Cardiovascular Syphilis Research Articles

A Case of Surgical Treatment for Coronary Artery Ostium Obstruction and Aortic Regurgitation due to Cardiovascular Syphilis

A Case of Surgical Treatment for Coronary Artery Ostium Obstruction and Aortic Regurgitation due to Cardiovascular Syphilis

Syphilitic ostial coronary artery occlusion treated with percutaneous coronary intervention: Case series and literature review

IntroductionNon-atherosclerotic causes of acute coronary syndrome (ACS) are important contributors to a substantial number of acute ischemic coronary events. Syphilitic aortitis is a rare complication of tertiary cardiovascular syphilis that may result in ostial coronary artery stenosis, aortic insufficiency, and ascending aortic aneurysm. MethodsIn this manuscript, we present two Case Reports of patients with bilateral syphilitic coronary artery ostial occlusion, and we review the associated literature. The immunofluorescent test was positive for syphilis in both patients. ResultsDiagnostic coronary angiography revealed bilateral occlusions of the left main coronary artery (LMCA) and right coronary artery (RCA), which were successfully treated with percutaneous coronary intervention (PCI) with bare metal stents (BMS). After deployment of the stents, arterial blood flow was re-established with TIMI flow grade 3. DiscussionThe angiographic finding of bilateral coronary ostial lesions in young patients should raise the suspicion of cardiovascular syphilis. Options for revascularization should be discussed amongst the patient and the Heart Team. PCI may be an option for treatment of isolated syphilitic coronary stenosis in the setting of acute hemodynamic instability or chronic inflammation.

Syphilis and some other STIs in the Russian Federation: past, present and ways to control of the epidemiological situation in the future

The article is devoted to assessing the situation with syphilis and other sexually transmitted infections in the USSR and Russia in the period after the Second World War. On the basis of long-term statistical data, the patterns of rises and decreases in syphilis, gonorrhea, chlamydia infection are analyzed, possible factors influencing the epidemic process are discussed and a comparative assessment of the current situation in Russia and Western countries is carried out. Comparing to the previous year, there was an increase of the syphilis incidence by 39.4% in 2021, by 33.7% in 2022 and by 14.7% in the first 4 months of 2023. The incidence of gonococcal infection increased by 10.4%, 10.0% and 5.5%, respectively. The attention is drawn to the negative trend of an increase of latent and late syphilis among other forms, as well as rising number of late neurosyphilis and late cardiovascular syphilis cases. In view of the predicted increase in the incidence of syphilis and other STIs in the coming years, the authors emphasize the urgent need to develop and implement a state interdisciplinary program aimed to epidemiological monitoring, improvement of the diagnosis and treatment, prevention of the dissemination of syphilis and other STIs and controlling of factors that negatively affect the reproductive health of the nation.

Treatment of syphilitic aortitis with coronary artery bypass grafting and "open" stent placement.

Cardiovascular syphilis manifests many years after primary infection. Here, we report the successful treatment of a patient who developed syphilitic aortitis with bilateral coronary ostial stenosis and aortic insufficiency. The patient underwent right coronary artery bypass grafting, left main coronary ostial "open" stent placement, and mechanical aortic valve placement during open-heart surgery.

Syphilis - a disease that still occurs

Introduction: Syphilis is a systemic disease caused by Treponema pallidum. Humans are the only hosts, and the incubation period lasts from 9-90 days. Currently it can be divided into congenital or acquired. This division is due to the moment in which the infection occurred. Congenital Syphilis- when the infection happens during the prenatal period, whereas acquired, when the infection took place in the period after birth. In early acquired syphilis the I and II stages can be distinguished as well as early latent syphilis. As defined, early latent syphilis includes an acquired infection up to 1 or 2 years back, depending on the guidelines. Late syphilis however includes: late latent syphilis, tertiary syphilis, late cardiovascular syphilis, late neurosyphilis. Congenital syphilis has also been divided into early (which includes the first 2 years) as well as late, which is characterised by signs of congenital syphilis, the so-called stigmata of congenital syphilis constituting the untreated infection during the fetal stage or the infancy stage. Aim of the Study: The aim of our study is to divert the attention to one of the sexually transmitted diseases, which despite the downward trend at the end of the 20th century, rebounded at the beginning of the 21st century, especially among men who have sexual contact with other men. We paid attention to the symptoms accompanying this disease, also in the context of congenital syphilis, as well as the different methods of pharmacological treatment according to European guidelines. Materials and methods: Reviewed literature available at scientific articles , Google Scholar using keywords: “syphilis – epidemiology”, “syphilis treatment”, “symptoms of syphilis”, as well as European guidelines regarding the treatment of syphilis.

Radiodiagnosis of multiple syphilitic aneurysms and great vessels: case report

Cardiovascular syphilis has a variety of localizations and signs including an aortic aneurysm. Syphilitic aneurysms are most commonly localized in the ascending aorta, less in the aortic arch and descending aorta. Multiple aneurysms of syphilitic etiology are rare. A clinical case of a 56-year-old patient with multiple aneurysms of the aorta and brachiocephalic trunk of syphilitic etiology has been reported. Computed tomography showed multiple aneurysms of various localization, rupture of the ascending aortic aneurysm with partial thrombosis, its localization and the formation of an aortopulmonary anastomosis. The data obtained made it possible to carry out surgical treatment.

Chest pain and chronic heart failure as a manifestation of tertiary syphilis: clinical case

In cardiological practice, there may be patients with chest pain and heart failure of a specific etiology, including an association with cardiovascular syphilis. This article describes a 49-year patient with chest pain, heart failure, and neurological symptoms associated with ongoing tertiary syphilis. The history included an antisyphilitic treatment 30 years before the current hospitalization. Further evaluation confirmed neuro- and cardiovascular syphilis with severe aortic regurgitation and syphilitic myocarditis. Tertiary syphilis is a rare but relevant challenge for various medical specialists, including cardiologists. This pathology requires increased medical alertness and interdisciplinary interaction for early diagnosis, effective and safe treatment, and improved prognosis.

Analysis of own observations of visceral syphilis lethal outcomes

The epidemiological situation of the syphilis incidence in the modern world is characterized as a hidden epidemic, which manifests itself in latent and late forms of the disease. Despite the general trend towards a decrease in the incidence of syphilis, there are some specific features in many regions of Russia. Deaths from visceral syphilis are now rare. The article presents data on the epidemiology, nosological forms of visceral syphilis, and describes two lethal outcomes. In observations, late syphilis was characterized by damage to several organs (liver, lungs, heart, brain), but the leading clinical manifestations were neurosyphilis (syphilitic meningoencephalitis) and cardiovascular syphilis (syphilitic mesaortitis, interstitial myocarditis). Damage of the respiratory and digestive organs (stomach, liver) are rare forms of visceral syphilis. In the presented observations, gummas in the lungs and liver, which were not clinically diagnosed, were detected. In all cases, the diagnosis of visceral syphilis was established at autopsy on the basis of a characteristic morphological picture (detection of gummas) and positive results of the Wassermann reaction.

A Rare and Lethal Ostial Left Main Trunk Lesion: A Case Report

Abstract Coronary artery involvement in cardiovascular syphilis is infrequent and often overlooked, especially in patients with latent syphilis. Herein, we present the case of myocardial infarction largely related to cardiovascular syphilis in a 63-year-old man. Invasive coronary angiography and contrast-enhanced computed tomography scan revealed a critical ostial narrowing of the left main trunk, an occlusive right coronary artery, and moderate-to-severe ostial stenosis of multiple major branches of the abdominal aorta. Syphilis screening and confirmatory tests were positive. Cardiovascular syphilis was considered. Percutaneous coronary intervention (PCI) was performed uneventfully, and a coronary stent was implanted in the ostium of the left main coronary artery. However, on day 3 after PCI, the patient died suddenly, likely because of stent thrombosis. In conclusion, severe coronary lesions confined to the ostia suggest rheumatologic large-vessel vasculitis or infectious aortitis.

ТРЕТИЧНЫЙ ПОЛИВИСЦЕРАЛЬНЫЙ СИФИЛИС: КЛИНИКО-АНАТОМИЧЕСКОЕ НАБЛЮДЕНИЕ ЛЕТАЛЬНОГО ИСХОДА

Fatal outcomes in visceral syphilis are now rare. The article presents data on the epidemiology, nosological forms of visceral syphilis and the description of the lethal outcome. In observations, late syphilis was characterized by multiple organ lesions (heart, brain, skin), but the leading clinical manifestations referred to neurosyphilis and cardiovascular syphilis. The diagnosis of visceral syphilis was established intra-vitam and at autopsy on the basis of a characteristic morphological picture (detection of gummas) and positive test results for antibodies to Treponema pallidum.

Evaluation of the nontreponemal IgM antibodies in syphilis serofast patients: A new serologic marker for active syphilis

BackgroundSerofast status is challenging to interpret in clinical work, and distinguishing active syphilis in serofast patients can provide a reference for clinical diagnosis and treatment. However, effective serologic markers for active syphilis are still lacking. ObjectivesWe aimed to explore the possibility of nontreponemal IgM antibodies in distinguishing active syphilis in serofast patients. MethodsA total of 1501 clinical serum samples were collected from 301 serofast patients, and nontreponemal IgM antibodies were detected by chemiluminescence immunoassay. ResultsThe results showed that a total of 29 samples (9.63%) of 301 serofast patients were positive for nontreponemal IgM antibodies, and our limited follow-up data showed that 66.67% (2/3) of the serofast patients progressed to neurosyphilis and cardiovascular syphilis. ConclusionThese findings demonstrate that most serofast patients with positive nontreponemal IgM antibodies have evidence of progressive syphilis, and nontreponemal IgM antibodies can be used as a new serologic marker for the activity of syphilis. Nontreponemal IgM antibodies may play a role in the management of serofast patients.

Syphilitic Aortitis and Coronary Ostial Stenosis: A Focused Review

Cardiovascular syphilis is a manifestation of tertiary syphilis, and is one that can have many complications, including syphilitic aortitis. In this review article, we review the epidemiology and pathophysiology of syphilitic aortitis and focus in on one of its complication, coronary ostial stenosis. Next, we will discuss the diagnosis and treatment options for both cardiovascular syphilis as well as coronary ostial stenosis. Finally, we present the findings of case reports in patients who had syphilitic aortitis with coronary ostial stenosis and their outcomes.

The Estimated Lifetime Medical Cost of Syphilis in the United States.

The purpose of this study was to estimate the cost of syphilis in the United States, in terms of the average lifetime direct medical cost per infection. We used a decision tree model of the natural history of syphilis. The model allowed for numerous possible outcomes of infection, including treatment for syphilis at various stages, inadvertent treatment, and late syphilis outcomes in those who are alive and still infected 30 years after acquisition. Future costs were discounted at 3% annually. Model inputs, such as the cost and probability of each outcome, were based on published sources. The probabilities we applied yielded outcomes consistent with reported cases of syphilis by stage from national surveillance data and number of deaths due to late syphilis from national mortality data. The estimated, discounted lifetime cost per infection was $1190 under base case assumptions (2019 dollars). Treatment costs associated with late syphilis outcomes, such as cardiovascular syphilis, accounted for only $26 of the average lifetime cost per infection. Results were most sensitive to assumptions regarding the treatment cost per case of unknown duration or late syphilis. In the probabilistic sensitivity analyses, the 2.5th and 97.5th percentiles of the 10,000 simulations of the lifetime cost per infection were $729 and $1884, respectively. Our estimate of the lifetime cost per infection is about 50% higher than in a previous study, a difference due in large part to our higher cost assumptions for benzathine penicillin G.

Сифилис как междисциплинарная проблема: от полиморфизма клинической картины висцеральных поражений к основным причинам и последствиям прогрессирования заболевания

Syphilis is a significant infection that can affect not only the mucous membranes and skin, but also internal organs. Visceral changes in patients with syphilis often cause nonspecific clinical manifestations and develop without any skin symptoms, which makes this disease an interdisciplinary problem. Untimely therapy, insufficient control of cure, late diagnosis of syphilitic lesions of internal organs may result in irreversible dystrophic changes and even permanent disability. Given that these patients might seek medical assistance in any healthcare institutions, it is important that not only dermatovenerologists, but also related specialists should be well aware of syphilis. In this article, we report cases of syphilitic lesions to the nervous and cardiovascular systems. Case series focus the attention of specialists on the negative consequences of improper clinical and serological control and late treatment of syphilis, which resulted in disease progression and organic lesions. Some of the patients with syphilisrelated visceral pathology described in this article had late diagnosis of syphilis primarily due to a narrow approach to symptom evaluation. Our study aims to raise doctors' awareness about current characteristics of syphilis and possible diagnostic errors. Key words: cardiovascular syphilis, neurosyphilis, ocular syphilis, diagnostic errors

Lues Maligna in an Immune-Reconstituted Patient with Retroviral Infection: A Case Report

Lues Maligna in an Immune-Reconstituted Patient with Retroviral Infection: A Case Report

Peripheral blood mononuclear cell microRNA profiles in syphilitic patients with serofast status.

Syphilis is a chronic sexually transmitted disease caused by infection with Treponema pallidum, which can invade various system organs, leading to clinical manifestations such as neurosyphilis, ocular syphilis, and cardiovascular syphilis and seriously endangering human health. Serofast status is a common outcome after syphilis treatment that presents an important clinical problem. At present, the etiology of serofast status remains unknown. A systematic investigation of the microRNA (miRNA) expression profiles in peripheral blood mononuclear cells (PBMCs) of patients with serofast status or secondary syphilis and of healthy control subjects was conducted using small RNA-seq. The expression of miRNAs was further confirmed by real-time fluorescence quantitative PCR (qPCR) assays. The data reveal a specific miRNA expression profile that was displayed in cells from patients with serofast status. Known and novel predicted (np)-miRNAs were also identified and verified, such as miR-338-5p, np-miR-163, np-miR-128, np-miR-244, and np-miR-5, which together may be used as indicators for treatment evaluation. The functions of genes targeted by the miRNAs differentially expressed in serofast status patients were further analyzed; these genes were found to be involved in various biological functions, such as T-cell receptor signaling pathways, metabolism, and growth. Our study presents the first systematic landscape of miRNAs in PBMCs from patients with serofast status and proposes specific miRNAs linked with serofast status. Our results provide further evidence that serofast status is closely related to host immune function. Additionally, the miRNA expression profile in PBMCs of patients with serofast status generated by this work offers insight into the complex immune network in humans. We hope our results can provide new insights into the pathogenesis of serofast status.

The Treponema pallidum outer membrane protein Tp92 activates endothelial cells via the chemerin/CMKLR1 pathway

Endothelium damage caused by Treponema pallidum is the key step in the systemic dissemination and pathophysiology of syphilis, particularly cardiovascular syphilis and neurosyphilis. However, the molecular mechanisms supporting endothelium damage of syphilis are undefined. The outer membrane proteins were thought to be involved. Tp92 was first identified as an outer membrane protein of T. pallidum. Homologous proteins to Tp92 play important roles in cell attachment, inflammation, and tissue destruction in other bacterial species. In this study, we investigated the effect of Tp92 on endothelial cells activation. The data showed that Tp92 induced chemerin production in activated endothelial cells. Endothelial cell-derived chemerin upregulated the expression of TNF-α and ICAM-1 in endothelial cells via CMKLR1. In addition, endothelial cell-derived chemerin promoted THP-1-derived macrophage migration towards endothelial cells. These findings suggest that Tp92 may play an important role in mediating endothelial cell activation by inducing the secretion of chemerin.

CARDIOVASCULAR SYPHILIS PRESENTING AS PENETRATING AORTIC ULCERS

Cardiovascular syphilis is a late phase complication of the now rare tertiary syphilis complex since the discovery of penicillin, most commonly presenting as an ascending aortic aneurysm. Migration of T. pallidum to the vasa vasorum during early phases of the infection when left untreated leads to

Cardiovascular syphilis (current state of the problem and analysis of own observations)

A description of two cases of cardiovascular syphilis is presented. The introduction discusses the relevance of visceral syphilis. The literary review is constructed in a chronological format and reflects the stages of studying the problem of cardiovascular syphilis. It emphasizes that cardiovascular syphilis is currently a rare pathology and internists are more likely to encounter it. Verification of the pathology of the cardiovascular system, including aortic aneurysm, during the early stages of syphilis (early latent) does not exclude the option of combined pathology. Early forms of syphilis in patients with diseases of the cardiovascular system should be considered a factor that complicates diagnosis. Such patients should be carefully examined to determine the cause of the disease. Rationale for the diagnosis of cardiovascular syphilis requires a comprehensive assessment of the results of clinical, laboratory and instrumental examination of the patient. A preliminary diagnosis of the specific etiology of an aortic aneurysm should be based on the following criteria: 1) relatively young age of patients with socially inappropriate sexual behavior; 2) sudden onset and rapid progression of the main signs of the disease. All patients with newly diagnosed aortic aneurysm at the outpatient stage should perform a serological examination. The diagnosis of cardiovascular syphilis, namely a syphilitic mesaortitis, can be established or confirmed by an autopsy.

Retrospective review of tertiary and neurosyphilis cases in Alberta, 1973–2017

ObjectivesTo review the notification rate and characteristics of tertiary and neurosyphilis cases in Alberta, Canada in the postantibiotic era.MethodsA retrospective review of all neurosyphilis and tertiary syphilis cases reported in...