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Talhari C, Arriel K, Serra MS, Veasey JV. Acquired syphilis: update on clinical, diagnostic and therapeutic aspects ⋆. An Bras Dermatol 2025:S0365-0596(25)00040-6. [PMID: 40210541 DOI: 10.1016/j.abd.2024.11.002] [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: 09/10/2024] [Revised: 11/15/2024] [Accepted: 11/19/2024] [Indexed: 04/12/2025] Open
Abstract
Syphilis, an infection caused by Treponema pallidum, transmitted predominantly through sexual contact, affects several organs, causing skin, mucous membranes and systemic lesions. Despite being a secular disease, it still poses a major challenge for the public health system, since the number of cases continues to increase after years of warnings from the scientific community. Recognizing the clinical manifestations is essential for formulating the clinical hypothesis and diagnostic confirmation with complementary exams. However, recognizing skin lesions is not always simple, given the diversity of clinical manifestations which resemble other diseases. This review presents an overview of the disease, with current epidemiological data, a representation of the various clinical manifestations, a description of the pertinent diagnostic methods for laboratory confirmation, and appropriate therapeutic approaches for each clinical form.
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Affiliation(s)
- Carolina Talhari
- Postgraduate Program in Dermatology-Applied Sciences, Universidade do Estado do Amazonas, Manaus, AM, Brazil; Department of Dermatology, Fundação Hospitalar Alfredo da Matta de Dermatologia, Manaus, Amazonas, Brazil
| | - Kaique Arriel
- Department of Dermatology, Universidade Santo Amaro, São Paulo, Brazil
| | - Marcio Soares Serra
- Department of Sexually Transmitted Infections, Sociedade Brasileira de Dermatologia (SBD) Board of Directors 2023-2024, Rio de Janeiro, RJ, Brazil
| | - John Verrinder Veasey
- Dermatology Clinic, Hospital da Santa Casa de São Paulo, São Paulo, SP, Brazil; Discipline of Dermatology, Faculty of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil.
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Gallais Sérézal I, Kirma J, Sarkar MK, Cole C, Xing X, Bogle R, Fox J, Coon A, vanStraalen KR, Dobry C, Xu LH, Kahlenberg JM, Harms PW, Billi AC, Tsoi LC, Giacani L, Gudjonsson JE. Characterizing the immune infiltrate in secondary syphilis: implications for transmission and pathology. Front Immunol 2025; 16:1549206. [PMID: 40201184 PMCID: PMC11975926 DOI: 10.3389/fimmu.2025.1549206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Accepted: 02/14/2025] [Indexed: 04/10/2025] Open
Abstract
Introduction Syphilis is a complex disease with variable clinical presentation where symptomatic and potentially infectious stages alternate with periods of latency, representing a fascinating model to study immune evasion and host immune responses. Methods Immunohistochemistry (IHC), bulk, and single-cell RNA sequencing were performed on formalin-fixed paraffin-embedded skin biopsies collected from subjects with secondary syphilis. Additionally, PBMCs from healthy individuals and either primary or MyD88 knock-out keratinocytes were exposed to live Treponema pallidum cells to define initial skin responses to the bacteria. Results Immunohistochemistry of secondary syphilis skin lesions showed a polymorphous immune infiltrate with colocalization of T cells, B cells and antigen-presenting cells. Single-cell analysis revealed distinct cellular contributions to the immune response, with prominent immune-stromal crosstalk accompanied by altered keratinocyte differentiation and decreased intraepidermal communication. Notably, prominent inflammatory signals were countered by concomitant regulatory responses, particularly in infiltrating myeloid cells. Exposure of PBMCs to live T. pallidum inhibited immune responses, while exposure to sonicated cells triggered CXCL1 and CXCL3 upregulation. Keratinocytes responded to both intact and sonicated T. pallidum with upregulation of type-I interferon responses that, however, were abolished in MYD88-deficient but not in STING-deficient keratinocytes. Discussion Our data provide novel insights into the contribution of epidermal TLR sensing through MYD88 to the host response to syphilis infection, highlighting mechanisms by which T. pallidum evades immune responses in skin that may facilitate transmission of this pathogen through the skin.
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Affiliation(s)
- Irène Gallais Sérézal
- Department of Dermatology, Institut National de la Santé et de la Recherche Médicale (INSERM) 1098, Franche Comté University, Besançon University Hospital, Besançon, France
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Joseph Kirma
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Mrinal K. Sarkar
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Christopher Cole
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Xianying Xing
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Rachael Bogle
- Laboratory for Experimental Immunodermatology, Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jennifer Fox
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Anthony Coon
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Kelsey R. vanStraalen
- Laboratory for Experimental Immunodermatology, Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Craig Dobry
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Linda H. Xu
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - J. Michelle Kahlenberg
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, United States
| | - Paul W. Harms
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
| | - Allison C. Billi
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Lam C. Tsoi
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Johann E. Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, United States
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Wang YJ, Liu ZC, Wang J, Yang YM. Multiple liver metastases of unknown origin: A case report. World J Gastrointest Oncol 2025; 17:100210. [PMID: 39817126 PMCID: PMC11664613 DOI: 10.4251/wjgo.v17.i1.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 10/17/2024] [Accepted: 11/07/2024] [Indexed: 12/12/2024] Open
Abstract
BACKGROUND The liver is the most common site of digestive system tumor metastasis, but not all liver metastases can be traced back to the primary lesions. Although it is unusual, syphilis can impact the liver, manifesting as syphilitic hepatitis with inflammatory nodules, which might be misdiagnosed as metastasis. CASE SUMMARY This case report involves a 46-year-old female who developed right upper abdominal pain and intermittent low fever that persisted for more than three months. No definitive diagnosis of a tumor had been made in the past decades, but signs of multiple liver metastases were recognized after a computed tomography scan without evidence of primary lesions. With positive serological tests for syphilis and a biopsy of the liver nodules, a diagnosis of hepatic syphilis was made and confirmed with follow-up nodule reduction after anti-syphilis therapy. CONCLUSION Clinicians must be aware of the possibility that syphilis can cause hepatic inflammatory masses, especially when liver metastasis is suspected without evidence of primary lesions. A definitive diagnosis should be established in conjunction with a review of the patient's medical history for accurate therapeutic intervention.
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Affiliation(s)
- Ying-Jin Wang
- Department of Hepatobiliary Pancreatic Surgery, Peking University First Hospital, Beijing 100034, China
| | - Ze-Chuan Liu
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing 100034, China
| | - Jian Wang
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing 100034, China
| | - Yin-Mo Yang
- Department of Hepatobiliary Pancreatic Surgery, Peking University First Hospital, Beijing 100034, China
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Kaminiów K, Kiołbasa M, Pastuszczak M. The Significance of the Cell-Mediated Host Immune Response in Syphilis. Microorganisms 2024; 12:2580. [PMID: 39770782 PMCID: PMC11677580 DOI: 10.3390/microorganisms12122580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 12/06/2024] [Accepted: 12/11/2024] [Indexed: 01/11/2025] Open
Abstract
Syphilis, caused by the highly invasive pathogen Treponema pallidum, remains one of the oldest and most significant public health challenges. According to the World Health Organization (WHO), the number of new syphilis cases among adults aged 15-49 years in 2022 was estimated at approximately 8 million, with notable increases observed in Europe, the Americas, and Africa. The cellular immune response plays a critical role in combating this infection, and its insufficient activity may contribute to chronic progression of the disease. T. pallidum effectively evades the host immune response, enabling its prolonged survival within the host and increasing the risk of late complications such as neurosyphilis and cardiovascular syphilis. This review article discusses the mechanisms of cellular immune responses in T. pallidum infection, including T lymphocyte activation, proinflammatory cytokine production, and the roles of macrophages and dendritic cells in pathogen recognition and elimination. Additionally, it examines the immune evasion strategies employed by T. pallidum, such as the low immunogenicity of its antigens and its ability to suppress the activation of effector cells. A comprehensive understanding of the current knowledge regarding cellular immune mechanisms may contribute to the development of more effective diagnostic and therapeutic approaches in syphilis management.
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Affiliation(s)
- Konrad Kaminiów
- Clinical Department of Dermatology, Medical University of Silesia, Marii Curie-Skłodowskiej 10, 41-800 Zabrze, Poland; (M.K.); (M.P.)
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Kingston M, Apea V, Evans C, Fifer H, Foster K, Patrick P, Grant A, Manns V, Ramsden S, Sinka K, Sukthankar A, Sullivan A, Tyler S. BASHH UK guidelines for the management of syphilis 2024. Int J STD AIDS 2024; 35:1142-1160. [PMID: 39270129 DOI: 10.1177/09564624241280406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
The 2024 UK guidelines for the management of syphilis are in line with current evidence and practice within the UK. Key updates are detailed at the start of the article. These guidelines are accompanied by the first UK guidelines for the management of syphilis in pregnant people and children, 2024.
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Affiliation(s)
- Margaret Kingston
- Consultant Physician Genitourinary Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vanessa Apea
- Consultant Physician Genitourinary Medicine, Barts Health NHS Trust, London, UK
| | - Ceri Evans
- Senior Sexual Health Advisor, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Helen Fifer
- Consultant Microbiologist, UK Health Security Agency, Newcastle upon Tyne, UK
| | - Kirsty Foster
- Consultant in Health Protection, UK Health Security Agency, Newcastle upon Tyne, UK
| | - Patrick Patrick
- Mortimer Market Centre, Central and North West London NHS Trust, London, UK
| | - Alison Grant
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vicky Manns
- Advanced Nurse Specialist, Churchill Hospital, Oxford, UK
| | - Sophie Ramsden
- Consultant Physician Genitourinary Medicine, Bolton NHS Foundation Trust, Bolton, UK
| | - Katy Sinka
- Consultant Scientist and Epidemiologist, UK Health Security Agency, Newcastle upon Tyne, UK
| | - Ashish Sukthankar
- Consultant Physician Genitourinary Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ann Sullivan
- BASHH Clinical Effectiveness Group (CEG) Editor, Consultant Physician Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Sequeira VE, Lobo C, Kaimal S. Psoriasiform plaques: A great mimic. THE NATIONAL MEDICAL JOURNAL OF INDIA 2024; 37:357. [PMID: 40257150 DOI: 10.25259/nmji_1111_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2025]
Affiliation(s)
- Viola Elvia Sequeira
- Department of Dermatology, St John's Medical College, Sarjapura Road, Bengaluru 560034, Karnataka, India
| | - Carol Lobo
- Department of Dermatology, St John's Medical College, Sarjapura Road, Bengaluru 560034, Karnataka, India
| | - Sowmya Kaimal
- Department of Dermatology, St John's Medical College, Sarjapura Road, Bengaluru 560034, Karnataka, India
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Duarte G, Melli PPDS, Miranda AE, Milanez HMBPM, Menezes ML, Travassos AG, Kreitchmann R. Syphilis and pregnancy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-FPS09. [PMID: 39380581 PMCID: PMC11460428 DOI: 10.61622/rbgo/2024fps09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024] Open
Abstract
•Although congenital syphilis has a known etiological agent, accessible diagnosis and low-cost, effective treatment with low fetal toxicity, it continues to challenge obstetric and antenatal care services. •The increasing rates of syphilis in the general population have direct repercussions on the increase in cases of congenital syphilis, a situation of objective interest for public health. •Although transforming the recording of syphilis and congenital syphilis into notifiable diseases improved the records and has made it possible to measure the occurrence of these diseases and create solutions, no effects on reducing their frequency have been reached yet. •The failure to control syphilis/congenital syphilis is multifactorial, and associates variables that range from the deficiency in teaching about these diseases in schools and in the training system of the various health professional segments, as well as the lack of rigid policies for quality control from antenatal care until the clinical follow-up of children exposed to Treponema pallidum during pregnancy. •To date, benzathine penicillin is the only antimicrobial accepted as effective by the main health authorities on the planet for the treatment of syphilis in pregnant women. •The fear of anaphylaxis in response to the treatment of syphilis with benzathine penicillin is an important factor hindering the prompt and correct treatment of pregnant women with syphilis, even though health authorities have made efforts to face the problem with solid arguments, still insufficient to resolve the question. •Although specific protocols are published, the failure to control the treatment of syphilis in pregnant women is still observed with high frequency, indicating and reinforcing a failure in the quality control of these care principles. The National Specialized Commission on Infectious Diseases of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) endorses this document. Content production is based on scientific evidence on the proposed topic and the results presented contribute to clinical practice.
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Affiliation(s)
- Geraldo Duarte
- Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo Ribeirão PretoSP Brazil Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Patrícia Pereira Dos Santos Melli
- Hospital das Clínicas Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo Ribeirão PretoSP Brazil Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Angélica Espinosa Miranda
- Faculdade de Medicina Universidade Federal do Espírito Santo VitóriaES Brazil Faculdade de Medicina, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Helaine Maria Besteti Pires Mayer Milanez
- Faculdade de Ciências Médicas Universidade Estadual de Campinas CampinasSP Brazil Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Maria Luiza Menezes
- Faculdade de Ciências Médicas Universidade de Pernambuco RecifePE Brazil Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, PE, Brazil
| | - Ana Gabriela Travassos
- Faculdade de Medicina Universidade do Estado da Bahia SalvadorBA Brazil Faculdade de Medicina, Universidade do Estado da Bahia, Salvador, BA, Brazil
| | - Regis Kreitchmann
- Universidade Federal de Ciências da Saúde de Porto Alegre Porto AlegreRS Brazil Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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AlKhayal FA, Albusair MK. Secondary syphilis presenting with non-arteritic anterior ischemic optic neuropathy (NAION). Oxf Med Case Reports 2024; 2024:omae012. [PMID: 38532752 PMCID: PMC10962234 DOI: 10.1093/omcr/omae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/14/2024] [Accepted: 01/21/2024] [Indexed: 03/28/2024] Open
Abstract
Syphilis is a sexually transmitted disease caused by the spirochete bacterium Treponema pallidum. Syphilis is a significant public health issue, notably in (HIV) positive patients. Due to the absence of pathognomonic signs in secondary syphilis and its ability to present and mimic a wide variety of clinical findings, it gained the name "the Great imitator '(mimicker).' Herein, we describe a case of a 51-year-old man who presented with acute painless loss of vision of the right eye preceded by a few erythematous plaques with thick scales over bilateral legs and multiple discrete and confluent scaly papules over the palms and soles. During the hospital stay, a diagnosis of non-arteritic anterior ischemic optic neuropathy (NAION) as a manifestation of neurosyphilis is made. To the best of our knowledge, this is the first reported case of NAION as the presenting symptom of neurosyphilis in secondary syphilis in an immunocompetent patient.
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Affiliation(s)
- Fares A AlKhayal
- Dermatology and Dermatologic Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Moath K Albusair
- Dermatology and Dermatologic Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Lorenz Z, Rybolt L, Ghanem KG, Shiroky-Kochavi J. A patient with secondary syphilis following incomplete treatment of primary infection. THE LANCET. INFECTIOUS DISEASES 2023; 23:e497-e504. [PMID: 37414065 DOI: 10.1016/s1473-3099(23)00211-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/06/2023] [Accepted: 03/24/2023] [Indexed: 07/08/2023]
Abstract
Syphilis is a bacterial infection caused by Treponema pallidum and is primarily transmitted via skin-to-skin or mucosal contact during sexual encounters, or through vertical transmission during pregnancy. Cases continue to rise globally across various demographic groups despite effective treatment and prevention interventions. We discuss the case of a 28-year-old cisgender man who presented with secondary syphilis 1 month after being inadequately treated for primary syphilis. Individuals can present with symptoms and signs of syphilis to clinicians of various subspecialties due to diverse clinical presentation. All health-care providers should be able to identify the common and less common manifestations of this infection, and adequate treatment and follow-up are crucial to preventing serious sequelae. Novel biomedical prevention interventions, such as doxycycline post-exposure prophylaxis, are on the horizon.
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Affiliation(s)
- Zachary Lorenz
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Bayview Medical Center, Baltimore, MD, USA
| | - Lauren Rybolt
- Department of Internal Medicine, Division of General Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Khalil G Ghanem
- Department of Internal Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Bayview Medical Center, Baltimore, MD, USA
| | - Jennifer Shiroky-Kochavi
- Department of Internal Medicine, Division of General Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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Takei S, Suzuki K, Otsuka H, Watanabe S. Secondary Syphilis Rash. JMA J 2023; 6:546-547. [PMID: 37941701 PMCID: PMC10627907 DOI: 10.31662/jmaj.2023-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/08/2023] [Indexed: 11/10/2023] Open
Affiliation(s)
- Shun Takei
- Department of General Medicine, Ageo Central General Hospital, Saitama, Japan
| | - Kiyozumi Suzuki
- Department of General Medicine, Ageo Central General Hospital, Saitama, Japan
| | - Hiromasa Otsuka
- Department of General Medicine, Ageo Central General Hospital, Saitama, Japan
| | - Seishi Watanabe
- Department of General Medicine, Ageo Central General Hospital, Saitama, Japan
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Patel P, Turbin RE, Husain S, Wang S. Neurosyphilis Mimicking Connective Tissue Disease. BMJ Case Rep 2023; 16:e256301. [PMID: 37770241 PMCID: PMC10546142 DOI: 10.1136/bcr-2023-256301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
A male in his 60s developed a pruritic, maculopapular rash on his torso and arms, sparing his palms and soles. He tested positive for ANA and an initial skin biopsy identified "bullous lupus," supporting the diagnosis of a connective tissue disease. Additional symptoms included headaches, facial nerve palsy and hearing loss, which partially responded to oral corticosteroids. He subsequently developed a steroid-dependent left eye scotoma, neuroretinitis and optic nerve papillitis. Mycophenolate mofetil was added but an attempted oral steroid taper led to a worsening rash, progressive retinitis and papillitis. Neurosyphilis was confirmed by serum positive rapid plasma reagin test, reactive treponema pallidum antibodies, positive cerebrospinal fluid venereal disease research laboratory and positive spirochete immunostain of skin biopsy of lesional (rash) tissue. Treatment with intravenous ceftriaxone resolved his rash and visual symptoms. It is important to consider syphilis as a mimicker of connective tissue diseases.
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Affiliation(s)
- Pooja Patel
- Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Roger E Turbin
- Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sameera Husain
- Division of Dermatopathology, Columbia University, New York, New York, USA
| | - Shuwei Wang
- Division of Rheumatology, Department of Medicine, VA New Jersey Health Care System, East Orange, New Jersey, USA
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Liu M, Zhou J, Lan Y, Zhang H, Wu M, Zhang X, Leng L, Mi X, Li J. A Neglected Narrative in the COVID-19 Pandemic: Epidemiological and Clinical Impacts of the COVID-19 Outbreak on Syphilis. Clin Cosmet Investig Dermatol 2023; 16:2485-2496. [PMID: 37719933 PMCID: PMC10505047 DOI: 10.2147/ccid.s417522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/11/2023] [Indexed: 09/19/2023]
Abstract
The COVID-19 pandemic has profoundly changed our lives. While healthcare resources were redistributed and mobilized to focus on dealing with the COVID-19 crisis, there have been unmet medical needs of patients with other diseases such as syphilis, weaving an integral but neglected component of the pandemic story. In different countries, the epidemiology of newly reported syphilis underwent diverse changes during the COVID-19 pandemic. Asymptomatic cases experienced the largest decline in number. From the perspective of transmission, on one hand, the implementation of lockdown measures led to a higher degree of abstinence and sex distancing in many countries, thereby reducing the transmission of syphilis. On the other hand, vertical transmission was reported to have increased significantly during COVID-19. Meanwhile, the volume of STI clinic capacity declined, and STI staff were redeployed to facilitate the contact tracing of COVID-19. As a result, many STI centers converted traditional in-person clinical services to telemedicine and self-testing. However, syphilis testing and clinical treatment cannot fully adapt to this conversion. In syphilis diagnosis, COVID-19 infection and vaccination were reported to cause false positivity in syphilis serological tests. Diverse cutaneous manifestations of COVID-19 could resemble the skin lesions in syphilis patients, requiring differential diagnosis from clinicians. As for the post-pandemic years, consequent to service interruptions and diagnosis delays, a surge in the number of confirmed cases of syphilis is expected. The COVID-19 pandemic has also been a meaningful lesson for the control and prevention of infectious diseases. The experience in combating COVID-19 has underscored the importance of maintaining a robust and well-supported medical system for the provision of sexual health services and better healthcare equality even during eras of crisis, not least for syphilis patients.
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Affiliation(s)
- Mingjuan Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- 4+4 M.D. Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Jia Zhou
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Yining Lan
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Mengyin Wu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Xinyi Zhang
- Departments of Internal Medicine and Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Ling Leng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Xia Mi
- Department of Dermatology, Strategic Support Force Medical Center, Beijing, People’s Republic of China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
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Montero-Menárguez J, Puerta-Peña M, Agud-de Dios M, Guzmán-Pérez LM, Gutiérrez-Collar C, Fulgencio-Barbarin J. Annular genital lesions, not an unusual presentation of secondary syphilis. J Dtsch Dermatol Ges 2023; 21:907-909. [PMID: 37212344 DOI: 10.1111/ddg.15086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/10/2023] [Indexed: 05/23/2023]
Affiliation(s)
| | - Mario Puerta-Peña
- Dermatology Department of the Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Agud-de Dios
- Dermatology Department of the Hospital Universitario 12 de Octubre, Madrid, Spain
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14
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Montero-Menárguez J, Puerta-Peña M, Agud-de Dios M, Guzmán-Pérez LM, Gutiérrez-Collar C, Fulgencio-Barbarin J. Anuläre Genitalläsionen sind bei sekundärer Syphilis nicht unüblich. J Dtsch Dermatol Ges 2023; 21:907-909. [PMID: 37574678 DOI: 10.1111/ddg.15086_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/10/2023] [Indexed: 08/15/2023]
Affiliation(s)
| | - Mario Puerta-Peña
- Dermatology Department of the Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Agud-de Dios
- Dermatology Department of the Hospital Universitario 12 de Octubre, Madrid, Spain
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15
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Goda K, Katsurada M, Doi T, Saga N, Maniwa Y, Kenzaka T. Pulmonary syphilis with a cicatricial variant of organizing pneumonia: a case report. BMC Pulm Med 2023; 23:170. [PMID: 37198568 DOI: 10.1186/s12890-023-02469-6] [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: 11/22/2022] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Syphilis is a chronic disease that progresses in the primary, secondary, latent, and tertiary stages. Pulmonary manifestations of syphilis are rare, and their histological features have not been well-described. CASE PRESENTATION A 78-year-old man was referred to our hospital because of a solitary nodular shadow in the right middle lung field on a chest radiograph. Five years prior, a rash appeared on both legs. He was tested for syphilis at a public health center, and the non-treponemal test result was negative. When he was approximately 35 years old, he had unspecified sexual intercourse. Chest computed tomography showed a 13-mm nodule with a cavity in S6 of the right lower lobe of the lung. Robot-assisted resection of the right lower lobe was performed because of suspected localized right lower lobe lung cancer. A cicatricial variant of organizing pneumonia (CiOP) was observed, and immunohistochemistry identified Treponema pallidum inside the macrophages in the nodule cavity. The rapid plasma regain (RPR) value was negative, and the Treponema pallidum hemagglutination assay was positive. The patient was diagnosed as having secondary syphilis with pulmonary involvement. Insidious progression of secondary syphilis may result in CiOP and a negative RPR test result. CONCLUSIONS We report the first case of pulmonary syphilis with a histological pattern of CiOP. It may be asymptomatic and difficult to diagnose because the RPR test may be negative for a long period of time. When either non-treponemal or treponemal test results are positive, the possibility of pulmonary syphilis should be considered along with appropriate medical treatment.
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Affiliation(s)
- Ken Goda
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami- cho, Tamba, 669-3495, Japan.
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan.
| | - Masahiro Katsurada
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami- cho, Tamba, 669-3495, Japan
- Department of Oncology Respiratory Medicine, Kita-harima Medical Center, 926-250 Ichiba-cho, Ono, 675-1392, Japan
- Department of Respiratory Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chu-o-ku, Kobe, 650-0017, Japan
| | - Takefumi Doi
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Nobuyuki Saga
- Department of Diagnostic Pathology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chu-o-ku, Kobe, 650-0017, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami- cho, Tamba, 669-3495, Japan
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan
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16
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Panarelli NC. Infectious Mimics of Inflammatory Bowel Disease. Mod Pathol 2023:100210. [PMID: 37172904 DOI: 10.1016/j.modpat.2023.100210] [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: 03/28/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Distinguishing inflammatory bowel disease (IBD) from its mimics remains a diagnostic challenge for surgical pathologists. Several gastrointestinal infections produce inflammatory patterns that overlap with typical findings of IBD. Although stool culture, PCR, and other clinical assays may identify infectious enterocolitides, these tests may not be performed or the results may be unavailable at the time of histologic evaluation. Furthermore, some clinical tests, including stool PCR, may reflect past exposure rather than ongoing infection. It is important for surgical pathologists to be knowledgeable about infections that simulate IBD in order to generate an accurate differential diagnosis, perform appropriate ancillary studies, and prompt clinical follow-up. This review covers bacterial, fungal, and protozoal infections in the differential diagnosis of IBD.
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Affiliation(s)
- Nicole C Panarelli
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
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17
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Brockshus A, Evans MO, Punch C. Secondary Syphilis Presentation and Urticarial Eruption After Moderna COVID-19 Vaccination. Mil Med 2023; 188:844-847. [PMID: 35778833 PMCID: PMC9384410 DOI: 10.1093/milmed/usac191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/29/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
The diversity of the cutaneous manifestations of syphilis and the ability of the spirochete to evade diagnosis have been well documented by medical literature. However, what triggers the onset of secondary syphilis is not yet clear because of difficulties studying the bacterium. Our case describes the onset of a heterogeneous rash (or coexisting rashes) that presented the day after vaccination with the Moderna mRNA-1273 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. The potential etiologies of the patient's rash: A vaccine reaction, reactivation of chronic spontaneous urticaria, or a physical sign of syphilis itself are then reviewed. The potential for the Moderna coronavirus disease 2019 (COVID-19) vaccine to be the catalyst of this patient's cutaneous manifestations of his immune system responses is also hypothesized.
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Affiliation(s)
- Aaron Brockshus
- Department of Internal Medicine, Evans Army Community Hospital, Fort Carson, CO 80913, USA
| | - Martin O Evans
- Department of Allergy and Immunology, Blanchfield Army Community Hospital, Fort Campbell, KY 42223, USA
| | - Chandra Punch
- Department of Allergy and Immunology, Evans Army Community Hospital, Fort Carson, CO 80913, USA
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18
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Long B, Liang SY, Carius BM, Chavez S, Gottlieb M, Koyfman A, Brady WJ. Mimics of Monkeypox: Considerations for the emergency medicine clinician. Am J Emerg Med 2023; 65:172-178. [PMID: 36640626 PMCID: PMC9812851 DOI: 10.1016/j.ajem.2023.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/22/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Mpox, formerly known as monkeypox, is a public health emergency most commonly presenting with a painful rash and several systemic findings. However, there are several conditions that may mimic its presentation. OBJECTIVE This narrative review provides a focused overview of mpox mimics for emergency clinicians. DISCUSSION Mpox is a global health emergency. The disease is primarily spread through contact, followed by the development of a centrifugally-spread rash that evolves from macules to papules to vesicles to pustules. This is often associated with lymphadenopathy and fever. As the rash is one of the most common presenting signs of the infection, patients mpox may present to the emergency department (ED) for further evaluation. There are a variety of mimics of mpox, including smallpox, varicella, primary and secondary syphilis, acute retroviral syndrome, and genital herpes simplex virus. CONCLUSION Knowledge of mpox and its mimics is vital for emergency clinicians to differentiate these conditions and ensure appropriate diagnosis and management.
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Affiliation(s)
- Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States.
| | - Stephen Y Liang
- Department of Emergency Medicine and Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States of America.
| | - Brandon M Carius
- Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, United States
| | - Summer Chavez
- Department of Health Systems and Population Health Sciences, Tilman J Fertitta Family College of Medicine, University of Houston, Houston, TX 77204, United States
| | - Michael Gottlieb
- Ultrasound Director, Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America.
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19
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Iwasawa O, Kamiya K, Okada H, Maekawa T, Komine M, Ohtsuki M. Diagnostic difficulties in secondary syphilis: a case report. Int J Dermatol 2023; 62:e59-e61. [PMID: 35579379 DOI: 10.1111/ijd.16238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/31/2022] [Accepted: 04/19/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Okuto Iwasawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Hirofumi Okada
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
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20
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Cantisani C, Rega F, Ambrosio L, Grieco T, Kiss N, Meznerics FA, Bánvölgyi A, Vespasiani G, Arienzo F, Rossi G, Soda G, Pellacani G. Syphilis, the Great Imitator-Clinical and Dermoscopic Features of a Rare Presentation of Secondary Syphilis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1339. [PMID: 36674095 PMCID: PMC9859468 DOI: 10.3390/ijerph20021339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Syphilis is characterized by a wide range of variable clinical symptoms; therefore, it is often referred to as "The Great Imitator". Here, we report the case of a 69-year-old hepatitis-C-positive MSM patient, who was admitted to our clinic due to a solitary firm painless erythematous maculopapular lesion with a central crater-like crust on the upper right thigh that occurred two months prior. The dermoscopy showed an erythematous, copper-colored, oval lesion with diffuse monomorphic dotted and glomerular vessels, central crust, and circular scaling (Biett's sign). The histological findings ruled out neoplasia and described a plasma cell infiltrate and endothelial swelling. Finally, the combination of the dermoscopic image, histological findings and the additionally acquired knowledge about the sexual history of the patient at the second visit led to the diagnosis, which was then confirmed with serological tests. Dermoscopy may become a supportive tool to facilitate the recognition of secondary syphilis; however, the reporting of these atypical cases is crucial to highlight the many faces of the disease so that clinicians consider syphilis as part of the differential diagnosis of non-specific lesions.
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Affiliation(s)
- Carmen Cantisani
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Federica Rega
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Luca Ambrosio
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Teresa Grieco
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Norbert Kiss
- Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Fanni Adél Meznerics
- Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - András Bánvölgyi
- Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Giordano Vespasiani
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Francesca Arienzo
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza Medical School” University of Rome, 00161 Rome, Italy
| | - Giovanni Rossi
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Giuseppe Soda
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza Medical School” University of Rome, 00161 Rome, Italy
| | - Giovanni Pellacani
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
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21
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Peng LW, Gao YJ, Cui YL, Xu H, Gao ZX. Missed opportunities for screening congenital syphilis early during pregnancy: A case report and brief literature review. Front Public Health 2023; 10:1073893. [PMID: 36684903 PMCID: PMC9853042 DOI: 10.3389/fpubh.2022.1073893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
Congenital syphilis is a significant public health problem. Pregnant women infected with Treponema pallidum present with various clinical manifestations, mainly including skin or visceral manifestations. The extensive clinical manifestations of T. pallidum infection mimic those of many other diseases during pregnancy, which may lead to delayed diagnosis and serious consequences. We report a case of fetal T. pallidum infection and premature delivery in a woman whose syphilis screening was negative at 16 weeks of gestation. Despite presenting to the dermatologist at 24 weeks of gestation with maculopapular rash which is usually associated with secondary syphilis, the diagnosis of syphilis was not considered. This case shows that even if early syphilis screening of pregnant women is negative, they may still get infected with T. pallidum later on in pregnancy. Therefore, in patients presenting with a rash without an obvious cause, T. pallidum infection should be excluded. The health status of patients' spouses should be assessed during pregnancy. Additionally, perinatal health education is necessary for women and their spouses during pregnancy. The abovementioned factors could reduce the probability of T. pallidum infection in pregnant women and their infants.
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Affiliation(s)
- Lei-Wen Peng
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Yu-Jie Gao
- Department of Laboratory Medicine, Meishan Women and Children's Hospital, Alliance Hospital of West China Second University Hospital, Sichuan University, Meishan, China
| | - Ya-li Cui
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Laboratory Medicine, Meishan Women and Children's Hospital, Alliance Hospital of West China Second University Hospital, Sichuan University, Meishan, China
| | - Huang Xu
- Department of Laboratory Medicine, Meishan Women and Children's Hospital, Alliance Hospital of West China Second University Hospital, Sichuan University, Meishan, China
| | - Zheng-Xiang Gao
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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22
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Syphilis-Associated Proteinuria and Hepatitis in the Setting of Human Immunodeficiency Virus (HIV) Co-Infection. Case Rep Infect Dis 2022; 2022:7247946. [PMID: 36249314 PMCID: PMC9553697 DOI: 10.1155/2022/7247946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
Syphilis has long been known as “the great imitator”, mimicking a wide variety of diseases, and often its diagnosis is delayed or missed. It remains an important public health issue that continues to occur at high rates among patients with HIV. We report a case of a 52-year-old man who presented with a constellation of unusual symptoms highlighting that syphilis should be included in the differential diagnosis in patients with HIV presenting with abnormal liver enzymes, rash, proteinuria, conjunctivitis, and/or sexual risk factors.
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23
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Ruiz de Villa A, Haider AA, Frimer L, Lleshi A, Bazikian Y. A Rare Presentation of Undiagnosed Systemic Syphilis: A Case Report and Review of Literature. Cureus 2022; 14:e27911. [PMID: 36110468 PMCID: PMC9464350 DOI: 10.7759/cureus.27911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Within the specialties of infectious diseases and dermatology, few rashes involve the palms and soles. The syphilitic rash has a pathognomonic association with these body surfaces and signals physicians to investigate this disease. However, the distinct presentations and symptoms associated with syphilis and the various stages of the disease make it diagnostically challenging. We herein report a rather intricate and unusual case of a patient who presented with a new-onset headache and blurred vision and a two-month history of diffuse pruritic maculopapular rash sparing the palms and soles. Several physicians had not established a diagnosis in the outpatient setting. Inpatient workup eventually revealed that the patient was suffering from secondary syphilis with neurological and ocular involvement. Management included a prolonged course of intravenous penicillin G leading to a complete recovery. We share images of the skin findings and the details of the intricate workup and hospital course, as well as a review of the literature.
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24
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Yu T, Che J, Song J, Duan X, Yang J. Annular rupioid secondary syphilis confined to the face. Int J Infect Dis 2022; 122:644-646. [PMID: 35842215 DOI: 10.1016/j.ijid.2022.07.028] [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: 06/02/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022] Open
Abstract
Syphilis is a sexually transmitted infection (STI) caused by treponema pallidum. Its rash usually affects the trunk and limbs extensively, including the palms and soles of the feet. Secondary syphilis confined to the face is extremely rare. We report a case of annular rupioid secondary syphilis, which was misdiagnosed as verruca vulgaris. The patient's lesions were confined to the face and resembled oyster shells. According to epidemiological history, clinical presentation, non-treponemal tests, treponemal tests, and effective benzathine penicillin G treatment, confirmed secondary syphilis.
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Affiliation(s)
- Tianhang Yu
- Department of Dermatology, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei Province, China
| | - Jiaozi Che
- Department of Clinical Laboratory, Chengde Central Hospital, Chengde, Hebei Province, China
| | - Jikai Song
- Zhejiang Provincial People's Hospital, Qingdao University, Hangzhou, Zhejiang Province, China
| | - Xinsuo Duan
- Department of Dermatology, Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China.
| | - Jie Yang
- Department of Dermatology, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei Province, China.
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25
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Zhou Y, Gao G, Zhang X, Gao B, Duan C, Zhu H, Barbera AR, Halcrow S, Pechenkina K. Identifying treponemal disease in early East Asia. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022. [PMCID: PMC9545539 DOI: 10.1002/ajpa.24526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objectives Historic records suggest that a virulent form of treponematosis, sexually transmitted syphilis was introduced to Asia from Europe by the da Gama crew, who landed in India in 1498. Our objective is to assess the gross pathology of human skeletal remains from the Tang dynasty of China to test the presence of treponemal infection in East Asia before 1498. We interpret this paleopathological evidence in the context of site ecology and sociocultural changes during the Tang dynasty. Materials and methods We examined the gross pathology of 1598 human skeletons from Xingfulindai (AD 618 to AD 1279) archeological site located on the Central Plain of China. Using the modified diagnostic criteria defined by Hackett's classical work, we classify the pathology as consistent, strongly suggestive, or pathognomonic for treponemal infection. Results Twelve adult individuals from Xingfulindai had bone lesions suggestive of systemic pathology. Two of these individuals displayed a combination of lesion patterns pathognomonic of treponemal disease and one had lesions consistent with treponematosis. The radiocarbon dates for the bone samples from these skeletons place them before AD 1200. Conclusions The location of Xingfulindai in a continental climatic zone is not typical for yaws and bejel ecology, because these strains occur in the tropics, or in hot, dry environments, respectively. The urban setting, where there is documented evidence for increased interaction between multiple ethnic groups and a developed institution of courtesans during the Tang dynasty, favors sexually transmitted syphilis as the more likely diagnosis. This study supports an earlier spread of syphilis to China than 1498.
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Affiliation(s)
- Yawei Zhou
- College of History Zhengzhou University Zhengzhou Henan China
| | - Guoshuai Gao
- School of Archaeology Jilin University Changchun Jilin China
| | - Xiangyu Zhang
- Xi'an Institute of Cultural Relics Protection and Archaeology Xian Shanxi China
| | - Bo Gao
- Xi'an Institute of Cultural Relics Protection and Archaeology Xian Shanxi China
| | - Chenggang Duan
- Xi'an Institute of Cultural Relics Protection and Archaeology Xian Shanxi China
| | - Hong Zhu
- School of Archaeology Jilin University Changchun Jilin China
| | - Aida R. Barbera
- Université Laval Québec Quebec Canada
- Department of Anthropology Queens College of the City University of New York Queens New York USA
| | | | - Kate Pechenkina
- Department of Anthropology Queens College of the City University of New York Queens New York USA
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26
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Towns JM, Denham I, Chow EPF, Graves S, Fairley CK, Williamson D, Azzato F, Chen MY. Clinical and laboratory aspects of condylomata lata lesions of syphilis. Sex Transm Infect 2022; 99:162-166. [PMID: 35732476 DOI: 10.1136/sextrans-2021-055385] [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] [Received: 12/22/2021] [Accepted: 05/14/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Condylomata lata are a less common but distinctive syphilitic lesion. Variable theories as to their nature and origin exist. The aim of this study was to determine the clinical and laboratory characteristics of condylomata lata by determining (1): the most closely aligned stage of syphilis, based on the rapid plasma reagin (RPR) titre; (2) symptom duration and (3) Treponema pallidum PCR cycle threshold (CT) values, as an indicator of organism load. METHODS This was a retrospective study of patients with T. pallidum PCR-positive condylomata lata lesions, attending a clinic in Melbourne, Australia, between 2011 and 2021. Syphilis serology was undertaken and RPR titres compared between condylomata lata, primary and secondary syphilis cases. RESULTS 51 cases with T. pallidum PCR-positive condylomata lata were included. 41 cases were in men, 40 of whom were men who have sex with men (MSM), and 10 in women. Twelve of 51 (24%) cases were in HIV-positive MSM. Thirty-three of 51 (65%) had other mucocutaneous signs of secondary syphilis; 18 (35%) had no other signs of secondary syphilis. The median RPR titre among the 51 condylomata lata cases was 1:128, compared with the median RPR titre of primary syphilis (1:4) and of secondary syphilis (1:128). The median duration of lesions was 24 (IQR 10-60) days, with no significant difference between those with and without other signs of secondary syphilis (p=0.75). Median CT values for condylomata lata (CT=31) and primary syphilis (CT=31) were significantly lower than for other secondary syphilis lesion types (CT=33), indicating higher T. pallidum loads for condylomata lata and primary lesions compared with other secondary syphilis lesion types. DISCUSSION These findings support condylomata lata as lesions that occur during the secondary stage of syphilis and which are likely to be highly infectious.
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Affiliation(s)
- Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Stephen Graves
- Barwon Health, Australian Rickettsial Reference Laboratory, Geelong, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Deborah Williamson
- Department of Infectious Diseases, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Francesca Azzato
- Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Clayton, Victoria, Australia
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A Case Report of Secondary Syphilis Co-Infected with Measles: A Diagnostic Dilemma with Fever and Rash. Trop Med Infect Dis 2022; 7:tropicalmed7050070. [PMID: 35622697 PMCID: PMC9144679 DOI: 10.3390/tropicalmed7050070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022] Open
Abstract
Fever and rash as manifestations of infection by microorganisms are collectively known as febrile exanthem. Since viruses are more frequently associated with fever and rash, these symptoms are thus impetuously termed viral exanthem. However, bacteria represent a frequently overlooked infectious etiology causing rash in humans. In addition, certain microbes may exhibit pathognomonic features that erupt during illness and facilitate clinical diagnosis. Conversely, coinfections often obscure the clinical characteristics of the primary disease and further challenge clinicians attempting to reach a diagnosis. We retrospectively looked at de-identified clinical data of a patient who presented to the Hospital for Tropical Diseases in Bangkok in July 2019 with complaints of fever and rash. The case involved a 35-year-old who presented with a 3-day history of fever, respiratory symptoms, myalgia, conjunctivitis, diarrhea, and a generalized maculopapular rash. On examination, the patient was febrile, tachycardic, and tachypneic, with a mean arterial pressure of 95 mmHg. A differential white blood cell count showed: leukocytes, 5800/µL; neutrophils, 4408/µL; lymphocytes, 406/µL; and platelets, 155,000/µL. Striking findings involving the integumentary system included Koplik’s spots and generalized maculopapular rash. Further serology revealed positive immunoglobulin (Ig)M and IgG for both measles and rubella virus, including reactive serology for Treponema pallidum. Here we describe the clinical course and management of this patient.
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Curious Condylomatous Lesion on the Perianal Skin-The Great Imitator Struck Again: Answer. Am J Dermatopathol 2022; 44:73-74. [PMID: 34889816 DOI: 10.1097/dad.0000000000002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Drago F, Ciccarese G, Merlo G, Trave I, Javor S, Rebora A, Parodi A. Oral and cutaneous manifestations of viral and bacterial infections: Not only COVID-19 disease. Clin Dermatol 2021; 39:384-404. [PMID: 34517997 PMCID: PMC7849469 DOI: 10.1016/j.clindermatol.2021.01.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Globalization entails several medical problems along with economic and social complications. Migrations from other continents, increasing numbers of tourists worldwide, and importation of foreign parasites (eg, Aedes albopictus) have made diseases previously unknown in Europe a reality. The rapid spread of the coronavirus disease 2019 pandemic throughout the world is a warning that other epidemics are still possible. Most, if not all of these diseases, transmitted by viruses or bacteria, present with cutaneous symptoms and signs that are highly important for a speedy diagnosis, a fundamental concept for arresting the diseases and saving lives. Dermatologists play a significant role in delineating cutaneous and mucosal lesions that are often lumped together as dermatitis. We provide a review of many of these cutaneous and mucosal lesions that sometimes are forgotten or even ignored.
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Affiliation(s)
- Francesco Drago
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, Genoa, Italy; DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
| | - Giulia Ciccarese
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, Genoa, Italy.
| | - Giulia Merlo
- Dermatology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, Alessandria, Italy
| | - Ilaria Trave
- DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
| | - Sanja Javor
- Dermatology Unit, Galliera Hospital, Via Mura delle Cappuccine 14, Genoa, Italy
| | - Alfredo Rebora
- DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
| | - Aurora Parodi
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, Genoa, Italy; DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
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30
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Leavens J, Furukawa D, Gates G. Condyloma latum of the plantar foot: Case report of an unusual manifestation of secondary syphilis. Int J STD AIDS 2021; 32:1354-1357. [PMID: 34284668 DOI: 10.1177/09564624211032798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Condyloma lata, a cutaneous manifestation of secondary syphilis, typically presents as verrucous papules or plaques in the anogenital area. Here, we present a case of secondary syphilis presenting in a 38-year-old man as condyloma latum of the plantar foot in the absence of other cutaneous findings of secondary syphilis. The plantar foot is an unusual location for condyloma lata which has not previously been reported in the medical literature. Histopathology was essential to diagnosis in this case and demonstrated verrucous epidermal hyperplasia with a plasma cell-rich infiltrate in the dermis and innumerable spirochetes in the epidermis. The patient was successfully treated with intramuscular penicillin benzathine G. Given the recent rise in the incidence of primary and secondary syphilis, it is essential for clinicians to be aware of atypical presentations of secondary syphilis to avoid delays in treatment and decrease the risk of transmission to sexual partners.
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Affiliation(s)
- Joan Leavens
- Department of Medicine, Division of Pathology, 8783University of California, Los Angeles, CA, USA
| | - Daisuke Furukawa
- Department of Medicine, Division of Infectious Diseases, 8783University of California, Los Angeles, CA, USA
| | - Gregory Gates
- Department of Medicine, Division of Pathology, 8783University of California, Los Angeles, CA, USA
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Bose S. The great imitator: A rare presentation of annular and corymbose secondary syphilis. Int J STD AIDS 2021; 32:1178-1179. [PMID: 34106025 DOI: 10.1177/09564624211024811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A corymbose (or corymbiform) arrangement in secondary syphilis (derived from the Greek word korymbos) is characterised by a central large plaque or papule surrounded by smaller satellite lesions akin to an explosion, whereas annular plaques consist of a peripheral ring of erythematous papules with central hyperpigmentation. These are very rare cutaneous manifestations of secondary syphilis. This case report focuses on one such interesting case which presented with the annular and corymbose pattern involving the face and genitalia.
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32
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Middelveen MJ, Haggblad JS, Lewis J, Robichaud GA, Martinez RM, Shah JS, Du Cruz I, Fesler MC, Stricker RB. Dermatological and Genital Manifestations of Lyme Disease Including Morgellons Disease. Clin Cosmet Investig Dermatol 2021; 14:425-436. [PMID: 33986606 PMCID: PMC8110212 DOI: 10.2147/ccid.s299526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/09/2021] [Indexed: 12/02/2022]
Abstract
Although the erythema migrans (EM) skin rash is traditionally considered a hallmark of Lyme disease, other dermatological manifestations of the tickborne disease are less well known. We describe a 49-year-old woman with erosive genital ulcerations, secondary EM rashes and jagged skin lesions associated with Lyme disease. The skin rashes exhibited fibers characteristic of Morgellons disease. Molecular testing confirmed the presence of Borrelia DNA in both vaginal culture and serum specimens. In further studies on a secondary EM lesion containing filaments, Gömöri trichrome staining revealed the presence of collagen in the filaments, while Dieterle and anti-Borrelia immunostaining revealed intracellular and extracellular Borrelia organisms. Intracellular staining for Borrelia was also observed in lymphocytic infiltrates. Lyme disease may present with a variety of genital lesions and dermatological manifestations including Morgellons disease. Careful evaluation is required to determine the presence of Borrelia organisms associated with these dermopathies.
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Affiliation(s)
| | | | - Julie Lewis
- Department of Chemistry and Biochemistry, Université de Moncton, Moncton, NB, Canada
| | - Gilles A Robichaud
- Department of Chemistry and Biochemistry, Université de Moncton, Moncton, NB, Canada
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Persistent Verrucous Plaques in an HIV-Positive Patient With Secondary and Neurosyphilis. Sex Transm Dis 2021; 47:e33-e35. [PMID: 32496387 DOI: 10.1097/olq.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 23-year-old HIV-positive woman presented with persistent yellowish verrucous plaques on both ankles, which had been present for 2 years, and blurred vision, which had persisted for 1 month. Serological tests confirmed a syphilis diagnosis. Her condition improved after systemic penicillin treatment, with no topical treatment except petrolatum ointment.
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34
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Plaques en prairie fauchée. IDCases 2021; 24:e01080. [PMID: 33850722 PMCID: PMC8022820 DOI: 10.1016/j.idcr.2021.e01080] [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: 03/08/2021] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
Mowed meadow pattern of the tongue also called “Plaques en prairie fauchée” is a manifestation of secondary syphilis. It results from the hematogenous dissemination of Treponema pallidum from syphilitic chancres. Suspected case is confirmed by serology or nucleic acid amplification on a tongue swab.
We report a clinical picture of a mowed meadow pattern of the tongue in a 29-year-old sexually active man who has sex with men. The painful lesions also called "Plaques en prairie fauchée", occur in the context of the discovery of a postive HIV serology. The diagnosis of secondary syphilis was confirmed by a positive syphilis serology (nontreponemal RPR test title of 64) and a positive Treponema pallidum PCR, amplifying the tpp47 gene, on a tongue swab. The lesions completely resolve with a penicillin treatment.
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35
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Affiliation(s)
- Yasmin Hughes
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, Australia
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36
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Performance characteristics of the SpeeDx PlexPCR VHS assay for the molecular detection of herpes simplex virus, varicella zoster virus, and Treponema pallidum in lesion swabs. Diagn Microbiol Infect Dis 2020; 99:115221. [PMID: 33176262 DOI: 10.1016/j.diagmicrobio.2020.115221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/01/2020] [Accepted: 09/14/2020] [Indexed: 11/20/2022]
Abstract
This study compares the performance of a commercial polymerase chain reaction (PCR) assay for detection of herpes simplex virus (HSV) 1 and 2, varicella zoster virus (VZV), and Treponema pallidum with laboratory-developed assays. A panel of 250 samples, previously tested using in-house assays, was tested on the PlexPCR® VHS assay. The panel consisted of 202 positive specimens [HSV-1 (n=51); HSV-2 (n=51); VZV (n=51); T. pallidum (n=49)] and 48 negative specimens. Genital samples had been previously tested for HSV-1/2 and T. pallidum and nongenital or unspecified samples for HSV-1/2 and VZV. The overall agreement between the PlexPCR® VHS and in-house assays was 97%. Negative agreement was ≥99%, and positive agreement for individual targets was 96% (47/49) for T. pallidum, 98% for HSV-1 and HSV-2 (50/51), and 100% (51/51) for VZV. Adoption of this assay would allow greater availability of molecular syphilis detection and enhance the diagnostic yield of samples collected from cutaneous/mucocutaneous lesions.
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37
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Khan MS, Kuruppu DK, Popli TA, Moorthy RS, Mackay DD. UNILATERAL OPTIC NEURITIS AND CENTRAL RETINAL VASCULITIS DUE TO OCULAR SYPHILIS. Retin Cases Brief Rep 2020; 14:35-38. [PMID: 28816862 DOI: 10.1097/icb.0000000000000614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Report a case of concurrent unilateral optic neuritis and central retinal artery occlusion as the presenting signs of syphilis. METHODS A case report of a 22-year-old man with progressive unilateral vision loss. RESULTS With no known previous history of syphilis, genital lesions, or other extraocular manifestations, the patient presented with pain with eye movements and decreased color vision. His vision dramatically worsened after a course of oral steroids. Examination was remarkable for severe right optic disk edema with a macular cherry-red spot and mild posterior uveitis. Magnetic resonance imaging of the orbits with contrast revealed enhancement and enlargement of the distal right optic nerve. Fluorescein angiography demonstrated delayed filling of the right central retinal artery, suggestive of impending central retinal artery occlusion. Syphilis serologies were positive from the serum, and cerebrospinal fluid Venereal Disease Research Laboratory test was reactive, consistent with neurosyphilis. Oral steroids were discontinued and vision improved with 2 weeks of intravenous penicillin. CONCLUSION This unusual case highlights one of the possible initial presentations of syphilis: unilateral optic neuritis and central retinal artery vasculitis with mild posterior uveitis. The worsening of vision after administration of oral steroids also highlights a potential complication of oral steroid use in the absence of a known etiology of vision loss. A thorough history and examination may be helpful in identifying risk factors for infectious causes, including syphilis, and should prompt additional evaluation.
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Affiliation(s)
- Murtaza S Khan
- Department of Neurology, Indiana University, Indianapolis, Indiana
| | | | - Tanav A Popli
- Indiana University School of Medicine, Indianapolis, Indiana; and
| | | | - Devin D Mackay
- Department of Neurology, Indiana University, Indianapolis, Indiana.,Departments of Neurosurgery, and.,Ophthalmology, Indiana University, Indianapolis, Indiana
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38
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Akdogan N, Bostan E, Ozdemir DA, Ersoy-Evans S. A case of lichenoid mycosis fungoides that became apparent after penicillin treatment for secondary syphilis. Dermatol Ther 2020; 33:e13984. [PMID: 32643226 DOI: 10.1111/dth.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Neslihan Akdogan
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ecem Bostan
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Ates Ozdemir
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sibel Ersoy-Evans
- Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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39
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Leite MGM, Freitas EDS, de Vasconcelos Ii AJA, Pinheiro TN. Low-Level Laser Therapy Approach of Bilateral Necrotizing Sialometaplasia of the Hard and Soft Palates. J Lasers Med Sci 2020; 11:348-354. [PMID: 32802297 DOI: 10.34172/jlms.2020.56] [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: 01/04/2023]
Abstract
Introduction: Necrotizing sialometaplasia (NS) is a rare locally destructive inflammatory benign disease that commonly affects the minor salivary glands. It is frequently associated with the glands located in the posterior portion of the hard and soft palates. Low-level laser therapy (LLLT), also called photobiomodulation therapy (PBMT), has been deemed a substantial method for the regenerative wound process. Case Presentation: A 32-year-old male patient was referred with a chief complaint of two asymptomatic crater-like ulcers measuring approximately 1.5 cm wide on the right side of the hard and soft palates, and another measuring 0.3 cm wide on the left side of the hard palate. The lesion had two weeks of evolution followed by a previous infectious "sore throat" event that kept the patient hospitalized for 4 days. A clinical diagnosis of NS was made. LLLT was applied during 2 sessions per week, favoring the total wound healing within 2 weeks. At 3 months of clinical followup, the patient did not present any complication or relapse and was thus released. Conclusion: This is, to our knowledge, the first clinical report of LLLT applied for the management of NS. Large palatal ulcers caused by NS usually have long healing periods. The shortened healing period observed in this case encourages the inclusion of LLLT in any treatment protocol for similar lesions.
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Affiliation(s)
- Milena Gomes Melo Leite
- Undergraduate Student, Superior School of Health Science, Amazonas State University, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus-AM, 69065-001, Brazil
| | - Eliandro de Souza Freitas
- Undergraduate Student, Superior School of Health Science, Amazonas State University, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus-AM, 69065-001, Brazil
| | | | - Tiago Novaes Pinheiro
- DDS, MSc, PhD, Superior School of Health Science, Amazonas State University, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus-AM, 69065-001, Brazil
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40
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Govender D, Jackson C, Chetty D. Syphilitic Pulmonary Inflammatory Pseudotumor: A Diagnostic Challenge. Int J Surg Pathol 2020; 29:90-96. [PMID: 32486870 DOI: 10.1177/1066896920928584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 46-year-old man presented with nonproductive cough and lower limb swelling. Chest radiograph showed a left lower lobe lung mass and multiple subpleural nodules. Other investigations revealed that he had nephrotic syndrome. Core biopsies of the left lower lobe lung mass showed features of inflammatory pseudotumor with endarteritis obliterans and a lymphoplasmacytic infiltrate. Immunohistochemical stain for Treponema pallidum was positive. Resolution of the lung mass and nephrotic syndrome was achieved after treatment with intramuscular benzathine benzylpenicillin. The differential diagnosis of pulmonary inflammatory pseudotumor, manifestations of pulmonary syphilis, and a literature review of secondary syphilis of the lung are discussed.
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Affiliation(s)
- Dhirendra Govender
- University of Cape Town, Cape Town, South Africa.,PathCare, Claremont, Cape Town, South Africa
| | - Christopher Jackson
- University of Cape Town, Cape Town, South Africa.,NHLS-Groote Schuur Hospital, Cape Town, South Africa
| | - Dharshnee Chetty
- University of Cape Town, Cape Town, South Africa.,NHLS-Groote Schuur Hospital, Cape Town, South Africa
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41
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Identification of the Neuroinvasive Pathogen Host Target, LamR, as an Endothelial Receptor for the Treponema pallidum Adhesin Tp0751. mSphere 2020; 5:5/2/e00195-20. [PMID: 32238570 PMCID: PMC7113585 DOI: 10.1128/msphere.00195-20] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Treponema pallidum subsp. pallidum is the causative agent of syphilis, a human-specific sexually transmitted infection that causes a multistage disease with diverse clinical manifestations. Treponema pallidum undergoes rapid vascular dissemination to penetrate tissue, placental, and blood-brain barriers and gain access to distant tissue sites. The rapidity and extent of T. pallidum dissemination are well documented, but the molecular mechanisms have yet to be fully elucidated. One protein that has been shown to play a role in treponemal dissemination is Tp0751, a T. pallidum adhesin that interacts with host components found within the vasculature and mediates bacterial adherence to endothelial cells under shear flow conditions. In this study, we further explore the molecular interactions of Tp0751-mediated adhesion to the vascular endothelium. We demonstrate that recombinant Tp0751 adheres to human endothelial cells of macrovascular and microvascular origin, including a cerebral brain microvascular endothelial cell line. Adhesion assays using recombinant Tp0751 N-terminal truncations reveal that endothelial binding is localized to the lipocalin fold-containing domain of the protein. We also confirm this interaction using live T. pallidum and show that spirochete attachment to endothelial monolayers is disrupted by Tp0751-specific antiserum. Further, we identify the 67-kDa laminin receptor (LamR) as an endothelial receptor for Tp0751 using affinity chromatography, coimmunoprecipitation, and plate-based binding methodologies. Notably, LamR has been identified as a receptor for adhesion of other neurotropic invasive bacterial pathogens to brain endothelial cells, including Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae, suggesting the existence of a common mechanism for extravasation of invasive extracellular bacterial pathogens.IMPORTANCE Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subsp. pallidum. The continued incidence of syphilis demonstrates that screening and treatment strategies are not sufficient to curb this infectious disease, and there is currently no vaccine available. Herein we demonstrate that the T. pallidum adhesin Tp0751 interacts with endothelial cells that line the lumen of human blood vessels through the 67-kDa laminin receptor (LamR). Importantly, LamR is also a receptor for meningitis-causing neuroinvasive bacterial pathogens such as Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae Our findings enhance understanding of the Tp0751 adhesin and present the intriguing possibility that the molecular events of Tp0751-mediated treponemal dissemination may mimic the endothelial interaction strategies of other invasive pathogens.
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Middelveen MJ, Martinez RM, Fesler MC, Sapi E, Burke J, Shah JS, Nicolaus C, Stricker RB. Classification and Staging of Morgellons Disease: Lessons from Syphilis. Clin Cosmet Investig Dermatol 2020; 13:145-164. [PMID: 32104041 PMCID: PMC7012249 DOI: 10.2147/ccid.s239840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/16/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Morgellons disease (MD) is a contested dermopathy that is associated with Borrelia spirochetal infection. A simple classification system was previously established to help validate the disease based on clinical features (classes I-IV). METHODS Drawing on historical and pathological parallels with syphilis, we formulated a more detailed staging system based on clinical features as well as severity of skin lesions and corresponding histopathological infection patterns, as determined by anti-Borrelia immunohistochemical staining. RESULTS Clinical classes I-IV of MD are further categorized as mild, moderate and severe, or stages A, B and C, respectively, based on histopathological findings. Stage A lesions demonstrated little or no immune infiltrates and little or no disorganization of cells; macrophages were not present, and hemorrhage was negligible. Extracellular isolated spirochetes and intracellular staining of keratinocytes in the lower epidermis was occasionally seen. Stage C lesions demonstrated positive staining of keratinocytes in the stratum basale and stratum spinosum and positive intracellular staining of macrophages for Borrelia. Aggregate Borrelia colonies were frequently encountered, hemorrhage was frequent, and intracellularly stained fibroblasts were occasionally seen. Stage B lesions demonstrated a pattern intermediate between Stages A and C. CONCLUSION The enhanced staging system provides objective criteria to assess the severity of dermopathy in MD. Further studies are needed to determine the optimal treatment for MD based on this staging system related to Borrelia infection.
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Affiliation(s)
| | | | | | - Eva Sapi
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA
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Secondary Syphilis with Eosinophilia Complicated by Severe Jarisch-Herxheimer Reaction. Case Rep Infect Dis 2020; 2020:2150314. [PMID: 32518698 PMCID: PMC7201786 DOI: 10.1155/2020/2150314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 11/06/2019] [Accepted: 11/30/2019] [Indexed: 11/18/2022] Open
Abstract
It has long been acknowledged that syphilis is a disease with a diverse range of presentations. We herein describe a case of a young man who presented with fever, rash, and eosinophilia following the commencement of allopurinol, only to be diagnosed with secondary syphilis on histopathology. His treatment was complicated by a severe exacerbation of his cutaneous eruption following the commencement of penicillin, likely secondary to a Jarisch-Herxheimer reaction, an entity often overlooked by clinicians managing syphilis.
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44
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Adas A, Arnault JP, Attencourt C, Lok C, Chaby G. Secondary syphilis presenting as diffused folliculitis. J Eur Acad Dermatol Venereol 2019; 34:e191-e193. [PMID: 31774197 DOI: 10.1111/jdv.16109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Adas
- Department of Dermatology, Amiens University Hospital, Amiens, France
| | - J-P Arnault
- Department of Dermatology, Amiens University Hospital, Amiens, France
| | - C Attencourt
- Department of Pathology, Amiens University Hospital, Amiens, France
| | - C Lok
- Department of Dermatology, Amiens University Hospital, Amiens, France
| | - G Chaby
- Department of Dermatology, Amiens University Hospital, Amiens, France
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45
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Bandara HMHN, Samaranayake LP. Viral, bacterial, and fungal infections of the oral mucosa: Types, incidence, predisposing factors, diagnostic algorithms, and management. Periodontol 2000 2019; 80:148-176. [PMID: 31090135 DOI: 10.1111/prd.12273] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
For millions of years, microbiota residing within us, including those in the oral cavity, coexisted in a harmonious symbiotic fashion that provided a quintessential foundation for human health. It is now clear that disruption of such a healthy relationship leading to microbial dysbiosis causes a wide array of infections, ranging from localized, mild, superficial infections to deep, disseminated life-threatening diseases. With recent advances in research, diagnostics, and improved surveillance we are witnessing an array of emerging and re-emerging oral infections and orofacial manifestations of systemic infections. Orofacial infections may cause significant discomfort to the patients and unnecessary economic burden. Thus, the early recognition of such infections is paramount for holistic patient management, and oral clinicians have a critical role in recognizing, diagnosing, managing, and preventing either new or old orofacial infections. This paper aims to provide an update on current understanding of well-established and emerging viral, bacterial, and fungal infections manifesting in the human oral cavity.
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Affiliation(s)
| | - Lakshman P Samaranayake
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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Unique Facial and Oral Lesions in a Patient With Human Immunodeficiency Virus. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Streight KL, Paranal RM, Musher DM. The oral manifestations of syphilitic disease: a case report. J Med Case Rep 2019; 13:227. [PMID: 31345262 PMCID: PMC6659237 DOI: 10.1186/s13256-019-2171-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/20/2019] [Indexed: 12/27/2022] Open
Abstract
Background Syphilis is a sexually transmitted bacterial infection of the spirochete, Treponema pallidum. While primary syphilis often involves genitalia, oral manifestations are observed in a subset of patients. These lesions are often associated with submandibular and cervical lymphadenopathy. This is a case report of a primary syphilitic lesion located on the hard palate of the oral cavity, with only a very few cases described previously. Case presentation We describe a rare case of syphilis in a 59-year-old African American man presenting with subjective fevers, chills, marked submental lymphadenopathy, a diffuse skin rash, and an ulcer of the hard palate. Conclusions This case report demonstrates the importance of maintaining a high index of suspicion for syphilitic infection when a patient presents with nonspecific symptoms, a diffuse rash, and an oral lesion.
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Affiliation(s)
| | - Ronald M Paranal
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Daniel M Musher
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
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Gao Z, Luo X, Liu L, Lin L, Tong M, Yang T. Recombinant
Treponema pallidum
protein Tp47 induces angiogenesis by modulating the matrix metalloproteinase/tissue inhibitor of metalloproteinase balance in endothelial cells. J Eur Acad Dermatol Venereol 2019; 33:1958-1970. [PMID: 31166625 DOI: 10.1111/jdv.15725] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/08/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Z.‐X. Gao
- Center of Clinical Laboratory Zhongshan Hospital School of Medicine Xiamen University Xiamen China
- Institute of Infectious Disease School of Medicine Xiamen University Xiamen China
| | - X. Luo
- Center of Clinical Laboratory Zhongshan Hospital School of Medicine Xiamen University Xiamen China
| | - L.‐L. Liu
- Center of Clinical Laboratory Zhongshan Hospital School of Medicine Xiamen University Xiamen China
- Institute of Infectious Disease School of Medicine Xiamen University Xiamen China
| | - L.‐R. Lin
- Center of Clinical Laboratory Zhongshan Hospital School of Medicine Xiamen University Xiamen China
- Institute of Infectious Disease School of Medicine Xiamen University Xiamen China
| | - M.‐L. Tong
- Center of Clinical Laboratory Zhongshan Hospital School of Medicine Xiamen University Xiamen China
| | - T.‐C. Yang
- Center of Clinical Laboratory Zhongshan Hospital School of Medicine Xiamen University Xiamen China
- Institute of Infectious Disease School of Medicine Xiamen University Xiamen China
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49
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
- Sexual Health Clinic, Ottawa Public Health, Ottawa, Ontario K1N 5P9
| | - Paul MacPherson
- Division of Infectious Diseases, Ottawa Hospital General Campus, Ottawa, Ontario
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50
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Gao ZX, Liu LL, Lin LR, Tong ML, Liu F, Yang TC. Treponema pallidum Induces the Secretion of HDVSMC Inflammatory Cytokines to Promote the Migration and Adhesion of THP-1 Cells. Front Cell Infect Microbiol 2019; 9:220. [PMID: 31293985 PMCID: PMC6598120 DOI: 10.3389/fcimb.2019.00220] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
Abstract
The pathological features of syphilis, a disease caused by Treponema pallidum (T. pallidum), are characterized by vascular involvement with endarteritis and periarteritis. Little is known about the interactions of infiltrating immunocytes with human dermal vascular smooth muscle cells (HDVSMCs) in arterioles during the immunopathogenesis of syphilis. In the present study, we demonstrated that stimulation of HDVSMCs with T. pallidum resulted in the upregulated gene transcription and protein expression of interleukin (IL)-6, monocyte chemoattractant protein-1 (MCP-1), and intercellular adhesion molecule-1 (ICAM-1) in a dose- and time-dependent manner. Moreover, the migration and adhesion of THP-1 cells to HDVSMCs were significantly suppressed by anti-MCP-1 and anti-ICAM-1 neutralizing antibodies, respectively. Further studies revealed that T. pallidum activated the NF-κB signaling pathway in HDVSMCs. Inhibition of NF-κB suppressed T. pallidum-induced IL-6, MCP-1, and ICAM-1 expression. In addition, the migration and adhesion of THP-1 cells to T. pallidum-treated HDVSMCs were significantly decreased by pretreatment with an NF-κB inhibitor. These findings demonstrate that T. pallidum induces the production of IL-6, MCP-1, and ICAM-1 in HDVSMCs and promotes the adherence and migration of THP-1 cells to HDVSMCs through the NF-κB signaling pathway, which may provide new insight into the pathogenesis of T. pallidum infection.
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Affiliation(s)
- Zheng-Xiang Gao
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Li-Li Liu
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Li-Rong Lin
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Man-Li Tong
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Fan Liu
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Tian-Ci Yang
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
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