RESUMO
La coinfección entre el Treponema pallidum y el virus de la inmunodeiciencia humana (VIH) altera el curso clínico clásico de la sífilis aumentando la probabilidad de aparición de formas atípicas del secundarismo sifilítico. Entre estas formas se ha descripto a la sífilis elegante, entidad caracterizada por un exantema maculopapuloso descamativo, de aspecto anular, por lo general, con indemnidad de las regiones palmo plantar y de las mucosas. Se presenta un caso de sífilis secundaria, con lesiones típicas por su aspecto y localización, de sifílides elegantes en una paciente con diagnóstico de sida
Co-infection between Treponema pallidum and HIV alters the classic clinical course of syphilis, increasing the likelihood of atypical forms of syphilitic secondaryism. Among these forms, elegant syphilis has been described, an entity characterized by a desquamating maculopapular rash of annular appearance, with indemnity of the palmoplantar surface and mucous regions. Here, we present a case of secondary syphilis with typical lesions of elegant syphillides, in a patient diagnosed with AIDS
Assuntos
Humanos , Feminino , Adolescente , Sífilis Cutânea/diagnóstico , Treponema pallidum , Infecções por HIV/imunologia , Síndrome da Imunodeficiência Adquirida/imunologiaRESUMO
It is essential for health care providers to be familiared with the full spectrum of clinical presentations of syphilis. We present herein a case of syphilide psoriasiforme, an uncommon but well recognized clinical presentation of secondary syphilis. A 46-year-old HIV-infected female patient was referred to our attention with a presumptive diagnosis of palmoplantar psoriasis. On examination, there were exuberant pinkish-red papules and plaques covered with a thick silvery scale in the palms, flexor surfaces of the wrists, and the medial longitudinal arches of the feet. Serological and histopathological analyses uncovered the diagnosis of syphilis. Clinical remission was obtained after treatment. A detailed review of the literature on syphilide psoriasiforme, including descriptions from older syphilology textsis provided. The present case report emphasizes the need for clinicians to have a heightened awareness of the varied and unusual clinical phenotypes of syphilis.
Assuntos
Penicilina G Benzatina/administração & dosagem , Sífilis Cutânea/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Sífilis Cutânea/tratamento farmacológico , Sífilis Cutânea/patologiaRESUMO
It is essential that healthcare providers are familiar with the full spectrum of clinical presentations of syphilis. A rare manifestation of secondary syphilis is the corymbiform (or corymbose) arrangement, in which a central greater papule is surrounded by smaller satellite lesions. Very few reports of corymbiform syphilis are available in current biomedical databases. We present the case of a 28 year-old HIV-infected male patient on regular, successful antiretroviral therapy who developed an asymptomatic corymbiform maculopapular lesion in the medial aspect of the right thigh. There were also a few brownish macular lesions on the left sole. New serological tests for syphilis (which had been negative in the past) were reactive. The coymbiform lesion slowly regressed and the non-treponemal test reverted to negative after benzathine penicillin G treatment. A review of the literature is provided. This is the first report of corymbiform syphilis in an HIV-infected patient.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Sífilis Cutânea/diagnóstico , Sífilis/diagnóstico , Adulto , Antibacterianos/administração & dosagem , Humanos , Injeções Intramusculares , Masculino , Penicilina G/administração & dosagem , Sífilis/tratamento farmacológico , Sífilis Cutânea/tratamento farmacológicoRESUMO
La anetodermia es una entidad cutánea benigna, rara e infrecuente, cuya característica es la pérdida localizada de fibras elásticas a nivel de la dermis. Suele observarse en pacientes con síndrome antifosfolípidico, lupus eritematoso sistémico, acné y varicela y de manera inusual como manifestación de una sífilis secundaria. Comunicamos el caso de una mujer con secundario o sifilítico que desarrolló anetodermia posterior a este proceso infeccioso.
Anetoderma is a benign, rare and infrequent cutaneous entity whose characteristic is the localized loss of elastic fibers at the level of the dermis. It is usually observed in patients with antiphospholipid syndrome, systemic lupus erythematosus, acne and varicella and an unusual way as a manifestation of secondary syphilis. We report a case of a woman with syphilitic secondary disease who developed an anetoderma after this infectious process.
Assuntos
Humanos , Feminino , Adulto , Sífilis Cutânea/diagnóstico , Diagnóstico Diferencial , Tecido Elástico/fisiopatologia , Anetodermia/terapia , BiópsiaRESUMO
Leucoderma syphiliticum (LS), originally described as syphilide pigmentaire, encompasses a spectrum of dyschromic lesions that emerge during the course of secondary syphilis. Very few case reports are available in modern biomedical databases. We present the case of a 57-year-old HIV-infected male patient who presented with several round to oval, non-scaling, slightly raised and well-demarcated hypochromic lesions scattered over the trunk, abdomen, dorsum, and arms. Prior non-treponemal tests were negative for syphilis, but novel studies yielded positive results at high titers. Skin lesions slowly regressed and the hypochromic areas repigmented a few weeks after benzathine penicillin G treatment. This is the first report of LS in an HIV-infected patient. A review of modern and ancient literature was performed. The present case report emphasizes the need for clinicians to have a heightened awareness of the varied and unusual clinical phenotypes of syphilis.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Sífilis Cutânea/diagnóstico , Sífilis/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adulto , Humanos , Masculino , Sífilis/tratamento farmacológico , Sífilis Cutânea/tratamento farmacológicoRESUMO
Syphilis is an infection caused by Treponema pallidum, mainly transmitted by sexual contact. Since 2001, primary and secondary syphilis rates started to rise, with an epidemic resurgence. The authors describe an exuberant case of secondary syphilis, presenting with annular and lichen planus-like lesions, as well as one mucocutaneous lesion. Physicians must be aware of syphilis in daily practice, since the vast spectrum of its cutaneous manifestations is rising worldwide.
Assuntos
Sífilis Cutânea/diagnóstico , Sífilis/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Sífilis/patologia , Sífilis Cutânea/patologiaRESUMO
Syphilis is a systemic and sexually transmitted infection caused by Treponema pallidum ssp. pallidum. This spirochete causes different clinical and subclinical stages depending on the duration of infection and immune status of the host. Several tests have been developed for diagnosis, and are classified into direct and indirect methods. The first one includes dark field microscopy, direct fluorescent antibody test in fluids or tissue, and molecular biology techniques. In the indirect method (serologic), the routine tests are used, and are divided in two categories: non-treponemal and treponemal ones. The objective of this work was to identify T. pallidum ssp. pallidum in paraffin-embedded skin biopsies positive by immunohistochemistry, using conventional polymerase chain reaction (PCR) and quantitative real time PCR (qPCR). We included a sample of 17 paraffin-embedded biopsies. DNA was extracted and processed by conventional PCR and real-time PCR with a TaqMan® probe to identify the polA gene. Using PCR, 11 tested positive (64.7%) and 6 (35.3%) were negative. With qPCR and TaqMan® probe, 100% of samples tested positive. The minimum number of spirochetes detected in each sample was 2. With this work, we can conclude that qPCR is a fast and very accurate method for diagnosis of syphilis in tissue specimens.
Assuntos
Genes pol/genética , Reação em Cadeia da Polimerase em Tempo Real/métodos , Pele/microbiologia , Sífilis Cutânea/diagnóstico , Treponema pallidum/genética , Treponema pallidum/isolamento & purificação , Biópsia , DNA Bacteriano/análise , DNA Bacteriano/genética , Humanos , Imuno-Histoquímica , Inclusão em Parafina , Pele/patologia , Sorodiagnóstico da Sífilis , Sífilis Cutânea/imunologia , Taq Polimerase , Treponema pallidum/imunologiaRESUMO
El artículo describe el caso de un paciente de 28 años de edad con antecedente de VIH, quien presentaba múltiples lesiones en la piel y las mucosas, producto de sífilis secundaria, y quien mostraba un amplio espectro de manifestaciones cutáneas características de esta enfermedad.
We describe the case of a 28-year-old patient with HIV history who has multiple skin and mucous lesions that showing a broad spectrum of cutaneous manifestations of secondary syphilis.
Assuntos
Sífilis Cutânea/diagnóstico , Treponema pallidum/patogenicidade , HIV/classificaçãoAssuntos
Sífilis Cutânea/diagnóstico , Sífilis/diagnóstico , Adulto , Biópsia , Feminino , Humanos , Sífilis/patologia , Sífilis Cutânea/patologiaAssuntos
Exantema/microbiologia , Nódulos Pulmonares Múltiplos/microbiologia , Infecções Respiratórias/microbiologia , Sífilis Cutânea/microbiologia , Sífilis/microbiologia , Adulto , Antibacterianos/uso terapêutico , Biópsia , Exantema/diagnóstico , Exantema/tratamento farmacológico , Humanos , Masculino , Nódulos Pulmonares Múltiplos/diagnóstico , Nódulos Pulmonares Múltiplos/tratamento farmacológico , Penicilinas/uso terapêutico , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sífilis Cutânea/diagnóstico , Sífilis Cutânea/tratamento farmacológico , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Patients with HIV infection may develop common diseases with atypical clinical features. HIV infection can change the classic clinical course of syphilis and increase the incidence of malignant syphilis. Malignant syphilis is a rare subtype of secondary syphilis that presents special clinical and histological features and has been associated with several processes characterized by variable degrees of immunosuppression. It is necessary to consider the possibility of this entity in the differential diagnoses in HIV-infected patients with cutaneous lesions. The dental surgeon (or oral surgeon) is vital to the medical team for promoting the health and improving the quality of life of syphilis patients. A patient with HIV infection was referred to us for complaints of a white patch on the tongue, stinging and burning sensation on the tongue, loss of taste, and dryness of the mouth. On clinical examination, the patient was found to have a tabetic gait (the Prussian soldier gait) associated with Charcot arthropathy. We also identified bilateral lesions with ulceration and exposure of the tissue that were tender, characterized by discrete necrosis. The treatment that was initiated at that time involved cleaning the area with gauze to remove all the white patches, followed by rinsing with bicarbonate in water (one teaspoon of baking soda dissolved in half a glass of water) four times a day. Additionally, fluconazole (100 mg/day for 7 days) was prescribed. We diagnosed secondary malignant syphilis of approximately 5 days duration. As an adjunctive therapy, we performed low-intensity laser treatment using a GaAsAl (gallium-aluminum arsenide) laser at 790 nm. With this treatment there was progressive resolution of the lesions.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Síndrome da Ardência Bucal/microbiologia , Sífilis/diagnóstico , Doenças da Língua/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Ageusia/microbiologia , Antifúngicos/uso terapêutico , Soluções Tampão , Síndrome da Ardência Bucal/tratamento farmacológico , Candidíase Bucal/diagnóstico , Terapia Combinada , Fluconazol/uso terapêutico , Seguimentos , Humanos , Hospedeiro Imunocomprometido , Lasers Semicondutores/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Masculino , Antissépticos Bucais/uso terapêutico , Bicarbonato de Sódio/uso terapêutico , Sífilis/tratamento farmacológico , Sífilis Cutânea/diagnóstico , Doenças da Língua/tratamento farmacológico , Xerostomia/microbiologia , Adulto JovemRESUMO
Syphilis is a sexually transmitted disease caused by Treponema pallidum. The diagnosis is based mainly in clinical presentation and non-specific assays. PCR-based diagnosis has been suggested as an attractive alternative method. The aim of this study was the validation of a PCR-based test for the diagnosis of early syphilis (ES) and neurosyphilis (NS). Clinical samples of mucocutaneous lesions and cerebrospinal fluid (CSF) specimens from patients previously diagnosed for ES and NS respectively using an enlarged gold standard, were tested by PCR. The reaction was done using primers targeting the tpN47 gene. Twenty out of 21 mucocutaneous samples from patients diagnosed with ES were positive by PCR, with a clinical sensitivity of 95%. Four out of 8 CSF samples from patients previously diagnosed with NS were positive by PCR, with a clinical sensitivity of 50%. The clinical specificity for both ES and NS was 100%. The PCR sensitivity and specificity for mucocutaneous samples allowed us to implement this assay in our laboratory for routine diagnosis. Although the sensitivity of the PCR in CSF was low, it may be useful to support clinical diagnosis.
Assuntos
DNA Bacteriano/análise , Neurossífilis/diagnóstico , Reação em Cadeia da Polimerase , Sífilis Cutânea/diagnóstico , Treponema pallidum/genética , Feminino , Humanos , Masculino , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/patologia , Estudos Prospectivos , Sensibilidade e Especificidade , Sífilis Cutânea/líquido cefalorraquidiano , Sífilis Cutânea/patologiaRESUMO
Syphilis is a sexually transmitted disease caused by Treponema pallidum. The diagnosis is based mainly in clinical presentation and non-specific assays. PCR-based diagnosis has been suggested as an attractive alternative method. The aim of this study was the validation of a PCR-based test for the diagnosis of early syphilis (ES) and neurosyphilis (NS). Clinical samples of mucocutaneous lesions and cerebrospinal fluid (CSF) specimens from patients previously diagnosed for ES and NS respectively using an enlarged gold standard, were tested by PCR. The reaction was done using primers targeting the tpN47gene. Twenty out of 21 mucocutaneous samples from patients diagnosed with ES were positive by PCR, with a clinical sensitivity of 95 percent. Four out of 8 CSF samples from patients previously diagnosed with NS were positive by PCR, with a clinical sensitivity of 50 percent. The clinical specificity for both ES and NS was 100 percent. The PCR sensitivity and specificity for mucocutaneous samples allowed us to implement this assay in our laboratory for routine diagnosis. Although the sensitivity of the PCR in CSF was low, it may be useful to support clinical diagnosis.
La sífilis es una enfermedad de transmisión sexual producida por Treponema pallidum, cuyo diagnóstico se realiza presuntivamente basándose en aspectos clínicos y análisis de especificidad limitada. La reacción de la polimerasa en cadena (RPC) ha sido planteada como una alternativa diagnóstica de mayor sensibilidad y especificidad. El objetivo de este trabajo fue validar una RPC para el diagnóstico de sífilis temprana (ST) y neurosífilis (NS). Se utilizaron muestras de lesiones muco-cutáneas y de LCR de pacientes con sospecha de cursar ST y NS respectivamente, previamente diagnosticados, utilizando un estándar de oro ampliado. La RPC fue realizada con partidores dirigidos al gen tpN47. De las 21 muestras de pacientes con ST, la RPC resultó positiva en 20, lo que resulta en una sensibilidad clínica de 95 por ciento. De las 8 muestras de pacientes con NS, la RPC resultó positiva en 4, obteniéndose una sensibilidad clínica de 50 por ciento. La especificidad clínica para ST y NS fue de 100 por ciento. La excelente sensibilidad y especificidad de la RPC para muestras muco-cutáneas permitió la exitosa implementación de este análisis en nuestro laboratorio para el diagnóstico de rutina. Si bien la sensibilidad de la RPC en LCR es baja, es muy útil para apoyar el diagnóstico clínico.
Assuntos
Feminino , Humanos , Masculino , DNA Bacteriano/análise , Neurossífilis/diagnóstico , Reação em Cadeia da Polimerase , Sífilis Cutânea/diagnóstico , Treponema pallidum/genética , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/patologia , Estudos Prospectivos , Sensibilidade e Especificidade , Sífilis Cutânea/líquido cefalorraquidiano , Sífilis Cutânea/patologiaRESUMO
Syphilis, a disease that in the past was associated with significant morbidity and lethality rates, has resurged in recent years principally as a consequence of changes in risk behavior. An epidemiological group that is commonly affected is the HIV-infected population. The characteristics of the disease and its progression may differ in these patients. The present report describes a case of an HIV-positive male patient, who developed florid secondary syphilis: in addition to syphilitic roseola, he also presented with bilateral panuveitis and involvement of the central nervous system. Investigation revealed the prozone phenomenon and histological examination of the skin lesions showed the presence of leukocytoclastic vasculitis. This finding is extremely rare and few cases have been documented.
Assuntos
Sífilis Cutânea/diagnóstico , Vasculite Leucocitoclástica Cutânea/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Humanos , Masculino , Sífilis Cutânea/patologia , Vasculite Leucocitoclástica Cutânea/patologiaRESUMO
A sífilis, doença de importante morbiletalidade no passado, tem ressurgido nos últimos anos, graças, sobretudo, às alterações nos comportamentos de risco. Um grupo epidemiológico, frequentemente, acometido é a população com infecção pelo HIV: estes pacientes podem apresentar características peculiares nas manifestações e evolução da doença. Relatamos o caso de um paciente masculino, HIV-positivo, que desenvolveu um quadro florido de secundarismo: além da roséola sifilítica, apresentou pan-uveíte bilateral e acometimento do sistema nervoso central. A investigação, apresentou fenomeno pro-zona e no estudo histologico, mostrou a presenca de vasculite leucocitoclastica achado este extremamente raro e pouco documentado.
Syphilis, a disease that in the past was associated with significant morbidity and lethality rates, has resurged in recent years principally as a consequence of changes in risk behavior. An epidemiological group that is commonly affected is the HIV-infected population. The characteristics of the disease and its progression may differ in these patients. The present report describes a case of an HIV-positive male patient, who developed florid secondary syphilis: in addition to syphilitic roseola, he also presented with bilateral panuveitis and involvement of the central nervous system. Investigation revealed the prozone phenomenon and histological examination of the skin lesions showed the presence of leukocytoclastic vasculitis. This finding is extremely rare and few cases have been documented.