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1.
BMC Infect Dis ; 19(1): 1017, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791265

RESUMO

BACKGROUND: Early diagnosis and treatment of neurosyphilis is of great significance for regression. There is no gold standard for the diagnosis of neurosyphilis. We did this study to explore the factors associated with the clinical diagnosis of neurosyphilis and assess their accuracy for the diagnosis of neurosyphilis. METHODS: We retrospectively reviewed 100 cases of syphilis patients who underwent lumbar puncture at a major dermatology hospital in Guangzhou, China between April 2013 and November 2016. Fifty patients who were clinically diagnosed with neurosyphilis were selected as case group. Control group consisted of 50 general syphilis patients who were matched with age and gender. The records of patients were reviewed to collect data of socio-demographic information, clinical symptom, and laboratory indicators. Multivariable logistic regression was used to explore diagnostic indictors, and ROC analysis was used to assess diagnostic accuracy. RESULTS: Neurological symptoms (odds ratio (OR) = 59.281, 95% CI:5.215-662.910, P = 0.001), cerebrospinal fluid (CSF) Treponema pallidum particle agglutination (TPPA) titer (OR = 1.004, 95% CI:1.002-1.006, P < 0.001), CSF protein (OR = 1.005, 95% CI:1.000-1.009, P = 0.041), and CSF white blood cell (WBC) (OR = 1.120, 95% CI:1.017-1.233, P = 0.021) were found to be statistically associated with neurosyphilis. In ROC analysis, CSF TPPA titer had a sensitivity of 90%, a specificity of 84%, and an area under curve (AUC) of 0.941. CONCLUSION: CSF TPPA can potentially be considered as an alternative test for diagnosis of neurosyphilis. Combining with neurological symptoms, CSF protein, CSF WBC, the diagnosis would have a higher sensitivity.


Assuntos
Soronegatividade para HIV , Neurossífilis/diagnóstico , Adulto , Estudos de Casos e Controles , China/epidemiologia , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Feminino , Infecções por HIV/líquido cefalorraquidiano , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/complicações , Neurossífilis/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Sífilis/líquido cefalorraquidiano , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/epidemiologia , Treponema pallidum
2.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(12): 1284-1289, 2019 Dec 06.
Artigo em Chinês | MEDLINE | ID: mdl-31795587

RESUMO

Objective: To analyze the status and related factors of adverse pregnancy outcomes in pregnant women with syphilis infection in Guangxi Zhuang Autonomous Region. Methods: A total of 9378 pregnant women with syphilis infection who were diagnosed by Guangxi medical and health care institutions at all levels and were registered in the national "Management information system for mother-to-child transmission of AIDS, syphilis and hepatitis B" . The delivery date of these pregnant women were from 1 January 2014 to 31 December 2018, and their demographic characteristics, treatment, non-treponema pallidum titer, and pregnancy outcomes were collected. Multivariate logistic regression model was used to analyze the related factors of adverse pregnancy outcome. Results: The age of the pregnant women with syphilitic infection was (30.05±6.07) years old. There were 1 184 cases with an adverse pregnancy outcome. The incidence of adverse pregnancy outcome was 12.63%, and 83.30% (7 812 cases) of patients received syphilis treatment, of which 50.32% (3 931 cases) were treated with standard treatment. The results of multivariate analysis showed that, the probability of an adverse pregnancy outcome for a 35-year-old was higher than those of the <25 year old [OR (95%CI)=1.37(1.13-1.67)]. The possibility of the occurrence of an adverse pregnancy outcome in 1-2 times of delivery was lower than that of 0 times of delivery in the past, with the OR (95%CI) value was 0.81 (0.70-0.94). Compared with those who tested for syphilis in the early stages of pregnancy, patients with gestational weeks ≥ 28 weeks of initial examination were more likely to have adverse pregnancy outcomes, with the OR (95%CI) value was 1.54 (1.26-1.88). Compared with the first test titer level was <1:8, the probability of an adverse pregnancy outcome was higher in the titer of ≥1:8, with the OR (95%CI) value was 1.33 (1.12-1.57). There was a higher probability of an adverse pregnancy outcome in the untreated patients compared to the treatment of the syphilitic, with the OR (95%CI) value was 1.41(1.19-1.68). Patients with unregulated treatment were more likely to have adverse pregnancy outcomes than those with standardized treatment, with the OR (95%CI) value was 1.27 (1.09-1.47). Conclusion: Gestational weeks of first examination in pregnant women with syphilis infection, the first test titer, and the treatment condition were closely related to the occurrence of the adverse pregnancy outcome. Pregnant women with syphilis infection without treatment and unstandardized treatment were more likely to have adverse pregnancy outcomes than those of treatment and standardized treatment.


Assuntos
Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Complicações Infecciosas na Gravidez/microbiologia , Resultado da Gravidez/epidemiologia , Sífilis/diagnóstico , Adulto , China/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Sífilis/complicações , Sífilis/epidemiologia
3.
Medicina (B Aires) ; 79(5): 415-418, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31671396

RESUMO

We present the case of a 62-year-old woman who consulted for fever (38°), stabbing thoracic pain (on one side), and pruritic skin lesions. She underwent peripheral blood tests, chest X-rays and CT. Her symptoms were interpreted as severe communityacquired pneumonia. After a treatment with antibiotics, her skin lesions persisted, and other symptoms were only partially relieved. A skin biopsy was performed, which revealed Treponema pallidum. Such finding was confirmed through positive serum VDRL and FTA-ABS tests. The patient received 4 doses of benzathine penicillin G with favorable evolution of skin lesions and improvement of radiological images.


Assuntos
Pneumopatias/microbiologia , Sífilis/complicações , Biópsia , Dermatite/microbiologia , Dermatite/patologia , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Pessoa de Meia-Idade , Radiografia Torácica , Sífilis/microbiologia , Tomografia Computadorizada por Raios X , Treponema pallidum/isolamento & purificação
5.
Turk J Ophthalmol ; 49(5): 297-299, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31650814

RESUMO

We report a patient with unilateral syphilitic intermediate uveitis without dermatological, neurological, or any systemic involvement. He presented to our clinic with complaints of eye floaters and worsening visual acuity in the left eye. He had intermediate uveitis and cystoid macular edema in that eye and both venereal disease research laboratory and microhemagglutination assay for Treponema pallidum serological tests were confirmatory for syphilis. Ocular manifestations of syphilis have variable presentations, and it should be considered when diagnosing unexplained ocular inflammatory diseases, even if the patient's recent history and systemic evaluation are not compatible.


Assuntos
Infecções Oculares Bacterianas/etiologia , Sífilis/complicações , Uveíte Intermediária/etiologia , Acuidade Visual , Anticorpos Antibacterianos/análise , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/microbiologia , Humanos , Macula Lutea/patologia , Masculino , Sífilis/diagnóstico , Sífilis/microbiologia , Tomografia de Coerência Óptica , Treponema pallidum/imunologia , Uveíte Intermediária/diagnóstico , Uveíte Intermediária/microbiologia , Adulto Jovem
6.
Afr Health Sci ; 19(2): 1858-1865, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656468

RESUMO

Background: A significant proportion of newborns in the developing countries are born with congenital anomalies. Objective: This study investigated congenital infections due to Rubella virus, Toxoplasma gondii, Treponema pallidum among presumed normal neonates from full term pregnant women in Mwanza, Tanzania. Methods: Sera from mothers were tested for Treponema pallidum and Toxoplasma gondii infection while newborns from mothers with acute infections were tested for T. pallidum and T. gondii, and all newborns were tested for Rubella IgM antibodies. Results: A total of 13/300 (4.3 %) mothers had T. pallidum antibodies with 3 of them having acute infection. Two (0.7 %) of the newborns from mothers with acute infection were confirmed to have congenital syphilis. Regarding toxoplasmosis, 92/300 (30.7 %) mothers were IgG seropositive and 7 had borderline positivity, with only 1/99 (1%) being IgM seropositive who delivered IgM seronegative neonate. Only 1/300 (0.3 %) newborn had rubella IgM antibodies indicating congenital rubella infection. Conclusion: Based on these results, it is estimated that in Mwanza city in every 100,000 live births about 300 and 600 newborns have congenital rubella and syphilis infections, respectively. Rubella virus and T. pallidum are likely to be among common causes of congenital infections in developing countries.


Assuntos
Complicações Infecciosas na Gravidez/epidemiologia , Vírus da Rubéola/imunologia , Rubéola (Sarampo Alemão)/congênito , Rubéola (Sarampo Alemão)/epidemiologia , Sífilis Congênita/epidemiologia , Toxoplasma/imunologia , Toxoplasmose Congênita/epidemiologia , Treponema pallidum/imunologia , Adolescente , Adulto , Anticorpos Antivirais/sangue , Estudos Transversais , Feminino , Sangue Fetal/imunologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/imunologia , Cuidado Pré-Natal , Prevalência , Rubéola (Sarampo Alemão)/diagnóstico , Vírus da Rubéola/isolamento & purificação , Estudos Soroepidemiológicos , Sífilis/complicações , Sífilis/epidemiologia , Sífilis Congênita/diagnóstico , Tanzânia/epidemiologia , Toxoplasma/isolamento & purificação , Toxoplasmose/complicações , Toxoplasmose/epidemiologia , Toxoplasmose Congênita/diagnóstico , Treponema pallidum/isolamento & purificação , População Urbana
7.
Heart Surg Forum ; 22(5): E401-E404, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31596720

RESUMO

Since the discovery of penicillin, the incidence of tertiary syphilis dramatically has decreased. However, cases of cardiovascular complications of syphilis still are present. Ascending aortic aneurysms are some of the most devastating complications. Nonetheless, syphilitic aortitis (SA) can appear and should be suspected in patients with syphilis and aortic aneurysm. We report a case of a 57-year-old patient with a large ascending aortic aneurysm with cartilage and rib erosion. The purpose of this article is to discuss the particular surgical aspects of this unusual case.


Assuntos
Aorta/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Sífilis Cardiovascular/complicações , Sífilis/complicações , Parede Torácica , Aorta/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Implante de Prótese Vascular , Ponte Cardiopulmonar , Ecocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Fraturas das Costelas/diagnóstico por imagem , Sorodiagnóstico da Sífilis , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X
8.
Rev Soc Bras Med Trop ; 52: e20190044, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618305

RESUMO

We present a case of atypical presentation of secondary syphilis with extensive lymph node involvement and pulmonary lesions, initially suspected as lymphoma. The patient presented with weight loss, dry cough, chest pain, palpable lymph nodes in several peripheral chains, and multiple pulmonary nodules and masses on chest imaging. The key features for secondary syphilis diagnosis were a lymph node biopsy suggestive of reactive lymphadenopathy, positive serologic tests for syphilis, and complete recovery after antisyphilitic treatment.


Assuntos
Pneumopatias/diagnóstico , Linfadenopatia/diagnóstico , Linfoma/diagnóstico , Sífilis/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Pneumopatias/microbiologia , Linfadenopatia/microbiologia , Masculino , Sífilis/complicações , Tomografia Computadorizada por Raios X
9.
Medicine (Baltimore) ; 98(36): e17040, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490394

RESUMO

RATIONALE: Syphilis can share clinical features with autoimmune diseases, such as cutaneous Lupus or rheumatoid arthritis. Moreover, secondary syphilis can have visceral involvement, thus affecting the kidney. Syphilitic nephropathy causes nephrotic syndrome with a classic membranous pattern. We present a unique presentation of a co-infection by syphilis and parvovirus B19 sharing all the biological and histological features of proliferative lupus nephritis (LN). PATIENT CONCERNS: We present a case of a 71-year-old Caucasian male returning from a trip to Asia presenting with nephrotic syndrome with antinuclear antibodies (ANA) positivity. DIAGNOSES: Because of nephrotic syndrome a kidney biopsy was performed. It demonstrated a membranous nephropathy with extracapillary proliferation and a full house pattern (presence of IgA, IgG, IgM and C1Q deposits) on immunofluorescence (IF), highly suggestive of LN class III and V. However, several atypical clinical features notably the age, sex of the patient and the history of travel prompt us to search for another cause of nephropathy. INTERVENTIONS: A serology was positive for syphilis and a PCR in the renal biopsy was also positive for parvovirus B19. Thus, a co-infection by syphilis and parvovirus B19 was funded to be the cause of the renal lesions. OUTCOMES: The proteinuria improved; a course of antibiotic was administrated because of neurologic syphilitic involvement (presence of headache with positive syphilis serology in the CSF). LESSONS: A co-infection by syphilis and parvovirus B19 can share all the biological and histological features of proliferative LN and must be recognized as a cause of pseudo-lupus nephritis.


Assuntos
Eritema Infeccioso/diagnóstico , Nefrite Lúpica/diagnóstico , Sífilis/diagnóstico , Idoso , Coinfecção , Diagnóstico Diferencial , Eritema Infeccioso/complicações , Humanos , Masculino , Sífilis/complicações
12.
Reumatol. clín. (Barc.) ; 15(4): 242-245, jul.-ago. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-184418

RESUMO

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


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Sífilis/complicações , Periostite/etiologia , Tenossinovite/etiologia , Dor Musculoesquelética/etiologia , Fígado/anormalidades , Infecções Oportunistas Relacionadas com a AIDS/complicações , Penicilina G Benzatina/uso terapêutico
13.
J Med Case Rep ; 13(1): 227, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31345262

RESUMO

BACKGROUND: Syphilis is a sexually transmitted bacterial infection of the spirochete, Treponema pallidum. While primary syphilis often involves genitalia, oral manifestations are observed in a subset of patients. These lesions are often associated with submandibular and cervical lymphadenopathy. This is a case report of a primary syphilitic lesion located on the hard palate of the oral cavity, with only a very few cases described previously. CASE PRESENTATION: We describe a rare case of syphilis in a 59-year-old African American man presenting with subjective fevers, chills, marked submental lymphadenopathy, a diffuse skin rash, and an ulcer of the hard palate. CONCLUSIONS: This case report demonstrates the importance of maintaining a high index of suspicion for syphilitic infection when a patient presents with nonspecific symptoms, a diffuse rash, and an oral lesion.


Assuntos
Úlceras Orais/etiologia , Sífilis/complicações , Idoso , Progressão da Doença , Exantema/etiologia , Humanos , Masculino , Palato Duro , Sífilis/diagnóstico , Sífilis/fisiopatologia , Treponema pallidum/isolamento & purificação
14.
New Microbiol ; 42(3): 166-170, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31157398

RESUMO

Although far less common now than in the past, syphilis continues to pose a danger to public health and should not be overlooked. In this study, we evaluated the presence and characteristics of syphilis in a group of patients attending an STI Clinic in the North of Italy. A retrospective study was carried out, analysing the data from the 5609 subjects who attended the STI Clinic of St. Orsola-Malpighi Hospital (Bologna) for syphilis screening from January 2016 to December 2017. Globally, 692 patients (12.3%) were found positive for treponemal tests, with a significant difference between males and females (16.6% vs 4.1%; P<0.0001). Moreover, positive women were more likely foreign (63.3%), in contrast to men, who were more likely Italian (86.1%; P<0.0001). A total of 306 patients (44.2%), mainly males (47% vs 25%; P=0.0003), received a diagnosis of early syphilis. These cases peaked among patients 35-44 years (31%) and 25-34 years (26.8%). Overall, 32.9% of the women found positive for treponemal tests were pregnant. Among them, 84.6% were foreign (mainly from Eastern Europe) and 38.4% received a diagnosis of early syphilis. No cases of mother-to-child syphilis were found. The presence of an HIV-syphilis co-infection was found in 21.5% of patients with early syphilis, with a significant association with the male sex (P<0.009). In-depth knowledge of the characteristics of syphilis could help set up effective strategies for its control.


Assuntos
Sífilis , Coinfecção , Feminino , Infecções por HIV/complicações , Humanos , Itália/epidemiologia , Masculino , Gravidez , Estudos Retrospectivos , Fatores Sexuais , Sífilis/complicações , Sífilis/epidemiologia
15.
Dtsch Med Wochenschr ; 144(11): 759-763, 2019 06.
Artigo em Alemão | MEDLINE | ID: mdl-31163477

RESUMO

HISTORY AND ADMISSION FINDINGS: In this case series, we describe 4 patients who presented to a rheumatologic clinic with very different complains however were ultimately diagnosed with the same underlying disease. The wide spectrum of symptoms included generalized maculopapular exanthema, arthralgia, myalgia and vision problems. One patient received anti-TNF therapy for ankylosing spondylitis and recurrent uveitis. On exam, joint swelling and skin changes were found. INVESTIGATION: All patients were found to have an elevated Treponema pallidum antibody titer and a positive of the rapid plasma reagin test. DIAGNOSIS: Patients were diagnosed with syphilis. TREATMENT AND COURSE: The first three patients received an intramuscular injection of 2.4 million benzabine penicillin G. The fourth patient was treated with penicillin 6 million IV 4 times a day for more than 14 days, due to immunosuppression CONCLUSION: In the presence of non-specific and often rather diffuse symptoms, with which patients in rheumatology often present, a non-primary rheumatological, e. g. infectious genesis, also needs to be considered. Due to the increasing incidence of syphilis in Germany in recent years special attention needs to be paid to this disease in rheumatological care.


Assuntos
Artralgia/microbiologia , Exantema , Infecções Oculares Bacterianas , Sífilis , Treponema pallidum , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Exantema/complicações , Exantema/diagnóstico , Exantema/tratamento farmacológico , Exantema/microbiologia , Infecções Oculares Bacterianas/complicações , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Penicilina G/administração & dosagem , Penicilina G/uso terapêutico , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sífilis/microbiologia , Sorodiagnóstico da Sífilis , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-31035429

RESUMO

OBJECTIVES: To determine the prevalence of active syphilis infection and explore the risk factors for active syphilis in human immunodeficiency virus (HIV)-positive men who had sex with men (MSM) in Zhejiang Province, 2015. DESIGN: Data on HIV-positive MSM living in Zhejiang Province were obtained from the National Center for AIDS/STD Control and Prevention (NCAIDS) reporting system and the Zhejiang provincial AIDS/STD surveillance system between June and December 2015. The information included risky behavior, years with diagnosed HIV, and highly active antiretroviral therapy (HAART). SPSS 19.0 was used for the data analysis. RESULTS: The analysis included 3616 MSM. Of these, 11.3% (407/3616) had active syphilis. Multivariate logistic regression analysis revealed that HAART was significantly associated with an increased risk of active syphilis infection (odds ratio (OR) = 1.760, 95% confidence interval (CI) 1.187-2.611). Compared with participants diagnosed with HIV for <2 years, patients diagnosed with HIV for >5 years had a higher risk of active syphilis infection (OR = 1.707, 95% CI 1.167-2.495). Age and number of sex partners were also independent risk factors for active syphilis infection. CONCLUSIONS: The incidence of active syphilis infection is high among HIV-positive MSM in Zhejiang Province; age, number of sex partners, years with diagnosed HIV, and receiving HAART were risk factors. Patients who are elderly, have lived with HIV for a longer period, have more sex partners, and receive HAART should be the focus of interventions to promote changes in behavior and decrease syphilis infection.


Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina/psicologia , Sífilis/epidemiologia , Adolescente , Adulto , Idoso , Terapia Antirretroviral de Alta Atividade , China/epidemiologia , Estudos Transversais , HIV , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco , Assunção de Riscos , Parceiros Sexuais , Sífilis/complicações , Adulto Jovem
18.
Klin Monbl Augenheilkd ; 236(4): 516-522, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30999329

RESUMO

PURPOSE: The spectrum of intraocular and systemic findings in patients with ocular syphilis is described. Persistent visual dysfunction and structural abnormality, in spite of targeted antibiotic therapy, were identified and analysed. METHODS: Patients with ocular syphilis who were treated at University Hospital Zurich (USZ) between 2010 and 2018 were included in this study. General characteristics, ocular manifestation and visual function (best-corrected visual acuity [BCVA], visual field) before and after treatment were analysed retrospectively. RESULTS: Ocular syphilis was diagnosed in one female and 16 male patients (median age 42 years, range 22 to 53 years). A bilateral infection was present in 11 cases, and 28 of 34 eyes were affected (82%). Manifestations included anterior (n = 3), intermediate (n = 4), posterior (n = 10) uveitis, as well as panuveitis (n = 5) and papillitis (n = 6). Abnormal liquor findings were present in 8 patients (47%). Six patients were human immunodeficiency virus (HIV) positive. In all patients, intravenous benzyl penicillin was initiated and led to inactivation of intraocular inflammation. Before the initial intravenous treatment, all patients received one dose of steroids orally (Prednisone [PDN] 50 to 70 mg). Seven patients had systemic steroids added over the course of the antibiotic treatment being gradually decreased during and after the antibiotic treatment. The initial median BCVA of all affected eyes (n = 28) of 17 patients was 0.1 logMAR (0.8 decimal), range 2.8 to - 0.1 logMAR (light perception to 1.25 decimal). At the last visit, the median BCVA was 0 logMAR, range 0.4 to - 0.1 logMAR (0.4 to 1.25 decimal). Median follow-up time was 11 months (range 3 to 60 months). At the last visit, BCVA of 4 eyes (3 patients) was ≤ 0.6. Six eyes of 5 patients had a persisting scotoma with central visual field defects. Morphologically, disintegration and irregularities of outer retinal layers after central retinitis (5 eyes) and atrophy of the peripapillary retinal nerve fibre layer (4 eyes) after papillitis correlated with abnormal vision. CONCLUSIONS: The spectrum of ocular manifestations in syphilis is broad. Despite targeted antibiotic therapy, more than a third of affected eyes had lasting abnormal vision. Patients with papillitis and retinitis were at an increased risk for persistent visual dysfunction.


Assuntos
Infecções Oculares Bacterianas , Sífilis , Uveíte , Transtornos da Visão , Adulto , Infecções Oculares Bacterianas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sífilis/complicações , Transtornos da Visão/microbiologia , Acuidade Visual , Adulto Jovem
19.
Int J STD AIDS ; 30(5): 509-511, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30999832

RESUMO

The presentation of syphilis as a manifestation of immune reconstitution inflammatory syndrome in patients with human immunodeficiency virus (HIV) infection is rare and can be associated with the varied clinical expression of unusual syphilitic manifestations. We report a case of immune reconstitution syndrome with dermatologic, ophthalmologic and neurologic compromise of secondary syphilis in a patient with HIV infection.


Assuntos
Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Sífilis/diagnóstico , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Alopecia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Soropositividade para HIV/complicações , Humanos , Síndrome Inflamatória da Reconstituição Imune/complicações , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/imunologia , Masculino , Pan-Uveíte , Penicilinas/administração & dosagem , Penicilinas/uso terapêutico , Sífilis/complicações , Sífilis/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
20.
Intern Med ; 58(15): 2251-2255, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30996173

RESUMO

We herein report a patient with syphilitic cervicitis and cervical cancer presenting as oropharyngeal syphilis. A 31-year-old Japanese woman with a history of unprotected vaginal and oral sex visited our hospital with right submandibular adenomas and erythema in the extremities. The fornix uteri was red, with a nodule noted. The rapid plasma reagin ratio was 1:3. She was diagnosed with syphilitic cervicitis and treated with amoxicillin for four weeks. Initial cervical cytology showed cells with mild nuclear enlargement, which was thought to be metaplasia associated with syphilis. Repeated cytology a month later showed a high-grade squamous intraepithelial lesion. A punch biopsy of the lesion led to the pathological diagnosis of cervical carcinoma in situ. We performed cervical conization, and no recurrence occurred. Human papillomavirus (HPV) immunostaining was positive in the lesion. Mucosal lesions are an infrequently reported symptom of syphilis. When oropharyngeal lesions are found, the sexual history should be ascertained, and the patient should be screened for sexually transmitted diseases. HPV is especially significant because of its association with cervical cancer. Coinfection of HPV with cervical cancer must be ruled out during follow-up for women when oropharyngeal syphilis involves genital lesions.


Assuntos
Doenças da Boca/complicações , Doenças Faríngeas/complicações , Sífilis/complicações , Neoplasias do Colo do Útero/complicações , Cervicite Uterina/complicações , Adulto , Amoxicilina , Biópsia , Citodiagnóstico , Feminino , Humanos , Doenças da Boca/microbiologia , Recidiva Local de Neoplasia/patologia , Infecções por Papillomavirus/complicações , Doenças Faríngeas/microbiologia , Sífilis/tratamento farmacológico , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Cervicite Uterina/microbiologia
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