, UK
| | - Jaydeep Sarma
- Department of Cardiology, University Hospital of South Manchester, UK
| | - Simon Ray
- Department of Cardiology, University Hospital of South Manchester, UK
| | - Isaac Kadir
- Department of Cardiothoracic Surgery, University Hospital of South Manchester, UK
| | - Eavan G Muldoon
- Department of Infectious Diseases, University Hospital of South Manchester, UK The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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