RESUMO
Syphilis is a significant public health concern worldwide. According to the 2020 estimates, nearly 7.1 million new cases of syphilis have been reported globally, with over 30 % of these cases reported from American nations, particularly Brazil. Concerns have been raised regarding the susceptibility of specific groups to syphilis due to challenges and vulnerabilities that place these groups at a higher risk of infections or complications in the treatment outcomes. The present study aimed to compare the seroprevalence and the factors associated with syphilis among such high-risk groups. The study was designed as a cross-sectional one and was conducted with pregnant women, people living with HIV (PLHIV), people living with tuberculosis (PLTB), indigenous and healthy populations in Mato Grosso do Sul, Brazil. The study was conducted between June 2019 and August 2022, during which the included patients were subjected to treponemal and non-treponemal serological assays. The study also included a survey conducted through a self-reported questionnaire to collect information regarding the participants' demographics and sexual behaviors. A total of 550 samples were collected, with 110 participants in each of the five groups. The results of the study revealed that the seroprevalence of Treponema pallidum infection in pregnant women, PLHIV, PLTB, indigenous and healthy populations of the study region was 10 % (n = 11/110), 41.81 % (n = 46/110), 17.27 % (n = 19/110), 5.45 % (n = 6/110), and 8.18 % (n = 9/110), respectively. Homosexual orientation (p = 0.04) and a history of sexually transmitted infection (STI) (p = 0.01) were associated with the seroprevalence of T. pallidum infection in PLHIV. However, no such associations were noted in the remaining four groups. The seroprevalence of T. pallidum infection was observed to vary significantly among the different high-risk groups, which highlighted the persistent concern of syphilis, particularly among vulnerable populations. These findings underscore the significance of focused interventions and public health strategies customized to the specific requirements of each of the groups evaluated in the present study to decrease the number of cases of syphilis and thereby prevent future complications in patients with other serious infections.
Assuntos
Sífilis , Treponema pallidum , Humanos , Sífilis/epidemiologia , Brasil/epidemiologia , Estudos Soroepidemiológicos , Feminino , Adulto , Estudos Transversais , Treponema pallidum/imunologia , Masculino , Gravidez , Adulto Jovem , Pessoa de Meia-Idade , Infecções por HIV/epidemiologia , Infecções por HIV/complicações , Adolescente , Fatores de Risco , Tuberculose/epidemiologia , Comportamento SexualRESUMO
Background: Neurosyphilis is the most severe presentation of acquired and congenital syphilis, it occurs when Treponema pallidum penetrates the central nervous system. This development can occur at any time during the evolution of the disease phases. In Brazil in 2021, 2,343 children born with congenital syphilis were diagnosed with neurosyphilis, representing 9.3% of the total. The objective of this study was to analyze the scientific evidence on the medical manifestations presented by pediatric patients affected by neurosyphilis. Methods: In February 2023, PubMed, VHL, Scopus, Lilacs and Bdenf databases were researched for published case reports of patients aged zero to less than 18 years with T. pallidum infection. The data analysis period covered 55 years. Results: Nine articles were found in the period of publication from 1967 to 2022. There were two cases in females and only one with manifestation in an adolescent of acquired neurosyphilis. The adolescent's case was the only one with a favorable outcome after adequate treatment. Other cases resulted in impaired quality of life for patients and family members involved in child care. Conclusion: The reported cases of neurosyphilis were mostly related to late diagnosis. Evidencing the fragility of prenatal care, which is crucial for prevention and intervention by T. pallidum infection causes serious consequences for child development. Therefore, control measures should focus on mandatory prenatal screening during the first trimester of pregnancy, partner notification, prompt treatment and postnatal follow-up of the newborn.
Introdução: A neurossífilis é a apresentação mais grave da sífilis adquirida e congênita, ocorre quando o Treponema pallidum penetra no sistema nervoso central. Esse desenvolvimento pode ocorrer a qualquer momento durante a evolução das fases da doença. No Brasil, em 2021, 2.343 crianças nascidas com sífilis congênita foram diagnosticadas com neurossífilis, representando 9,3% do total. O objetivo deste estudo foi analisar as evidências científicas sobre as manifestações clínicas apresentadas por pacientes pediátricos acometidos por neurossífilis. Métodos: Em fevereiro de 2023, os bancos de dados PubMed, BVS, Scopus, Lilacs e Bdenf foram pesquisados para relatos de casos publicados de pacientes de zero a menos de 18 anos com infecção por T. pallidum. O período de análise dos dados abrangeu 55 anos. Resultados: Foram encontrados nove artigos no período de publicação de 1967 a 2022. Houve dois casos no sexo feminino e apenas um com manifestação em adolescente de neurossífilis adquirida. O caso da adolescente foi o único com evolução favorável após tratamento adequado. Outros casos resultaram em comprometimento da qualidade de vida dos pacientes e familiares envolvidos no cuidado da criança. Conclusão: Os casos notificados de neurossífilis foram, em sua maioria, relacionados ao diagnóstico tardio. Evidenciando a fragilidade do pré-natal, fundamental para a prevenção e intervenção da infecção pelo T. pallidum, trazendo sérias consequências para o desenvolvimento infantil. Portanto, as medidas de controle devem se concentrar na triagem pré-natal obrigatória durante o primeiro trimestre de gravidez, notificação do parceiro, tratamento imediato e acompanhamento pós-natal do recém-nascido.
Introducción: La neurosífilis es la presentación más grave de la sífilis adquirida y congénita, se presenta cuando Treponema pallidum penetra al sistema nervioso central. Este desarrollo puede ocurrir en cualquier momento durante la evolución de las fases de la enfermedad. En Brasil, en 2021, 2.343 niños nacidos con sífilis congénita fueron diagnosticados con neurosífilis, lo que representa el 9,3% del total. El objetivo de este estudio fue analizar la evidencia científica sobre las manifestaciones médicas que presentan los pacientes pediátricos afectados por neurosífilis. Métodos: en febrero de 2023, se investigaron las bases de datos PubMed, VHL, Scopus, Lilacs y Bdenf para obtener informes de casos publicados de pacientes de cero a menos de 18 años con infección por T. pallidum. El período de análisis de los datos abarcó 55 años. Resultados: Se encontraron nueve artículos en el período de publicación de 1967 a 2022. Hubo dos casos en el sexo femenino y solo uno con manifestación en un adolescente de neurosífilis adquirida. El caso de la adolescente fue el único con evolución favorable luego de un tratamiento adecuado. Otros casos resultaron en deterioro de la calidad de vida de los pacientes y familiares involucrados en el cuidado de niños. Conclusión: Los casos notificados de neurosífilis se relacionaron en su mayoría con un diagnóstico tardío. Evidenciando la fragilidad del control prenatal, que es fundamental para la prevención e intervención de la infección por T. pallidum que provoca graves consecuencias para el desarrollo infantil. Por lo tanto, las medidas de control deben centrarse en el tamizaje prenatal obligatorio durante el primer trimestre del embarazo, la notificación a la pareja, el tratamiento oportuno y el seguimiento posnatal del lactante.
RESUMO
We describe a case of congenital syphilis in an adopted infant with a unique dermatologic presentation of scalp granulomas, along with lymphadenopathy, anemia, and elevated liver transaminases. To our knowledge, this cutaneous morphology has not been previously reported in the literature. This case highlights the varied clinical presentation of congenital syphilis and the diagnostic challenge it poses for clinicians, especially in the context of unknown prenatal history/unknown risk factors, or if syphilis is acquired during pregnancy after routine screening is performed. As the incidence of congenital syphilis has more than tripled in recent years, this diagnosis should be considered when a neonate or infant presents with unexplained skin nodules.
RESUMO
A sífilis persiste como um problema de saúde pública, sobretudo pelos entraves existentes no enfrentamento da sífilis gestacional e congênita. Considerando que a ocorrência dessas infecções se relaciona a fatores maternos e programáticos, este estudo buscou analisar as características epidemiológicas do binômio mãe-filho exposto à sífilis e sua distribuição espacial no Paraná entre 2012 e 2020. Trata-se de estudo descritivo e ecológico, com dados dos sistemas nacionais de informação do Brasil. Foram considerados os casos de gestantes e de crianças registrados entre 2012 e 2020 no estado do Paraná. Foram apresentadas as frequências absolutas e relativas para a caracterização, calculando-se a variação percentual entre o primeiro e o último triênio. Ainda, foi empregado o índice de Moran para a geoespacialização segundo regiões de saúde. Houve predomínio em mulheres de 20 a 39 anos (71,24%), brancas (67,22%) e com até oito anos de estudo (80,76%), com diagnóstico nas fases primária e latente (76,42%). Os casos concentraram-se em crianças do sexo masculino (48,72%), diagnosticadas na fase recente (96,42%), e naquelas cujas mães aderiram ao pré-natal (88,88%), mas os parceiros, por sua vez, não foram tratados (69,46%). Houve aumento do diagnóstico materno durante o pré-natal (16,61%) e redução dos óbitos infantis por sífilis (31,25%). Observou-se concentração das notificações nas regiões Metropolitana e de Pato Branco. Em suma, as gestantes apresentaram idade reprodutiva e baixa escolaridade e foram tratadas durante o pré-natal, contudo, sem a inclusão dos parceiros. Ademais, evidenciou-se comportamento espacial aleatório nas regiões de saúde, com disparidade entre a sífilis gestacional e a congênita.
Syphilis remains as serious public health issue due to existing obstacles in combating gestational and congenital syphilis. Since the onset of these infections is related to maternal and programmatic factors, this study analyzed the epidemiological profile of the mother-child binomial exposed to syphilis and its spatial distribution in Paraná from 2012 to 2020. This is a descriptive, ecological study with data from Brazilian national information systems. Cases of pregnant women and children recorded between 2012 and 2020 in the state of Paraná were considered. Absolute and relative frequencies were estimated for characterization, calculating the percentage variation between the first and last three years. The Moran index was also used for geospacialization according to health regions. Most women were aged 20 to 39 years (71.24%), white (67.22%), and had up to 8 years of schooling (80.76%), with diagnosis in the primary and latent stages (76.42%). Most cases concerned male children (48.72%), diagnosed in the recent phase (96.42%), and from mothers who adhered to prenatal care (88.88%), but the partners were untreated (69.46%). Maternal diagnosis increased during prenatal care (16.61%) and infant deaths by syphilis decreased (31.25%). Most cases were notified in the Metropolitan and Pato Branco regions. In short, the pregnant women were of reproductive age, had low education, and were treated during prenatal care, but their partners were not included. The health regions showed random spatial behavior, with disparity between gestational and congenital syphilis.
La sífilis persiste como un problema de salud pública, principalmente por los obstáculos en hacer frente la sífilis gestacional y congénita. Teniendo en cuenta que la ocurrencia de estas infecciones está relacionada con los factores maternos y programáticos, este estudio tuvo como objetivo analizar las características epidemiológicas del binomio madre-hijo expuestos a la sífilis y la distribución espacial en Paraná (Brasil) entre 2012 y 2020. Se trata de un estudio descriptivo y ecológico, con datos de los sistemas de información nacionales de Brasil. Se consideraron los casos de mujeres embarazadas y niños registrados entre 2012 y 2020 en Paraná. Se presentaron las frecuencias absolutas y relativas, calculando la variación porcentual entre el primer y el último trienio. Asimismo, se utilizó el índice de Moran, según regiones de salud. Predominaron las mujeres de entre 20 y 39 años de edad (71,24%), blancas (67,22%), con hasta ocho años de estudio (80,76%), con diagnóstico en estadio primario y latente (76,42%). Los casos se concentraron en hijos varones (48,72%), diagnosticados en fase reciente (96,42%), y en aquellos cuyas madres tuvieron acceso a los cuidados prenatales (88,88%), pero su pareja no recibió el tratamiento (69,46%). Hubo un aumento en el diagnóstico materno durante la atención prenatal (16,61%) y una reducción en las muertes de niños por sífilis (31,25%). Se observó una concentración de casos en las regiones Metropolitana y de Pato Branco. En resumen, las mujeres embarazadas se encontraban en edad reproductiva, tenían bajo nivel de estudios y eran atendidas durante el prenatal, sin incluir su pareja. Además, se evidenció un comportamiento espacial aleatorio en las regiones de salud, con disparidad entre sífilis gestacional y congénita.
Assuntos
Humanos , Feminino , Gravidez , Complicações Infecciosas na Gravidez , Sífilis CongênitaRESUMO
Syphilis is a sexually transmitted infection, caused by the anaerobic spirochete Treponema pallidum. It is characterized by a variety of clinical manifestations including the oral mucosa, mimicking several diseases, thereby making diagnosis a challenge for clinicians. Therefore, the objective of this work is to report three cases of syphilis that were diagnosed based on oral lesions of different clinical aspects. In this series of cases, the lesions were found on the tongue and hard palate and presented as white plaques, ulcers or erythematous spots associated with ulcers. In the two cases, incisional biopsy was performed, and the histopathological aspects were suggestive of syphilis. Treponemic and nontreponemic tests were positive for all the patients, confirming syphilis. Therapy with benzathine-penicillin, administered intramuscularly led to complete remission of oral lesions in all the patients. The syphilis reemergence in the last years demands its inclusion in the differential diagnosis of several oral lesions. Diagnosing syphilis by oral lesions can be difficult once it can mimic other conditions. Therefore, dentists should know the clinical aspects of this infection, since many cases may exhibit only oral manifestations, to help in the diagnosis and control of the infection spread. (AU)
A sífilis é uma infecção sexualmente transmissível, causada pela espiroqueta anaeróbia Treponema pallidum. É caracterizada por uma variedade de manifestações clínicas, incluindo a mucosa oral, podendo mimetizar várias doenças, tornando o diagnóstico um desafio. Portanto, o objetivo deste trabalho é relatar três casos de sífilis diagnosticados a partir de lesões orais de diferentes aspectos clínicos. Nesta série de casos, as lesões foram encontradas na língua e palato duro e apresentadas como placas brancas, úlceras ou manchas eritematosas associadas a úlceras. Em dois casos, foi realizada biópsia incisional e os aspectos histopatológicos foram sugestivos de sífilis. Os testes treponêmicos e não treponêmicos foram positivos para todos os pacientes, confirmando a sífilis. A terapia com penicilina benzatina, administrada por via intramuscular, levou à remissão completa das lesões orais em todos os pacientes. O ressurgimento da sífilis nos últimos anos exige sua inclusão no diagnóstico diferencial de várias lesões bucais. O diagnóstico da sífilis por lesões orais pode ser difícil, pois pode mimetizar outras condições. Portanto, o dentista deve conhecer os aspectos clínicos dessa infecção, pois muitos casos podem apresentar apenas manifestações orais, para auxiliar no diagnóstico e controle da disseminação da infecção. (AU)
RESUMO
Abstract Background: Syphilis is one of the most common diseases that start with genital ulcers. Aside from the initial, classic ulcerative lesion of syphilis, called hard chancre, atypical presentations are common, with erosions, erythema, edema, balanitis, and other dermatological manifestations. Associated with initial genital lesions, the presence of inguinal adenopathies is frequent, and the presence of hardened and painless lymphangitis on the dorsum of the penis is rare. Objectives: To describe atypical penile manifestations in patients with early syphilis. Methods: The present study reports patients who developed cord-like lesions on the penis. Results: The study included 25 patients with cord-like lesions on the penis; in 19 of those, the diagnosis of syphilis was confirmed. Study limitations: Small number of patients included. Conclusions: In view of the findings of the present investigation, it is important to emphasize that all patients who present with cord-like lesions on the penis must undergo a rapid test for syphilis, VDRL, serologies for HIV viral hepatitis B and C and, whenever possible, histopathological and Doppler exams.
Assuntos
Humanos , Masculino , Balanite (Inflamação) , Sífilis/diagnóstico , Hepatite B , Pênis , EdemaRESUMO
BACKGROUND: Syphilis is one of the most common diseases that start with genital ulcers. Aside from the initial, classic ulcerative lesion of syphilis, called hard chancre, atypical presentations are common, with erosions, erythema, edema, balanitis, and other dermatological manifestations. Associated with initial genital lesions, the presence of inguinal adenopathies is frequent, and the presence of hardened and painless lymphangitis on the dorsum of the penis is rare. OBJECTIVES: To describe atypical penile manifestations in patients with early syphilis. METHODS: The present study reports patients who developed cord-like lesions on the penis. RESULTS: The study included 25 patients with cord-like lesions on the penis; in 19 of those, the diagnosis of syphilis was confirmed. STUDY LIMITATIONS: Small number of patients included. CONCLUSIONS: In view of the findings of the present investigation, it is important to emphasize that all patients who present with cord-like lesions on the penis must undergo a rapid test for syphilis, VDRL, serologies for HIV viral hepatitis B and C and, whenever possible, histopathological and Doppler exams.
Assuntos
Balanite (Inflamação) , Hepatite B , Sífilis , Edema , Humanos , Masculino , Pênis , Sífilis/diagnósticoRESUMO
O objetivo desse trabalho foi analisar os casos de sífilis no Estado do Paraná, e descrever o perfil epidemiológico dos infectados, entre os anos de 2010 e 2018. O presente estudo é quantitativo, descritivo e observacional, foi desenvolvido com dados secundários do Sistema Nacional de Agravos de Notificação (SINAN), com a análise das taxas de detecção da sífilis adquirida. Entre 2010 e 2018 o Paraná registrou 39.900 casos de sífilis adquirida, sendo que 58,5% ocorreram em homens e 41,5% em mulheres. A faixa etária de maior incidência foi entre 20-29 anos (26,9%), seguida por 30-39 anos (21,4%). Quanto a escolaridade, a maioria dos infectados possuía ensino fundamental (18,5%) e médio (19%). A macrorregião leste do Estado apresentou a maior incidência de casos (59,28% dos casos em 2016). Devido ao aumento dos casos de sífilis adquirida no Paraná entre os anos de 2010 a 2018, conclui-se a necessidade do direcionamento de ações de prevenção e rastreio. (AU)
The study aimed to analyze the syphilis cases in Paraná State, and to describe the epidemiological profile of infected individuals, between 2010 and 2018. The present study is quantitative, descriptive and observational; it was developed with secondary data from the National System of Disorders notification, evaluating the detection rate of syphilis acquired. Between 2010 and 2018 Paraná registered 39,900 cases of Acquired Syphilis, being 58.5% in males and 41.5% in females. The age group with the highest incidence was between 20-29 years (26.9%), followed by 30-39 years (21.4%). As for schooling, most of the individuals in the identified cases had elementary (18.5%) and high school education (19%). The eastern macro- region of the state had the highest cases incidence (59.28% of cases in 2016). Due to the increase in syphilis cases acquired in Paraná between 2010 and 2018, it concludes the need to target prevention and screening actions. (AU)
Assuntos
Humanos , Masculino , Feminino , Infecções por Treponema , Sífilis , Programas de Rastreamento , Prevenção de DoençasRESUMO
Introduction: Congenital syphilis is a disease of great magnitude due to increasing numbers of new annual cases, affecting a large contingent of children, which translates into high incidence rates. The occurrence of syphilis cases evidences failures in health services, especially in prenatal care. Objective: To describe the epidemiological profile of congenital syphilis in the municipality of São Luís. Methods: Descriptive study with a quantitative approach. Congenital syphilis data recorded in SINAN from 2008 to 2017 were used. Results: The detection rate in the municipality shows a continuous increase. A total of 1,060 cases of congenital syphilis were diagnosed in neonates, 1,017 (96.0%) after the first week of life. Regarding the final diagnosis of cases, it was observed that 967 (91.2%) were classified as early congenital syphilis. The predominant maternal age range was 20 to 34 years, corresponding to 743 cases (70.1%). Regarding access to prenatal care, 802 (75.6%) mothers underwent prenatal care, while 219 (20.66%) did not. Among those who received prenatal care, 352 (33.0%) were diagnosed with syphilis during prenatal care, 481 (46.0%) were diagnosed at the time of delivery/curettage, and 59 (5.0%) were diagnosed after childbirth. Regarding the treatment regimen during pregnancy, 736 (70.0%) received inadequate treatment, 95 (8.0%) received no treatment and 62 (6.0%) received adequate treatment. Conclusion: The study contributed to the identification of possible losses in the stages of such care, and in obtaining qualified information that will guide decision-making and planning of health actions, supporting the epidemiological surveillance work in guiding managers and health teams.
Introdução: A sífilis congênita é uma doença de grande magnitude, pelos crescentes números de casos novos anuais, afetando grande contingente de crianças, que traduz elevadas taxas de incidência. A ocorrência dos casos de sífilis evidencia falhas dos serviços de saúde, principalmente na atenção pré-natal. Objetivo: Descrever o perfil epidemiológico da doença no município de São Luís. Métodos: Estudo descritivo com abordagem quantitativa. Utilizaram-se dados de sífilis congênita registrados no Sistema de Informação de Agravos de Notificação, no período de 2008 a 2017. Resultados: A taxa de detecção no município apresenta crescente aumento. Foram diagnosticados 1.060 casos em neonatos, sendo 1.017 (96%) após a primeira semana de vida. Quanto ao diagnóstico final dos casos, observou-se que 967 (91,2%) foram classificados como sífilis congênita recente. A faixa etária da mãe predominante era de 20 a 34 anos, correspondendo a 743 casos (70,1%). Quanto ao acesso ao pré-natal, 802 (75,6%) das mães fizeram prénatal, enquanto 219 (20,66%) não fizeram. Entre aquelas que fizeram, 352 (33%) tiveram diagnóstico de sífilis durante o pré-natal, 481 (46%) no momento do parto/curetagem e 59 (5%) após o parto. Em relação ao esquema de tratamento da gestante, 736 (70%) receberam tratamento inadequado, 95 (8%) não receberam tratamento e 62 (6%) receberam tratamento adequado. Conclusão: O estudo contribuiu para a identificação de eventuais perdas nas etapas desse cuidado e a obtenção de informações qualificadas, que irão nortear tomadas de decisão e planejamento das ações em saúde, subsidiando o trabalho da vigilância epidemiológica na orientação aos gestores e equipes de saúde.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Lactente , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Sífilis Congênita/epidemiologia , Cuidado Pré-Natal , Sífilis Congênita/terapia , Fatores de Tempo , Brasil/epidemiologia , Incidência , Distribuição por Idade , Escolaridade , Distribuição por EtniaRESUMO
Abstract INTRODUCTION Syphilis is a sexually transmitted infection caused by Treponema pallidum. Considering the high rates of syphilis in pregnancy and congenital syphilis reported in Brazil in the past, and their serious consequences, this study described the epidemiological and clinical profile of pregnant women with a confirmed diagnosis of syphilis in Campo Grande, in the state of Mato Grosso do Sul, Brazil, from 2011 to 2017. METHODS: This is a descriptive study, based on syphilis notifications among pregnant women reported to the Sistema de Informação de Agravos de Notificação (National System of Disease Notification of Brazil). RESULTS: Over the study period, 2,056 confirmed cases of syphilis in pregnancy were reported, resulting in a crude cumulative incidence of 144.76 cases per 1,000 live-born babies. The incidence increased from 9.97 cases per 1,000 live-born babies in 2011 to 36.10 cases per 1,000 live-born babies in 2017. It was more prevalent in women who were young, of mixed race, with low educational attainment. Over one third of women were diagnosed in the first trimester of pregnancy; therefore, they were at risk of reinfection if they or their sexual partners were inadequately treated. Furthermore, syphilis was not well classified according to its clinical stage, which led to inappropriate treatments. CONCLUSIONS: Despite efforts to reduce the incidence of syphilis, syphilis during pregnancy remains a public health problem, reflecting possible inadequacies in antenatal care, especially in vulnerable populations. It is important to include sexual partners in syphilis treatment during pregnancy to prevent reinfection.
Assuntos
Humanos , Feminino , Gravidez , Criança , Adolescente , Adulto , Adulto Jovem , Complicações Infecciosas na Gravidez , Sífilis Congênita , Sífilis , Treponema pallidum , BrasilRESUMO
Neurosyphilis (NS) is more frequently seen in patients with human immunodeficiency virus (HIV) infection, especially those not on antiretroviral therapy or with a low CD4 cell count. Ocular syphilis is an unusual and early form of neurosyphilis. Lumbar puncture should be considered in all HIV infected patients who present with neurologic or ocular disease. A 47-year-old homosexual male with HIV-1 infection, on antiretroviral therapy (last CD4 cell count 1022 cells/µL) presented to our emergency department with a five-day history of headache, blurry vision, pain and redness of the left eye. He had unprotected anal sex with a new partner four months before presentation. Based on the fundoscopy findings as well as the cerebrospinal fluid (CSF) analysis on initial evaluation, a repeat serum rapid plasma reagin (RPR) along with microhemagglutination assay for treponema pallidum (MHA-TP) were done due to high suspicion of syphilis, even though an RPR five months prior to this visit was negative. Both RPR and MHA-TP were positive and the patient was treated for neurosyphilis. The patient's symptoms as well as the RPR titers improved significantly thereafter. A high index of suspicion for neurosyphilis should be maintained in HIV-infected patients presenting with ocular symptoms even if they are compliant with retroviral therapy with good CD4 cell counts. Physicians must be mindful of this uncommon presentation and consider a lumbar puncture in any patient with suspicion of neurosyphilis for prompt diagnosis and treatment to avoid further neurological complications.
RESUMO
The aim of this study was to describe 40 cases of acquired oral syphilis (AOS) and to discuss the distribution of demographic characteristics, clinical features, and differential diagnosis of the disease. A retrospective study was conducted covering a 17-year period at a single institution in southern Brazil. Moreover, a literature review was performed through a search of the PubMed database for articles on AOS published between 1955 and March 2018. Data were analyzed descriptively. The predominant group within the case series was male patients in their twenties. The vast majority of cases (92.5%) were in the secondary stage of the disease. The lips were the most commonly affected site, with greyish-white mucous patches and reddish ulcers. In the literature review, the largest number of reported cases came from North America. Male patients in the third and fourth decades of life were most affected. AOS occurred more commonly as mucous patches and ulcers on the tongue and palate. Similarities regarding the distribution by sex, age, and anatomical location were found in the present study when compared to cases reported elsewhere. Clinicians, oral pathologists, and maxillofacial surgeons should familiarize themselves with the variable spectrum of signs and symptoms of AOS in their clinical practice to improve diagnosis and management.
Assuntos
Doenças da Boca , Sífilis , Doenças da Língua , Brasil , Humanos , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVES: In resource-limited settings, screening pregnant women for syphilis using rapid diagnostic tests (RDTs) is a key tool in the prevention of congenital syphilis. However, most syphilis RDTs detect only treponemal antibodies (T-RDT), meaning antibiotics may be provided unnecessarily to previously treated pregnant women, particularly in non-venereal treponematoses endemic regions. We estimated the potential reduction in overtreatment when comparing T-RDT (SD Bioline) to a newer rapid test (Dual Path Platform (DPP) Screen and Confirm Assay, Chembio) detecting both treponemal and non-treponemal antibodies. METHODS: Pregnant women in Déou, Burkina Faso, screened for syphilis during antenatal care (ANC) visits were prospectively enrolled in the study after providing consent. DPP and T-RDT tests were performed on whole blood specimens. Plasma was tested in an international reference laboratory by Treponema pallidum passive particle agglutination (TPPA) and quantitative rapid plasma reagin (RPR). Presumptive active syphilis was defined as a result that was both TPPA and RPR reactive. RESULTS: Of the 242 pregnant women included in the study, 91 (37.6%) had presumptive active syphilis and 19.0% had RPR titres ≥8. DPP testing did not reduce the number of pregnant women who would have been overtreated compared with T-RDT (0.0% vs 2.5%; p=0.218) and had a higher proportion of underdiagnosis (48.4% vs 2.2%; p<0.001). Seven women with high RPR titres ≥8 would not have received treatment had only DPP testing been used. CONCLUSION: In the first evaluation comparing DPP with traditional screening methods in pregnant women, we saw no reduction in unnecessarily treated syphilis and an underestimation of those needing treatment. High seroprevalence in the population may indicate the presence of other treponemal infections in the area, and further study of DPP in a variety of Sahelian and other contexts is warranted.
Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Sífilis/diagnóstico , Adolescente , Adulto , Anticorpos Antibacterianos/imunologia , Burkina Faso/epidemiologia , Feminino , Humanos , Uso Excessivo dos Serviços de Saúde , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Gestantes , Cuidado Pré-Natal , Estudos Prospectivos , Sífilis/tratamento farmacológico , Sífilis/epidemiologia , Sífilis/microbiologia , Sorodiagnóstico da Sífilis , Treponema pallidum/genética , Treponema pallidum/imunologia , Treponema pallidum/isolamento & purificação , Adulto JovemRESUMO
Este estudo avaliou o perfil de nascidos vivos com sífilis congênita precoce na adesão à terapêutica de seguimento, para investigar possíveis falhas que acarretaram na transmissão vertical. Toda a análise foi feita na vigilância epidemiológica do município de Cachoeirinha/RS, no ano de 2017. Estudo epidemiológico descritivo com abordagem quantitativa. A coleta de dados foi realizada no município de Cachoeirinha (RS) no período de março a maio de 2018 com os dados fornecidos pelo protocolo de investigação de casos de sífilis congênita precoce elaborado pelo Ministério da Saúde do Brasil em 2014. O perfil descrito encontrou 16 crianças com peso em média de 3,248 kg e idade média de 8,9 meses; em sua maioria, são assintomáticas ao nascer 12 (75,0%). No protocolo foi observado que as mães dessas crianças, são mulheres com 25,7 anos em média, brancas 13 (81,2%), com baixa escolaridade (9,5 anos de estudo) e de baixa renda 6 (37,5%), que realizaram o pré-natal 14 (87,5%); e o esquema de tratamento para prevenção da transmissão vertical 10 (62,5%). Neste sentido, verificou-se que em Cachoeirinha há desafios quanto à qualidade da assistência ao pré-natal oferecido. A eliminação da sífilis congênita depende da qualificação na assistência à saúde, portanto, a educação permanente dos profissionais em saúde envolvidos no cuidado pré-natal deve ser estimulada, a fim de promover o diagnóstico precoce, tratamento adequado e acompanhamento dos pacientes, para alcançar o objetivo de prevenir a sífilis congênita.
This paper evaluated the profile of live-born with early congenital syphilis in adherence to therapeutic follow-up to investigate possible failures that resulted in vertical transmission. In the epidemiological surveillance of Cachoeirinha/RS/Brazil, in 2017, was the place done the analysis this work. Descriptive epidemiological study with a quantitative approach. Data collection performed in Cachoeirinha/ RS/Brazil March to May 2018 with data provided by the protocol of investigation of cases of early congenital syphilis elaborated by the Ministry of Health of Brazil in 2014. The profile described found 16 children with mean weight of 3,248 kg and mean age of 8.9 months; in the majority, are asymptomatic at birth 12 (75.0%). According to the protocol, the mothers of these children were women with a mean age of 25.7 years, white 13 (81.2%), low schooling (9.5 years of schooling), and low income 6 (37.5%), who underwent prenatal care. 14 (87.5%); and the treatment plan for prevention of vertical transmission 10 (62.5%). In this sense, it verified that in Cachoeirinha there are challenges regarding the quality of prenatal care offered. The elimination of congenital syphilis depends on the qualification in health, therefore, the continuing education of health professionals involved in prenatal care should be stimulated in order to promote early diagnosis, appropriate treatment and follow-up of these patients, so that the objective the prevention of congenital syphilis is achieved.
Assuntos
Humanos , Gravidez , Recém-Nascido , Lactente , Sífilis Congênita/prevenção & controle , Terapêutica , Infecções por Treponema , Transmissão Vertical de Doenças Infecciosas , Cuidado Pré-Natal , EpidemiologiaRESUMO
ABSTRACT Objectives: to evaluate the efficiency of educational interventions related to the knowledge of health care professionals of Primary Care and to verify the impact on the vertical transmission rates of congenital syphilis. Method: a quasi-experimental study conducted in the city of Londrina, Paraná, between 2013 and 2015. An educational intervention on diagnosis, treatment and notification was carried out with 102 professionals with knowledge measurement before and after the intervention. Incidence and mortality data from congenital syphilis were taken from the system for notifiable diseases (SINAN) and the Mortality Information System (SIM). Excel tabulation and statistical analysis was done in the Statistical Package for Social Sciences, version 2.1. A descriptive and inferential analysis was performed. Results: the mean number of correct responses increased from 53% to 74.3% after the intervention (p < 0.01). The adherence to professional training was 92.6%. There was a significant reduction in the vertical transmission rate of syphilis from 75% in 2013 to 40.2% in 2015. In 2014 and 2015 there were no records of infant mortality from this condition. Conclusion: the educational intervention significantly increased the knowledge of health professionals about syphilis and collaborated to reduce the rate of vertical transmission of the disease.
RESUMO Objetivos: avaliar a eficiência da intervenção educacional no conhecimento dos profissionais de saúde da Atenção Básica e verificar o impacto nas taxas de transmissão vertical da sífilis congênita. Método: estudo quase-experimental, conduzido na cidade de Londrina, Paraná, no período entre 2013 e 2015. Foi realizada intervenção educacional sobre diagnóstico, tratamento e notificação com 102 profissionais com medida do conhecimento antes e após a intervenção. Os dados de incidência e mortalidade pela sífilis congênita foram retirados do Sistema de Informação de Agravos de Notificação (SINAN) e do Sistema de Informação sobre Mortalidade (SIM). A tabulação em Excel e a análise estatística no Statistical Package for Social Sciences, versão 2.1. Realizou-se análise descritiva e inferencial. Resultados: a média de respostas corretas passou de 53% para 74,3% após a intervenção (p < 0,01). A adesão ao treinamento dos profissionais foi de 92,6%. Existiu redução importante na taxa de transmissão vertical da sífilis de 75% em 2013 para 40,2% em 2015. Em 2014 e 2015 não ocorreram registros de mortalidade infantil por esse agravo. Conclusão: a intervenção educacional aumentou significativamente o conhecimento dos profissionais de saúde sobre a sífilis e colaborou para a redução da taxa de transmissão vertical do agravo.
RESUMEN Objetivo: evaluar la eficiencia de la intervención educacional en el conocimiento de los profesionales de la salud de la Atención Primaria y verificar el impacto en las tasas de transmisión vertical de la sífilis congénita. Método: estudio casi experimental, realizado en la ciudad de Londrina, Paraná, en el período entre 2013 y 2015. Fue realizada una intervención educacional sobre diagnóstico, tratamiento y notificación, con 102 profesionales, midiendo el conocimiento antes y después de la intervención. Los datos de incidencia y mortalidad por la sífilis congénita fueron obtenidos del Sistema de Información de Enfermedades de Notificación (SINAN) y del Sistema de Información sobre Mortalidad (SIM). La tabulación fue realizada en el Excel y el análisis estadístico en el Statistical Package for Social Sciences, versión 2.1. Se realizó un análisis descriptivo e inferencial. Resultados: la media de respuestas correctas pasó de 53% para 74,3%, después de la intervención (p < 0,01). La adhesión al entrenamiento de los profesionales fue de 92,6%. Existió reducción importante en la tasa de transmisión vertical de la sífilis de 75% en 2013 para 40,2% en 2015. En 2014 y 2015 no ocurrieron registros de mortalidad infantil por esa enfermedad. Conclusión: la intervención educacional aumentó significativamente el conocimiento de los profesionales de la salud sobre la sífilis y colaboró para la reducción de la tasa de transmisión vertical de la enfermedad.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Atenção Primária à Saúde , Sífilis Congênita/prevenção & controle , Sífilis Congênita/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Transmissão Vertical de Doenças Infecciosas/prevenção & controleRESUMO
Abstract: Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. About 25% of patients with untreated primary syphilis will develop late signs that generally occur after three to five years, with involvement of several organs. The authors present an immunocompetent female who developed a tertiary stage syphilis presenting with long-standing nodular plaques.
Assuntos
Humanos , Feminino , Adulto , Sífilis Cutânea/imunologia , Sífilis Cutânea/patologia , Sífilis/imunologia , ImunocompetênciaRESUMO
Abstract: Syphilis is a sexually transmitted disease caused by Treponema pallidum and divided into three stages according to the duration of the disease: primary, secondary and tertiary. Secondary syphilis has diverse clinical presentations, such as papular-nodular lesions. This presentation is rare, with 15 cases reported in the literature over the past 20 years. We report a case of secondary syphilis with papular-nodular lesions in a healthy 63-year-old patient, who has presented treponema in immunohistochemical examination of the skin lesions.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Sífilis Cutânea/patologia , Sífilis/patologia , Pênis/patologia , Pele/patologia , Biópsia , Testes Sorológicos , Imuno-HistoquímicaRESUMO
Due to diverse clinical and histopathological presentations, diagnosis of secondary syphilis can occasionally prove challenging. Variable clinical presentations of secondary syphilis in HIV disease may result in an incorrect diagnosis and an inappropriate treatment regimen. Similarly, the histology of secondary syphilitic lesions may show considerable variation, depending on the clinical morphology of the eruption. We report a case of secondary syphilis in an HIV infected patient with cutaneous palmoplantar lesions simulating palmoplantar psoriasis.
.Assuntos
Adulto , Humanos , Masculino , Infecções por HIV/patologia , Psoríase/patologia , Sífilis Cutânea/patologia , Antibacterianos/uso terapêutico , Biópsia , Coinfecção/tratamento farmacológico , Coinfecção/patologia , Diagnóstico Diferencial , Ceratodermia Palmar e Plantar/tratamento farmacológico , Ceratodermia Palmar e Plantar/patologia , Penicilina G Benzatina/uso terapêutico , Sífilis Cutânea/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: The high prevalence of STDs among women indicates the need to implement approaching techniques, case detection and prevention of new cases. OBJECTIVES: To describe the frequency of risk factors for syphilis and assess attitudes towards sexual risk in a population of young women in Vitória, ES. METHODS: Cross-sectional, population-based study, performed in Vitória. Interviews were held and VDRL and MHA-TP were investigated in blood samples. RESULTS: Among the 904 eligible women (18-29 years) sampled from the Family Health Program (FHP), 11 were diagnosed with syphilis, a prevalence of 1.2% (CI95% 0.5-1.9). Median age was 23 years (interquartile range 20-26 years); 65.7% of participants were in high school or college and 85.4% lived with their family or sexual partner. Factors associated with syphilis included: lower educational level (<8 years of schooling) [Adjusted Odds Ratio aOR=4.3 (CI 95% 1.01-17.99)]; >1 lifetime sexual partners [(aOR) =6.50 (CI95% 1.37-30.82)], and history of a previously diagnosed STD [aOR=10.3 (CI95% 2.37-44.33)]. Two thirds (67.7%) of the women surveyed agreed that it is not easy to tell their sexual partner they do not want to have sex without condoms; 52.3% thought it is difficult to use condoms in all sexual intercourses, and 36.2% said they cannot do anything if their partner refuses to use condoms. CONCLUSIONS: Using the FHP as an approach to perform routine VDRL can contribute to decreasing the vulnerability of these women and help control congenital syphilis.
FUNDAMENTOS: A prevalência elevada de DST entre as mulheres indica a necessidade de implementação de abordagem, de detecção de casos e de prevenção de novos agravos. OBJETIVO: descrever a frequência dos fatores de risco para sífilis e as percepções de risco sexual, em mulheres jovens, na cidade de Vitória, ES. MÉTODOS: Estudo populacional, em corte-transversal, por amostragem, realizado em Vitória. Foram realizadas entrevista e pesquisa de VDRL e MHA-TP em amostra de sangue. RESULTADOS: Entre as 904 mulheres elegíveis (18-29 anos) selecionadas pelo Programa de Saúde da Família (PSF), 11 foram diagnosticadas com sífilis sendo a prevalência de 1,2% (IC95% 0,5-1,9). A mediana de idade foi de 23 anos (distância interquartil de 20-26 anos); 65,7% das participantes alcançavam o ensino médio ou superior e 85,4% moravam com a família ou com o parceiro sexual. Fatores associados com a sífilis: menor nível educacional (<=oito anos de estudo) [Odds ratio ajustado (Ora) =4,3 (IC95% 1,01-17,99)]; ter tido mais de um parceiro na vida [ORa=6,50 (IC95% 1,37-30,82)] e história prévia de DST [ORa=10,3 (IC95% 2,37-44,33)]. Dois terços (67,7%) das mulheres entrevistadas relataram não achar fácil dizer ao parceiro que não fará sexo sem preservativo, 52,3% consideram difícil usar preservativo em todos os intercursos sexuais e 36,2% acham que não há o que fazer, se o parceiro recusar usar preservativo. CONCLUSÕES: A utilização do PSF como porta de entrada para a realização do VDRL, na rotina de atendimento, pode contribuir para diminuir a vulnerabilidade destas mulheres e ajudar no controle da sífilis congênita.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Adulto Jovem , Infecções por HIV/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Sífilis/epidemiologia , Saúde da Mulher , Brasil/epidemiologia , Estudos Transversais , Saúde da Família , Estratégias de Saúde Nacionais , Programas Governamentais , Hepatite Viral Humana/epidemiologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Comportamento Sexual/psicologiaRESUMO
Biópsias são ocasionalmente necessárias para confirmação diagnóstica de sífilis secundária, normalmente obtida por correlação clínico-sorológica. Entretanto, o exame histopatológico pode oferecer pistas que conduzam a um diagnóstico em casos antes insuspeitos ou de apresentação clínica incomum. Apresentamos um paciente de 35 anos, há dois com lesões acrômicas vitiligoides, para o qual sífilis foi sugerida somente após o exame histopatológico. Alguns aspectos microscópicos observados são discutidos e comparados com dados disponíveis na literatura.
Biopsies are occasionally necessary to confirm the diagnosis of secondary-stage syphilis, currently achieved by clinico-serological correlation. However, histopathologic examination may offer clues that can lead to the diagnosis of the disease in previously unsuspected or unusual cases. We report the case of a 35-year-old male patient with vitiligo-like lesions for two years, whose diagnosis of syphilis was suggested only after histopathologic examination. Some microscopic aspects observed are discussed and compared to data from the literature.