RESUMO
Purpose: To evaluate immunoblot (IB) and polymerase chain reaction (PCR) to diagnose ocular- and neurosyphilis. Methods: Prospective cross-sectional study. Aqueous humor (AH) and cerebrospinal fluid (CSF) samples were tested for treponemal DNA or antibodies to treponemal antigens. Results: Thirteen of 106 cases had positive syphilis serology of which 69.2% were HIV+ (median CD4+ = 181 cells/µL). Four cases met CDC criteria for neurosyphilis (3 confirmed, 1 probable) and 2 additional cases required neurosyphilis treatment according to UpToDate algorithms. All AH and CSF samples tested PCR negative. Five cases were CSF IB+ and 3 cases AH IB+. Using our classification, eight patients had confirmed neurosyphilis, one had probable neurosyphilis, three had confirmed ocular syphilis and nine had probable ocular syphilis. Conclusion: Our findings suggest that IB of AH and CSF provides additional evidence to diagnose ocular and neurosyphilis and allows us to classify them as probable or confirmed.
Assuntos
Humor Aquoso/microbiologia , Líquido Cefalorraquidiano/microbiologia , Infecções Oculares Bacterianas/diagnóstico , Soropositividade para HIV/diagnóstico , Neurossífilis/diagnóstico , Sífilis/diagnóstico , Treponema pallidum/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/imunologia , Estudos Transversais , DNA Bacteriano/genética , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Feminino , Soronegatividade para HIV , Humanos , Immunoblotting , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Neurossífilis/tratamento farmacológico , Neurossífilis/microbiologia , Penicilinas/uso terapêutico , Reação em Cadeia da Polimerase , Estudos Prospectivos , Sífilis/tratamento farmacológico , Sífilis/microbiologia , Sorodiagnóstico da Sífilis , Treponema pallidum/genética , Treponema pallidum/imunologia , Adulto JovemRESUMO
A 68-year-old man diagnosed with cT3N2 adenocarcinoma of the rectum presented with a synchronous solitary liver metastasis on CT scan. Neoadjuvant chemoradiotherapy was started to downstage the primary tumour. Resection of the rectal tumour followed 3â months after the last radiotherapy session and primary resection of the isolated liver lesion was performed in the intervening period. Histopathological assessment of the liver lesion, however, showed no malignancy, but did reveal a necrotic infection due to Enterobius vermicularis. This parasite is frequently found in the intestines, but only rarely infects the liver. The patient was subsequently treated with the anthelmintic drug mebendazole 100â mg once a week for 2â weeks. Histopathological assessment of the rectal specimen showed complete regression after neoadjuvant chemoradiotherapy without evidence of remaining E. vermicularis, suggesting pinworm eradication. The patient recovered promptly after both surgical procedures.