Tertiary Syphilis Research Articles

Hearing loss, uveomeningitis, and stroke in a 55‐year‐old man

Hearing loss, uveomeningitis, and stroke in a 55‐year‐old man

Syphilitic Aortic Aneurysm in a Young HIV-Infected Man: Case Presentation

We describe the case of a young HIV-positive man who presented to the emergency room in hypovolemic shock. During subsequent evaluation, we documented a huge aortic aneurysm consistent with tertiary syphilis. The final autopsy demonstrated the extent of cardiovascular compromise caused by this aneurysm.

Serologic Testing for Syphilis in the United States: A Cost-Effectiveness Analysis of Two Screening Algorithms

The introduction of automated treponemal enzyme immunoassays and chemiluminescence assays (EIA/CA) tests has led some laboratories in the United States to use new syphilis screening algorithms that start with a treponemal test. We compared the economic and health outcomes of this new algorithm with the standard algorithm from the perspective of the United States health system. We used a cohort decision analysis to estimate the expected costs and effects (including follow-ups and overtreatment) of the 2 algorithms from a health-care system perspective. In the standard algorithm, rapid plasma reagin (RPR) is followed (if reactive) by EIA/CA (Nontreponemal-First). In the new algorithm, EIA/CA is followed (if reactive) by RPR. If the RPR is negative, Treponema pallidum passive particle agglutination assay (TP-PA) test is used (Treponemal-First). For a cohort of 200,000 individuals (1000 current infections and 10,000 previous infections), the net costs were $1.6 m (Treponemal-First) and $1.4 m (Nontreponemal-First). The Treponemal-First option treated 118 more cases (986 vs. 868) but resulted in a substantially higher number of follow-ups (11,450 vs. 3756) and overtreatment (964 vs. 38). Treating the additional 118 cases might prevent 1 case of tertiary syphilis. The estimated cost-effectiveness ratios were $1671 (Treponemal-First) and $1621 (Nontreponemal-First) per case treated. The overtreatment was a function of the specificity of the EIA/CA and the lack of independence of EIA/CA and TP-PA. The Treponemal-First option costs slightly more and results in more unnecessary treatment.

Jarisch–Herxheimer reaction among syphilis patients in Rio de Janeiro, Brazil

The Jarisch-Herxheimer reaction (JHR) is a syndrome observed after antimicrobial treatment of some infectious diseases. The syndrome has clinical characteristics of an inflammatory reaction to antibiotic treatment. A prospective study of patients with a clinical and laboratory diagnosis of syphilis was conducted at a sexually transmitted diseases clinic in Rio de Janeiro, Brazil. Patients were treated with benzathine penicillin and observed for the JHR. A total of 115 patients were included in this study. Fifty-one patients (44%) had secondary syphilis; 37 (32%), primary; 26 (23%), latent; and one (1%), tertiary syphilis. Ten patients (9%) developed the JHR. All JHRs occurred in patients with secondary and latent syphilis. No patients experienced an allergic reaction to penicillin. The JHR occurred less frequently than in previous studies. It is important that health-care professionals recognize the clinical characteristics of the JHR so that it is not misinterpreted as an allergic reaction to penicillin.

Syphilis and HIV co-infection in Ghana

Syphilis and HIV co-infection is common in Africa and frequently presents atypically with earlier progression to tertiary syphilis. Screening for and treating syphilis prevents complications of the disease and reduces transmission of both syphilis and HIV, and congenital syphilis. The aims of this study were: 1. To determine the seroprevalence of syphilis co-infection in HIV infected patients attending a large Teaching Hospital in Kumasi, Ghana; 2.To evaluate the sensitivity and specificity of three different tests (RPR and 2 EIAs) in this population, and 3.

Cavernous sinus syndrome, an atypical presentation of tertiary syphilis: Case report and review of the literature

Cavernous sinus syndrome is rarely caused by tertiary syphilitic infection. To our knowledge only two other cases of cavernous sinus syndrome caused by syphilis have been reported in the literature. We report a case of a 62-year-old female who presented with a mass in the cavernous sinus, which was initially diagnosed as a meningioma radiologically, necessitating a biopsy for diagnostic confirmation. Clinical features of syphilitic aortitis and subsequent positive neurosyphilis laboratory results lead to the suspicion of a gumma infiltrating the cavernous sinus. Empirical treatment with penicillin in an attempt to defer the need for biopsy led to both significant clinical improvement and radiological resolution. This confirmed the diagnosis of a syphilitic gumma in the cavernous sinus. In this paper we emphasize the rarity of cavernous sinus syndrome as a result of syphilitic infection, highlight the diagnostic difficulties using current serological and radiological measures, and propose treating intracerebral mass lesions in serum positive cases empirically prior to more invasive measures.

Chronic syphilitic aortic aneurysm complicated with chronic aortic dissection

BackgroundHistorically, tertiary syphilis infection has been the most common cause of thoracic aortic aneurysm, resulting in 5% to 10% of cardiovascular deaths until the era of antibiotics. MethodsA 49-year-old Caucasian man presented to our institution with progressive dysphagia, weight loss, incomplete bladder emptying, alcohol and tobacco consumption, systemic arterial hypertension, Argyll Robertson pupil, leg paresthesias, and mediastinal widening. He was admitted to investigate clinical alterations. Thoracic computed tomography revealed an aortic aneurysm complicated with chronic aortic dissection from the ascending aorta to the iliac vessels with 2 communicating lumens. Cerebrospinal fluid examination tested positive for neurosyphilis in a venereal disease research laboratory test (titre 1/32). ResultsChronic syphilitic aortic aneurysm complicated with chronic aortic dissection was diagnosed. ConclusionsThis is a unique presentation of a syphilitic infection. Syphilitic aortitis, the hallmark of cardiovascular syphilis, has become rare and is hardly considered by today's clinicians in their differential diagnosis.

Aortite sifilítica: diagnóstico e tratamento. Relato de caso

Aortitis is one of the many possibilities of lesion caused by tertiary syphilis. Between all the cardiovascular lesions, the aorta's injury is the most common. We report a case of a 48-year-old patient diagnosed with syphilitic aortitis who had undergone surgery for the replacement of the aortic root and aortic valve. The diagnosis hypothesis was pondered because of the in situ aspect of the arterial damage. Although the rarity of the disease, it persists.

A case of late diagnostics of tertiary syphilis

The article describes a case of late diagnostics of tertiary syphilis affecting the musculoskeletal system in a patient who was under long-term supervision with a district general practitioner and who was diagnosed with thrombophlebitis. The diagnosis was verified only after the autotomy of the right lower leg

Case Report: Neuropathic Arthropathy of the Hip as a Sequela of Undiagnosed Tertiary Syphilis

Neuropathic arthropathy is characterized by rapidly progressive bone destruction in the setting of impaired nociceptive and proprioceptive innervation to the involved joint. It is seen most commonly in the foot and ankle, secondary to peripheral neuropathy in patients with diabetes mellitus. Other less common sites of involvement may include the knee, hip, shoulder, and spine, depending on the underlying etiology. Neuropathic arthropathy can be associated with tabes dorsalis, a unique manifestation of late, tertiary neurosyphilis that may arise in individuals with untreated syphilis many years after initial infection, and usually involves the knee, or less commonly, the hip. We report the case of a 73-year-old man with neuropathic arthropathy of the hip and tabes dorsalis attributable to previously undiagnosed tertiary syphilis. There was considerable delay in the diagnosis and unnecessary diagnostic testing owing to failure to consider syphilis as the cause. With the advent of effective antimicrobial therapy and public health campaigns, the relationship between untreated syphilis and neuropathic arthropathy has been primarily a historic point of interest. However, current epidemiologic research suggests a resurgence of syphilis in the United States, with an increased incidence of patients presenting with manifestations of tertiary syphilis from unidentified and untreated primary infections. Treatment options for neuropathic arthropathy of the hip are limited. Arthrodesis has had poor success and treatment with THA has had high complication rates. Syphilis is not merely a historic cause of neuropathic arthropathy. Neurosyphilis and tabes dorsalis should be considered in the differential diagnosis for patients presenting with rapid joint destruction consistent with Charcot arthropathy and no other apparent cause.

Secondary syphilis in a patient with renal transplant

Syphilis is a sexually acquired infection caused by the bacterium Treponema pallidum. The initial clinical manifestation is usually a sole and painless chancre at the site of inoculation (in HIV patients several chancres are frequent). This is termed primary syphilis [1]. The chancre usually heals spontaneously within a few weeks. If untreated, a haematogenous spreading of T. pallidum from the site of inoculation occurs and develops a secondary syphilis [2], characterized by a cutaneous rash, fever, headache, malaise and diffuse lymphadenopathy. The rash typically involves the palms (absence in 20% of patients with secondary syphilis) and soles, but it may also include mucosal surfaces. Lesions may be maculopapular, papular, annular or even pustular. Similar to primary disease, the acute symptoms of secondary syphilis typically resolve spontaneously in several weeks. When patients remain untreated, a late or tertiary syphilis may appear in 40% at any time from 1 to 30 years after primary infection [3], producing cardiovascular (aortitis), gummatous (nodular lesions most commonly in skin and bones) and central nervous system syphilis (neurosyphilis, particularly general paresis and tabes dorsalis).

Progressive painless lower limbs weakness in a dialyzed patient: undiagnosed tertiary syphilis: a case report

IntroductionSyphilis is a sexually transmitted disease, remaining under-estimated, under-recognized due to the variability of clinical presentation and ageing of the population with chronic comorbidities. Hence, some manifestations of the past are nowadays superimposed on the course of chronic diseases. Clinical suspicion should be guided by past medical history of contracting any other sexual disease in a heterosexual person or man who has sex with man.Case presentationWe describe a rare case of tertiary syphilis in a hemodialyzed diabetic patient whom was career of chronic liver disease due to the evolution of chronic hepatitis B virus infection complicated by a hepatocellular carcinoma. Initial orientation in diagnosing this rare presentation of progressive painless lower limbs weakness was attributed to possible side effects of ongoing anti viral therapy including lamivudine and adefovir. We continued administering both drugs while patient notified a spectacular improvement under Ceftriaxone therapy introduced empirically for a possible chest infection. Routine ophthalmologic examination realized in a teaching hospital, scheduled without knowing the course of late infection showed the presence of a syphilitic uveitis.ConclusionThis case emphasizes the need for a high index of clinical suspicion for syphilis before the occurrence of symptoms related to its end organ damage dominated by neurosyphilis form. Early diagnosis is the key to preventing significant morbidity and mortality and improving prognosis. However, in the setting of chronic diseases such as chronic kidney diseases either before setting up methods of renal replacement therapy or under immune-suppressive therapy; clinical presentation might resemble any disease, delaying the certitude of the diagnosis by prescribing a rapid plasma reagin.

Tertiary syphilis mimicking hepatic metastases of underlying primary peritoneal serous carcinoma

Tertiary syphilis, especially in cases involving visceral gummatous disease, can be confused with cancer of the solid organs. We report a case of tertiary hepatic syphilis that manifested with intrahepatic masses in a patient who had an underlying primary peritoneal serous carcinoma (PPSC). The patient was diagnosed with PPSC and achieved a complete remission of PPSC following six cycles of platinum-based chemotherapy. Two hepatic nodules developed during the follow-up period and were initially labeled as hepatic metastases from the underlying PPSC, based on radiological findings. A resection of hepatic nodules was performed for therapeutic and diagnostic purposes, because there were no other metastatic foci except in the liver. Unexpectedly, serology and histology confirmed tertiary syphilis. This rare case emphasizes the importance of including tertiary syphilis in the differential diagnosis of a space-occupying lesion, even with an existing diagnosis of underlying cancer.

Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case.

Secondarily infected syphilitic aortic arch aneurysm in a patient on chronic renal dialysis with fatal haemoptysis

This paper reports a case study of a 45-year-old man with known chronic renal failure requiring haemodialysis, hypertension and ischaemic heart disease, who presented with a three-week history of dyspnoea, orthopnoea and a productive cough. He developed sudden onset chest pain and haemoptysis without associated back pain. He was treated for pneumonia and Staphylococcus aureus sepsis, which was confirmed with two separate blood cultures. Chest radiography revealed a widened mediastinum. Computed tomography of the chest confirmed a saccular aortic arch aneurysm. Serodiagnostic tests for syphilis were positive. The patient consequently died due to massive haemoptysis. Postmortem investigation showed a ruptured aortic arch aneurysm, surrounded by a large haematoma, bulging into the patient’s left lung. The case reported here should serve as a reminder of the importance of adequate treatment of primary syphilis in order to reduce the incidence of tertiary syphilis often associated with grave complications.

Patient with Syphilitic Thoracic and Abdominal Aortic Aneurysms

Patient with Syphilitic Thoracic and Abdominal Aortic Aneurysms We are presenting a rare case of patient with two syphilitic aneurysms localized in thoracic and abdominal aorta. Routine lung computer tomography (CT) for the patient with complains about irritating and unclear ethiology cough revealed 10 cm diameter aneurysm of descending thoracic aorta (TAA) and additionally 4.8 cm aneurysm of abdominal aorta (AAA) just below the aortic hiatus. As there was no evidence of previous trauma, Marfan syndrome or connective tissue disease patient was screened for syphilis. Diagnosis of tertiary syphilis was confirmed and specific treatment started. As complains of irritating cough intensified - patients TAA was successfully treated endovascularly with thoracic stent graft (Valiant®Captivia, Medtronic Ltd.) on emergency basis. On control CT angiography 3 month after treatment there was no evidence of graft migration, endoleaks and aneurysmal sac was thrombosed. AAA has not increased in size, and open repair is planned.

History of Dermatology and venereology in Serbia - part III/2: Dermatovenereology in Serbia from 1881 - 1918 / Istorija dermatologije i venerologije u Srbiji – III/2: Dermatovenerologija u Srbiji u periodu od 1881. do 1918. godine

Abstract Owing to the enforced sanitary laws, the health care service in Serbia evolved systematically till the beginning of the Balkan Wars (1912). At the early phase of this period, in general hospitals dermatovenereology diseases accounted for 10.5% (Užice) to 45% (Zaječar), while venereal diseases prevailed (83.3% and 16.7%, respectively). In the period from 1880 to 1897, there were 12.354 Serbian soldiers with venereal diseases: 56.9% had Gonorrhoea, 28.9% had Ulcusmolle, and 14.2% had Syphilis. The first official and professional statistics on Syphilis was done in 1898, and according to the report, 0.26% of the population of Serbia was affected by Syphilis: 1.42% in the Timok Region and 0.27% in Belgrade. Nevertheless, these data must be taken with caution, being very low. In regions with endemic Syphilis, tardive and tertiary Syphilis prevailed, whereas out of these regions, secondary forms of the disease were most common. In the period from 1882 to 1910, according to the reports of the Sanitary Department of the Ministry of Defense, skin diseases were reported in 3.1% to 15.2% of all hospitalized soldiers. Leprosy was diagnosed in 15 cases in Serbia; notification of all cases became compulsory in 1890. From 1912 to 1918, Serbia was at war, and the most common skin disease was a dermatozoonosis - pediculosios (lice infestation), which caused a tragic epidemic of exanthematous typhus in the army, but also among civilians. It was estimated that there were 500.000 sick persons, out of which over 150.000 died, including 56% of physicians and other medical staff working in hospitals. Disinfestation was the main treatment modality, using steam in so called “Serbian barrel”. At the Thessaloniki front line, in the Dermatovenereology Department, there were 41 dermatoses or groups of dermatoses, affecting the hospitalized soldiers, but scabies was scarce, owing to good hygiene. After the end of the First World War, the Serbian army and population were decimated, and the country ruined. Reconstruction of the country began once again.

PO13-TU-07 Intravenous thrombolysis in patient with stroke due association between bilateral internal carotid artery dissection and tertiary syphilis

PO13-TU-07 Intravenous thrombolysis in patient with stroke due association between bilateral internal carotid artery dissection and tertiary syphilis

Tronco de coronária esquerda ocluso secundário a Lues terciária

A 27-year-old patient with tertiary syphilis, manifested as myocardial ischemia, presenting unstable angina, secondary to left coronary trunk occlusion. The diagnosis was confirmed by the serological findings and the pathological assessment of the aorta fragment.

Diagnostic reappraisal of disease in famous persons

Reassessment of the illnesses of famous historical figures has sometimes led to revised diagnosis and provided insights into former areas of medical practice. However, such reassessments may be difficult as the historical person cannot amplify his medical history, medical records may be incomplete, the physical findings may be inadequate and key laboratory diagnostic tests may have not been performed. Despite these hindrances, some reviews have led to more precise diagnostic probabilities. But which cases should be analysed? Some indication may be given when clinical data may have previously been interpreted erroneously, details of an illness may be in an obscure source that awaits discovery, new information may have emerged recently, knowledge of candidate diseases may have been insufficient at the time, key diagnostic studies may have been unavailable, new medical discoveries may lead to a diagnostic re-evaluation and emotional investment in a diagnosis may have discouraged analysis. Archival materials include medical records, pictures, writings and correspondence from the subject, physicians, family, friends and colleagues. The search may take one to medical libraries, historical collections, newspapers and other pertinent sources. Much may be gained from examining the remains of famous individuals. Analysis of human and microbial genes in preserved tissues may provide evidence for a genetic or infectious disease. Heavy metal toxins found in hair, bones or other preserved tissues 1 can be informative. Skeletal remains and remnants of other organs can be imaged for evidence of disease including congenital deformity and trauma, or infectious disease such as tertiary syphilis or tuberculosis. Imaging methods augmented by computer analysis can also aid in reconstructing facial and other body configurations that