scholarly journals Unusual clinical manifestation and challenging serological interpretation of syphilis: insights from a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
F. Magri ◽  
M. G. Donà ◽  
C. Panetta ◽  
M. Pontone ◽  
F. Pimpinelli ◽  
...  
Keyword(s):  
Serological Test ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Secondary Syphilis ◽  
Nucleic Acid Amplification ◽  
Clinical Aspects ◽  
Cutaneous Lesions ◽  
Serological Tests ◽  
Syphilis Infection ◽  
Ulcerative Lesions

Abstract Background The clinical manifestations of recent syphilis can be variable, with typical and atypical patterns. Several conditions may cause atypical clinical aspects, including human immunodeficiency virus (HIV) co-infection. Besides the clinical features, co-infections may completely alter syphilis serological tests, causing interpretative difficulties and diagnostic delays. Aim of the work is to describe the difficulties encountered during the diagnostic evaluation of atypical skin manifestations and of the serology for syphilis of an HIV-infected patient who had contracted it several times. Case presentation In 2020, a 52-year old HIV-positive bisexual male patient was admitted to our department with a 4-month history of moderately itchy cutaneous lesions localized at his neck, trunk and arms. In 2013, the patient presented with a classic syphilitic roseola of the trunk and a secondary syphilis was diagnosed, with increased levels of rapid plasma reagin (RPR), Treponema pallidum hemagglutination assay (TPHA), anti-Treponema pallidum IgM and IgG Index. A second episode occurred in 2018, as a primary syphilis with multiple ulcerative lesions of the penis, and increased levels of RPR, IgG and IgM. In 2019, a further episode of secondary syphilis was treated with Doxycycline. In 2020, erythematous and papular lesions with vesicular components and urticarial erythema multiforme (EM)-like lesions were present at the neck, trunk and arms. Serological tests and Nucleic Acid Amplification Test (NAAT) for Treponema Pallidum were performed, as well as a cutaneous biopsy with histological and immunohistochemical evaluation of one lesion. NAAT was negative for T. pallidum. Serological test results were discordant with a new syphilis infection, showing only increased levels of RPR and anti-Treponema IgG. The cutaneous biopsy revealed a non specific histological pattern, while the immunohistochemical evaluation with anti-spirochetal antibodies was mandatory for the diagnosis of recent syphilis, showing clusters of rod-shaped elements, some of which with spiral form, focally present at the epidermis and adnexal structures. Conclusions Nowadays, syphilis may present with atypical clinical and serological features. Physicians should be aware of these possible alterations and consider syphilis even in case of uncommon clinical aspect and unclear serological tests. Cutaneous biopsy and immunohistochemical exam may be mandatory for the diagnosis.

Unusual presentation of secondary syphilis: membranoproliferative glomerulonephritis andmuco-cutaneous lesions

2017 ◽  
Vol 29 (4) ◽  
pp. 410-413 ◽  
Author(s):  
Linda Tognetti ◽  
Elisa Cinotti ◽  
Sergio Tripodi ◽  
Guido Garosi ◽  
Pietro Rubegni
Keyword(s):  
Membranoproliferative Glomerulonephritis ◽  
Congenital Syphilis ◽  
Renal Involvement ◽  
Treponema Pallidum ◽  
Membranous Glomerulonephritis ◽  
Secondary Syphilis ◽  
Cutaneous Lesions ◽  
Syphilis Infection ◽  
Cutaneous Manifestations ◽  
Nephritic Syndrome

The worldwide re-emergence of secondary syphilis which happened in the last decade, has led to an increase in primary and secondary syphilis cases, along with the presentation of atypical forms. Nevertheless, reports of renal syphilis with mucosal and/or cutaneous manifestations are nowadays increasing. Typically, secondary syphilis infection in adults causes nephrotic syndrome due to a membranous glomerulonephritis. Here, we report a case of a 30-year-old immunocompetent man presenting with skin rash, oral and perianal erosions and nephritic syndrome. Laboratory investigations revealed a form of membranoproliferative glomerulonephritis secondary to Treponema pallidum infection. Therapy with benzathine penicillin brought prompt and complete remission of the disease. Although well described for congenital syphilis, this histopathologic pattern of renal involvement is very rarely reported in adult patients. In case of detection of an otherwise unexplained nephritic syndrome in sexually active patients with mucosal and/or anal lesions, an unrecognized syphilis infection should be suspected.

scholarly journals Beyond appearance: An unusual manifestation of isolated oral secondary syphilis

2019 ◽  
Vol 33 ◽  
pp. 205873841984556
Author(s):  
Elena Mari ◽  
Maurizio Nudo ◽  
Enzo Palese ◽  
Luisa Cotticelli ◽  
Ciro Cotticelli ◽  
...  
Keyword(s):  
Chronic Infection ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Secondary Syphilis ◽  
Unusual Manifestation ◽  
Oral Manifestation ◽  
Secondary Stage ◽  
Recurrent Activity ◽  
Systemic Manifestations ◽  
Mucosal Lesions

Syphilis is a sexually acquired chronic infection caused by Treponema pallidum and is characterized by a variety of clinical manifestations. The secondary stage of the disease results from the hematogenous and lymphatic dissemination of treponemes after a few weeks or months, and it is characterized by recurrent activity of the disease, with muco-cutaneous as well as systemic manifestations. Mucosal lesions range from small, superficial ulcers that resemble painless aphthae to large gray plaques, and they are generally associated with systemic manifestations of the disease. The exclusive asymptomatic oral localization not associated with general manifestations is uncommon but may actually be unrecognized and under-reported. We report a case of isolated oral manifestation as the unique presentation of secondary syphilis.

scholarly journals Clinical and Paraclinical Screening for Celiac Disease in Children with Intractable Epilepsy

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Golnaz Ghazizadeh Esslami ◽  
Bahar Allahverdi ◽  
Reza Shervin Badv ◽  
Morteza Heidari ◽  
Nahid Khosroshahi ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Serological Test ◽  
Venous Blood ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Intractable Epilepsy ◽  
Underlying Disease ◽  
Growth Disorders ◽  
Serological Tests ◽  
Cross Sectional

Background. Celiac disease is the inflammatory entropy caused by hypersensitivity to gluten, which occurs in susceptible individuals. Some studies have suggested a link between celiac disease and epilepsy in children. Our aim was to screen for clinical and paraclinical features of celiac disease in children with intractable epilepsy. Methods. This was a cross-sectional study. Children aged 2 to 18 years with refractory epilepsy that referred to the pediatric neurology clinic within one year (2018–2019) were enrolled. Demographic and clinical characteristics of patients, especially clinical manifestations of celiac disease, were recorded in a questionnaire. A venous blood sample was sent to determine the total IgA, anti-tTG (IgA), and anti-endomysial antibody (IgA). Endoscopy was performed in cases where the celiac serological test was positive. Results. Seventy children with idiopathic drug-resistant epilepsy (44 boys) were evaluated. The height-for-age index was 49.2% and the weight-for-age index was 38.2% less than normal. Constipation (48.6%), anorexia (25.7%), and abdominal pain (21.4%) were the most common gastrointestinal symptoms. Celiac serological tests were negative in all children. Therefore, endoscopy and bowel biopsy were not performed in any case. Conclusion. Celiac disease was not found in any patient with intractable epilepsy. Gastrointestinal symptoms and growth disorders in this group may be related to the underlying disease or medications and not to celiac disease.

scholarly journals Syphilis Diagnosis through Oral Lesions of Different Clinical Aspects: Report of 3 Cases

2021 ◽  
Vol 23 (2) ◽  
pp. 106-109
Author(s):  
Matheus Bruno Costa ◽  
Erika Terumi Tomisaki ◽  
Fabio Augusto Ito ◽  
Heliton Gustavo de Lima ◽  
Willian Ricardo Pires ◽  
...  
Keyword(s):  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Clinical Aspects ◽  
Oral Lesions ◽  
Oral Manifestations ◽  
Benzathine Penicillin ◽  
Incisional Biopsy ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
And Control

Abstract Syphilis is a sexually transmitted infection, caused by the anaerobic spirochete Treponema pallidum. It is characterized by a variety of clinical manifestations including the oral mucosa, mimicking several diseases, thereby making diagnosis a challenge for clinicians. Therefore, the objective of this work is to report three cases of syphilis that were diagnosed based on oral lesions of different clinical aspects. In this series of cases, the lesions were found on the tongue and hard palate and presented as white plaques, ulcers or erythematous spots associated with ulcers. In the two cases, incisional biopsy was performed, and the histopathological aspects were suggestive of syphilis. Treponemic and non-treponemic tests were positive for all the patients, confirming syphilis. Therapy with benzathine-penicillin, administered intramuscularly led to complete remission of oral lesions in all the patients. The syphilis reemergence in the last years demands its inclusion in the differential diagnosis of several oral lesions. Diagnosing syphilis by oral lesions can be difficult once it can mimic other conditions. Therefore, dentists should know the clinical aspects of this infection, since many cases may exhibit only oral manifestations, to help in the diagnosis and control of the infection spread. Keywords: Syphilis. Treponemal Infections. Oral Manifestations. ResumoA sífilis é uma infecção sexualmente transmissível, causada pela espiroqueta anaeróbia Treponema pallidum. É caracterizada por uma variedade de manifestações clínicas, incluindo a mucosa oral, podendo mimetizar várias doenças, tornando o diagnóstico um desafio. Portanto, o objetivo deste trabalho é relatar três casos de sífilis diagnosticados a partir de lesões orais de diferentes aspectos clínicos. Nesta série de casos, as lesões foram encontradas na língua e palato duro e apresentadas como placas brancas, úlceras ou manchas eritematosas associadas a úlceras. Em dois casos, foi realizada biópsia incisional e os aspectos histopatológicos foram sugestivos de sífilis. Os testes treponêmicos e não treponêmicos foram positivos para todos os pacientes, confirmando a sífilis. A terapia com penicilina benzatina, administrada por via intramuscular, levou à remissão completa das lesões orais em todos os pacientes. O ressurgimento da sífilis nos últimos anos exige sua inclusão no diagnóstico diferencial de várias lesões bucais. O diagnóstico da sífilis por lesões orais pode ser difícil, pois pode mimetizar outras condições. Portanto, o dentista deve conhecer os aspectos clínicos dessa infecção, pois muitos casos podem apresentar apenas manifestações orais, para auxiliar no diagnóstico e controle da disseminação da infecção. Palavras-chave: Sífilis. Infecção Treponêmica. Manifestações Orais.

scholarly journals Moth-Eaten Essential Syphilitic Alopecia in Human Immunodeficiency Virus-Positive Patient: A Case Report

2021 ◽  
Vol 6 (5) ◽  
pp. 01-03
Author(s):  
Satiti Pudjiati
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hair Loss ◽  
Serological Test ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Serological Tests ◽  
Immunodeficiency Virus ◽  
High Risk Sexual Behaviour ◽  
Risk Sexual Behaviour ◽  
Unclear Etiology

Hair loss is rare to be reported as sole manifestation of secondary syphilis. Syphilitic alopecia consists of symptomatic syphilitic alopecia that presents with other secondary syphilis manifestation, and essential syphilitic alopecia which can be patchy ("moth-eaten" type), diffuse, or combination without other manifestations of secondary syphilis. Here we report a case of secondary syphilis in patient with Human Immunodeficiency Virus (HIV) that present with moth-eaten alopecia as a sole manifestation. A 35-year-old male with HIV complained hair loss on his scalp and eyebrows. Physical examination showed non scarring moth-eaten alopecia on his scalp and lossof lateral third of his eyebrows without other lesions. Serological test for syphilis was positive. He was treated with 2.4 millions unit of benzathine penicillin G (BPG), single dose intramuscular injection. Six months after injection, patient showed clinical and serological improvement. Syphilitic alopecia cannot be ruled out in patients with non scarring hair loss with unclear etiology. Serological tests are recommended especially for patients with history of high risk sexual behaviour.

scholarly journals Secondary Syphilis in Human Immunodeficiency Virus (HIV)-Infected Men Who Have Sex with Men (MSM): A Case Report

2020 ◽  
Vol 32 (1) ◽  
pp. 75
Author(s):  
Ade Fernandes ◽  
Evy Ervianti
Keyword(s):  
Human Immunodeficiency Virus ◽  
Treatment Success ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Secondary Syphilis ◽  
Response To Treatment ◽  
Immunodeficiency Virus ◽  
Tertiary Stage ◽  
Sex With Men

Background: Recently, the incidence of syphilis among men who have sex with men (MSM) has increased rapidly, especially among Human Immunodeficiency Virus (HIV)-infected MSM. Coinfection with these two organisms alter the symptoms and signs, progression of the disease, and the risk of progressing to the tertiary stage. Purpose: To report a case of secondary syphilis in HIV-infected MSM.  Case: A 24-year-old male complaint of multiple redness macule for 1-month duration on his chest, back, groin, palm, and soles. The rash was neither painful nor pruritic. He also complains of hair loss resulting "moth eaten" alopecia. One month before, he had a painless ulcer on his genital, which resolved without treatment. His HIV infection was diagnosed two years earlier. He had been sexually active with multiple homosexual partners without using a condom since 2010. The Venereal Disease Research Laboratory test (VDRL) titer was 1/32, and Treponema pallidum haemagglutination assay (TPHA) was 1/20480. Initial treatment was a single dose of 2.4 million units of benzathine penicillin. Serologic examination was reevaluated on month 1, 3, 6, and 9 after therapy and declined in the third month. Discussion: For HIV-infected persons, the clinical manifestations of syphilis in most of the cases remain the same. However, the lesions are more aggressive, and coexistence of primary and secondary syphilis is more frequent. Serologic tests are accurate and reliable for the diagnosis and for following a patient’s response to treatment. Penicillin is effective but physical and serological follow up is needed. Conclusion: HIV-infected MSM have higher risk of syphilis. Staging is needed to determine the treatment. Serologic examination should be repeated and long enough to monitor the treatment success.

scholarly journals Essential syphilitic alopecia: Non-scarring alopecia in 21-year-old man

2021 ◽  
Vol 12 (e) ◽  
pp. 1-3
Author(s):  
Hafssa Chehab ◽  
Bertrand Richert
Keyword(s):  
Hair Loss ◽  
Previous History ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Secondary Syphilis ◽  
Laboratory Evaluation ◽  
History Of ◽  
High Level

ABSTRACT Alopecia syphilitica is a less common clinical manifestations of secondary syphilis. It is uncommon for hair loss to be the sole or predominant manifestation, as hair loss is the chief clinical and histologic differential diagnosis of. The main difference between alopecia areata and Alopecia syphilitica is the detection of Treponema pallidum in syphilis. We present the case of a 21- year-old belgium man with different patches of non-cicatricial alopecia of his scalp. The patient denied previous history of genital or other skin lesions. Laboratory evaluation was positive for syphilis. The diagnosis of alopecia syphilitica was made and he was treated with single intramuscular injections of benzathine penicillin. The lesions improved with treatment in all the patients who attended follow-up. Dermatologists should maintain a high level of clinical suspicion for this uncommon manifestation of syphilis, particularly when it is the only symptom.

Treponema pallidum PCR testing for diagnosis of mucocutaneous ulcers suspicious for syphilis

2021 ◽  
pp. sextrans-2021-055192
Author(s):  
Muhammad Hyder Junejo ◽  
Mark Collery ◽  
Gary Whitlock ◽  
Alan McOwan ◽  
Victoria Tittle ◽  
...  
Keyword(s):  
Demographic Data ◽  
Treponema Pallidum ◽  
Added Value ◽  
Contact Tracing ◽  
Bisexual Men ◽  
Electronic Patient Records ◽  
Serological Tests ◽  
Syphilis Infection ◽  
Cross Sectional ◽  
History Of

BackgroundPrimary syphilis is characterised by the appearance of an ulcerated lesion (chancre) on the anogenital or oral mucosa from which Treponema pallidum DNA may be detectable by PCR. Serological tests for syphilis may be non-reactive in early infection, even after the appearance of a chancre. We reviewed the use of a multiplex-PCR (M-PCR) test to determine the added value of T. pallidum DNA detection in the management of individuals presenting with mucocutaneous ulceration at a sexual health service in central London.MethodsWe performed a cross-sectional analysis of all individuals with detectable T. pallidum DNA from September 2019 to April 2020. Electronic patient records were reviewed and concomitant results for treponemal serology and/or rapid plasma reagin (RPR) extracted, along with demographic data, history of syphilis and indices of sexual behaviour including number of sexual partners contacted. Any subsequent treponemal serology and RPR results were also reviewed.ResultsM-PCR swab specimens were performed in 450 individuals, of whom 63 (14%) had detectable T. pallidum DNA; 60 of 63 (95%) were gay or bisexual men and 11 of 63 (17%) were living with HIV. A history of treated syphilis was present in 17 of 63 (27%). Same-day treponemal serology/RPR testing was performed in 58 of 63 (92%) patients. Of the 58 who had same-day syphilis serology/RPR, 9 (16%) had their syphilis infection confirmed by treponemal DNA PCR alone. A total of 165 partners were traced as contacts of infection, of whom 25 (15%) were contacts of individuals diagnosed by M-PCR testing alone.ConclusionIn individuals with T. pallidum PCR-positive lesions, around one in six in our cohort were negative on standard diagnostic serological tests for syphilis. Treponemal DNA testing is an important addition to serological assays in individuals with mucocutaneous ulceration who are at risk of recent syphilis infection and facilitates early diagnosis and contact tracing.

scholarly journals Syphilis Infection during Pregnancy: Fetal Risks and Clinical Management

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Marco De Santis ◽  
Carmen De Luca ◽  
Ilenia Mappa ◽  
Terryann Spagnuolo ◽  
Angelo Licameli ◽  
...  
Keyword(s):  
Congenital Syphilis ◽  
Clinical Manifestations ◽  
Fetal Loss ◽  
Immunological Response ◽  
Maternal Infection ◽  
Serological Tests ◽  
Syphilis Infection ◽  
Serological Screening ◽  
Adequate Treatment ◽  
Adverse Pregnancy

Congenital syphilis is still a cause of perinatal morbidity and mortality. Untreated maternal infection leads to adverse pregnancy outcomes, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborns. Clinical manifestations of congenital syphilis are influenced by gestational age, stage of maternal syphilis, maternal treatment, and immunological response of the fetus. It has been traditionally classified in early congenital syphilis and late congenital syphilis. Diagnosis of maternal infection is based on clinical findings, serological tests, and direct identification of treponemes in clinical specimens. Adequate treatment of maternal infection is effective for preventing maternal transmission to the fetus and for treating fetal infection. Prenatal diagnosis of congenital syphilis includes noninvasive and invasive diagnosis. Serological screening during pregnancy and during preconception period should be performed to reduce the incidence of congenital syphilis.

scholarly journals Bead-assisted SARS-CoV-2 multi-antigen serological test allows effective identification of patients

2021 ◽  
Author(s):  
Yaiza Caceres-Martell ◽  
Daniel Fernandez-Soto ◽  
Carmen Campos-Silva ◽  
Eva Maria Garcia-Cuesta ◽  
Jose M. Casasnovas ◽  
...  
Keyword(s):  
Serological Test ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Machine Learning Techniques ◽  
Serological Tests ◽  
Learning Techniques ◽  
Antigen Assay ◽  
Full Picture ◽  
Immunogenic Proteins ◽  
Vaccination Campaigns

Many new aspects of COVID-19 disease, including different clinical manifestations, have been identified during the pandemic. The wide array of symptoms and variation in disease severity after SARS-CoV-2 infection might be related to heterogeneity in the immune responses of different patients. Here we describe a new method for a simple multi-antigen serological test that generates a full picture of seroconversion in a single reaction. The assay is based on the detection by flow cytometry of multiple immunoglobulin classes (isotypes) specific for four SARS-CoV-2 antigens: the Spike glycoprotein (one of the highly immunogenic proteins), its RBD fragment (the major target for neutralising antibodies), the nucleocapsid protein and the main cysteine-like protease. Until now, most diagnostic serological tests measured antibodies to only one antigen and some patients seemed to not make any antibody response. Our data reveal that while most patients respond against all the viral antigens tested, others show a marked bias to make antibodies against either proteins exposed on the viral particle or those released after cellular infection. Combining all the four antigens and using machine learning techniques, it was possible to clearly discriminate between patients and healthy controls with 100% confidence. Further, combination of antigens and different immunoglobulin isotypes in this multi-antigen assay improved the classification of patients with mild and severe disease. Introduction of this method will facilitate massive screenings of patients to evaluate their immune response. It could also support vaccination campaigns both to select non-immune individuals and to distinguish infected patients from vaccine responders.

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