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1.
Rev Saude Publica ; 54: 109, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33146299

RESUMEN

OBJECTIVE: To analyze the shortage of benzathine penicillin G (BPG), characterizing its temporal evolution and spatial distribution in the city of Rio de Janeiro from 2013 to 2017. METHODS: This ecological study used gestational and congenital syphilis notifications, BPG distribution records, and sociodemographic data from the population of Rio de Janeiro. To quantify the shortage, a BPG supply indicator was estimated per quarter for each neighborhood between 2013 and 2017. Thematic maps were created to identify areas and periods with greater BPG shortage, described according to sociodemographic factors, health services network, and epidemiological features in the incidence of syphilis. RESULTS: BPG shortage in Rio de Janeiro from 2013 to 2017 was not homogeneous in space nor in time. The temporal evolution and spatial distribution of BPG scarcity shows that the shortage affected the inhabitants of the municipality in different ways. Shortage was lower in 2013 and 2016 and more severe in 2014, 2015, and 2017, particularly in neighborhoods within the programmatic areas PA3 and PA5, poorer and with higher prevalence rates of gestational and congenital syphilis. CONCLUSIONS: Analyzing BPG shortage and its temporal evolution and spatial distribution in Rio de Janeiro allowed us to realize that the inhabitants are affected in different ways. Understanding this process contributes to the planning of actions to face shortage crises, minimizing possible impacts on the management of syphilis and reducing inequality in access to treatment.


Asunto(s)
Accesibilidad a los Servicios de Salud , Disparidades en el Estado de Salud , Penicilina G Benzatina/provisión & distribución , Sífilis Congénita/epidemiología , Sífilis/epidemiología , Brasil/epidemiología , Femenino , Humanos , Masculino , Penicilina G Benzatina/uso terapéutico , Embarazo , Análisis Espacio-Temporal , Sífilis/tratamiento farmacológico , Sífilis Congénita/tratamiento farmacológico
2.
PLoS One ; 15(10): e0238617, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33027255

RESUMEN

BACKGROUND: Neurosyphilis (NS) presents with a variety of clinical syndromes that can be attributed to other aetiologies due to difficulties in its diagnosis. We reviewed all cases of NS from the "Top End" of the Australian Northern Territory over a ten-year period to assess incidence, clinical and laboratory manifestations. METHODS: Patient data (2007-2016) were extracted from hospital records, centralised laboratory data and Northern Territory Centre for Disease Control records. Clinical records of patients with clinically suspected NS were reviewed. A diagnosis of NS was made based on the 2014 US CDC criteria. Results were also recategorized based on the 2018 US CDC criteria. RESULTS: The population of the "Top End" is 185,570, of whom 26.2% are Indigenous. A positive TPPA was recorded in 3126 individuals. A total of 75 (2.4%) of TPPA positive patients had a lumbar puncture (LP), of whom 25 (35%) were diagnosed with NS (9 definite, 16 probable). Dementia was the most common manifestation (58.3%), followed by epilepsy (16.7%), psychosis (12.5%), tabes dorsalis (12.5%) and meningovascular syphilis (8.3%). 63% of probable NS cases were not treated appropriately due to a negative CSF VDRL. Despite increased specificity of the 2018 US CDC criteria, 70% of patient in the probable NS group were not treated appropriately. The overall annual incidence [95%CI] of NS was 2.47[1.28-4.31] per 100 000py in the Indigenous population and 0.95[0.50-1.62] in the non-Indigenous population (rate ratio = 2.60 [1.19-5.70];p = 0.017). CONCLUSION: Neurosyphilis is frequently reported in the NT, particularly in Indigenous populations. Disturbingly, 60% of probable neurosyphilis patients based on the 2014 criteria, and 70% based on the 2018 criteria with were not treated appropriately. It is critical that clinicians should be aware of the diagnosis of NS and treat patients appropriately.


Asunto(s)
Neurosífilis/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neurosífilis/diagnóstico , Neurosífilis/tratamiento farmacológico , Northern Territory/epidemiología , Penicilina G Benzatina/uso terapéutico , Prevalencia , Estudios Prospectivos , Estudios Retrospectivos
3.
PLoS Negl Trop Dis ; 14(8): e0008558, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32804953

RESUMEN

Rheumatic heart disease (RHD) as a chronic sequela of repeated episodes of acute rheumatic fever (ARF), remains a cause of cardiac morbidity in Egypt although it is given full attention through a national RHD prevention and control program. The present report reviews our experience with subjects presenting with ARF or its sequelae in a single RHD centre and describes the disease pattern over the last decade. A cross-sectional study was conducted in El-Mahalla RHD centre between 2006 and 2018. A total of 17014 individual were enrolled and evaluated. Diagnosis ARF was based on the 2015 revised Jones criteria and RHD was ruled in by echocardiography. The majority of the screened subjects were female (63.2%), in the age group 5-15 years (64.6%), rural residents (61.2%), had primary education (43.0%), and of low socioeconomic standard (50.2%). The total percentage of cases presenting with ARF sequelae was 29.3% [carditis/RHD (10.8%), rheumatic arthritis (Rh.A) (14.9%), and Sydenham's chorea (0.05%)]. Noticeably, 72% were free of any cardiac insult, of which 37.7% were victims of misdiagnoses made elsewhere by untrained practitioners who prescribed for them long term injectable long-acting penicillin [Benzathine Penicillin G (BPG)] without need. About 54% of the study cohort reported the occurrence of recurrent attacks of tonsillitis of which 65.2% underwent tonsillectomy. Among those who experienced tonsillectomy and/or received BPG in the past, 14.5% and 22.3% respectively had eventually developed RHD. Screening of family members of some RHD cases who needed cardiac surgery revealed 20.7% with undiagnosed ARF sequalae [RHD (56.0%) and Rh.A (52.2%)]. Upon the follow-up of RHD cases, 1.2% had improved, 98.4% were stable and 0.4% had their heart condition deteriorated. Misdiagnosis of ARF or its sequelae and poor compliance with BPG use may affect efforts being exerted to curtail the disease. Updating national guidelines, capacity building, and reliance on appropriate investigations should be emphasized. Since the genetic basis of RHD is literally confirmed, a family history of RHD warrants screening of all family members for early detection of the disease.


Asunto(s)
Cardiopatía Reumática/diagnóstico , Cardiopatía Reumática/prevención & control , Adolescente , Niño , Preescolar , Estudios de Cohortes , Progresión de la Enfermedad , Ecocardiografía , Egipto , Femenino , Humanos , Tamizaje Masivo , Penicilina G Benzatina/uso terapéutico , Fiebre Reumática/prevención & control , Cardiopatía Reumática/epidemiología
4.
BMC Infect Dis ; 20(1): 405, 2020 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-32522244

RESUMEN

BACKGROUND: Syphilis is a sexually and vertically transmitted infection caused by the bacteria Treponema pallidum for which there are few proven alternatives to penicillin for treatment. For pregnant women infected with syphilis, penicillin is the only WHO-recommended treatment that will treat the mother and cross the placenta to treat the unborn infant and prevent congenital syphilis. Recent shortages, national level stockouts as well as other barriers to penicillin use call for the urgent identification of alternative therapies to treat pregnant women infected with syphilis. METHODS: This prospective, randomized, non-comparative trial will enroll non-pregnant women aged 18 years and older with active syphilis, defined as a positive rapid treponemal and a positive non-treponemal RPR test with titer ≥1:16. Women will be a, domized in a 2:1 ratio to receive the oral third generation cephalosporin cefixime at a dose of 400 mg two times per day for 10 days (n = 140) or benzathine penicillin G 2.4 million units intramuscularly based on the stage of syphilis infection (n = 70). RPR titers will be collected at enrolment, and at three, six, and nine months following treatment. Participants experiencing a 4-fold (2 titer) decline by 6 months will be considered as having an adequate or curative treatment response. DISCUSSION: Demonstration of efficacy of cefixime in the treatment of active syphilis in this Phase 2 trial among non-pregnant women will inform a proposed randomized controlled trial to evaluate cefixime as an alternative treatment for pregnant women with active syphilis to evaluate prevention of congenital syphilis. TRIAL REGISTRATION: Trial identifier: www.Clinicaltrials.gov, NCT03752112. Registration Date: November 22, 2018.


Asunto(s)
Antibacterianos/uso terapéutico , Cefixima/uso terapéutico , Sífilis/tratamiento farmacológico , Brasil/epidemiología , Protocolos de Ensayos Clínicos como Asunto , Ensayos Clínicos Fase II como Asunto , Femenino , Humanos , Penicilina G Benzatina/uso terapéutico , Distribución Aleatoria , Sífilis/microbiología , Sífilis/prevención & control , Resultado del Tratamiento , Treponema pallidum/efectos de los fármacos , Treponema pallidum/aislamiento & purificación
5.
Braz. j. otorhinolaryngol. (Impr.) ; 86(3): 358-363, May-June 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1132604

RESUMEN

Abstract Introduction: A resurgence of syphilis in Brazil has been reported in recent years. Objective: With this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital. Methods: A retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected. Results: A total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%). Conclusion: The frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis.


Resumo Introdução: Um ressurgimento da sífilis no Brasil tem sido relatado nos últimos anos. Objetivo: Investigar a frequência, as características demográficas e clínicas dos pacientes com sífilis adquirida com envolvimento oral que receberam atendimento médico em um centro de referência em medicina oral em um hospital público brasileiro. Método: Estudo retrospectivo, abrangeu 12 anos, feito para identificar tendências de mudança na sífilis. Registros médicos de todos os pacientes diagnosticados com sífilis adquirida que receberam atendimento médico na clínica de medicina oral do hospital de 2005 a 2016 foram revisados e os dados demográficos e clínicos foram coletados. Resultados: Foram diagnosticas 85 pacientes com sífilis adquirida, com um aumento significativo no número de casos nos últimos 5 anos. A idade dos pacientes variou de 16 a 76 anos, com pico na terceira e quarta décadas; 48 casos eram do sexo masculino (56,5%) e 37 do sexo feminino (43,5%). A maioria das lesões orais apareceu como úlceras ou placas únicas, os lábios e a língua representaram os locais mais afetados. Todos os casos foram positivos para Venereal Disease Research Laboratory e Fluorescent Treponemal Antibody Absorption Test e o tratamento foi feito com penicilina G benzatina na maioria dos casos (84,7%). Conclusão: A frequência da sífilis oral tem aumentado com o tempo e as lesões orais podem representar uma pista diagnóstica; portanto, os profissionais de saúde bucal devem ser conscientizados e devidamente treinados na tentativa de desenvolver um alto grau de suspeição clínica no diagnóstico da sífilis.


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Sífilis/diagnóstico , Enfermedades de la Boca/diagnóstico , Penicilina G Benzatina/uso terapéutico , Sífilis/tratamiento farmacológico , Estudios Retrospectivos , Enfermedades de la Boca/tratamiento farmacológico
6.
Int J STD AIDS ; 31(7): 699-701, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32362198

RESUMEN

Annular syphilis may range from mildly raised lesions with scaly borders to verrucous plaques. Localized annular syphilis on the genitalia has been rarely reported in HIV-negative cases. This paper reports a case of annular secondary syphilis on the penis. Dermoscopy showed peripheral dotted and short linear vessels and white scaling with a relatively clear central area in an erythematous annular plaque. Histopathology revealed mild hyperkeratosis, parakeratosis, psoriasiform acanthosis, and focal basal vacuolar degeneration with lichenoid, perivascular, and periadnexal infiltrate of lymphohistiocytes and plasma cells in the superficial dermis. Silver stain showed several spirochetes in the lower epidermis and superficial dermis. Electron microscopy revealed a few intercellular and intracytoplasmic spirochetes in the basal epidermis and free spirochetes in the papillary dermis. Rapid plasma reagin and Treponema pallidum particle agglutination assays were positive. The lesions disappeared after intramuscular benzathine penicillin, with no relapse at six-month follow-up.


Asunto(s)
Pene/patología , Sífilis Cutánea/patología , Sífilis/diagnóstico , Treponema pallidum/aislamiento & purificación , Adulto , Humanos , Masculino , Microscopía Electrónica , Penicilina G Benzatina/uso terapéutico , Sífilis/tratamiento farmacológico , Serodiagnóstico de la Sífilis , Resultado del Tratamiento
7.
Braz J Otorhinolaryngol ; 86(3): 358-363, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30956150

RESUMEN

INTRODUCTION: A resurgence of syphilis in Brazil has been reported in recent years. OBJECTIVE: With this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital. METHODS: A retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected. RESULTS: A total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%). CONCLUSION: The frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis.


Asunto(s)
Enfermedades de la Boca/diagnóstico , Sífilis/diagnóstico , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Boca/tratamiento farmacológico , Penicilina G Benzatina/uso terapéutico , Estudios Retrospectivos , Sífilis/tratamiento farmacológico , Adulto Joven
8.
Int J Infect Dis ; 91: 57-59, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31743797

RESUMEN

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum and has shown a significant increase in recent decades. It may be associated with other STIs such as soft chancre or chancroid, which is an uncommon infection in Brazil. The presence of ulcerated genital lesions is associated with a higher risk of HIV transmission. An accurate clinical and laboratory diagnosis of genital ulcer disease is essential for the appropriate treatment of pregnant women, in order to avoid congenital syphilis, a severe complication of mother-to-child vertical transmission. We report the case of a woman in the third trimester of pregnancy with Rollet's mixed chancre and describe the clinical and laboratory diagnosis, as well as the treatment of these diseases in pregnancy. We emphasize the importance of training health professionals on early diagnosis and treatment in order to avoid mother-to-child transmission.


Asunto(s)
Chancro/diagnóstico , Complicaciones Infecciosas del Embarazo/microbiología , Adulto , Antibacterianos/uso terapéutico , Brasil , Chancro/tratamiento farmacológico , Chancro/patología , Femenino , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Penicilina G Benzatina/uso terapéutico , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Sífilis/diagnóstico
9.
Clin Nephrol ; 93(2): 106-110, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31813414

RESUMEN

Renal manifestations of syphilis are variable, with membranous nephropathy being the most commonly described lesion. Rapidly progressive glomerulonephritis (RPGN) is rare and there is only one case report in the literature describing syphilis-associated crescentic glomerulonephritis. We report a rare case of RPGN secondary to latent syphilis, which resolved with penicillin treatment in the absence of immunosuppressive therapy. A 28-year-old Black male with a history of HIV was evaluated for severe acute kidney injury, nephrotic-range proteinuria, and active urine sediment. Serologies for glomerulonephritis were negative. Rapid plasma reagin and treponema pallidum particle agglutination assay were reactive, confirming syphilis diagnosis. Kidney biopsy revealed focal and segmental necrotizing and crescentic lesion. Patient received weekly benzathine penicillin (PCN) for 3 weeks, and renal function improved to baseline. This dramatic improvement happened with PCN alone, a finding which has not been previously reported. We recommend that syphilis be considered in the differential diagnosis of all patients with proteinuria or suspected glomerulonephritis.


Asunto(s)
Antibacterianos/uso terapéutico , Glomerulonefritis/microbiología , Penicilina G Benzatina/uso terapéutico , Sífilis Latente/complicaciones , Sífilis Latente/tratamiento farmacológico , Lesión Renal Aguda/etiología , Adulto , Glomerulonefritis/patología , Glomerulonefritis/fisiopatología , Infecciones por VIH/complicaciones , Humanos , Riñón/patología , Masculino , Proteinuria/patología
10.
Sci Rep ; 9(1): 19547, 2019 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-31862938

RESUMEN

The aim of this study was to evaluate the effectiveness of preventing mother to child syphilis transmission to improve pregnancy outcomes. We performed a retrospective analysis of municipal databases of mother-to-child syphilis transmission. Pregnant women with syphilis were included. Group specific pregnancy outcomes were analyzed according to treatment. A total of 28 pregnant women were diagnosed with syphilis in 2012; 321 were diagnosed with syphilis in 2018. A prevalence of 0.14% was observed amongst pregnant women in Suzhou city from 2012-2018. Primary treatments included benzathine penicillin, ceftriaxone sodium or erythromycin when patients were allergic to Benzathine penicillin. The treatment coverage was 81.57%, and only 52.86% of pregnant women were adequately treated. Adverse pregnant outcomes were higher amongst untreated women. Expanding early screening coverage and promoting treatment were key to improving pregnancy outcomes amongst women with syphilis.


Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Sífilis/prevención & control , Sífilis/transmisión , Adulto , Antibacterianos/uso terapéutico , Ceftriaxona/uso terapéutico , Eritromicina/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Penicilina G Benzatina/uso terapéutico , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Resultado del Embarazo , Atención Prenatal , Estudios Retrospectivos , Adulto Joven
12.
Aust J Gen Pract ; 48(12): 859-865, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31774991

RESUMEN

BACKGROUND AND OBJECTIVES: Acute rheumatic fever (ARF) is a complication of infection with group A streptococcus. ARF is treated with a long-term regimen of antibiotic secondary prophylaxis. Recent data have shown that only 36% of clients receive >80% of their regimen. The aim of this study was to determine clinic-level factors independently associated with the performance of primary healthcare clinics in delivering secondary prophylaxis to patients with ARF. METHOD: Cross-sectional de-identified data from clinics agreeing to data retention through the Audit and Best Practice for Chronic Disease National Research Partnership were accessed to calculate secondary prophylaxis performance scores and clinic-level factors associated with secondary prophylaxis performance using regression analysis. RESULTS: Thirty-six clinics and 496 client records met eligibility criteria for analysis. Clinic secondary prophylaxis performance was significantly associated with 'systematic processes of follow-up'. Every one unit increase in 'systematic approach to follow-up' increased the median level of secondary prophylaxis performance by 30% (95% confidence interval: 2, 66). Clinic accreditation status, location or workforce were not associated with secondary prophylaxis performance. DISCUSSION: General practitioners as clinical leaders are well placed to support managers to critically review follow-up and electronic reminder systems for secondary prophylaxis delivery at clinic level.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Antibacterianos/administración & dosificación , Cumplimiento de la Medicación , Penicilina G Benzatina/administración & dosificación , Atención Primaria de Salud/organización & administración , Cardiopatía Reumática/prevención & control , Prevención Secundaria/estadística & datos numéricos , Adolescente , Adulto , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Antibacterianos/uso terapéutico , Australia , Quimioprevención , Auditoría Clínica , Duración de la Terapia , Femenino , Humanos , Inyecciones Intramusculares , Masculino , Persona de Mediana Edad , Grupo de Ascendencia Oceánica , Penicilina G Benzatina/uso terapéutico , Atención Primaria de Salud/estadística & datos numéricos , Fiebre Reumática/tratamiento farmacológico , Fiebre Reumática/prevención & control , Cardiopatía Reumática/tratamiento farmacológico , Adulto Joven
14.
BMC Gastroenterol ; 19(1): 191, 2019 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-31744461

RESUMEN

BACKGROUND: Syphilis is a common disease that has been researched and focused on for many years, however, syphilitic hepatitis has not been well-recognized. We report this case of syphilitic hepatitis with intrahepatic cholestasis and liver granulomas to make a deeper impression. CASE PRESENTATION: A 47-year-old male was admitted with jaundice and rashes. The laboratory examination showed abnormal liver enzymes with significant increases in ALP and GGT but mild increases in ALT and AST. His HBV surface antigen was weakly positive, with negative HIV antibody, HCV antibody, and undetectable HBV DNA. The rapid plasma reagin test and the Treponema pallidum particle assay tests for Syphilis were both positive. Abdominal ultrasonography and magnetic resonance cholangiopancreatography revealed the normal biliary tract, liver, and spleen. The liver pathological examination showed cholangiocyte inflammation and micro-granulomas with coagulation necrosis. After 2 months of benzathine penicillin treatment, his liver enzyme decreased rapidly and remained normal after 1-year of follow-up. CONCLUSIONS: Increased liver enzymes, intrahepatic cholestasis and liver granulomas with well-response to antibiotics may provide clues for the diagnosis of syphilitic hepatitis.


Asunto(s)
Hepatitis/microbiología , Sífilis/diagnóstico , Antibacterianos/uso terapéutico , Colestasis Intrahepática/patología , Granuloma/patología , Hepatitis/diagnóstico , Hepatitis/tratamiento farmacológico , Hepatitis/patología , Humanos , Hígado/enzimología , Hígado/patología , Masculino , Persona de Mediana Edad , Penicilina G Benzatina/uso terapéutico , Sífilis/tratamiento farmacológico , Sífilis/patología , Treponema pallidum/aislamiento & purificación
15.
BMC Infect Dis ; 19(1): 883, 2019 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-31646969

RESUMEN

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).


Asunto(s)
Anestésicos Locales/uso terapéutico , Mepivacaína/uso terapéutico , Dolor/tratamiento farmacológico , Penicilina G Benzatina/uso terapéutico , Sífilis/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adolescente , Adulto , Anestésicos Locales/administración & dosificación , Anestésicos Locales/efectos adversos , Método Doble Ciego , Combinación de Medicamentos , Femenino , Infecciones por VIH/microbiología , Humanos , Inyecciones Intramusculares/instrumentación , Masculino , Mepivacaína/administración & dosificación , Mepivacaína/efectos adversos , Agujas , Penicilina G Benzatina/administración & dosificación , Penicilina G Benzatina/efectos adversos
17.
Reumatol. clín. (Barc.) ; 15(4): 242-245, jul.-ago. 2019. ilus
Artículo en Inglés | IBECS | ID: ibc-184418

RESUMEN

We herein describe two cases of secondary syphilis in patients with human immunodeficiency virus (HIV) infection with an unusual presentation, a diffuse polyostotic periosteitis. Patients referred mainly intense bone pain. Other relevant aspects of the clinical pictures were flexor tenosynovitis and hepatic abnormalities. Given the persistence of symptoms, the treatment duration performed was different from most described in literature. However, although more slowly than expected, both obtained a favorable clinical response after treatment with benzathine penicillin G


Presentamos 2 casos de la sífilis secundaria en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) con una presentación inusual, una periosteitis difusa poliostótica. Los pacientes han reportado principalmente al dolor óseo intenso. Otros aspectos relevantes de los cuadros clínicos fueron tenosinovitis y anomalías hepáticas. Dada la persistencia de los síntomas, la duración del tratamiento realizado ha sido diferente de la mayoría de los descritos en la literatura. Sin embargo, aunque más lentamente de lo esperado, ambos han obtenido una respuesta clínica favorable después del tratamiento con benzatina penicilina G


Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Sífilis/complicaciones , Periostitis/etiología , Tenosinovitis/etiología , Dolor Musculoesquelético/etiología , Hígado/anomalías , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Penicilina G Benzatina/uso terapéutico
18.
Diagn Microbiol Infect Dis ; 95(1): 89-92, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31279583

RESUMEN

Malignant syphilis (also known lues maligna) is a rare and severe variant of secondary syphilis. It is most commonly seen in patients who are infected with human immunodeficiency virus (HIV), and rarely, it can occur in immunocompetent individuals. The exact mechanism of the development of malignant syphilis is not clear. It could probably be associated with immunosuppression, inappropriate immune response of the host, or virulent strain of Treponema pallidum. Coexistence of immunosuppression and inappropriate immune response may predispose to develop malignant syphilis in HIV-infected patients with immune reconstitution inflammatory syndrome. Herein, we report the first case of malignant syphilis after adalimumab therapy for Crohn's disease due to bariatric surgery and discuss the underlying possible pathogenic mechanisms.


Asunto(s)
Adalimumab/efectos adversos , Antiinflamatorios/efectos adversos , Cirugía Bariátrica/efectos adversos , Enfermedad de Crohn/etiología , Sífilis/diagnóstico , Treponema pallidum/aislamiento & purificación , Adalimumab/uso terapéutico , Adulto , Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Femenino , Humanos , Penicilina G Benzatina/uso terapéutico , Sífilis/tratamiento farmacológico , Sífilis/etiología , Sífilis/patología , Resultado del Tratamiento , Treponema pallidum/efectos de los fármacos
19.
Pak J Pharm Sci ; 32(3): 1107-1110, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31278727

RESUMEN

One of the most common endocrinological disorder affecting women in adolescence is Polycystic Ovarian Syndrome (PCOS). Women suffering from PCOS diagnosed with follicles in ovaries show enlarged reproductive organs with small filled follicles. Unusual bleeding, prolonged menstruation, unwanted hair growth, accumulation of fat and acne are the most common problems experienced by adolescents with PCOS. Nowadays, PCOS is treated successfully with the oral antidiabetic drug, metformin and hormone replacement therapy. Its off-label use is still controversial with unknown mechanisms due to patient risk versus benefit hypothesis by practitioners as they successfully treat PCOS in adolescents with metformin. But in few reported cases metformin has potential to induce back pain and swollen joints less frequently with rare cases of behavior alteration. Penicillin belongs to the beta-lactam antibiotics and is most commonly used to treat rheumatic fever although it has potential to cause allergic reactions affecting 10% of patients who exhibit IgE-mediated immunological reactions. Here, we present a case of a female diagnosed with PCOS who after treatment with metformin for more than two years, reported with hyperuricemia, migraine, neurological pain, severe joint and knee pains on shoulders and legs, and rheumatic fever. After treatment with benzathine benzyl penicillin for rheumatic fever, the patient also exhibited Type IV delayed hypersensitivity reaction.


Asunto(s)
Artralgia/inducido químicamente , Metformina/efectos adversos , Penicilina G Benzatina/efectos adversos , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Fiebre Reumática/tratamiento farmacológico , Analgésicos/uso terapéutico , Artralgia/tratamiento farmacológico , Artralgia/etiología , Hipersensibilidad a las Drogas/etiología , Femenino , Humanos , Hiperuricemia/inducido químicamente , Metformina/uso terapéutico , Trastornos Migrañosos/inducido químicamente , Penicilina G Benzatina/uso terapéutico , Síndrome del Ovario Poliquístico/diagnóstico por imagen , Fiebre Reumática/inducido químicamente , Fiebre Reumática/microbiología , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/etiología , Streptococcus pyogenes/patogenicidad , Adulto Joven
20.
Am Heart J ; 215: 95-105, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31301533

RESUMEN

Rheumatic heart disease (RHD) remains a high prevalence condition in low- and middle-income countries. Most individuals with RHD present late, missing the opportunity to benefit from secondary antibiotic prophylaxis. Echocardiographic screening can detect latent RHD, but the impact of secondary prophylaxis in screen-detected individuals is not known. METHODS/DESIGN: This trial aims to determine if secondary prophylaxis with every-4-week injectable Benzathine penicillin G (BPG) improves outcomes for children diagnosed with latent RHD. This is a randomized controlled trial in consenting children, aged 5 to 17 years in Northern Uganda, confirmed to have borderline RHD or mild definite RHD on echocardiography, according to the 2012 World Heart Federation criteria. Qualifying children will be randomized to every-4-week injectable intramuscular BPG or no medical intervention and followed for a period of 2 years. Ongoing intervention adherence and retention in the trial will be supported through the establishment of peer support groups for participants in the intervention and control arms. A blinded echocardiography adjudication panel consisting of four independent experts will determine the echocardiographic classification at enrollment and trajectory through consensus review. The primary outcome is the proportion of children in the BPG-arm who demonstrate echocardiographic progression of latent RHD compared to those in the control arm. The secondary outcome is the proportion of children in the BPG-arm who demonstrate echocardiographic regression of latent RHD compared to those in the control arm. A sample size of 916 participants will provide 90% power to detect a 50% relative risk reduction assuming a 15% progression in the control group. The planned study duration is from 2018-2021. DISCUSSION: Policy decisions on the role of echocardiographic screening for RHD have stalled because of the lack of evidence of the benefit of secondary prophylaxis. The results of our study will immediately inform the standard of care for children diagnosed with latent RHD and will shape, over 2-3 years, practical and scalable programs that could substantially decrease the burden of RHD in our lifetime. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03346525. Date Registered: November 17, 2017.


Asunto(s)
Antibacterianos/uso terapéutico , Ensayos Clínicos Fase III como Asunto , Penicilina G Benzatina/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Cardiopatía Reumática/prevención & control , Prevención Secundaria/métodos , Adolescente , Antibacterianos/administración & dosificación , Niño , Preescolar , Progresión de la Enfermedad , Esquema de Medicación , Ecocardiografía , Humanos , Evaluación de Resultado en la Atención de Salud , Penicilina G Benzatina/administración & dosificación , Cardiopatía Reumática/diagnóstico por imagen , Cardiopatía Reumática/tratamiento farmacológico , Cardiopatía Reumática/microbiología , Uganda
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