Fluorescent Treponemal Antibody Absorption Research Articles

ORAL MANIFESTATION OF SYPHILIS: AN UNUSUAL PRESENTATION OF TERTIARY SYPHILIS

A 48-year-old female patient, a smoker and alcohol user, presented a painful ulcer lesion with a central crusty, bleeding-to-the-touch growth of 2.5 cm on her lower lip for 40 days. Also, skin lesions looked like eczematous dermatoses, and lymph nodes were soft and sore. Exfoliative cytology excluded malignancy, immunophenotype was negative, and histopathology showed formation of granulomas and vascular proliferations, suggesting Spirochaetas presence. Laboratorial examinations showed human hepesvirus 8/Epstein-Barr virus/cytomegalovirus (−), HIV 1-2 (−), Venereal Disease Research Laboratory (+), rapid plasma reagin test reactive at 1:64, and fluorescent treponemal antibody absorption (+). The final diagnosis was tertiary syphilis, and the lesion on the lower lip was characterized as syphilitic gumma. The patient was referred to gynecology service. The treatment was based on intramuscular benzathine penicillin, divided in 3 weekly doses. After a small improvement of the lesion, another Venereal Disease Research Laboratory serology was performed without any changes. The patient is in good health and continues under follow-up.

ORAL SYPHILIS CLINICOPATHOLOGIC FEATURES OF 19 NEW CASES

Objective To report the clinicopathologic features of 19 new cases of oral syphilis in a population from Brazil. Study Design Oral syphilis cases diagnosed in the last 4 years were retrieved and a descriptive analysis was performed. Results There were 11 men and eight women, with age ranging from 16 to 60 years (mean of 27.2 years). The most common clinical appearance of oral syphilis was of white plaques or ulcers usually affecting the tongue, buccal mucosa, palate, and lower lip. Two patients showed cervical lymphadenopathy, with skin involvement of the hands and abdominal region. Fourteen patients were subjected to biopsy and microscopically, all cases revealed perivascular and subepithelial lymphoplasmacytic infiltrate in a vascularized connective tissue, which was covered by stratified squamous epithelium with acanthosis, hyperkeratosis, and microabscesses. The diagnosis of oral syphilis in all patients was confirmed by serologic positivity for Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS). Eighteen patients showed oral manifestations of secondary syphilis and 1 patient of primary syphilis. Conclusions Patients with oral syphilis from Brazil showed similar clinicopathologic features compared with other countries. Oral manifestations may be the first sign of syphilis.

SYPHILIS: WHY THE NUMBER OF CASES IS INCREASING

Syphilis is an ancient sexually transmitted infection currently facing a vertiginous increase in its incidence. This study reports 2 cases that contribute to this assertion. EJS, a 43-year-old woman, sought the service of stomatology, complaining of a nonhealing ulcer. Clinically, she presented a lesion on the buccal mucosa primarily with an erosive aspect and later as whitish plaques. In the anamnesis she reported unprotected sex. DTM, a 25-year-old man, reporting a complaint of pain when swallowing, presented erythematous, necrotic, and yellowish-white lesions on the oropharynx and palate. In the anamnesis he reported inguinal lymphadenopathy and wounds in the penis that appeared 2 months earlier with spontaneous resolution. Serology test results for syphilis (fluorescent treponemal antibody absorption) were positive for both patients, and treatment recommended by the World Health Organization was instituted as well as compulsory notification and the research of potentially coinfected individuals. Patients and partners responded successfully to treatment, and serology test results for syphilis were negative afterward.

EXTENSIVE PARACOCCIDIOIDOMYCOSIS ORAL MANIFESTATION ASSOCIATED WITH SYSTEMIC SYPHILIS: A CASE REPORT

Paracoccidioidomycosis is a disease caused by the dimorphic fungus Paracoccidioides brasiliensis. A 46-year-old male patient, chronic smoker, crack and cocaine user reported a history of completed syphilis treatment 5 years ago. The patient described a recent history of a mouth burn secondary to chlorine. Clinical examination revealed moriform ulcers with hemorrhagic dots on the surface on the lower labial mucosa, buccal mucosa, and hard palate. The histopathologic diagnosis of this incisional biopsy was paracoccidioidomycosis. Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) were considered reactant in both serologic investigations. The patient was referred for treatment of both infections. After 7 months of drug therapy, the oral lesions regressed, and the patient did not report more symptoms. The present case emphasizes the importance of the detailed clinical examination and complementary tests. The presence of coinfections is highlighted, because the patient's habits could favor these contaminations. The oral surgeon knowledge about these diseases allows for prompt diagnosis and minimizes morbidity.

ACQUIRED ORAL SYPHILIS: REPORT OF 2 CASES AND REVIEW OF THE LITERATURE

Acquired oral syphilis (AOS) is an infectious disease caused by the bacterium Treponema pallidum. Transmission occurs mainly by sexual contact with infectious lesions. Two cases of AOS have been reported. A 29-year-old male patient presented with grayish-white mucous patches and reddish ulcers in the lips, lateral border of the tongue, floor of the mouth, and the oropharynx. The patient was a marijuana user. A 33-year-old female patient presented with pruritus of the tongue and throat, pain in the upper labial mucosa for 1month, and halitosis. Reddish ulcers 5 mm in size were detected in the upper labial mucosa, posterior dorsal surface of the tongue, gingiva, and palate. A maculopapular cutaneous rash was also observed. The patients did not report systemic comorbidities. Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) were both positive, confirming the clinical diagnosis of syphilis. They patients were referred for adequate treatment and remission of the oral lesions was observed. Support: FAPEMIG.

Evaluation of Immunochromatography Test Using Tp17 Antigen for Detection of Treponemal Antibody in Blood Donors

Syphilis transmission through blood transfusion urged WHO recommend examination of treponemal antibody in blood donors. Treponemal antibody was identified to be formed against the membrane of lipoprotein antigen Tp15, Tp17, and Tp47 of T.pallidum. Tp17 antigen may have important role in the pathogenesis of syphilis. Evaluation of CLIA method using Tp17 antigen showed a good diagnostic value. Currently immunochromatography test using Tp17 antigen was available but the diagnostic value has not been widely published. The aim of this study was to determine the diagnostic value of immunochromatography test using Tp17 antigen for treponemal antibody detection in blood donors. Total 100 serum samples with reactive (n=66) and non-reactive (n=34) treponemal antibody screened with ELISA and CLIA methods in blood transfusion unit of Surabaya, Mojokerto, and Sidoarjo Indonesian Red Cross from May 2018-August 2018 were examined for treponemal antibody with immunochromatography test using Tp17 antigen (StandardTM Q Syphilis Ab, Standard Biosensor) and Fluorescent Treponemal Antibody Absorption /FTA-ABS (EUROIMMUN, AG) as gold standard. Kappa Cohen analysis showed the concordance of immunochromatography test using Tp17 antigen was moderate and significant with IgG anti-treponemal FTA-ABS (k = 0.477 p: 0.000). The IgM anti-treponemal was non-reactive in all samples. The sensitivity was 69.8% with 81% of specificity. The sensitivity was not high may be due to the use of a single antigen (Tp17) while the treponemal antibody was formed by Tp15, Tp17, and Tp47 antigen predominantly, the others possbilities were decreased of IgG anti-Tp17 in donors after syphilis treatment, and differences of gold standard with other studies (FTA-ABS vs TPHA). Further study was needed with TPHA that was routinely used as a confirmation test, Western Blot to determine the antibody others than anti-Tp17, and non-treponemal test to determine the disease activity.

First report of hare treponematosis seroprevalence of European brown hares (Lepus europaeus) in the Czech Republic: seroprevalence negatively correlates with altitude of sampling areas

BackgroundThe aim of this study was to quantify the seroprevalence of hare treponematosis in European brown hare (Lepus europaeus) populations in the Czech Republic and to test for an association between treponematosis prevalence and the altitude of the areas in which hares were sampled. We tested 289 serum samples of brown hares collected between 2015 and 2017. The sampling areas included 12 districts (73 villages) distributed throughout the Czech Republic. Serum samples were tested for the presence of antibodies against the causative agent of hare treponematosis (Treponema paraluisleporidarum ecovar Lepus, TPeL) using two serological tests for human syphilis that cross-react with TPeL: the Treponema pallidum hemagglutination assay (TPHA) and the fluorescent treponemal antibody absorption (FTA-ABS) test. To account for the imperfect diagnostic sensitivity and specificity of each test, apparent prevalence estimates of TPeL were converted to true prevalence estimates using the Rogan Gladen estimator.The correlation between TPeL true seroprevalence and altitude of sampling areas was analyzed using Pearson’s correlation coefficient at three levels of spatial resolution: (1) four groups, each composed of two merged districts, with ≥20 samples collected, differing in their altitude median (206, 348, 495, and 522 m above sea level); (2) separately tested eight districts, where ≥20 samples were collected per district; and (3) 27 groups composed of villages of the same altitude level distributed across the whole dataset.ResultsOne hundred and seven of the 289 samples were seropositive to both tests, the FTA-ABS test was positive for an additional 47 samples. Seropositive samples were found in all 12 districts. True seroprevalence of TPeL in the sampled hares was 52% (95% confidence interval 46 to 58%).A statistically significant negative correlation between TPeL seroprevalence and altitude was identified at the district level (Pearson’s r = − 0.722, p = 0.043).ConclusionsBetween 2015 and 2017 hare treponematosis was present at a relatively high prevalence in brown hares in all 12 districts in the Czech Republic where sampling was carried out. The seroprevalence of TPeL in brown hares was negatively correlated with the altitude of the areas in which hares were sampled.

2318 A Rare Case of Cytomegalovirus Hepatitis Complicated by Secondary Syphilis Hepatitis in an Immunocompetent Patient

INTRODUCTION: Cytomegalovirus (CMV) hepatitis most commonly presents with subclinical transaminitis and less commonly with the elevation of alkaline phosphatase (ALP) and total bilirubin (TB). Syphilis hepatitis, on the other hand, generally has a non-specific presentation with a more cholestatic picture. We present a rare case of cholestatic hepatitis from acute CMV infection complicated by syphilis hepatitis. CASE DESCRIPTION/METHODS: A 57-year-old homosexual man presented to the emergency room with complaints of intermittent fever and general malaise for the past two weeks. Blood work showed aspartate aminotransferase (AST) of 235 U/L, alanine aminotransferase (ALT) of 284 U/L, ALP of 940 U/L. TB and coagulation profile were normal. Acute hepatitis A, B, C, Epstein-Barr virus, and herpes simplex virus were ruled out. HIV was negative. Workup for autoimmune hepatitis, primary biliary cholangitis, alpha-1-antitrypsin deficiency, and Wilson’s disease was all negative. Abdominal CT scan with contrast was notable for hepatosplenomegaly without liver lesion. CMV IgM was positive with PCR of 7490 copies/mL, indicating acute CMV infection. The patient subsequently improved without treatment. He presented two months later with worsening liver tests with a peaked ALP of 1981 U/L, TB of 1.6 mg/dL, AST 230 U/L, ALT 195 U/L, associated with the macular rash on his trunk, abdomen, both palms, and soles. Abdominal MRI with contrast showed three < 2cm liver lesions. The patient was subsequently diagnosed with secondary syphilis with rapid plasma reagin (RPR) of 1:16 and confirmatory positive fluorescent treponemal antibody absorption (FTA-ABS). Biopsy of the liver lesions showed granulomatous inflammation with negative immunohistochemistry for CMV which was compatible with clinical syphilis hepatitis. The patient was treated with penicillin G. His rash resolved in 2 months with significant improvement of liver tests. The CMV PCR and RPR were negative with normalization of liver enzymes in 4 months. Follow-up MRI showed resolution of the liver lesions. DISCUSSION: Our patient initially had an atypical presentation of acute CMV hepatitis with cholestatic features. He subsequently developed secondary syphilis associated hepatitis with severe intrahepatic cholestasis and liver lesions. This is, to our knowledge, the first case of CMV hepatitis complicated by syphilis hepatitis. Resolving CMV hepatitis with recurrent elevation in liver tests warrant the workup for possible superimposed liver disease.

A case of secondary syphilis presenting on the oral mucosa: A case report

AbstractSyphilis is a sexually transmitted disease caused by Treponema pallidum. We report a case of secondary syphilis originating in the oral mucosa. The patient was a 58‐year‐old man who visited our hospital at May 2009. Clinical examination revealed a mass at the right angle of the mouth with a white mass on the tip of the tongue and an indurated ulcer on the left border of the tongue. Magnetic resonance imaging revealed multiple swollen lymph nodes in the bilateral submandibular glands, as well as in the bilateral deep cervical and supraclavicular lymph nodes. Serological examination revealed elevated rapid plasma reagin (RPR) (titer, 1:32) and Fluorescent treponemal antibody absorption test (2+) values. Consequently, the mass at the right angle of the mouth, the white patch on the tip of the tongue, and the ulcer on the left border of the tongue were diagnosed as secondary syphilis. Oral amoxicillin 1500 mg/d was administered for 4 weeks. The oral lesions improved after 20 days of treatment and the RPR titer had improved to 1:2 after 5 months of treatment.

Spirochetal Diseases and Seventh Nerve Palsy

Abstract Treponema pallidum and Borrelia burgdorferi may lead to seventh nerve palsy and should be suspected in the appropriate clinical context. Serologic testing for syphilis and Lyme disease (LD) is valuable but may show cross-reactivity. We describe a 20-year-old woman with left seventh nerve palsy secondary to latent syphilis of unknown duration, with complete recovery after penicillin G benzathine. In addition to reactive rapid plasma reagin and positive T. pallidum particle agglutination testing, Lyme enzyme-linked immunosorbent assay was equivocal, and Lyme Western blot was positive for immunoglobulin M. In syphilis, Lyme enzyme-linked immunosorbent assay may be falsely positive, but Western blot is known to remain negative. Similarly, in LD, fluorescent treponemal antibody absorption testing may be falsely positive, but rapid plasma reagin remains nonreactive. Careful interpretation of these serologic tests is of utmost importance in differentiating between the 2, especially in areas with low prevalence of LD.

Evaluating congenital syphilis in a reverse sequence testing environment.

To examine the effect of maternal reverse-sequence (RS) syphilis screening on management of infants at risk for congenital syphilis (CS) using a standardized approach. A retrospective study from 2011 to 2014 at an academic medical center using RS testing, involving chemiluminescent immunoassay (CIA), rapid plasma reagin (RPR), and fluorescent treponemal antibody-absorption (FTA-ABS) assays for syphilis. Clinical management and outcomes of infants born to mothers with discordant (CIA+/RPR-/FTA+) serology were compared with national or internal guidelines. Sixty-three infants were classified as discordant (n = 21), presumed false positive (CIA+/RPR-/FTA-; n = 16), or true positive (CIA+/RPR+; n = 26) based on maternal serology. Only 24% of cases in the discordant group underwent recommended full evaluation. None of the evaluated infants in the discordant group (n = 8) were diagnosed with CS. Management of infants with discordant maternal RS serology remained reliant on clinical judgment. In our high-risk population, RS testing did not identify additional cases of CS.

Diagnosing acquired syphilis through oral lesions: the 12 year experience of an Oral Medicine Center

IntroductionA resurgence of syphilis in Brazil has been reported in recent years. ObjectiveWith this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital. MethodsA retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected. ResultsA total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%). ConclusionThe frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis.

Current ophthalmology practice patterns for syphilitic uveitis

BackgroundSyphilitic uveitis is re-emerging alongside the systemic infection. In July 2017, an international group of uveitis-specialised ophthalmologists formed the International Ocular Syphilis Study Group to define current practice patterns.Methods103 Study...

Evaluation of the Elecsys Syphilis electrochemiluminescence immunoassay as a first-line screening test in the reverse algorithms for syphilis serodiagnosis

ObjectivesWith the development of the automated treponemal test, new syphilis serodiagnosis algorithms, reverse algorithm, and European Centre for Disease Prevention and Control (ECDC) algorithm have been recommended recently. We investigated the efficacy of an electrochemiluminescence immunoassay (ECLIA) as an initial screening test in the reverse and ECDC algorithms. MethodsSamples from 4,771 subjects were included in this study. We performed rapid plasma reagin (RPR), ECLIA, and Treponema pallidum particle agglutination (TPPA) according to these three algorithms. The fluorescent treponemal antibody absorbed (FTA-ABS) test was additionally applied for discordant cases between the RPR and ECLIA results. The FTA-ABS results and the consensus of three algorithms were considered a gold standard. ResultsA total of 208 subjects were diagnosed with syphilis. The traditional algorithm had a sensitivity of 25.96%, specificity of 100%, and accuracy of 96.77%. Both the reverse and ECDC algorithms showed the same diagnostic performance, sensitivity of 95.19%, specificity of 99.96%, and accuracy of 99.75%. The agreements between the traditional algorithm and the other algorithms were 96.9% with a kappa value of 0.415. ConclusionsThe diagnostic accuracy of the reverse and ECDC algorithms using the ECLIA as a first-line screening test was superior to that of the traditional algorithm.

Investigation of syphilis coinfection and performance of the Architect Syphilis Tp ELISA screening test in HIV positive patients

Limited data on syphilis coinfection in human immunodeficiency virus (HIV) positive cases exist in Turkey. Our aim is to investigate syphilis coinfection and to evaluate the compatibility of the screening Architect Syphilis Tp ELISA with the fluorescent treponemal antibody absorption (FTA-abs) confirmation test in HIV positive cases. Totally 519 HIV positive patients were included in the study. Enzyme linked fluorescent assay (ELFA) was used as a screening test and positive samples were confirmed by line immunassay (LIA). In order to discriminate acute HIV infection and false ELISA positivity, HIV-1 RNA PCR was performed in ELFA positive and LIA negative samples. Architect Syphilis TP ELISA was used for the detection of total antibodies against Treponema pallidum in HIV positive patients. Positive results were confirmed by the FTA-abs test. Out of 519 HIV-1 positive patients, IgG and IgM positivity, and only IgG positivity was detected as 1.9% and 11.4% in all the samples, respectively. A total of 79 (15.2%) sera were positive with Architect Syphilis Tp ELISA test and 69 (13.3%) were positive with FTA-abs test. Statistically significant, almost perfect agreement was found between Architect Syphilis Tp ELISA and FTA-abs tests (kappa = 0.921 and P < 0.001). Implementation of syphilis and HIV screening tests together among risk groups is considered to be appropriate.

Oral Lesions as a Single Manifestation of Secondary Syphilis

A 19-year-old Caucasian woman presented with a 1-week history of pain at the border between the hard and soft palates. The medical history was unremarkable. Physical examination revealed an erythematous lesion measuring approximately 1 cm in diameter. A provisional diagnosis of traumatic injury was established, and topical corticosteroid was prescribed. After 2 weeks, the patient was reassessed because of worsening of the clinical scenario, with 2 additional oral lesions characterized as thin asymptomatic white membranes, 5 mm in size, in the lower anterior alveolar mucosa. Considering this development, a provisional diagnosis of secondary syphilis was raised. Biopsy samples were taken; Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) for serology were performed. Histopathologic examination revealed nonspecific chronic inflammation with a predominantly plasma cell infiltrate. Anti-Treponema pallidum immunohistochemistry was positive. VDRL, FTA-ABS, and immunoglobulin G were “reactive,” 1/16, and +++, respectively. A diagnosis of secondary syphilis was confirmed, and the patient was referred for treatment.

Palatal Lesion Leading to the Diagnosis of Syphilis

A 30-year-old woman presented with a painful lesion in the hard and soft palates with 3 months of evolution. Extraoral examination revealed painless brownish nodules in the nose, legs, back, palms of hands, and soles of feet. Incisional biopsy was performed under local anesthesia on the hard palate, and serology for syphilis (Venereal Disease Research Laboratory and fluorescent treponemal antibody absorption) yielded positive results. The histopathologic report was descriptive, containing the following: pseudoepitheliomatous hyperplasia and underlying inflammatory infiltrate containing neutrophils, histiocytes, and plasma cells, demonstrating foci of granulomatous inflammation with well-circumscribed collections of histiocytes and multinucleated giant cells; the findings were considered compatible with the clinical hypothesis of syphilis. The patient was referred for medical treatment, and follow-up visit within a short period demonstrated complete regression of the lesion in the palate. The patient is still undergoing medical treatment and follow-up.

Performance evaluation of nine different syphilis serological tests in comparison with the FTA-abs test

BackgroundSerological methods have great importance for the detection of Treponema pallidum antibodies in syphilis diagnosis. The goal of the present study is to evaluate various commercially available screening assays in comparison with the FTA-abs test. MethodsA total of 363 serum samples were enrolled in the study. Following routine testing including RPR and TPHA tests, each sample was tested by treponemal immunoassays (Chorus Syphilis Screen Recombinant, Architect Syphilis TP, Syphilis Virclia Monotest, Siemens Advia Centaur Syphilis, Euroimmun Treponema pallidum Screen ELISA, Vircell Syphilis ELISA IgG + IgM, SD Bioline Syphilis). The result obtained from each test was compared with the confirmatory FTA-abs test. Kappa (κ) coefficients were used to compare the concordance of the tests. ResultsWhen the various tests were evaluated in comparison with the FTA-abs test, the sensitivity, specificity and percent agreement of each test were as follows: Architect Syphilis TP, 92.3%, 94.5%, 92.8%; Chorus Syphilis Screen Recombinant, 87.9%, 91.2%, 88.7%; Syphilis Virclia Monotest, 80.5%, 97.8%, 84.9%; Siemens Advia Centaur Syphilis, 87.5%, 89%, 87.9%; Euroimmun Treponema pallidum Screen ELISA, 87.5%, 85.7%, 87.1%; Vircell Syphilis ELISA IgG + IgM, 73.2%, 62.6%, 70.5%; TPHA, 89%, 63.7%, 82.6%; SD Bioline Syphilis, 58.1%, 94.5%, 67.2%; RPR test, 57.7%, 57.1%, 57.6%. ConclusionThe results of the present study show that Treponema pallidum specific immunoassays with a performance similar or better than TPHA test generally performed well with the confirmatory FTA-abs test and may be an alternative for screening total antibodies in syphilis infection.

Autopsy case of acute pulmonary thromboembolism with neurosyphilis

BackgroundSyphilis is caused by the bacterium Treponema pallidum. Syphilis is a multistage disease, and the clinical stages of syphilis are divided to primary, secondary, and tertiary syphilis, where the tertiary stage is classified as neurosyphilis, cardiovascular syphilis, or gummatous syphilis. Here, we describe an autopsy case of acute pulmonary thromboembolism with neurosyphilis.Case presentationA male in his early 40s began to complain of hallucinations. He was admitted to a psychiatric hospital as an emergency case 4 days before death. He was physically restrained to control agitation and aggressiveness. The patient was severely obese (BMI 36.45). At autopsy, large thromboembolic masses filled the pulmonary trunk and both pulmonary arteries. Thrombi were also noted in the right popliteal vein and bilateral gastrocnemius and soleus veins, suggesting bilateral lower extremity deep vein thrombosis. Dissection of the brain, which weighed 1457 g, revealed no noteworthy macroscopic findings. Histological examination showed lymphocyte infiltration into the perivascular space of the brain tissue with no vasculitis. Immunohistochemical staining of T. pallidum was negative, the fluorescent treponemal antibody-absorption test was positive, the rapid plasma reagin titer was 1:4, and the T. pallidum hemagglutination assay titer was 1:10,240. Real-time PCR assay of the brain tissue detected low copy numbers of T. pallidum genes. Altogether, the cause of death was acute pulmonary thromboembolism resulting from bilateral lower extremity deep vein thrombosis. The patient also had early-stage meningovascular neurosyphilis.ConclusionAn autopsy case of acute pulmonary thromboembolism with meningovascular neurosyphilis is presented, including histopathological examination, serological assessment, and genetic testing. Forensic pathologists should pay attention to a myriad of syphilitic manifestations. The contributing factors for thrombosis in the present case included severe obesity, probable dehydration, and physical restraints implemented to control meningovascular neurosyphilis-induced neuropsychiatric symptoms.

Cross-sectional Research: Epidemiological Profile of Syphilis Notified in the National Ins-titute of Public Health Research. Zones 6 and 7 Ecuador

BACKGROUND: Syphilis constitutes a challenge for national and global public health due to the repercussions on human life. The objective of the study was to characterize the epidemiological profile of the cases of syphilis treated in the health system of zones 6 and 7. METHODS: Cross-sectional study of secondary data collected in the form of investigation / notification of syphilis of all people attended and diagnosed by fluorescent treponemal antibody absorption tests. The inclusion criteria were the clinical and epidemiological data of suspicion for syphilis. The variables analyzed were age, sex, origin, residence and diagnostic tests. Odds Ratio and Chi2 were used for the statistical inference analysis using the Epi info 7.2 programs RESULTS: 72 % of people diagnosed with syphilis are between 20 and 49 years old, 53 % of women. The confirmatory tests were reactive in 75 % of the cases, of which 27 % presented non-reactive serological tests and 77 % without previous tests. The provinces with the highest incidence of cases were Cañar (93 %) and Morona Santiago (87 %). Protective factors were female sex (OR 0.41, 95 % CI 0.25 - 0.68) and residence in the province of Loja (OR 0.21, 95 % CI 0.10 - 0.46) CONCLUSIONS: The prevalence of cases of syphilis is found in the age group of 20 to 49 years andmale. The protective factors identified in a statistically significant manner were female sex and residence in the province of Loja. It is suggested to develop strategies to expand coverage in people with suspected syphilis, to undertake prevention and health promotion programs.