Successful Treatment Bilateral Panuveitis with Multiple Systemic Infection in HIV/AIDS Patient: A Case Report.

There is an increasing number of HIV/AIDS patients in Indonesia, starting from <0.1% in 2010 to 0.4% in 2012, which warrants awareness of ocular manifestation in HIV. This might appear in 70-100% of patients with HIV. A 47 years old man came to the infection and immunology clinic with blurry vision on both eyes. He had been treated before but there was no clinical improvement. Examination showed both eyes had vitreous haziness. Visual acuity was 1/60 in both eyes with appearance of flare and cells within +3. Uveitis workup showed positive results for HIV, HSV and syphilis. Patient was given 100 mg of doxyciclin two times daily and fixed dose tablet which contains the combination of antiretroviral. Three months later, final acuity was 6/10 on the right eye and 6/18 on the left eye. Prompt diagnosis and treatment warrant good prognosis including multidisciplinary approach by ophthalmologist, clinical allergist and immunologist, and dermato-venerologist.

Tolerability of IM penicillin G benzathine diluted or not with local anesthetics, or different gauge needles for syphilis treatment: a randomized clinical trial.

BACKGROUND: Penicillin G Benzathine (PGB) is the cornerstone of syphilis treatment. However, its intramuscular (IM) administration is associated with pain at the site of injection. The dilution of PGB with local anesthetics is recommended in some guidelines, but the evidence that supports it, particularly in adults and in HIV infection, is scarce. Preliminary clinical experience also suggests that the IM administration of PGB through increased needle gauges might improve its tolerability. The aim of the study to identify less painful ways of administering IM PGB in the treatment of syphilis in adults. METHODS: Multicenter, randomized, double-blinded clinical trial in patients diagnosed with primary syphilis that required a single IM injection of PGB 2400,00 IU. Patients were randomized to receive PGB diluted with 0.5 mL mepivacaine 1% (MV) or PGB alone, and both groups either with a long 19G or short 21G IM needle. The primary objective was the effect on local pain immediately after the administration through a visual scale questionnaire on pain (0 to 10). RESULTS: One hundred eight patients were included, 27 in each group. Ninety-four (94.4%) were male, and 41.7% were also HIV-infected. Mean age 36.6 years (SD 11). Significant differences in immediate pain intensity were observed when comparing the long 19G group with anesthesia (mean pain intensity, [MPI] 2.92 [CI 95% 1.08-4.07]) vs long 19G without anesthesia (MPI 5.56 [CI 95% 4.39-6.73), p < 0.001; and also between short 21G group with anesthesia (MPI 3.36 [CI 95% 2.22-4.50]) vs short 21G without anesthesia (MPI 5.06 [CI 95% 3.93-6.19]), p = 0.015). No significant differences in immediate pain were observed between 19G and 21G in the presence or absence of anesthesia (p = 1.0 in both cases). No differences were found between study arms after 6 and 24 h. CONCLUSIONS: The IM administration of 1% mepivacaine-diluted PGB induces significantly less immediate local pain as compared to PGB alone. The needle gauge did not have any effect on the pain. Based on these results, we suggest anesthetic-diluted IM PGB as the standard treatment for primary syphilis. TRIAL REGISTRATION: EudraCT 2014-003969-24 (Date of registration 18/09/2014).

An Unexpected Finding in a Concussed Circus Acrobat.

Persistent post-concussive syndrome (PPCS) outlines a complex array of neurocognitive and psychological symptoms that persist in patients after a concussion. A 58-year-old female presented reporting recurrent loss of consciousness, and retrograde and anterograde amnesia following multiple concussions. She also endorsed persistent nausea, balance insufficiencies, hearing loss, and cognitive impairment. In addition, this patient had high-risk sexual behavior without prior testing for sexually transmitted infections. Given her clinical history, the differential included PPCS, complex post-traumatic stress disorder, Korsakoff syndrome, hypothyroidism, and sexually transmitted infection (STI)-related neurocognitive disorder. On exam, this patient had a positive Romberg sign, prominent resting tremoring of upper extremities, and pinpoint pupils unresponsive to light, with bilateral nystagmus. Syphilis testing was positive. The patient was treated with intramuscular benzathine penicillin with significant improvement in gait, balance, headaches, vision, and cognition three months after treatment. Although rare, neurocognitive disorders, including late-stage syphilis, should be considered in the differential diagnosis for PPCS.

Fetal deaths in pregnancies with SARS-CoV-2 infection in Brazil: A case series.

BACKGROUND: There are few reports of miscarriages or stillbirths in women infected with SARS-CoV-2. We present five consecutive cases of fetal death (≥12 weeks) without other putative causes in women with laboratory-confirmed (RT-PCR) COVID-19 managed in a single Brazilian institution. CASE SERIES: All five women were outpatients with mild or moderate forms of COVID-19 and were not taking any medication. Four were nulliparous, all were overweight or obese, and none had any comorbidities or pregnancy complications that could contribute to fetal demise. Fetal death occurred at 21-38 weeks of gestation, on COVID-days 1-22. SARS-Cov-2 was detected by RT-PCR in amniotic fluid in one case and in placental specimens in two cases. All five women had acute chorioamnionitis on placental histology, massive deposition of fibrin, mixed intervillitis/villitis, and intense neutrophil and lymphocyte infiltration. One fetus had neutrophils inside alveolar spaces, suggestive of fetal infection. CONCLUSIONS: These five cases of fetal demise in women with confirmed COVID-19 without any other significant clinical or obstetric disorders suggest that fetal death can be an outcome of SARS-CoV-2 infection in pregnancy. The intense placental inflammatory reaction in all five cases raises the possibility of a direct effect of SARS-CoV-2 on the placenta.

Tendência temporal de internações por sífilis congênita entre 2008 e 2018, em Minas Gerais / Temporal trend of congenital syphilis hospitalizations between 2008 and 2018 in Minas Gerais

Objetivou-se analisar a tendência temporal de internações por sífilis congênita entre 2008 e 2018 em Minas Gerais. Método: estudo ecológico de série temporal. Para a análise de tendência, realizou-se modelo de Prais-Winsten. Calculou-se a Variação Percentual Anual para apresentar a intensidade da tendência. Resultados: foi observada tendência ascendente de internações por sífilis congênita em 12 macrorregiões de Minas Gerais. As maiores Variações Percentuais Anuais foram observadas nas regiões: Leste do Sul, Oeste e Leste. A macrorregião Leste do Sul apresentou a maior variação do estado (84,34%; IC95% 50,30; 126,09) e a Triângulo Norte apresentou menor variação percentual anual (19,62; IC95% 6,48; 34,38). Conclusão: a tendência de aumento de internações por sífilis congênita, observada em 12 das 13 macrorregiões de saúde, caracteriza uma tendência ascendente no estado e reforça a necessidade de formulação ou revisão de ações que priorizem a prevenção desse agravo.

The objective was to analyze the temporal trend of congenital syphilis hospitalizations between 2008 and 2018 in Minas Gerais. Method: ecological time-series study. Prais-Winsten estimation was used for trend analysis. The Annual Percentage Variation was calculated to show the trend intensity. Results: an ascending trend of congenital syphilis hospitalizations was observed in 12 macro-regions of Minas Gerais. The greater Annual Percentage Variations were observed in the Leste do Sul, West and East regions. The Leste do Sul macro-region showed the highest variation in the state (84.34%; CI95% 50.30; 126.09) while Triângulo Norte showed the lowest annual percentage variation (19.62; CI95% 6.48; 34.38). Conclusion: the ascending trend of congenital syphilis hospitalizations observed in 12 out of the 13 health macro-regions characterizes an ascending trend in the state and reinforces the need to develop or review actions that prioritize the prevention of this disease

A recrudescência da sífilis congênita / Congenital syphilis recrudescence

A Sífilis Congênita é uma doença sistêmica, de transmissão vertical ou sexual, com grande impacto para a saúde publica. Sendo um tema de grande relevância, este trabalho tem como objetivo determinar a incidência de sífilis congênita e comparar os dados encontrados com os dados dos últimos 15 anos e avaliar a taxa de notificação do agravo para a Diretoria de Vigilância Epidemiológica. Trata-se de um estudo observacional, transversal e de coleta secundária de dados que incluiu todos os casos de Sífilis Congênita ocorridos entre 01/02/2014 a 31/07/2015, através de busca ativa dos testes não-treponêmico reativos das puérperas no banco de dados informatizado do hospital, seguida da pesquisa no prontuário das mulheres e seus recém-nascidos identificando os casos da doença. Finalmente, comparou-se o número de casos identificados com aqueles notificados à Vigilância Epidemiológica e com resultados obtidos em estudos anteriores na mesma instituição. No período estudado, ocorreram 26 casos de Sífilis Congênita, com uma incidência de 8,6 casos para cada 1000 nascidos vivos e aumento de 126% quando comparado à taxa de 2008. Houve notificação de 88% dos casos. Conclui-se deste trabalho, que a atual incidência de Sífilis Congênita é elevada, com aumento significativo das suas taxas nos últimos 15 anos e que não houve notificação de todos os casos.

Congenital syphilis is a systemic disease, transmitted vertically or sexually, with great impact on public health. This study aims to determine the incidence of Congenital Syphillis (CS), comparing the data obtained in the last 15 years and to verify the proportion of cases that were notified to the Diretoria de Vigilância Epidemiológica. It was an observational, retrospective cross-secondary study including all cases of CS from February 1st, 2014 to July 31st, 2015, identified through an active search in the hospital's computerized database for parturient women with reactive non-treponemic test, followed by the research on their medical records. Finally, the number of CS cases identified was compared to those notified to the Epidemiological Surveillance State and with results obtained in previous studies in the same institution. During the study period, there were 26 cases of SC, with an incidence of 8.6 cases per 1,000 live births and an increase of 126% compared to the rate of 2008. 88% of the cases were reported. In conclusion, there was a high incidence of congenital syphilis, with significant increase in the rates over the past 15 years and not all cases were notified.

Secundarismo sifilítico: un amplio espectro de manifestaciones dermatológicas / Syphilitic Secondaryism: A Wide Spectrum of Dermatological Manifestations

El artículo describe el caso de un paciente de 28 años de edad con antecedente de VIH, quien presentaba múltiples lesiones en la piel y las mucosas, producto de sífilis secundaria, y quien mostraba un amplio espectro de manifestaciones cutáneas características de esta enfermedad.

We describe the case of a 28-year-old patient with HIV history who has multiple skin and mucous lesions that showing a broad spectrum of cutaneous manifestations of secondary syphilis.