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Li W, Li S, Wang J, Yu M, Yang H, He Z, Tang Y, Liu J, Guo N, Xie D, Liu Z, Zheng K, Xu M, Wu Y. The outer membrane protein Tp92 of Treponema pallidum delays human neutrophil apoptosis via the ERK, PI3K/Akt, and NF-κB pathways. Mol Microbiol 2023; 120:684-701. [PMID: 37718557 DOI: 10.1111/mmi.15164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023]
Abstract
Syphilis is a persistent sexually transmitted disease caused by infiltration of the elusive pathogen Treponema pallidum. Despite the prevalence of human polymorphonuclear neutrophils (hPMNs) within cutaneous lesions, which are characteristic of incipient syphilis, their role in T. pallidum infection remains unclear. Tp92 is the only T. pallidum helical outer membrane protein that exhibits structural features similar to those of outer membrane proteins in other gram-negative bacteria. However, the functional mechanism of this protein in immune cells remains unclear. Neutrophils are short-lived cells that undergo innate apoptosis in response to external stimuli that typically influence this process. In this study, we determined that Tp92 impedes the activation of procaspase-3 via the ERK MAPK, PI3K/Akt, and NF-κB signaling pathways, consequently suppressing caspase-3 activity within hPMNs, and thereby preventing hPMNs apoptosis. Furthermore, Tp92 could also modulate hPMNs apoptosis by enhancing the expression of the anti-apoptotic protein Mcl-1, stimulating IL-8 secretion, and preserving the mitochondrial membrane potential. These findings provide valuable insights into the molecular mechanisms underlying T. pallidum infection and suggest potential therapeutic targets for syphilis treatment.
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Affiliation(s)
- Weiwei Li
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, Institution of Pathogenic Biology, University of South China, Hengyang, China
- Department of Clinical Laboratory, The Second People's Hospital of Foshan, Foshan, China
| | - Sijia Li
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, Institution of Pathogenic Biology, University of South China, Hengyang, China
| | - Jianye Wang
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, Institution of Pathogenic Biology, University of South China, Hengyang, China
- Key Laboratory of Immune Microenvironment and Disease of the Ministry of Education, Department of Immunology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Maoying Yu
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, Institution of Pathogenic Biology, University of South China, Hengyang, China
| | - Hongyu Yang
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, Institution of Pathogenic Biology, University of South China, Hengyang, China
| | - Zhangping He
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, Institution of Pathogenic Biology, University of South China, Hengyang, China
| | - Yuanyuan Tang
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, Institution of Pathogenic Biology, University of South China, Hengyang, China
| | - Jie Liu
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, Institution of Pathogenic Biology, University of South China, Hengyang, China
| | - Ningyuan Guo
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, Institution of Pathogenic Biology, University of South China, Hengyang, China
| | - Dongde Xie
- Department of Clinical Laboratory, The Second People's Hospital of Foshan, Foshan, China
| | - Zhaoping Liu
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, Institution of Pathogenic Biology, University of South China, Hengyang, China
| | - Kang Zheng
- Department of Clinical Laboratory, Hengyang Central Hospital, Hengyang, China
| | - Man Xu
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, Institution of Pathogenic Biology, University of South China, Hengyang, China
| | - Yimou Wu
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, Institution of Pathogenic Biology, University of South China, Hengyang, China
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Bistas K, Mirza M. Neurosyphilis With Concomitant Respiratory Failure: A Case Study and Treatment Considerations. Cureus 2023; 15:e41363. [PMID: 37546114 PMCID: PMC10399702 DOI: 10.7759/cureus.41363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
This case report presents the case of a 58-year-old Caucasian male with hypercapnic respiratory failure (type 2 respiratory failure) and septic shock attributed to pneumonia. He also had multiorgan dysfunction and was subsequently diagnosed with neurosyphilis in the setting of underlying HIV. The patient initially presented with worsening shortness of breath and bilateral lower extremity edema. Further evaluation revealed HIV positivity with immunosuppression. The presence of neurologic symptoms on physical examination prompted investigation for an alternative etiology, ultimately leading to the diagnosis of neurosyphilis.
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Affiliation(s)
- Karlyle Bistas
- Psychiatry and Behavioral Sciences, Wayne State University Detroit Medical Center, Detroit, USA
| | - Maheen Mirza
- School of Medicine, Medical University of the Americas, Charlestown, KNA
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Cao W, Thorpe PG, O'Callaghan K, Kersh EN. Advantages and limitations of current diagnostic laboratory approaches in syphilis and congenital syphilis. Expert Rev Anti Infect Ther 2023; 21:1339-1354. [PMID: 37934903 PMCID: PMC10958575 DOI: 10.1080/14787210.2023.2280214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION The reemergence of syphilis, especially congenital syphilis, presents a significant public health threat. Accurate diagnosis of syphilis depends on recognition of a constellation of symptoms, review of medical and sexual history, and multiple laboratory tests. While reliable, current tests for syphilis can be difficult to interpret, which can lead to delays in treatment. AREA COVERED This review summarizes the major advantages and limitations of available diagnostic laboratory methods for syphilis, provides an update on recent advances in laboratory tools, and highlights the urgent need for coordinated efforts to create new tools to halt the resurgence of syphilis. EXPERT OPINION In syphilis, the wide variety of short-lived signs and symptoms followed by periods of latency create diagnostic challenges. Currently available laboratory tests, when positive, require additional information to interpret (prior testing, treatment, and sexual history). Point-of-care tests that can rapidly and accurately detect both treponemal and non-treponemal antibodies would be a huge step toward reducing test turnaround time and time to treatment. Incorporating biological insights and technology innovations to advance the development of direct detection assays is urgently needed. A comprehensive coordinated effort is critical to stem the tide of rising syphilis in the United States and globally.
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Affiliation(s)
- Weiping Cao
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Phoebe G Thorpe
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kevin O'Callaghan
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ellen N Kersh
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Katayama K, Ishizuka K, Tawara J, Kaji Y, Komuta M, Hayashi Y, Gomi H, Akahane M, Ohira Y. Temporal Arteritis Caused by Tertiary Syphilis. Intern Med 2023; 62:1095-1097. [PMID: 36047113 PMCID: PMC10125830 DOI: 10.2169/internalmedicine.9779-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 77-year-old man arrived at our hospital with bilateral shoulder pain persisting for several months and headache for 1 month. Giant cell arteritis with polymyalgia rheumatica was suspected. However, considering his medical history of testing positive for syphilis, we submitted a sample for a syphilis serology test, which yielded positive results. The Treponema pallidum hemagglutination assay of cerebrospinal fluid was positive, and a temporal artery biopsy revealed vasculitis, confirming the diagnosis of tertiary syphilis. He was successfully treated for two weeks with penicillin G infusions. Symptoms reminiscent of giant cell arteritis and polymyalgia rheumatica may reveal syphilis, which is called the "great imitator."
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Affiliation(s)
- Kohta Katayama
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Junsuke Tawara
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Yuki Kaji
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Mina Komuta
- Department of Pathology, International University of Health and Welfare, Japan
| | - Yuichiro Hayashi
- Department of Pathology, International University of Health and Welfare, Japan
| | - Harumi Gomi
- Office of Medical Education and Center for Infectious Diseases, International University of Health and Welfare, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, Japan
| | - Yoshiyuki Ohira
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
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Edmondson DG, De Lay BD, Hanson BM, Kowis LE, Norris SJ. Clonal isolates of Treponema pallidum subsp. pallidum Nichols provide evidence for the occurrence of microevolution during experimental rabbit infection and in vitro culture. PLoS One 2023; 18:e0281187. [PMID: 36917571 PMCID: PMC10013896 DOI: 10.1371/journal.pone.0281187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/17/2023] [Indexed: 03/15/2023] Open
Abstract
The recent development of a system for long-term in vitro culture of the syphilis spirochete, Treponema pallidum subsp. pallidum, has introduced the possibility of detailed genetic analysis of this bacterium. In this study, the in vitro culture system was used to isolate and characterize clonal populations of T. pallidum subsp. pallidum Nichols, the most widely studied strain. In limiting dilutions experiments, it was possible to establish cultures with inocula as low as 0.5 T. pallidum per well despite the long generation time (~35 to 40 hours) of this organism. Six Nichols strain clones isolated by limiting dilution were characterized in detail. All clones exhibited indistinguishable morphology and motility, highly similar in vitro multiplication rates, and comparable infectivity in the rabbit model (ID50 ≤ 100 bacteria). Genomic sequencing revealed sequence heterogeneity in the form of insertions or deletions at 5 sites, single nucleotide variations at 20 sites, and polynucleotide (polyG/C) tract length differences at 22 locations. Genomic sequences of the uncloned Nichols strain preparations propagated in rabbits or in vitro cultures exhibited substantial heterogeneity at these locations, indicating coexistence of many varied 'clonotypes' within these populations. Nearly all genetic variations were specific for the Nichols strain and were not detected in the >280 T. pallidum genomic sequences that are currently available. We hypothesize that these Nichols strain-specific sequence variations arose independently either during human infection or within the 110 years since the strain's initial isolation, and thus represent examples of microevolution and divergence.
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Affiliation(s)
- Diane G. Edmondson
- Department of Pathology & Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, United States of America
| | - Bridget D. De Lay
- Department of Pathology & Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, United States of America
| | - Blake M. Hanson
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, United States of America
- Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, Texas, United States of America
| | - Lindsay E. Kowis
- Houston Methodist Research Institute, Infectious Disease, Houston, Texas, United States of America
| | - Steven J. Norris
- Department of Pathology & Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, United States of America
- Department of Microbiology & Molecular Genetics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, United States of America
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Usmael SA, Gebremedhin TA. Atypical presentation of syphilis: Rapidly progressive glomerulonephritis. Clin Case Rep 2023; 11:e6864. [PMID: 36694644 PMCID: PMC9842786 DOI: 10.1002/ccr3.6864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Syphilis is a sexually transmitted disease with a wide range of clinical manifestations. With the recent worldwide resurgence of syphilis, it is imperative to recognize various presentations of this great imitator. Renal syphilis is rare and most commonly present as nephrotic range proteinuria associated with pathological features of membranous glomerulonephritis. Rapidly progressive glomerulonephritis (RPGN) is a rare and atypical form of renal syphilis. A 50-year-old Ethiopian woman presented with periorbital swelling, hematuria, proteinuria, and rapidly progressive renal failure. Rapid plasma reagin and confirmatory Treponema pallidum hemagglutination (TPHA) tests were reactive. Treatment with a weekly Benzathine penicillin for 3 weeks resulted in a rapid return of renal function to baseline, with the increasing rate of new syphilis, clinicians should be mindful of the various renal manifestation of syphilis. This case highlights the significance of considering syphilis as a reversible cause in any patient presenting with a clinical feature suggestive of RPGN.
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Affiliation(s)
- Semir Abdi Usmael
- Internal Medicine DepartmentCollege of Health and Medical Sciences, Haramaya UniversityHararEthiopia
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Muacevic A, Adler JR. Clinical Conundrums: Differentiating Monkeypox From Similarly Presenting Infections. Cureus 2022; 14:e29929. [PMID: 36348880 PMCID: PMC9634140 DOI: 10.7759/cureus.29929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 01/03/2023] Open
Abstract
Post the coronavirus disease 2019 (COVID-19) pandemic, there arises the concern of a new epidemic as cases of monkeypox are being confirmed, globally. With the initial clinical manifestation of monkeypox resembling that of the common cold or seasonal flu, recognizing alternative differential diagnoses is imperative as a medical health practitioner. The characteristic monkeypox maculopapular rash with the progression to vesicles and pustules before scabbing can be described in several other infections. Understanding the disease progression and distinct clinical presentation of monkeypox in its various stages may allow for a more expedient diagnosis among healthcare providers. Though eradicated, the clinical presentation of smallpox is the most similar to that of monkeypox; however, smallpox is no longer a concern for the general population. Other conditions such as molluscum contagiosum, syphilis, varicella zoster, measles, rickettsialpox, and scabies can present with rashes that may resemble singular or multiple states of the monkeypox rash progression. The ability to correctly diagnose an individual's condition promptly may allow healthcare providers to provide correct supportive therapies or treatments.
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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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Mehta N, Bhari N, Gupta S. Asian guidelines for syphilis. J Infect Chemother 2022; 28:1084-1091. [PMID: 35527175 DOI: 10.1016/j.jiac.2022.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Nikhil Mehta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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Šmit R, Wojtalewicz N, Vierbaum L, Nourbakhsh F, Schellenberg I, Hunfeld KP, Lohr B. Epidemiology, Management, Quality of Testing and Cost of Syphilis in Germany: A Retrospective Model Analysis. Front Public Health 2022; 10:883564. [PMID: 35558533 PMCID: PMC9086961 DOI: 10.3389/fpubh.2022.883564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background A multi-dimensional model can be a useful tool for estimating the general impact of disease on the different sectors of the healthcare system. We chose the sexually transmitted disease syphilis for our model due to the good quality of reported data in Germany. Methods The model included gender- and age-stratified incident cases of syphilis (in- and outpatients) provided by a German statutory health insurance company, as well as seroprevalence data on syphilis in first-time blood donors. Age standardized rates were calculated based on the standard German population. The test quality was assessed by extrapolating the number of false-positive and false-negative results based on data from Europe-wide external quality assessment (EQA) schemes. The model analysis was validated with the reported cases and diagnosis-related group (DRG)-statistics from 2010 to 2012. The annual direct and indirect economic burden was estimated based on the outcomes of our model. Results The standardized results were slightly higher than the results reported between 2010 and 2012. This could be due to an underassessment of cases in Germany or due to limitations of the dataset. The number of estimated inpatients was predicted with an accuracy of 89.8 %. Results from EQA schemes indicated an average sensitivity of 92.8 % and an average specificity of 99.9 % for the recommended sequential testing for syphilis. Based on our model, we estimated a total average minimal annual burden of €20,292,110 for syphilis on the German healthcare system between 2010 and 2012. Conclusions The linking of claims data, results from EQA schemes, and blood donor surveillance can be a useful tool for assessing the burden of disease on the healthcare system. It can help raise awareness in populations potentially at risk for infectious diseases, demonstrate the need to educate potential risk groups, and may help with predictive cost calculations and planning.
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Affiliation(s)
- Renata Šmit
- Northwest Medical Centre, Medical Faculty, Academic Teaching Hospital, Institute for Laboratory Medicine, Microbiology and Infection Control, Goethe University, Frankfurt, Germany
- INSTAND e.V. Gesellschaft zur Foerderung der Qualitaetssicherung in Medizinischen Laboratorien e.V, Duesseldorf, Germany
| | - Nathalie Wojtalewicz
- INSTAND e.V. Gesellschaft zur Foerderung der Qualitaetssicherung in Medizinischen Laboratorien e.V, Duesseldorf, Germany
| | - Laura Vierbaum
- INSTAND e.V. Gesellschaft zur Foerderung der Qualitaetssicherung in Medizinischen Laboratorien e.V, Duesseldorf, Germany
| | - Farzin Nourbakhsh
- Northwest Medical Centre, Medical Faculty, Academic Teaching Hospital, Institute for Laboratory Medicine, Microbiology and Infection Control, Goethe University, Frankfurt, Germany
| | - Ingo Schellenberg
- INSTAND e.V. Gesellschaft zur Foerderung der Qualitaetssicherung in Medizinischen Laboratorien e.V, Duesseldorf, Germany
- Center of Life Sciences, Institute of Bioanalytical Sciences (IBAS), Anhalt University of Applied Sciences, Bernburg, Germany
| | - Klaus-Peter Hunfeld
- Northwest Medical Centre, Medical Faculty, Academic Teaching Hospital, Institute for Laboratory Medicine, Microbiology and Infection Control, Goethe University, Frankfurt, Germany
- INSTAND e.V. Gesellschaft zur Foerderung der Qualitaetssicherung in Medizinischen Laboratorien e.V, Duesseldorf, Germany
| | - Benedikt Lohr
- Northwest Medical Centre, Medical Faculty, Academic Teaching Hospital, Institute for Laboratory Medicine, Microbiology and Infection Control, Goethe University, Frankfurt, Germany
- INSTAND e.V. Gesellschaft zur Foerderung der Qualitaetssicherung in Medizinischen Laboratorien e.V, Duesseldorf, Germany
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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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Ruangtragool L, Silver R, Machiha A, Gwanzura L, Hakim A, Lupoli K, Musuka G, Patel H, Mugurungi O, Tippett Barr BA, Rogers JH. Factors associated with active syphilis among men and women aged 15 years and older in the Zimbabwe Population-based HIV Impact Assessment (2015–2016). PLoS One 2022; 17:e0261057. [PMID: 35298475 PMCID: PMC8929562 DOI: 10.1371/journal.pone.0261057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Ulcerative STIs, including syphilis, increase the risk for HIV acquisition and transmission due to the presence of ulcers/chancres that serve as a point-of-entry and exit for HIV. In Zimbabwe, diagnosis of syphilis often occurs in pregnant women who seek ANC services where syphilis testing is offered, and among men and women who seek health care for STIs. Zimbabwe’s national syphilis estimates are based on these diagnosed cases, with little information available about the prevalence of untreated syphilis among the general population. This analysis uses data from ZIMPHIA (2015–2016) to describe factors associated with active syphilis among men and women ages 15 years and older. Methods ZIMPHIA collected blood specimens for HIV and syphilis testing from 22,501 consenting individuals (ages 15 years and older). Household HIV testing used the national HIV rapid-testing algorithm with HIV-positive results confirmed at satellite laboratories using Geenius HIV-1/2 rapid test (Bio-rad, Hercules, California, USA). Point-of-care non-Treponemal and Treponemal syphilis testing was performed using Chembio’s Dual-Path Platform Syphilis Screen & Confirm Assay. Factors associated with active syphilis were explored using multiple variable, weighted logistic regression and were stratified by gender. Results The likelihood of active syphilis in HIV-positive females was 3.7 times greater in HIV-positive females than HIV-negative females (aOR: 3.7, 95% CI 2.3–5.9). Among males odds of having active syphilis was 5 times higher among those that engaged in transactional sex than those who did not have sex or transactional sex (aOR: 5.3, 95% CI 1.9–14.7), and 6 times higher if HIV positive versus negative (aOR: 5.9, 95% CI 3.0–12.0). Urban residence, province, education (highest attended), marital status, number of sex partners, consistency of condom use, pregnancy status (females), and circumcision status (males) were not significant in the adjusted model for either females or males. Conculsion HIV status was found to be the only factor associated with active syphilis in both females and males. Given the persistent link between HIV and active syphilis, it is prudent to link individuals’ diagnoses and treatments, as recommended by the WHO. Enhanced integration of STI and HIV services in health delivery points such as ANC, reproductive services, or male circumcision clinics, combined with consistent, targeted outreach to high-risk populations and their partners, may assist the MOHCC to eliminate active syphilis in Zimbabwe.
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Affiliation(s)
- Leala Ruangtragool
- Public Health Institute / CDC Global HIV Surveillance Fellow, Harare, Zimbabwe
| | - Rachel Silver
- Public Health Institute / CDC Global HIV Surveillance Fellow, Harare, Zimbabwe
| | - Anna Machiha
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Avi Hakim
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Katie Lupoli
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Hetal Patel
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Beth A. Tippett Barr
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - John H. Rogers
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
- * E-mail:
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Yan X, Wang X, Zhang X, Wang L, Zhang B, Jia Z. The Epidemic of Sexually Transmitted Diseases Under the Influence of COVID-19 in China. Front Public Health 2022; 9:737817. [PMID: 34976912 PMCID: PMC8716580 DOI: 10.3389/fpubh.2021.737817] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/15/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Prevention and control of HIV/AIDS and other sexually transmitted diseases (STDs) are major public health priorities in China, but are influenced by the COVID-19 epidemic. In this study, we aimed to quantitatively explore the impact of the COVID-19 epidemic and its control measures on five major STD epidemics in China. Methods: A monthly number of newly reported cases of HIV/AIDS, hepatitis B and C, gonorrhea, and syphilis from January 2010 to December 2020 were extracted to establish autoregressive integrated moving average (ARIMA) models. Each month's absolute percentage error (APE) between the actual value and model-predicted value of each STD in 2020 was calculated to evaluate the influence of the COVID-19 epidemic on the STDs. Pearson correlation analysis was conducted to explore the confirmed COVID-19 case numbers and the COVID-19 control measures' correlations with the case numbers and the APEs of five STDs in 2020. Results: The actual number of five STDs in China was more than 50% lower than the predicted number in the early days of the COVID-19 epidemic, especially in February. Among them, the actual number of cases of hepatitis C, gonorrhea, and syphilis in February 2020 was more than 100% lower than the predicted number (APE was −102.3, −109.0, and −100.4%, respectively). After the sharply declines of STDs' reported cases in early 2020, the case numbers recovered quickly after March. The epidemic of STDs was negatively associated with the COVID-19 epidemic and its control measures, especially for restrictions on gathering size, close public transport, and stay-at-home requirements (p < 0.05). Conclusion: COVID-19 had a significant but temporary influence on the STD epidemic in China. The effective control of COVID-19 is vital for STD prevention. STD services need to be improved to prevent STDs from becoming a secluded corner in the shadow of COVID-19.
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Affiliation(s)
- Xiangyu Yan
- School of Public Health, Peking University, Beijing, China
| | - Xuechun Wang
- School of Public Health, Peking University, Beijing, China
| | - Xiangyu Zhang
- School of Public Health, Peking University, Beijing, China
| | - Lei Wang
- Taiyuan Center for Disease Control and Prevention, Taiyuan, China
| | - Bo Zhang
- School of Public Health, Peking University, Beijing, China
| | - Zhongwei Jia
- School of Public Health, Peking University, Beijing, China.,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China.,Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, China
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14
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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: 5] [Impact Index Per Article: 1.7] [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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15
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Chang KM, Nadi L, Wallach F. Secondary syphilis with alopecia and ocular manifestation. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 54:758-759. [PMID: 33423955 DOI: 10.1016/j.jmii.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Kai-Ming Chang
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, USA.
| | - Lemar Nadi
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, USA
| | - Frances Wallach
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, USA
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16
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West-Livingston LN, Dittman JM, Park JA, Pascarella L. Sexual orientation, gender identity, and gender expression: From current state to solutions for the support of lesbian, gay, bisexual, transgender, and queer/questioning patients and colleagues. J Vasc Surg 2021; 74:64S-75S. [PMID: 34303461 DOI: 10.1016/j.jvs.2021.03.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/23/2021] [Indexed: 01/16/2023]
Abstract
Many of the systemic practices in medicine that have alienated lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) individuals persist today, undermining the optimal care for these patients and isolating LGBTQ medical providers from their colleagues. The 2020 Task Force on Diversity, Equity, and Inclusion Report recently published by the Society for Vascular Surgery marked the first publication advocating for the inclusion of sexual orientation and sexual identity in the development of initiatives promoting and protecting diversity across vascular surgery. Vascular providers should be aware that it is crucial to cultivate an environment that is inclusive for LGBTQ patients because a large proportion of these patients have reported not self-disclosing their status to medical providers, either out of concern over potential personal repercussions or failing to recognize the potential relevance of LGBTQ status to their medical care. Safe Zone training has provided a standard resource for providers and staff that can be integrated into onboarding and routine training. Clarifying the current terminology for sexual orientation and identity will ensure that vascular providers will recognize patients who could benefit from screening for additional vascular risk factors relevant to this population related to sexual health, social behavior, physical health, and medical therapies. The adoption of gender neutral language on intake forms and general correspondence with colleagues is key to reducing the unintended exclusion of those with LGBTQ identities in both inpatient and outpatient environments. In many locales across the United States, the professional and personal repercussions for openly reporting LGBTQ status persist, complicating efforts toward quantifying, recognizing, and supporting these patients, practitioners, and trainees. Contributing to an inclusive environment for patients and peers and acting as a professional ally are congruent with the ethos in vascular surgery to treat all patients and colleagues with respect and optimize the healthcare of every vascular patient.
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Affiliation(s)
| | - James M Dittman
- Virginia Commonwealth University School of Medicine, Richmond, Va
| | - Jason A Park
- Boston University School of Medicine, Boston, Mass
| | - Luigi Pascarella
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.
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17
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Yuylana C, Iswanty M, Paturusi II. Secondary syphilis mimicking tinea cruris in an HIV infected patient: a case report. Pan Afr Med J 2021; 38:133. [PMID: 33912303 PMCID: PMC8052625 DOI: 10.11604/pamj.2021.38.133.27922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/03/2021] [Indexed: 11/11/2022] Open
Abstract
Syphilis is known as the great imitator with various clinical presentations which often lead to confusion and misdiagnosis. A 28-year-old male presented with non-pruritic and painless erythematous patches around the anus and scrotum. Initial differential diagnosis with tinea cruris. Fungal examination was negative. Serological tests for syphilis were positive and anti-HIV screening was reactive. A diagnosis of secondary syphilis was established and the patient was given intramuscular injection of 2.4 million unit of benzathine penicillin. The skin lesions improved significantly 1 week after treatment, confirming a diagnosis of secondary syphilis with HIV. Annular skin lesions in secondary syphilis are uncommon and often misleading. This case emphasizes the importance of considering secondary syphilis in the differential diagnosis of annular lesions.
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Affiliation(s)
- Cyntia Yuylana
- Department of Dermatology and Venereology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muji Iswanty
- Department of Dermatology and Venereology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Idrianti Idrus Paturusi
- Department of Dermatology and Venereology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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18
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Siddiqui RS, Sumbly V, Abrudescu A. A Case of Rapidly Proliferative Glomerulonephritis Secondary to Syphilis That Responded to Treatment With Penicillin. Cureus 2021; 13:e13468. [PMID: 33777557 PMCID: PMC7987295 DOI: 10.7759/cureus.13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The involvement of kidneys in syphilis has been reported in the literature with the majority of cases presenting with nephrotic-range proteinuria. We report a case of rapidly proliferative glomerulonephritis in a patient with secondary syphilis. A 40-year-old male with a history of human immunodeficiency virus (HIV), chronic hepatitis B virus, and chronic kidney disease stage 2 presented with fatigue, anorexia, weight loss, arthralgia, chills, and rash throughout the body. The patient was non-compliant with HIV medication and had unprotected sexual intercourse. Labs showed blood urea nitrogen of 57 mg/dL (range: 7-23 mg/dL), creatinine 8.2 mg/dL (range: 0.5-1.3 mg/dL), and high titers of rapid plasma reagin. The biopsy showed crescentic glomerulonephritis with c3 deposition in mesangium and basement membrane. The patient responded to treatment with penicillin therapy with gradual improvement in kidney function.
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Affiliation(s)
- Raheel S Siddiqui
- Internal Medicine, Icahn School of Medicine at Mount Sinai (New York City Health and Hospitals/Queens), Jamaica, USA
| | - Vikram Sumbly
- Internal Medicine, Icahn School of Medicine at Mount Sinai (New York City Health and Hospitals/Queens), Jamaica, USA
| | - Adriana Abrudescu
- Rheumatology, Icahn School of Medicine at Mount Sinai (New York City Health and Hospitals/Queens), Jamaica, USA
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19
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Stone CE, Onyekaba NA, Lucas M, Jukic D. Cutaneous Secondary Syphilis Resembling Non-Melanoma Skin Cancer. Cureus 2020; 12:e10774. [PMID: 33033668 PMCID: PMC7532864 DOI: 10.7759/cureus.10774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The cutaneous manifestations of secondary syphilis can vary significantly between patients, leading to a more difficult or delayed diagnosis. Here we present an instructive case of secondary syphilis in a 45-year-old, HIV-positive male patient. He presented with a solitary, crusted anterior neck nodule without concomitant systemic symptoms. Together, history and physical exam were concerning for non-melanoma skin cancer. Histopathologic evaluation of the lesion revealed an extensive infiltrate of plasma cells at the dermoepidermal junction, and immunohistochemical staining revealed numerous Treponema pallidum microorganisms. Physicians must keep syphilis in the differential diagnosis when evaluating atypical nodular lesions resembling non-melanoma skin cancer for the purpose of initiating appropriate antibiotic treatment and preventing future infectious complications.
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Affiliation(s)
| | | | - Matthew Lucas
- Dermatology, Winn Army Community Hospital, Fort Stewart, USA
| | - Drazen Jukic
- Dermatology, University of Florida, Gainesville, USA.,Pathology, Mercer University School of Medicine, Savannah, USA.,Dermatopathology, Georgia Dermatopathology, Savannah, USA.,Telepathology, James A. Haley Veterans' Hospital, Tampa, USA
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20
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Abstract
Since a brief low in 1998, reported cases of syphilis have continued to grow in the US. As primary care providers, NPs are at the forefront of the battle to eliminate syphilis. This article reviews the stages of this infection, diagnosis nuances, and treatment guidelines.
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21
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Roy M, Roy AK, Farrell JJ. Ocular syphilis in an immunocompetent host. IDCases 2019; 19:e00684. [PMID: 32099808 PMCID: PMC7030984 DOI: 10.1016/j.idcr.2019.e00684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 10/26/2022] Open
Abstract
Syphilis is an old disease that experienced a resurgence with the emergence of HIV/AIDS. Syphilis is a reportable infection that is monitored by the Centers for disease Control (CDC) in the U.S. and rates have been rising since 2000. Although ocular syphilis is a well known consequence of syphilis infection it continues to be less frequently diagnosed, partially because ocular manifestations are not reportable to CDC. While the majority of recent cases in the U.S. have been reported in men who have sex with men (MSM) population, 50 % of these cases are HIV negative. We present a case of acute iridocyclitis and ocular hypertension due to syphilis infection. This case reiterates the need to increase healthcare workers' awareness of the importance of timely recognition of potential ocular syphilis to prevent visual sequelae from the infection. Ocular syphilis should be kept in the differential diagnosis in immunocompetent/HIV negative patients, and the importance of obtaining a detailed sexual history should not be forgotten.
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Affiliation(s)
- Moni Roy
- OSF Saint Francis Medical Center, Peoria, IL, USA.,University Of Illinois College of Medicine, Department of Medicine, Peoria, IL, USA
| | - Ashish K Roy
- OSF Saint Francis Medical Center, Peoria, IL, USA
| | - John J Farrell
- University Of Illinois College of Medicine, Department of Medicine, Peoria, IL, USA.,OSF System Laboratory, Peoria, IL, USA
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22
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Xu L, Tan H, Yang Z. Multiple Liver Lesions in a Woman With Asthenia, Anorexia, and Fever. JAMA Surg 2019; 153:592-593. [PMID: 29710209 DOI: 10.1001/jamasurg.2018.0595] [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]
Affiliation(s)
- Li Xu
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Haidong Tan
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhiying Yang
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
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23
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Abstract
We herein report a patient with syphilitic cervicitis and cervical cancer presenting as oropharyngeal syphilis. A 31-year-old Japanese woman with a history of unprotected vaginal and oral sex visited our hospital with right submandibular adenomas and erythema in the extremities. The fornix uteri was red, with a nodule noted. The rapid plasma reagin ratio was 1:3. She was diagnosed with syphilitic cervicitis and treated with amoxicillin for four weeks. Initial cervical cytology showed cells with mild nuclear enlargement, which was thought to be metaplasia associated with syphilis. Repeated cytology a month later showed a high-grade squamous intraepithelial lesion. A punch biopsy of the lesion led to the pathological diagnosis of cervical carcinoma in situ. We performed cervical conization, and no recurrence occurred. Human papillomavirus (HPV) immunostaining was positive in the lesion. Mucosal lesions are an infrequently reported symptom of syphilis. When oropharyngeal lesions are found, the sexual history should be ascertained, and the patient should be screened for sexually transmitted diseases. HPV is especially significant because of its association with cervical cancer. Coinfection of HPV with cervical cancer must be ruled out during follow-up for women when oropharyngeal syphilis involves genital lesions.
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Affiliation(s)
- Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Yohei Kanzawa
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Hiroyuki Seto
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Saori Kinami
- Department of General Internal Medicine, Akashi Medical Center, Japan
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24
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Triningrat AAMP, Budi NMW, Juliari IGAM, Surasmiati NMA, Siska S, Suryaningrum IGAR. Neuroretinitis Syphilis in Human Immunodeficiency Virus-Infected Patient. Open Access Maced J Med Sci 2019; 7:1987-1990. [PMID: 31406542 PMCID: PMC6684424 DOI: 10.3889/oamjms.2019.471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In HIV-infected patient who accompanied by syphilis often difficult to diagnose and difficult to treat. The aim is to diagnostics understanding and to optimise the management and response therapy in patients with neuroretinitis syphilis in HIV-infected patients. CASE PRESENTATION A 53-years old, bisexual, male patient whose initial presentation was a blurry vision on the left eye. History of a painless genital lesion, HIV infection (+) on ARV therapy. The visual acuity of hand movement (HM), RAPD (+), with vitreous opacities and optic disc swelling. The OCT RNFL showed neural layer thickening in all areas. VEP showed increased P100 latency, normal head and orbital CT scan. High VDRL and TPHA titer. Lumbar puncture examination showed non-reactive VDRL. Treated with topical prednisolone eye drops, oral neurotropic vitamin, and intramuscular injection of Benzathine Penicillin G. Diagnosed with OS neuroretinitis et causa syphilis infection, HIV stage II on HAART. Follow up in 2 months, the visual acuity improved, and serology post-therapy VDRL was decreased. CONCLUSION High accuracy is needed for screening signs and symptoms in syphilis patients because of the varied clinical manifestations. Ocular syphilis manifestation in HIV has a higher risk for neurologic complications and the risk of failing treatment with the standard regimen.
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Affiliation(s)
| | | | - IGAM Juliari
- Department of Ophthalmology, Faculty of Medicine, Udayana University, Bali, Indonesia
| | | | - Siska Siska
- Department of Ophthalmology, Faculty of Medicine, Udayana University, Bali, Indonesia
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25
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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: 3] [Impact Index Per Article: 0.6] [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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26
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Ro A, Mori S, Kageyama N, Chiba S, Mukai T. Ruptured Syphilitic Aneurysm: A Cause of Sudden Death in a Man with Human Immunodeficiency Coinfection. J Forensic Sci 2019; 64:1555-1558. [DOI: 10.1111/1556-4029.14046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Ayako Ro
- Department of Legal Medicine St. Marianna University School of Medicine Kanagawa 216‐8511 Japan
- Tokyo Medical Examiner's Office Otuska 4‐21‐18, Bunkyo‐ku Tokyo 112‐0012 Japan
| | - Shinjirou Mori
- Tokyo Medical Examiner's Office Otuska 4‐21‐18, Bunkyo‐ku Tokyo 112‐0012 Japan
| | - Norimasa Kageyama
- Department of Legal Medicine St. Marianna University School of Medicine Kanagawa 216‐8511 Japan
- Tokyo Medical Examiner's Office Otuska 4‐21‐18, Bunkyo‐ku Tokyo 112‐0012 Japan
| | - Shoetsu Chiba
- Department of Legal Medicine St. Marianna University School of Medicine Kanagawa 216‐8511 Japan
| | - Toshiji Mukai
- Department of Legal Medicine St. Marianna University School of Medicine Kanagawa 216‐8511 Japan
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27
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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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Serigado J, Lewis E, Kim G. Rectal bleeding caused by a syphilitic inflammatory mass. BMJ Case Rep 2019; 12:12/1/e226595. [PMID: 30696637 DOI: 10.1136/bcr-2018-226595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 47-year-old man presented with fatigue, decrease appetite, abdominal pain and rectal bleeding. His colonoscopy revealed a single, firm, raised, centrally ulcerated mass at the anorectal junction. During this same admission, he was diagnosed with HIV and syphilis, found to have multiple hepatic lesions and positive cerebrospinal fluidvenereal disease research laboratory test (VDRL). Biopsies from both the hepatic lesions and rectal ulcer showed spirochaetes by immunostaining. The initial presentation was felt to be secondary to a rectal inflammatory mass caused by syphilis.
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Affiliation(s)
- Joao Serigado
- Medicine, University of Miami School of Medicine, Miami, Florida, USA
| | - Eugene Lewis
- St. Vincent's Medical Center, Bridgeport, Connecticut, USA
| | - Grace Kim
- St. Vincent's Medical Center, Bridgeport, Connecticut, USA
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López-Balderas N, Hernández-Romano J, Cámara-Contreras M, Bravo-Sarmiento E, Hernández-Romano PA. Trends in prevalence of HIV and syphilis in a central blood bank of Veracruz, Mexico. Transfus Apher Sci 2018; 58:94-99. [PMID: 30554960 DOI: 10.1016/j.transci.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/13/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
Syphilis and HIV infections continue to threaten the safety of blood banks in countries where altruistic donations are rare. The aim of this study of blood donors to the Centro Estatal de la Transfusion Sanguínea de Veracruz (Mexico) was to determine changes in the prevalence of syphilis and HIV, and to identify factors associated with these infections. A total of 109,054 blood donors were retrospectively analyzed from 2007 to 2014. Serological screening of blood units was performed, and demographic data were collected from clinical records to identify risk factors. The prevalence of Treponema pallidum was 1.4% and that of confirmed HIV was 0.11%. The main risk factors for HIV positivity were age of 18 to 24 years-old, being unmarried, and being an employee or student. The main risk factors for syphilis positivity were being a widow or divorced, being over 35 years-old, having a low level of education, and being a driver, fisherman, or trade worker. There were high prevalences for both infections in southeast Veracruz, where females and males had equal probabilities of each infection. Strengthening of education programs on sexually transmitted diseases for young people may help to prevent new and congenital infections.
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Affiliation(s)
- Nayali López-Balderas
- Laboratorio de Genética Humana y Biología Molecular, Hospital de Alta Especialidad de Veracruz, Veracruz, Mexico; Instituto de Medicina Forense, Universidad Veracruzana, Veracruz, Veracruz, Mexico
| | | | - Mireya Cámara-Contreras
- Laboratorio de Genética Humana y Biología Molecular, Hospital de Alta Especialidad de Veracruz, Veracruz, Mexico
| | | | - Pablo A Hernández-Romano
- Laboratorio de Biología Molecular, Centro Estatal de la Transfusión Sanguínea del Estado de Veracruz, Veracruz, Mexico; Facultad de Bioanálisis, Universidad Veracruzana, Veracruz, Veracruz, Mexico.
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Liang X, Liu T, Yuan C, Wang W, Liang P. The disappearance of femoral head and neck resulting from extensive bone defect caused by secondary syphilis: a case report and literature review. BMC Musculoskelet Disord 2018; 19:251. [PMID: 30045704 PMCID: PMC6060474 DOI: 10.1186/s12891-018-2152-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 06/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Treponema Pallidum (TP), the pathogen of syphilis, commonly infects bones in cases of congenital and tertiary syphilis, but it is rare in the primary and secondary stages. With its mild symptoms and rare clinical findings, it might be easy to dismiss the diagnosis of early syphilis. Usually, effective results can be achieved after the conventional strategy of antibiotic treatments, mainly penicillin. To our knowledge, our case is so far the most serious reported case of destructive bone lesion in secondary syphilis, and our treatment for the case is the first strategy using total hip arthroplasty in secondary syphilis. Case presentation We present the case of a 71-year-old man with local repeated pain and dysfunction in the right hip. Radiologic examinations showed the disappearance of the ipsilateral femoral head and neck. After excluding the aetiologies of cancer metastasis and tuberculosis, we confirmed the diagnosis of syphilitic arthritis. The patient received the medical treatment of antibiotics and the surgical treatment of total hip arthroplasty. At the follow-up of 1, 3, and 5.5 years after the operation, the patient presented with a pain-free and functional hip prosthesis without local signs of infection and loosening. Conclusions This report highlights the difficulties of early diagnosis of secondary syphilis with bone involvement. Bone defect of the femur with secondary syphilis, especially at the proximal femur, was an extremely rare complication in the previous reports. Our case was the first case of a patient who experienced the disappearance of femoral head and neck caused by secondary syphilis. Follow-up after the operation proved the successful treatment of the extensive bone defect of femur by total hip arthroplasty.
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Affiliation(s)
- Xiao Liang
- Department of Orthopaedics, the Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
| | - Tang Liu
- Department of Orthopaedics, the Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China
| | - Chuang Yuan
- Medical Research Center, Changsha Central Hospital, 161 Shaoshan Road, Changsha, 410004, Hunan, People's Republic of China
| | - Wanchun Wang
- Department of Orthopaedics, the Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, Hunan, 410011, People's Republic of China.
| | - Peixiong Liang
- Department of Orthopaedics, Xiangtan Central Hospital, 120 Heping Road, Xiangtan, 411100, Hunan, People's Republic of China
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Amaya-Guio J, Grillo-Ardila CF, Angel-Müller E, Torres-Montañez NA, Vasquez-Velez LF. Point of care rapid test for diagnosis of syphilis infection in pregnant women. Hippokratia 2018. [DOI: 10.1002/14651858.cd013037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jairo Amaya-Guio
- Faculty of Medicine, Universidad Nacional de Colombia; Department of Obstetrics and Gynecology; Bogota Colombia
| | - Carlos F Grillo-Ardila
- Faculty of Medicine, Universidad Nacional de Colombia; Department of Obstetrics and Gynecology; Bogota Colombia
| | - Edith Angel-Müller
- Faculty of Medicine, Universidad Nacional de Colombia; Department of Obstetrics and Gynecology; Bogota Colombia
| | - Nicolas A Torres-Montañez
- Faculty of Medicine, Universidad Nacional de Colombia; Department of Obstetrics and Gynecology; Bogota Colombia
| | - Luisa F Vasquez-Velez
- Faculty of Medicine, Universidad Nacional de Colombia; Department of Obstetrics and Gynecology; Bogota Colombia
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Provider Adherence to Syphilis Testing Recommendations for Women Delivering a Stillbirth. Sex Transm Dis 2018; 44:685-690. [PMID: 28876321 DOI: 10.1097/olq.0000000000000656] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess overall adherence to Centers for Disease Control and Prevention and American College of Obstetrics and Gynecology recommended guidelines for syphilis testing among women who delivered a stillbirth and compare it with other tests recommended for stillbirth evaluation. METHODS We used MarketScan claims data with 40 million commercially insured and 8 million Medicaid enrollees annually to estimate prenatal care and follow-up testing among women who had stillbirths between January 1, 2013, and December 24, 2013. Stillbirth was identified if women had any International Classification of Disease, Ninth Revision codes related to a stillbirth outcome. Among women with stillbirths, we estimated the proportions of women who received prenatal care and prenatal syphilis testing within 280 days before stillbirth, and testing at the time of stillbirth (syphilis testing, complete blood count, placental examination and autopsy) using Physician's Current Procedural Terminology codes. RESULTS We identified 3672 Medicaid-insured women and 6023 commercially insured women with stillbirths in 2013. Approximately, 61.7% of Medicaid-insured women and 66.0% of commercially insured women had claims data indicating prenatal syphilis testing. At the time of stillbirth, Medicaid-insured and commercially insured women had similar rates of syphilis testing (6.5% vs 9.3%), placental examination (61.6% vs 57.8%), and complete blood count (31.9% vs 37.6%). Autopsies were too infrequent to be reported. Approximately, 34.6% of Medicaid-insured women and 29.7% of commercially insured women had no syphilis testing either prenatally or at the time of stillbirth. CONCLUSIONS Syphilis testing among women after stillbirth was less than 10%, illustrating limited adherence to Centers for Disease Control and Prevention and American College of Obstetrics and Gynecology recommendations. Such low prenatal and delivery syphilis testing rates may impact the number of stillbirth cases identified as congenital syphilis cases and reported to the national surveillance system. Our results emphasize the need to improve syphilis testing to improve diagnosis of syphilitic stillbirths, identify women with syphilis infection, and provide treatment to these women to avoid syphilis-related adverse outcomes.
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Melo R, Antonello V, Ramos M. Painful interdigital lesion: could it be syphilis? J Eur Acad Dermatol Venereol 2017; 32:e129-e130. [DOI: 10.1111/jdv.14621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R.C.C. Melo
- Ambulatório de Dermatologia Sanitária; Porto Alegre Brazil
| | - V. Antonello
- Hospital Fêmina; Porto Alegre Brazil
- Secretaria Municipal de Saúde; Porto Alegre Brazil
- Faculdade de Medicina (Escola de Saúde); Unisinos; São Leopoldo Brazil
| | - M.C. Ramos
- Secretaria Municipal de Saúde; Porto Alegre Brazil
- Curso de Especialização em Dermatologia; Universidade Federal de Ciências da Saúde; Porto Alegre Brazil
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Drew VJ, Barro L, Seghatchian J, Burnouf T. Towards pathogen inactivation of red blood cells and whole blood targeting viral DNA/RNA: design, technologies, and future prospects for developing countries. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:512-521. [PMID: 28488960 PMCID: PMC5649960 DOI: 10.2450/2017.0344-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/15/2016] [Indexed: 01/22/2023]
Abstract
Over 110 million units of blood are collected yearly. The need for blood products is greater in developing countries, but so is the risk of contracting a transfusion-transmitted infection. Without efficient donor screening/viral testing and validated pathogen inactivation technology, the risk of transfusion-transmitted infections correlates with the infection rate of the donor population. The World Health Organization has published guidelines on good manufacturing practices in an effort to ensure a strong global standard of transfusion and blood product safety. Sub-Saharan Africa is a high-risk region for malaria, human immunodeficiency virus (HIV), hepatitis B virus and syphilis. Southeast Asia experiences high rates of hepatitis C virus. Areas with a tropical climate have an increased risk of Zika virus, Dengue virus, West Nile virus and Chikungunya, and impoverished countries face economical limitations which hinder efforts to acquire the most modern pathogen inactivation technology. These systems include Mirasol® Pathogen Reduction Technology, INTERCEPT®, and THERAFLEX®. Their procedures use a chemical and ultraviolet or visible light for pathogen inactivation and significantly decrease the threat of pathogen transmission in plasma and platelets. They are licensed for use in Europe and are used in several other countries. The current interest in the blood industry is the development of pathogen inactivation technologies that can treat whole blood (WB) and red blood cell (RBC). The Mirasol system has recently undergone phase III clinical trials for treating WB in Ghana and has demonstrated some efficacy toward malaria inactivation and low risk of adverse effects. A 2nd-generation of the INTERCEPT® S-303 system for WB is currently undergoing a phase III clinical trial. Both methodologies are applicable for WB and components derived from virally reduced WB or RBC.
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Affiliation(s)
- Victor J. Drew
- International PhD Program of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taiwan
| | - Lassina Barro
- International PhD Program of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taiwan
- National Center of Blood Transfusion, Ouagadougou, Burkina Faso, United Kingdom
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality Improvement/Safety, Audit/Inspection and DDR Strategy, London, United Kingdom
| | - Thierry Burnouf
- International PhD Program of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taiwan
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Gianfaldoni S, Tchernev G, Wollina U, Gianfaldoni R, Lotti T. Secondary Syphilis Presenting As Palmoplantar Psoriasis. Open Access Maced J Med Sci 2017; 5:445-447. [PMID: 28785328 PMCID: PMC5535653 DOI: 10.3889/oamjms.2017.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 11/05/2022] Open
Abstract
In a recent past, the incidence of syphilis has increased in various geographical regions. The authors describe a case of secondary syphilis mimicking palmoplantar psoriasis.
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Affiliation(s)
- Serena Gianfaldoni
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
| | - Georgi Tchernev
- Medical Institute of the Ministry of Interior, Dermatology, Venereology and Dermatologic Surgery; Onkoderma, Private Clinic for Dermatologic Surgery, Dermatology and Surgery, Sofia 1606, Bulgaria
| | - Uwe Wollina
- Krankenhaus Dresden-Friedrichstadt, Department of Dermatology and Venereology, Dresden, Sachsen, Germany
| | - Roberto Gianfaldoni
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
| | - Torello Lotti
- Univerisity G. Marconi of Rome, Dermatology and Venereology, Rome, Italy; Universitario di Ruolo, Dipartimento di Scienze Dermatologiche, Università degli Studi di Firenze, Facoltà di Medicina e Chirurgia, Dermatology, Via Vittoria Colonna 11, Rome 00186, Italy
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36
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Reinehr CPH, Kalil CLPV, Reinehr VPH. Secondary syphilis: The great imitator can't be forgotten. Rev Assoc Med Bras (1992) 2017; 63:481-483. [DOI: 10.1590/1806-9282.63.06.481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/04/2016] [Indexed: 11/21/2022] Open
Abstract
Summary Syphilis is an infection caused by Treponema pallidum, mainly transmitted by sexual contact. Since 2001, primary and secondary syphilis rates started to rise, with an epidemic resurgence. The authors describe an exuberant case of secondary syphilis, presenting with annular and lichen planus-like lesions, as well as one mucocutaneous lesion. Physicians must be aware of syphilis in daily practice, since the vast spectrum of its cutaneous manifestations is rising worldwide.
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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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Rogozińska E, Kara-Newton L, Zamora JR, Khan KS. On-site test to detect syphilis in pregnancy: a systematic review of test accuracy studies. BJOG 2017; 124:734-741. [PMID: 28029229 DOI: 10.1111/1471-0528.14455] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Syphilis in pregnancy can lead to fetal and neonatal death or congenital anomalies. Accurate on-site tests are an essential part of effective prevention of mother-to-child transmission of the disease. OBJECTIVE This systematic review assessed the accuracy of on-site tests to detect infection with Treponema pallidum in pregnant women. SEARCH STRATEGY Major databases were searched from inception to January 2016 using terms: 'pregnancy', 'antenatal', 'syphilis', 'Treponema pallidum' with their variations, and the search limit for the relevant study design. SELECTION CRITERIA We included studies that used dual reference standard (non-treponemal and treponemal tests) to detected syphilis in pregnancy. DATA COLLECTION AND ANALYSIS Extracted accuracy data were tabulated and pooled using hierarchical, bivariate random effects model. MAIN RESULTS Seven studies (combined sample 17 546) reporting the accuracy of four on-site tests met the eligibility criteria. On average, Determine™ and SD BioLine Syphilis 3.0 had the highest sensitivity of all the evaluated tests: 0.83 (95% CI 0.58, 0.98) and 0.86 (95% CI 0.82, 0.89), respectively, with a high specificity 0.96 (95% CI 0.89, 1.00) and 0.99 (95% CI 0.94, 1.00), respectively. The Qualitative Rapid Plasma Reagin card commonly used in clinical practice had a pooled sensitivity of 0.70 (95% CI 0.54, 0.88) and specificity of 0.97 (95% CI 0.96, 0.99). CONCLUSION Immunochromatographic tests such as Determine™ and SD BioLine Syphilis 3.0 seem to be acceptable options in antenatal testing for syphilis, especially in resource-limited settings. Future research should seek more evidence to strengthen this claim. TWEETABLE ABSTRACT On-site test to detect syphilis-options during antenatal care.
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Affiliation(s)
- E Rogozińska
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - L Kara-Newton
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - J R Zamora
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
- Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiology and Public Health, Madrid, Spain
| | - K S Khan
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
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Gottesman SP, Schoenling YS, Culpepper KS. Late latent mucinous syphilis mimicking connective tissue disease. J Cutan Pathol 2017; 44:578-581. [PMID: 28244118 DOI: 10.1111/cup.12924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/17/2017] [Accepted: 02/23/2017] [Indexed: 11/28/2022]
Abstract
As evidenced by the Centers for Disease Control and Prevention (CDC) statistics, syphilis is yet again on the rise. It is known as the great mimicker because of its variable symptoms and how frequently it can be confused with other diseases. The different stages of syphilis (primary, secondary, latent, late latent and tertiary) are discussed. We describe a new histopathologic pattern of syphilis, one that mimics connective tissue disease and can represent a diagnostic pitfall. In this time and age, when syphilis is rising especially among the men who have sex with men subgroup, it is important to keep a high index of suspicion of syphilis even when clinically and histopathologically the findings on first glance may not appear characteristic.
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Affiliation(s)
| | | | - Keliegh S Culpepper
- University of Arizona, Department of Medicine, Division of Dermatology, Tucson, Arizona.,Dermpath Diagnostics, Tucson, Arizona
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40
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Bianucci R, Perciaccante A. "The sins of the fathers will be visited upon the children": Congenital syphilis and leg braces pictorial depiction in eighteenth century Britain. Eur J Intern Med 2016; 35:e36-e37. [PMID: 27421914 DOI: 10.1016/j.ejim.2016.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 11/23/2022]
Affiliation(s)
- R Bianucci
- Department of Public Health and Pediatric Sciences, Legal Medicine Section, University of Turin, Italy; UMR 7268, Laboratoire d'Anthropologie bio-culturelle, Droit, Etique & Santé (Adés), Faculté de Médecine de Marseille, France
| | - A Perciaccante
- Department of Medicine, "San Giovanni di Dio" Hospital, Gorizia, Italy.
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Smith N, Dhillon S, Cotter JG, Ahmed Z. Syphilis: an atypical case of sepsis and multiple anogenital lesions in secondary syphilis. J Community Hosp Intern Med Perspect 2016; 6:32495. [PMID: 27802854 PMCID: PMC5089154 DOI: 10.3402/jchimp.v6.32495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/13/2016] [Accepted: 08/17/2016] [Indexed: 11/22/2022] Open
Abstract
The incidence of syphilis has historically been cyclical in nature, often in relation to the rise and fall of public health initiatives directed toward eradication along with social attitudes toward sexual practices. The incidence of syphilis has increased by 15% in the last 6 years in the United States, with similar increases worldwide. Herein, we present an atypical case of syphilis presenting with severe septic shock and multiple anogenital lesions in an immunocompetent host. A 22-year-old male with no significant past medical history presented with fevers, chills, sore throat, diaphoresis, and diarrhea. He was febrile, tachycardic, hypotensive, and unresponsive to fluid resuscitation requiring short-term vasopressor support. Physical exam revealed diffuse lymphadenopathy; lower extremity macular rash involving the soles of the feet; papular non-pustular lesions on the scrotum; and a 0.5 cm non-tender irregular, healing lesion on the shaft of the penis. Laboratory analysis was significant for leukocytosis and elevated creatinine. Serum screening rapid plasma reagin was positive, and further testing revealed a titer of 1:32, with confirmation via fluorescent treponemal antibody absorption test. The patient was diagnosed with secondary syphilis, which was determined to be the underlying etiology of the sepsis as all other serological evaluations were negative. He was treated with penicillin G benzathine 2.4 million units intramuscular and supportive management, with improvement of symptoms. The patient engaged in high-risk sexual behaviors, including prior unprotected sexual contact with males. New research indicates that up to one-third of patients may present with atypical cutaneous manifestations, as demonstrated by this patient. It is important for physicians to familiarize themselves with the varied clinical presentations of syphilis, which include multiple anogenital lesions and tender primary lesions in primary or secondary syphilis.
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Affiliation(s)
- Nichole Smith
- Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL, USA;
| | - Sonu Dhillon
- Department of Gastroenterology, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - John G Cotter
- Department of Infectious Disease, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Zohair Ahmed
- Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL, USA
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Ripoll E, Montironi C, Alós L, Pujol T, Berenguer J, Oleaga L. Oropharyngeal Syphilis: Imaging and Pathologic Findings in Two Patients. Head Neck Pathol 2016; 11:399-403. [PMID: 27699642 PMCID: PMC5550383 DOI: 10.1007/s12105-016-0758-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/23/2016] [Indexed: 12/29/2022]
Abstract
Syphilis is a widespread infection with increasing frequency in developed countries, especially among men who have sex with men. We present two cases of oropharyngeal syphilis in two middle-aged men who presented with a painless tonsillar ulcer and progressive enlargement of cervical lymph nodes suspected of being a tonsillar tumour. A pathologic analysis of the ulcer led to an accurate diagnosis. We review the imaging and pathologic findings to emphasize the importance of taking syphilis into account in the differential diagnosis.
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Affiliation(s)
- Enric Ripoll
- Radiology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Carla Montironi
- Pathology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Llucia Alós
- Pathology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Teresa Pujol
- Radiology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Joan Berenguer
- Radiology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Laura Oleaga
- Radiology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
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Soares Souza A, Soares Souza A, Zanetti G, Marchiori E. A skin rash with multiple pulmonary nodules. Eur Respir Rev 2016; 24:682-3. [PMID: 26621982 DOI: 10.1183/16000617.00001815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Arthur Soares Souza
- Dept of Radiology, Medical School of Rio Preto and Ultra X, São José do Rio Preto, Brazil
| | - Antonio Soares Souza
- Dept of Radiology, Medical School of Rio Preto and Ultra X, São José do Rio Preto, Brazil
| | - Gláucia Zanetti
- Dept of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Edson Marchiori
- Dept of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Oliveira GOB, Cavalcante LDW, Pagliuca LMF, Almeida PCD, Rebouças CBDA. Prevention of sexually transmitted diseases among visually impaired people: educational text validation. Rev Lat Am Enfermagem 2016; 24:e2775. [PMID: 27556880 PMCID: PMC5012502 DOI: 10.1590/1518-8345.0906.2775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/03/2016] [Indexed: 11/25/2022] Open
Abstract
Objective: to validate an educational text in the context of Sexually Transmitted Diseases (STD) for visually impaired persons, making it accessible to this population. Method: a validation study, in a virtual environment. Data collection occurred from May to September 2012 by emailing the subjects, and was composed by seven content experts about STDs. Analysis was based on the considerations of the experts about Objectives, Structure and Presentation, and Relevance. Results: on the Objectives and Structure and Presentation blocks, 77 (84.6%) and 48 (85.7%) were fully adequate or appropriate, respectively. In the Relevance block, items 3.2 - Allows transfer and generalization of learning, and 3.5 - Portrays aspects needed to clarify the family, showed bad agreement indices of 0.42 and 0.57, respectively. The analysis was followed by reformulating the text according to the relevant suggestions. Conclusion: the text was validated regarding the content of sexually transmitted diseases. A total of 35 stanzas were removed and nine others included, following the recommendations of the experts.
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Affiliation(s)
| | | | | | - Paulo César de Almeida
- PhD, Professor, Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, CE, Brazil
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Contribution of a Comparative Western Blot Method to Early Postnatal Diagnosis of Congenital Syphilis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:410-416. [PMID: 26961856 DOI: 10.1128/cvi.00032-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/01/2016] [Indexed: 01/20/2023]
Abstract
Serology has a pivotal role in the diagnosis of congenital syphilis (CS), but problems arise because of the passive transfer of IgG antibodies across the placenta. The aim of this study was to assess the diagnostic value of a comparative Western blot (WB) method finalized to match the IgG immunological profiles of mothers and their own babies at birth in order to differentiate between passively transmitted maternal antibodies and antibodies synthesized by the infants against Treponema pallidum Thirty infants born to mothers with unknown or inadequate treatment for syphilis were entered in a retrospective study, conducted at St. Orsola-Malpighi Hospital, Bologna, Italy. All of the infants underwent clinical, instrumental, and laboratory examinations, including IgM WB testing. For the retrospective study, an IgG WB assay was performed by blotting T. pallidum antigens onto nitrocellulose sheets and incubating the strips with serum specimens from mother-child pairs. CS was diagnosed in 11 out of the 30 enrolled infants; 9/11 cases received the definitive diagnosis within the first week of life, whereas the remaining two were diagnosed later because of increasing serological test titers. The use of the comparative IgG WB testing performed with serum samples from mother-child pairs allowed a correct CS diagnosis in 10/11 cases. The CS diagnosis was improved by a strategy combining comparative IgG WB results with IgM WB results, leading to a sensitivity of 100%. The comparative IgG WB test is thus a welcome addition to the conventional laboratory methods used for CS diagnosis, allowing identification and adequate treatment of infected infants and avoiding unnecessary therapy of uninfected newborns.
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Podlipnik S, Giavedoni P, Alsina M, García-Herrera A, Ferrando J, Mascaró JM. An erythematous nodule on the nipple: An unusual presentation of primary syphilis. J Cutan Pathol 2016; 42:239-43. [PMID: 25940793 DOI: 10.1111/cup.12491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sebastian Podlipnik
- Departments of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Giakoumelou S, Wheelhouse N, Cuschieri K, Entrican G, Howie SEM, Horne AW. The role of infection in miscarriage. Hum Reprod Update 2016; 22:116-33. [PMID: 26386469 PMCID: PMC4664130 DOI: 10.1093/humupd/dmv041] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/27/2015] [Accepted: 09/01/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Miscarriage is the spontaneous loss of a pregnancy before 12 weeks (early miscarriage) or from 12 to 24 weeks (late miscarriage) of gestation. Miscarriage occurs in one in five pregnancies and can have considerable physiological and psychological implications for the patient. It is also associated with significant health care costs. There is evidence that potentially preventable infections may account for up to 15% of early miscarriages and up to 66% of late miscarriages. However, the provision of associated screening and management algorithms is inconsistent for newly pregnant women. Here, we review recent population-based studies on infections that have been shown to be associated with miscarriage. METHODS Our aim was to examine where the current scientific focus lies with regards to the role of infection in miscarriage. Papers dating from June 2009 with key words 'miscarriage' and 'infection' or 'infections' were identified in PubMed (292 and 327 papers, respectively, on 2 June 2014). Relevant human studies (meta-analyses, case-control studies, cohort studies or case series) were included. Single case reports were excluded. The studies were scored based on the Newcastle - Ottawa Quality Assessment Scale. RESULTS The association of systemic infections with malaria, brucellosis, cytomegalovirus and human immunodeficiency virus, dengue fever, influenza virus and of vaginal infection with bacterial vaginosis, with increased risk of miscarriage has been demonstrated. Q fever, adeno-associated virus, Bocavirus, Hepatitis C and Mycoplasma genitalium infections do not appear to affect pregnancy outcome. The effects of Chlamydia trachomatis, Toxoplasma gondii, human papillomavirus, herpes simplex virus, parvovirus B19, Hepatitis B and polyomavirus BK infections remain controversial, as some studies indicate increased miscarriage risk and others show no increased risk. The latest data on rubella and syphilis indicate increased antenatal screening worldwide and a decrease in the frequency of their reported associations with pregnancy failure. Though various pathogens have been associated with miscarriage, the mechanism(s) of infection-induced miscarriage are not yet fully elucidated. CONCLUSIONS Further research is required to clarify whether certain infections do increase miscarriage risk and whether screening of newly pregnant women for treatable infections would improve reproductive outcomes.
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Affiliation(s)
- Sevi Giakoumelou
- Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Nick Wheelhouse
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Edinburgh EH26 0PZ, UK
| | - Kate Cuschieri
- Scottish HPV Reference Lab, Division of Lab Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Gary Entrican
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Edinburgh EH26 0PZ, UK The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian EH25 9RG, UK
| | - Sarah E M Howie
- Centre for Inflammation Research, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Andrew W Horne
- Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
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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: 18] [Impact Index Per Article: 2.0] [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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50
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Giesler DM, Casillas MA, Wilson DD, Nodit L. The Painful Diversity of Proctitis in the Modern Era. Am Surg 2015. [DOI: 10.1177/000313481508101205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Danielle M. Giesler
- Department of Surgery University of Tennessee Medical Center Knoxville, Tennessee
| | - Mark A. Casillas
- Department of Surgery University of Tennessee Medical Center Knoxville, Tennessee
| | - Douglas D. Wilson
- Department of Pathology University of Tennessee Medical Center Knoxville, Tennessee
| | - Laurentia Nodit
- Department of Pathology University of Tennessee Medical Center Knoxville, Tennessee
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