Sífilis la gran imitadora. Reporte de caso y revisión de la literatura / Sífilis o grande imitador. Relato de caso e revisão da literatura / Syphilis: the great imitator. A case report and literature review

Resumen La sífilis es una enfermedad de transmisión sexual causada por el Treponema pallidum. Sin tratamiento es crónica y altamente contagiosa. Sus variadas manifestaciones clínicas dificultan su diagnóstico. Presentamos el caso de una lesión sifilítica en cavidad oral con alta sugerencia clínica de carcinoma de células escamosas. Caso clínico: hombre de 31 años que presenta gran úlcera en mucosa labial inferior derecha de bordes indurados, 2 meses de evolución, asociada a dos adenopatías en cuello. Se realiza una minuciosa anamnesis y exámenes de laboratorio, confirmando el diagnóstico de una infección treponémica. Se le brindó tratamiento y la lesión resolvió. Los títulos de seguimiento fueron no reactivos. Conclusiones: Se demuestra la importancia de mantener sospecha de infección sifilítica cuando un paciente presenta linfoadenopatía y una lesión oral, fundamentar un diagnóstico correcto proporciona una pronta atención y recuperación del paciente, evitando complicaciones que afecten su calidad de vida y a sus parejas sexuales.

Resumo A sífilis é uma doença sexualmente transmissível causada por Treponema pallidum. Sem tratamento, é crônico e altamente contagioso. Suas variadas manifestações clínicas dificultam seu diagnóstico. Apresentamos o caso de uma lesão sifilítica na cavidade oral com uma alta sugestão clínica de carcinoma de células escamosas. Caso clínico: homem de 31 anos de idade, com úlcera grande na mucosa do lábio inferior direito, com bordas endurecidas, 2 meses de evolução, associado a linfadenopatia do pescoço. Uma anamnese completa e exames laboratoriais são realizados, confirmando o diagnóstico de uma infecção treponêmica. O tratamento foi realizado e a lesão resolvida. Os títulos de acompanhamento não foram reativos. Conclusões: A importância de manter uma suspeita de infecção sifilítica quando um paciente apresenta linfadenopatia e uma lesão oral é demonstrada, justificando um diagnóstico correto, proporcionam atenção e recuperação imediatas do paciente, evitando complicações que afetam sua qualidade de vida e seus parceiros sexuais.

Abstract Syphilis is a sexually transmitted disease caused by Treponema pallidum. Without treatment, it is chronic and highly contagious. Its varied clinical manifestations make it challenging to diagnose. We present the case of a syphilis oral lesion with a strong clinical suggestion of squamous cell carcinoma. Clinical case: a 31-year-old man with a large ulcer in the right lower lip mucosa with indurated edges, two months of evolution, associated with two enlarged neck lymph nodes (lymphadenopathy). A thorough history is taken, and laboratory tests are run, confirming the treponemal infection diagnosis. He was treated, and the injury resolved. Follow-up tests were nonreactive. Conclusions . It is important to suspect a syphilitic infection when a patient has lymphadenopathy and an oral lesion. Making the correct diagnosis allows for the proper care and recovery, avoiding complications that affect the patient's quality of life and sexual partners.

Trastorno neurocognitivo debido a neurosífilis: informe de un caso / Neurocognitive disorder due to neurosyphilis: a case report

RESUMEN Introducción: La neurosífilis es una enfermedad infecciosa crónica ocasionada por Treponema pallidum y puede producir una gran variedad de signos y síntomas neuropsiquiátricos, lo que complica su diagnóstico. Descripción del caso: Se presenta el caso de un paciente de 40 años que consultó al servicio de urgencias por una convulsión de novo, junto con un cuadro crónico de deterioro cognitivo y psicosis. Se le realizaron los estudios pertinentes para el diagnóstico de neurosífilis y se inició el tratamiento recomendado. El paciente presentó mejoría clínica y fue dado de alta. Discusión: Con resultados de serología VDRL positivos y hallazgos imagenológicos de atrofia cortical marcada, se consideró una neurosífilis parenquimatosa de tipo tardío, junto con franco deterioro cognoscitivo y psicosis. Se le dejó tratamiento con penicilina cristalina, que disminuyó la intensidad de los síntomas del paciente; sin embargo, el poco interés de este en asistir a sus controles disminuye sus probabilidades de una recuperación adecuada. Conclusiones: La neurosífilis se debe sospechar en pacientes con síntomas neurológicos o psiquiátricos clínicamente evidentes. El análisis de la serología de VDRL y los estudios de neuroimagen son importantes como evaluación inicial del paciente, que debe complementarse con pruebas cognitivas o examen mental para determinar el estado de deterioro cognitivo.

ABSTRACT Introduction: Neurosyphilis is a chronic infectious disease caused by Treponema pallidum that can cause a great variety of neuropsychiatric signs and symptoms, which complicates its diagnosis. Case description: This case occurred in a 40-year-old man who consulted the Emergency Department because of a convulsion (de novo) which was related to a chronic condition of cognitive impairment and psychosis. The appropriate studies were performed for the diagnosis of neurosyphilis and the recommended treatment was initiated. The patient presented clinical improvement and was discharged. Discussion: Positive VDRL serology results and imaging findings of marked cortical atrophy conducted to consider a late-stage parenchymatous neurosyphilis with serious cognitive impairment and associated psychosis. Treatment with crystalline penicillin was formulated, which reduced the intensity of the patient's symptoms; however, the patient's lack of interest to attend the check-ups significantly reduces his chances of an adequate recovery. Conclusions: Neurosyphilis must be suspected in patients with clinically evident neurological or psychiatric symptoms. Analysis of VDRL serology and neuroimaging studies are important as an initial evaluation of the patient and must be complemented with cognitive tests or mental examination to determine the state of cognitive impairment.

Prevalência de sífilis em pacientes atendidos no Laboratório de Análises Clínicas da Pontifícia Universidade Católica de Goiás em 2018 / Prevalence of syphilis in patients attended at the Laboratory of Clinical Analysis of the Pontifical Catholic University of Goiás in 2018

Objetivo: Apesar de o tratamento ser de fácil acesso e também eficaz, a sífilis permanece em nosso meio e por isso foi realizado um levantamento de dados sobre os casos de sífilis em pacientes do Sistema Único de Saúde (SUS) atendidos no Laboratório de Análises Clínicas da PUC-GO (LAC) no período de janeiro a dezembro de 2018. Métodos: Trata-se de um estudo quantitativo e retrospectivo. Resultados: Foi constatado um aumento de 3,6% do número total de casos em relação ao ano de 2014 e um maior índice de prevalência no sexo masculino (16,6%). Além disso, verificou-se que 51,1% dos casos de VDRL reagente do LAC- PUC em 2018 eram de pacientes em idade fértil com faixa etária entre 21 e 40 anos. Conclusão: Isso demonstra a necessidade de uma mudança mais profunda, não somente nas políticas de Saúde Pública, mas também na conscientização social sobre os riscos da mesma.

Abstract Objective: Although the treatment is easy to access and also effective, syphilis remains in our country, so a data collection was carried out on syphilis cases in patients from the Unified Health System (SUS) attended at the Laboratory of Clinical Analysis of PUC-GO (LAC) from January to December 2018. Methods: This is a quantitative and retrospective study. Results: There was a 3.6% increase in the number of cases in relation to 2014 and a higher prevalence rate in males (16.6%). In addition, it was found that 51.1% of the cases of reactive VLDL of the LAC-PUC in 2018 are of patients of fertile age, with age between 21 and 40 years. Conclusion: This demonstrates the need for a more profound change, not only in Public Health policies, but also in social awareness about the risks of the same.

Neurosífilis meningovascular como causa de accidente cerebrovascular en paciente joven: reporte de caso / Meningovascular neurosyphilis as a cause of stroke in a young patient: case report

Resumen El accidente cerebrovascular en adultos jóvenes es un evento raro presente en menos del 5% de los casos a nivel mundial, representando un reto diagnóstico debido a las múltiples etiologías posibles, entre ellas las infecciones. Del 15% al 40% de los pacientes con sífilis no tratada pueden desarrollar sífilis terciaria con manifestaciones principalmente neurodestructivas, descritas en la sífilis tardía pero con meningitis crónica y accidente cerebrovascular de tipo meningovascular en su fase temprana. Se presenta el caso de un paciente masculino de 40 años con antecedente de cambios de comportamiento, alucinaciones auditivas e insomnio, quien consulta a urgencias por presentar hemiplejia derecha, afasia motora, lesiones palmo-plantares y roseta en glande asociada a adenopatías inguinales. Dados los hallazgos imagenológicos y de líquido cefalorraquídeo se estableció diagnóstico de accidente cerebrovascular isquémico de circulación cerebral anterior izquierda secundario a neurosífilis meningovascular, con confirmación de inmunosupresión por virus de inmunodeficiencia humana. MÉD.UIS.2019;32(2):53-8

Abstract Stroke in young adults is a rare event present in less than 5% of cases worldwide, representing a diagnostic challenge due to the multiple possible etiologies, including infections. 15% to 40% of patients with untreated syphilis may develop tertiary syphilis; with mainly neurodestructive manifestations, described in late syphilis, but in its early stage with chronic meningitis and meningovascular stroke. The case of a 40-year-old male patient with a history of behavior changes, auditory hallucinations and insomnia is presented, who consults the emergency department for presenting right hemiplegia, motor aphasia, palmoplantar lesions and rosette in glans associated with inguinal adenopathies. Given the imaging and cerebrospinal fluid findings, a diagnosis of ischemic stroke of the left anterior cerebral circulation was established, secondary to meningovascular neurosyphilis, with confirmation of immunosuppression due to human immunodeficiency virus. MÉD.UIS.2019;32(2):53-8

Serorreacción y prevalencia de sífilis en donantes de un banco de sangre de Barranquilla, Colombia / Seroreactivity and prevalence of syphilis in donors at a blood bank in Barranquilla, Colombia

Resumen Introducción. La sífilis es una enfermedad de interés en salud pública por sus elevadas tasas de morbilidad y mortalidad. Objetivo. Determinar la serorreacción y la seroprevalencia de sífilis según las variables sociodemográficas de los donantes de un banco de sangre del distrito de Barranquilla, Colombia, durante 2015 y 2016. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal basado en los resultados de las pruebas treponémicas y no treponémicas. Se analizaron las variables sociodemográficas de la población estudiada y se hizo un análisis univariado en el que se determinaron las frecuencias absoluta y relativa de cada una de las variables categóricas. Se determinó la serorreacción a Treponema pallidum y la prevalencia de la infección activa. Se utilizó la prueba de ji al cuadrado de Pearson para evaluar las diferencias entre las proporciones. Resultados. Se encontró una serorreacción de 1,86 % para la infección previa con T. pallidum y una prevalencia de 0,93 % para la infección activa, las cuales fueron más altas en hombres adultos y en adultos mayores, viudos, desempleados y personas residentes en otros municipios del departamento de Atlántico diferentes de Barranquilla y su área metropolitana. Se encontró una asociación significativa entre la sífilis y las variables de sexo y ocupación. Conclusión. Se registró una serorreacción elevada a T. pallidum en donantes de sangre, comparada con el promedio nacional. Se encontró asociación entre la sífilis, y las variables sociodemográficas de sexo y ocupación, principalmente.

Abstract Introduction: Syphilis is a public health concern given its high impact on morbidity and mortality. Objective: We aimed to determine the association of syphilis seroreactivity and seroprevalence with sociodemographic variables of donors at a blood bank in the district of Barranquilla, Colombia, during 2015 and 2016. Materials and methods: We conducted a descriptive cross-sectional study based on the results of the treponemal and nontreponemal tests and the sociodemographic variables of the study population. We performed a univariate analysis to determine the absolute and relative frequencies for each categorical variable. We determined the seroreactivity against Treponema pallidum and the prevalence of active syphilis infection, and we used Pearson's chi-square test to evaluate the differences between the proportions. Results: We found a seroreactivity of 1.86% in individuals with previous T. pallidum infection, and a prevalence of 0.93% in those with active T. pallidum infection. These values were higher in adult men and older adults, widowers, the unemployed, and people living in municipalities of the Department of Atlántico other than Barranquilla and its metropolitan area. The incidence of syphilis infection showed a significant association with sex and occupation. Conclusion: In comparison to the national average, syphilis seroreactivity was high among blood donors. There was an association between syphilis infection incidence and sociodemographic variables such as sex and occupation.

Syphilis in female sex workers: an epidemiological study of the highway system of the state of Pará, northern Brazil

Abstract INTRODUCTION: Female sex workers (FSWs) are considered a bridge for transmission of pathogens from high-risk to general populations. We assessed the epidemiological status of syphilis in FSWs along the Pará highway system. METHODS: Two hundred and twenty-two FSWs were interviewed and samples were analyzed using rapid qualitative tests and real-time polymerase chain reaction. RESULTS: The prevalence of syphilis was high (36.94%). The high rate of prostitution, use of illicit drugs, and search for financial resources increased Treponema pallidum transmission through unprotected sex. CONCLUSIONS: Several characteristics of FSWs were identified, which reinforce the need for measures guaranteeing their health and protection.

Prevalence of positivity in rapid test for syphilis in campaign in Northeastern Brazil / Prevalência de positividade em teste rápido para sífilis em campanha no Nordeste do Brasil

Introduction: Syphilis is a systemic infectious disease caused by the Treponema pallidum bacterium of sexual transmission predominance. The cases diagnosed in Brazil increase each year, and the prevalence of syphilis during pregnancy is approximately 1%, but the reported number is lower than the expected, indicating difficulties in the diagnosis. Campaigns for the detection of syphilis are one of the strategies to enable early diagnosis and timely treatment. Objective: To survey the prevalence of rapid test reagent for syphilis and infection risk factors. Methods: Epidemiological, descriptive, transversal research. Collection was made in 2016's Carnival in the Piauí State capital, Teresina. Population was composed of individuals who agreed to voluntarily participate through express consent (n=532), 57% women and 43% men. The testing was carried out by trained professionals, initiated by the pre-test counseling through individual interview and guarantee of confidentiality of the information. Then, the rapid test was performed by blood puncture from the digital pulp. Finally, the result was passed through post-test counseling, guidance on prevention and referral of positive cases for further investigation of the infection. Results: The prevalence of rapid test reagents for syphilis was 5.4%. A predominance of males (65.5%), browns (45%), age group 29­39 years (38%), and singles (65.5%) was observed, 8 to 11 years of school education (34.4%), 52% were tested for the first time. Regarding sexual practice, 76% reported having one to five sexual partners in the last year, and only 24.1% reported using condoms with casual partners, and 55.2% affirmed no use of condoms with fixed partners. The use of alcohol and/or other drugs prior to intercourse was reported by 86.2%. Conclusion: The prevalence found justifies the need to intensify actions that increase access to diagnosis and timely treatment for the infection control. The study shows the importance of educational campaigns and cases detection due to the good adherence of the participants, and points out that strategies should be adopted to make the population aware of the increase in cases and the ways to prevent the disease.

Introdução: A sífilis é uma doença infecciosa sistêmica causada pela bactéria Treponema pallidum, de transmissão predominantemente sexual. Os casos diagnosticados no Brasil aumentam a cada ano, e a prevalência da sífilis na gestação é de aproximadamente 1%, sendo o número notificado inferior ao esperado, indicando dificuldades no diagnóstico. Campanhas para detecção da sífilis é uma das estratégias para possibilitar o diagnóstico precoce e o tratamento oportuno. Objetivo: Levantar a prevalência de teste rápido reagente para sífilis e os fatores de risco à infecção. Métodos: Pesquisa epidemiológica, descritiva, transversal. A coleta foi realizada no carnaval de 2016, na capital piauiense, Teresina. A população foi composta dos que aceitaram participar voluntariamente com consentimento expresso (n=532), sendo 57% mulheres e 43% homens. A testagem foi realizada por profissionais capacitados e iniciou-se pelo aconselhamento pré-teste por meio de entrevista individual e garantia de sigilo das informações. Em seguida, fez-se o teste rápido mediante punção de sangue da polpa digital. Ao final, o resultado foi repassado por aconselhamento pós-teste, com orientações sobre prevenção e encaminhamento dos casos positivos para continuação da investigação da infecção. Resultados: A prevalência de testes rápidos reagentes para sífilis foi de 5,4%. Observou-se predominância no sexo masculino (65,5%), de pardos (45%), idade entre 29 e 39 anos (38%), solteiros (65,5%), com escolaridade entre 8 e 11 anos de estudo (34,4%). Do total, 52% realizava o teste pela primeira vez. Quanto à prática sexual, 76% afirmaram ter tido de um a cinco parceiros sexuais no último ano, apenas 24,1% relataram usar preservativos com parceiros eventuais, e 55,2% contaram não usar camisinha com parceiros fixos. O uso de álcool e/ou outras drogas previamente às relações sexuais foi relatado por 86,2%. Conclusão: A prevalência encontrada justifica a necessidade de se intensificar ações que possibilitem a ampliação do acesso ao diagnóstico e o tratamento oportuno para controle da infecção. O estudo permite deduzir a importância de campanhas educativas e de detecção de casos em virtude da boa adesão dos participantes, além de apontar que devem ser adotadas estratégias para tornar mais evidente à população o aumento dos casos e formas de prevenção da doenç

Prevalencia del virus de la inmunodeficiencia humana, virus de la hepatitis B y Treponema pallidum en reclusos del Centro de Detención Preventiva de Arica, Chile / Prevalence of HIV, hepatitis B virus and Treponema pallidum in inmates in the Preventive Detention Center of Arica, Chile

Resumen Introducción: Los grupos de riesgo para las infecciones de transmisión sexual (ITS) son trabajadores sexuales, drogadictos, la población joven de inicio sexual precoz, así como la población penal. Objetivo: Determinar la prevalencia de infección por virus de inmunodeficiencia humana (VIH), Treponema pallidum y virus de hepatitis B (VHB) en reclusos (hombres) del Centro de Detención Preventiva (CDP) de Arica. Material y Métodos: El estudio se efectuó en 140 reclusos, con consentimiento informado. Se realizó encuesta epidemiológica y toma de muestra sanguínea. Los exámenes positivos se enviaron al Hospital Regional de Arica para confirmación y posteriormente al Instituto de Salud Pública. Resultados: La prevalencia de ITS fue de 13,6%. La mayor frecuencia se observó en VDRL positivos (7,1%), seguido por infección por VIH (5,7%) y VHB (2,9%). Por edad, la mayor frecuencia (57,9%) se presentó en individuos bajo 31 años. El 63,2% se encontraban en situación de hacinamiento, en 42,1% la edad de inicio de la actividad sexual fue antes de los 15 años y 94,7% declaró ser consumidor de drogas. Conclusiones: El estudio reafirma los factores predisponentes a la transmisión de las ITS, como edad, inicio sexual precoz, consumo de drogas y hacinamiento, destacando que las prisiones son ambientes altamente vulnerables, donde la sobrepoblación, condición sexual, inicio sexual precoz, alto consumo de drogas y la carente visita conyugal proporcionan un contexto epidemiológico favorable para el incremento de ITS.

Background: The risk groups for sexual transmitted diseases (STDs) are sex workers, drug addicts, young people in early sexual initiation, and population in prison. Aim: To determine the prevalence of HIV, Treponema pallidum and hepatitis B Virus (HBV) in male inmates at the Preventive Detention Center (CDP) of Arica. Methods: The study was conducted in 140 inmates, with informed consent. Epidemiological survey and blood sampling was conducted. The positive tests were sent to the Hospital Regional of Arica for confirmation and the National Reference Laboratory for confirmation. Results: STD prevalence was 13.6%. The most prevalent was VDRL positive (7.1%) followed by HIV infection (5.7%) and HBV (2.9%). The highest rate (57.9%) occurred in individuals under 31 years old. 63.2% were in an overcrowded situation, 42.1% of cases corresponded to those whose age of sexual activity onset of was before age 15 and 94.7% used drugs. Conclusions: The study reasserts the predisposing factors for the transmission of STDs as age, early sexual debut, drug abuse and overcrowding, noting that prisons are highly vulnerable environments where overcrowding, sexual condition, early sexual initiation, high drug abuse and the lacking spouses visits provide an epidemiological context favorable for increased STD.

Prevalencia de la infección por el VIH y de Treponema pallidum en mujeres trabajadoras sexuales de Argentina / Prevalence of HIV infection and Treponema pallidum in Argentine female sex workers

OBJETIVO: Estimar la prevalencia de infección por el virus de la inmunodeficiencia humana (VIH) y de Treponema pallidum en mujeres trabajadoras sexuales (MTS) de Argentina, y describir las características sociodemográficas de este grupo de población asociadas a la transmisión del VIH. MÉTODOS: Entre octubre de 2006 y diciembre de 2009 se realizó un estudio de corte transversal y un muestreo por conveniencia en MTS mayores de 18 años de nueve ciudades de Argentina. Un total de 1 255 mujeres participaron en este estudio. Se capacitó especialmente a un grupo de MTS para convocar a las otras mujeres a participar en talleres y a realizarse el diagnóstico del VIH y T. pallidum. RESULTADOS: Las características socio-epidemiológicas más destacadas de las MTS incluyeron un alto porcentaje de abuso sexual, escaso uso de preservativos con parejas sexuales no comerciales y un alto porcentaje de situaciones de violencia. La prevalencia del VIH fue de 2 por ciento (25/1 255, intervalo de confianza de 95 por ciento [IC95 por ciento]:1,2-2,8) y la de T. pallidum, de 22,4 por ciento (245/ 1 094, IC95 por ciento: 19,9-24,9). En las MTS de la ciudad de La Plata, la prevalencia del VIH fue significativamente más baja comparada con las participantes del resto del país (0,3 por ciento vs 2,7 por ciento, P < 0,05, respectivamente). CONCLUSIONES: La menor prevalencia del VIH y la mayor tasa de uso de preservativos informadas por las mujeres encuestadas de La Plata sugieren que la presencia de un lugar de atención sanitaria para MTS influye directamente en la disminución de sus conductas de riesgo y, por ende, en la infección por el VIH. La creación de centros de salud "amigables", como el que ya hay en dicha ciudad, contribuye a dar una respuesta integral al problema que enfrentan estas mujeres; asimismo, favorece su acercamiento al sistema de salud y contribuye así a revertir su situación de mayor vulnerabilidad y mayor riesgo frente al VIH y otras infecciones de transmisión sexual.

OBJECTIVE: Estimate the prevalence of human immunodeficiency virus (HIV) infection and Treponema pallidum in Argentine female sex workers (FSW), and describe the sociodemographic characteristics of this population group associated with HIV transmission. METHODS: A cross-sectional study and convenience sampling were conducted in FSW over 18 years of age in nine Argentine cities from October 2006 to December 2009. A total of 1 255 women participated in this study. A group of FSW was especially trained to invite other women to participate in the workshops and undergo screening for HIV and T. pallidum. RESULTS: The most noteworthy socioepidemiological characteristics of the FSW included a high percentage of sexual abuse, limited condom use with noncommercial sex partners, and a high percentage of violence. HIV prevalence was 2 percent (25/1 255, 95 percent confidence interval [95 percent CI]:1.2-2.8) and T. pallidum prevalence was 22.4 percent (245/1 094; 95 percent CI: 19.9-24.9). In the city of La Plata, HIV prevalence in FSW was significantly lower compared to that of other regions of the country (0.3 percent vs. 2.7 percent, P < 0.05, respectively). CONCLUSIONS: The lower HIV prevalence and the higher rate of condom use reported by the women from La Plata surveyed suggest that the presence of a health center for FSW has a direct influence on reducing risky behavior and, consequently, HIV infection. The creation of "friendly" health centers like the one already in this city contributes to providing a comprehensive response to the problems faced by these women and encourages use of the health system. It therefore helps reverse their vulnerability and higher risk of contracting HIV and other sexually transmitted infections.

Neurosífilis meningovascular y gomatosa cerebral concomitante, en paciente seronegativo para virus de inmunodeficiencia humana / Meningovascular neurosyphilis and concomitant syphilitic gummata in hiv-seronegative patients

Neurosyphilis (NS) is caused by the presence of Treponema Pallidum (TP) spirochete within the Central Nervous System (CNS), mainly affecting the meninges and cerebrospinal fluid (CSF). 5 percent to 10 percent of untreated syphilitic patients are deemed to develop symptomatic NSÕ. Its incidence and clinical spectrum have changed over the years with prevalence of early clinical stages of meningitic and meningovascular (MV) NS and exceptional occurrence of late clinical stages (tabes dorsalis, general paresis, and gummata) in the age of antibiotics. The case under analysis deals with aggressive MV and concomitant brain gumma (BG) NS. The case subject is a human inmunodeficiency virus (HIV)-seronegative, 44-year-old woman with 2-year symptomatic latency. Her medical record showed recurrent sensorimotor vascular involvement, fast cognitive damage and chronic, daily cephalea. She met clinical diagnosis, cerebrospinal fluid and serologic criteria for NS. Brain computerized tomography (CT) and magnetic resonance (MR) reported lenticulostriate artery infarction and bilateral ganglionic syphilitic gummata. She underwent Penicillin G-based treatment, making progress with neurological, cognitive-motor sequelae. Although NS has anticipated and speeded up its several clinical stages in connection with HIV/Syphilis co-infection, the peculiarity of this case is the concurrence of early and late NS manifestations in HIV-seronegative patient. The conclusion is that NS is a disease that still prevails and that appropriate diagnosis and treatment prevent irreversible neurological sequelae.

La Neurosífilis (NS) es causada por la invasión del Sistema Nervioso Central (SNC) por la espiroqueta Treponema Pallidum (TP), afectando primariamente las meninges y líquido cefalorraquídeo. Entre 5 a 10 por ciento de los pacientes sifilíticos no tratados desarrollarán una NS sintomáticaÕ. Su incidencia y espectro clínico ha cambiado a lo largo del tiempo, siendo las formas clínicas precoces meníngea y meningovascular (MV) las más prevalentes. En contraste, las formas tardías (tabes dorsal, parálisis general y gomas) son de ocurrencia excepcional en la era antibiótica. Se analiza un caso de NS menigovascular y gomas cerebrales concomitantes, de curso clínico agresivo. En una mujer de 44 años, seronegativa para virus de inmunodeficiencia humana (VIH), con latencia sintomática de dos años. Presentaba una historia de focalidad sensitivo-motor de perfil vascular recurrente, rápido deterioro cognitivo-motor y cefalea crónica diaria. Cumplía criterios diagnósticos clínicos, licuorales y serológicos para NS. La Tomografía computada (TC) y Resonancia Magnética (RM) cerebral mostró infartos arteriolares lentículo-estriados y gomas sifilíticas ganglionares bilaterales. Recibió tratamiento con Penicilina G, evolucionando con secuelas neurológicas cognitivas-motoras. Si bien, la NS actualmente, ha anticipado y acelerado sus diferentes formas clínicas en relación a co-infección VIH/Sífilis. Lo llamativo de este caso, es la presentación concomitante de con manifestaciones precoces y tardías de NS en paciente VIH seronegativo. Se concluye que la NS sigue siendo una enfermedad vigente y su diagnóstico y tratamiento oportuno previene secuelas neurológicas irreversibles.

Comparação de testes nao treponêmicos utilizados no diagnóstico da sifilis e interferência da inativação do soro / Comparison of non treponemic assays used in syphilis diagnosis and interference of serum inactivation

A sífilis é uma doença infecciosa crônica causada pelo Treponema pallidum, cujo diagnóstico incorreto propicia a transmissão da doença via sexual e placentária. O trabalho avaliou comparativamente os testes Veneral Diseases Research Laboratory (VDRL) e Rapid Plasm Reagin (RPR) na triagem sorológica e determinou a interferência da inativação do soro. Foram empregados reagentes comerciais na avaliação de amostras de soro de 110 indivíduos saudáveis e de 20 pacientes portadores de sífilis, antes e após a inativação a 56ºC/30min. O procedimento técnico seguindo as instruções do fabricante mostrou sensibilidade de 100% para ambos os testes, embora 45% das amostras reativas tenham mostrado títulos superiores no VDRL. A especificidade foi de 100% no VDRL e 97,3% no RPR. A inativação do soro mostrou não interferir nos resultados do VDRL, enquanto que o RPR mostrou maior especificidade para amostras inativadas, embora sem diferença significativa (p=0,248).

Syphilis is a chronic infectious illness caused by the Treponema pallidum, which incorrect diagnosis propitiates the transmission mainly by sexual contact and from mother to child (trans-placentary). The present work evaluated the Veneral Diseases Research Laboratory (VDRL) and the Rapid Plasm Reagin (RPR) assays and also determined the interference of the serum inactivation. Commercial reagents were used to evaluate sera samples from 110 healthful individuals and 20 patients with syphilis, before and after inactivation at 56ºC/30min. In the technical procedure according the manufacturers' instructions, both assays had presented 100% of sensitivity, although 45% of the reactive samples have shown bigger values in VDRL. The specificity was 100% for VDRL and 97.3% for RPR. The serum inactivation showed no interference in VDRL results, while in RPR was observed a greater specificity with inactivated samples, although with no significant difference (p=0,248).

Prevalence of HIV and Treponema pallidum infections in pregnant women in Campinas and their association with socio-demographic factors

The anonymous seroprevalence of HIV and syphilis was studied by collecting umbilical cord blood samples from 5,815 women who gave birth in Campinas'hospitals throughout a six-month period. ELISA and Western blot were used for HIV, and VDRL and TPHA for Treponema pallidum screening. While maintaining the anonymity of the women, information was recorded on the hospital of origin, divided into university (public) and private hospitals, as well as on the form of payment (social security, private insurance or direct payment), age, marital status, education, employment and place of residence. Seroprevalence was 0.42 percent for HIV and 1.16 percent for syphilis. There was a significant correlation between a positive reaction to the two infections (p=0.02). After univariate and logistic regression analysis, only university hospitals were shown to be associated with seropositivity for HIV, whereas the same variable and an older age were associated with syphilis. All positive reactions were found either in public hospitals or among social security patients treated at private institutions. The conclusion was that HIV infection is becoming almost as prevalent as syphilis among this population, and affects primarily the lower socio-economic strata. This suggests that routine, voluntary HIV serology should be considered and discussed with patients during prenatal or delivery care whenever a population shows a seroprevalence close to or greater than 1 percent.