Clinical characteristics and evolution of syphilis in 24 HIV+ individuals in Rio de Janeiro, Brazil

A total of 24 patients with syphilis and HIV infection were treated from January 1997 to March 2003 at the Infectious Dermatology Outpatient Clinic of the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. The caseload consisted of 20 males (83.3%) and four females (16.7%), with a mean age of 38.04 years and mean T CD4+ count of 389.5 cells/mL. Syphilis was diagnosed as secondary in 16 (62.5%) patients, late latent in eight (33.3%), and tertiary in one (4.2%). Manifestations of secondary syphilis were palmar and plantar erythematopapulous cutaneous lesions in nine (37.5%), papulous exanthema in four (16.7%), patchy alopecia in 3 (12.5%) and osteochondritis in one patient (4.2%). Tertiary syphilis was characterized by verrucous lesions. Neurosyphilis was diagnosed in four patients (16.7%), with headache as the only manifestation in two patients. Drugs used in treatment included benzathine penicillin, ceftriaxone, erythromycin, and crystalline penicillin. Cure was achieved in 18 patients (75%). Five patients (20.8%) were retreated, three of whom presented a history of re-exposure. This study confirms the importance of establishing the diagnosis of neurosyphilis in patients with HIV infection, in addition to performing follow-up on treatment for syphilis.

Download Full-text

Cardiac cephalalgia: severe, non-exertional headache presenting as unstable angina

Practical Neurology ◽

10.1136/practneurol-2018-002045 ◽

2018 ◽

Vol 19 (2) ◽

pp. 173-175

Author(s):

Jonathan Lazari ◽

Andrew Money-Kyrle ◽

Benjamin R Wakerley

Keyword(s):

Clinical Characteristics ◽

Troponin I ◽

Coronary Intervention ◽

Severe Stenosis ◽

Exertional Headache ◽

Percutaneous Coronary ◽

History Of ◽

St Elevation ◽

Cardiac Cephalalgia

Cardiac cephalalgia is a migraine-like headache that occurs during episodes of myocardial ischaemia. Clinical characteristics of the headache vary widely but are often severe in intensity, worsen with reduced myocardial perfusion and resolve with reperfusion. It can present along with typical symptoms of angina pectoris, although not always. We present a 64-year-old man with a 6-month history of severe, non-exertional headaches occurring with increasing frequency. A resting ECG showed ST elevation in the inferior leads. His serum troponin I was not elevated. Coronary angiography showed severe stenosis of his right coronary artery, which was successfully stented by percutaneous coronary intervention. He remains headache free at 2-year follow-up.

Download Full-text

Outbreak of Foodborne Botulism in Alexandria, Egypt: Modulating Indications for Administration of Heptavalent Botulinum Antitoxin

10.21203/rs.3.rs-267943/v1 ◽

2021 ◽

Author(s):

Sara A Ghitani ◽

Maha A Ghanem ◽

Eman A Sultan ◽

Maram Atef ◽

Maii F Henaidy

Keyword(s):

Prospective Study ◽

Clinical Characteristics ◽

Personal Data ◽

Poison Center ◽

Supportive Treatment ◽

Past Medical History ◽

Salted Fish ◽

History Of ◽

Foodborne Botulism

Abstract Background: In October 2019, 94 patients were admitted into Alexandria Poison Center (APC) with a history of ingestion of Feseekh (salted fish). As a trial to allocate the resources, not all patients were given Heptavalent botulinum antitoxin (HBAT) immediately.The current study aimed to portray the clinical characteristics of the cases, explore the possible relation between these characteristics and necessity of HBAT administration, explore the reliability of MLT, and to establish a clinical guide for management with preservation of resources.Subject and Method: the current prospective study included 94 patients who were admitted to Alexandria Poison Center (APC) in the period from 29 th September to 27 th October 2019. The patients' data was recorded using a checklist that includes: personal data, past medical history, clinical assessment, investigations, treatment and the outcome. The checklist was carried out to assess and follow up each patient. Hospitalized patients were categorized according to symptoms consistent with botulism. The equine HBAT, made by Emergent BioSolutions Canada Inc. (formerly Can gene Corporation) was used in the treatment.Results: HBAT was given to (36.2%) patients only out of the total admission. However, 87.2% of patients were completely cured, whereas 10.6% of patients were discharged with mild neurological sequelea and death occurred only in two cases (2.2%).Conclusion: 63.8% of cases with suspected foodborne botulism toxicity could be managed by supportive treatment only with no need for HBAT.

Download Full-text

Patients with History of Myocardial Infarction and Acute Cerebrovascular Accidentin Clinical Practice: Demographic, Clinical Characteristics, Drug Treatment and Outcomes (Data of Outpatient and Hospital Registry REGION)

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2019-15-5-656-662 ◽

2019 ◽

Vol 15 (5) ◽

pp. 656-662 ◽

Cited By ~ 1

Author(s):

E. Yu. Okshina ◽

M. M. Loukianov ◽

S. Yu. Martsevich ◽

S. S. Yakushin ◽

N. P. Kutishenko ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Practice ◽

Family History ◽

Drug Treatment ◽

Clinical Characteristics ◽

Beta Blockers ◽

All Cause Mortality ◽

History Of ◽

Hospital Registry

Aim. To assess the demographic and clinical characteristics, drug treatment and outcomes in patients with a history of acute cerebrovascular accident (ACVA) and with concomitant history of myocardial infarction (MI) in clinical practice based on outpatient and hospital parts of REGION registry.Material and methods. The total 1886 patients with a history of ACVA (aged of 70.6±12.5 years, 41.9% men) were enrolled into the outpatient registry REGION (Ryazan) and the hospital registry REGION (Moscow). 356 patients had ACVA and a history of MI (group “ACVA+MI” and 1530 patients had ACVA without history of MI (group “ACVA without MI”). The incidence of cardiovascular diseases (CVD), non-CVD comorbidities, drug therapy and outcomes were analyzed.Results. In the group ACVA+MI compared with group ACVA without MI the significantly higher proportions of patients with the following conditions (diagnosis) were revealed: arterial hypertension (AH) – 99.1% and 94.2%; coronary heart disease (CHD) – 100% and 57%; chronic heart failure (CHF) – 61.5% and 41.8%; atrial fibrillation (AF) – 42.7% and 23.8%; repeated ACVA – 32.9% and 18.9%, respectively, p<0.0001 for all. In ACVA+MI and ACVA without MI groups the respective proportions of patients were smokers – 16.2% and 23.7% (p=0.10), had a family history of premature CVD – 3.2% and 1.2% (p=0.01), and had a hypercholesterolemia – 47% and 59.7% (p<0.001). The incidence of drug administration with proved positive prognostic effect was insufficient in both groups, but higher in the ACVA+MI group compared with ACVA without MI group (on average 47.1% and 40%, respectively), including: anticoagulants in AF – 19.1% and 21.4% (p=0.55); antiplatelets in CHD without AF – 69.4% and 42% (p<0.001); statins in CHD – 26.4% and 17.2% (p<0.001); beta-blockers in CHF – 39% and 23.8% (p=0.002), respectively. During 4- year follow-up in the group ACVA+MI compared with group ACVA without MI there were significantly higher all-cause mortality – 44.9% and 26.8% (p<0.001), nonfatal recurrent ACVA – 13.7% and 5.6% (p=0.0001), and nonfatal MI – 6.9% and 1.0% (p<0.0001), respectively.Conclusion. The proportion of patients with a history of MI was 18.9% among the patients with a history of ACVA. In patients of ACVA+MI group, compared with patients of ACVA without MI group a higher incidence of the following characteristics was revealed: a presence of AH, CHD, CHF, AF, repeated ACVA and a family history of premature CVD. The incidence of taking drug with proved positive effect on prognosis in patients of the compared groups was insufficient, especially of statins and anticoagulants in AF. During the follow-up period ACVA+MI group was characterized by a higher all-cause mortality and higher incidence of nonfatal ACVA and MI. In these patients the improvement of the quality of pharmacotherapy and of the secondary prevention effectiveness are the measures of especial importance.

Download Full-text

P320Heart failure with mid-range (HFmrEF) or recovered (HFrecEF) ejection fraction: differential determinants of transition

European Heart Journal ◽

10.1093/eurheartj/ehz747.0155 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Cited By ~ 1

Author(s):

R De Maria ◽

F Macera ◽

M Gorini ◽

I Battistoni ◽

M Iacoviello ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ejection Fraction ◽

Clinical Characteristics ◽

Nyha Class ◽

Multivariable Logistic Regression Analysis ◽

Class Iii ◽

Mild Disease ◽

Lower Likelihood ◽

History Of

Abstract Background Heart failure with mid-range ejection fraction (HFmrEF) has been identified as a multi-faceted phenotype that may encompass both patients with mild disease or those who from previous HFrEF recover EF (HFrecEF) Purpose To describe clinical characteristics and factors associated with phenotype transition at follow-up. Methods From 2009 to 2016, 1194 patients with baseline EF<50% and a second echocardiographic determination during clinically stability at a median of 6 months were enrolled in the IN-CHF Registry. Based on EF at enrollment, 335 (28%) had HFmrEF and 859 (72%) had HFrEF. We compared baseline clinical characteristics and predictors associated with follow-up reclassification to HFmrEF or full EF recovery Results When compared to HFrEF patients, those with HFmrEF had less often an ischemic etiology, advanced symptoms and a HF admission in the previous year. No other differences were found in clinical characteristics and drug therapy (Table). At a median follow-up of 6 months, 30% of HFrEF patients improved EF by 14 (9) units: 21% showed partial EF recovery (transition to HFmrEF) and 9% had full EF recovery. Conversely among HFmrEF patients 22% improved EF, by 9 (5) units, to full recovery, and 18% deteriorated by 1.5 (5.5) units sloping to HFrEF. By multivariable logistic regression analysis, variables associated with EF recovery at 6-month follow-up differed between baseline phenotypes. Within HFrEF, ischemic etiology (OR 0.46, 95% CI 0.33–0.64) and NYHA class III-IV symptoms (OR 0.57, 95% CI 0.38–0.68) were associated with a lower likelihood of EF recovery, while a history of HF<6 month correlated with a higher likelihood of EF recovery (OR 2.44, 95% CI 1.76–3.39). Within HFmrEF, while ischemic etiology (OR 0.66, 95% CI 0.19–0.68) was also associated with a lower likelihood of EF recovery, a history of atrial fibrillation at enrollment correlated with higher likelihood of EF recovery (OR 2.66, 95% CI 1.37–5.17) by 6 month-follow-up. At a median follow-up of 36+28 months mortality was 4.6% vs 6.9% in HFrecEF vs non-recovered patients (log rank p=0.08). Baseline characteristics HFrEF vs HFmrEF Conclusions HFmrEF patients showed a less severe clinical picture than HFrEF patients, but had EF recovery less often. EF improvement is negatively associated with ischemic etiology in both phenotypes, and positively associated with atrial fibrillation in HFmrEF and a short history of HF in HFrEF.

Download Full-text

Imunopatogenesis Treponema pallidum dan Pemeriksaan Serologi

Jurnal Kesehatan Andalas ◽

10.25077/jka.v3i3.203 ◽

2014 ◽

Vol 3 (3) ◽

Author(s):

Efrida Efrida ◽

Elvinawaty Elvinawaty

Keyword(s):

Clinical Symptoms ◽

Early Stage ◽

Transmitted Disease ◽

Treponema Pallidum ◽

Secondary Syphilis ◽

Major Health Problem ◽

Sexually Transmitted ◽

Tertiary Syphilis ◽

History Of ◽

Latent Syphilis

AbstrakSifilis adalah penyakit menular seksual yang sangat infeksius, disebabkan oleh bakteri berbentuk spiral, Treponema pallidum subspesies pallidum. Penyebaran sifilis di dunia telah menjadi masalah kesehatan yang besar dengan jumlah kasus 12 juta pertahun. Infeksi sifilis dibagi menjadi sifilis stadium dini dan lanjut. Sifilis stadium dini terbagi menjadi sifilis primer, sekunder, dan laten dini. Sifilis stadium lanjut termasuk sifilis tersier (gumatous, sifilis kardiovaskular dan neurosifilis) serta sifilis laten lanjut. Sifilis primer didiagnosis berdasarkan gejala klinis ditemukannya satu atau lebih chancre (ulser). Sifilis sekunder ditandai dengan ditemukannya lesi mukokutaneus yang terlokalisir atau difus dengan limfadenopati. Sifilis laten tanpa gejala klinis sifilis dengan pemeriksaan nontreponemal dan treponemal reaktif, riwayat terapi sifilis dengan titer uji nontreponemal yang meningkat dibandingkan dengan hasil titer nontreponemal sebelumnya. Sifilis tersier ditemukan guma dengan pemeriksaan treponemal reaktif, sekitar 30% dengan uji nontreponemal yang tidak reaktifKata kunci: sifilis, Treponema pallidum, serologiAbstractSyphilis is a sexually transmitted disease that is highly infectious, caused by a spiral -shaped bacterium, Treponema pallidum subspecies pallidum. The spread of syphilis in the world has become a major health problem and the common, the number of 12 million cases per year. Infectious syphilis is divided into early and late-stage syphilis. Early-stage syphilis is divided into primary, secondary, and early latent. Advanced stage of syphilis include tertiary syphilis (gumatous, cardiovascular syphilis, and neurosyphilis) and late latent syphilis. Primary syphilis is diagnosed by clinical symptoms of the discovery of one or more chancre (ulcer). Secondary syphilis is characterized by the finding of localized mucocutaneous lesions or with diffuse lymphadenopathy. Latent syphilis without clinical symptoms of syphilis with a nontreponemal and treponemal reactive examination, history of syphilis therapy in nontreponemal test titer increased compared with the results of previous nontreponemal titers. Tertiary syphilis is found guma with reactive treponemal examination, approximately 30% of the non- reactive nontreponemal testKeywords: syphilis, Treponema pallidum, serologi

Download Full-text

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

Our Dermatology Online ◽

10.7241/ourd.2021e.2 ◽

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.

Download Full-text

Severe Symptomatic Hypocalcemia from HIV Related Hypoparathyroidism

Case Reports in Endocrinology ◽

10.1155/2018/8270936 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Sartaj Sandhu ◽

Akshata Desai ◽

Manav Batra ◽

Robin Girdhar ◽

Kaushik Chatterjee ◽

...

Keyword(s):

Hiv Infection ◽

Vital Signs ◽

Neck Surgery ◽

Normal Range ◽

Calcium Sensing ◽

Symptomatic Hypocalcemia ◽

History Of ◽

Inhaled Budesonide ◽

Lost To Follow Up

We report the case of a 54-year-old Caucasian female who presented with a two-year history of persistent hypocalcemia requiring multiple hospitalizations. Her medical history was significant for HIV diagnosed four years ago. She denied any history of prior neck surgery or radiation. Her vital signs were stable with an unremarkable physical exam. Pertinent medications included calcium carbonate, vitamin D3, calcitriol, efavirenz, emtricitabine, tenofovir disoproxil, hydrochlorothiazide, and inhaled budesonide/formoterol. Laboratory testing showed total calcium of 5.7 mg/dL (normal range: 8.4-10.2 mg/dL), ionized calcium of 2.7 mg/dL (normal range: 4.5-5.5 mg/dL), serum phosphate of 6.3 mg/dL (normal range: 2.7-4.5 mg/dL), and intact PTH of 7.6 pg/mL (normal range: 15-65 pg/mL). She was diagnosed with primary hypoparathyroidism. Anti-calcium-sensing receptor antibodies and NALP5 antibodies were tested and found to be negative. During subsequent clinic visits, doses of calcium supplements and calcitriol were titrated. Last corrected serum calcium level was 9.18 mg/dL. She was subsequently lost to follow-up. This case gives insight into severe symptomatic hypocalcemia from primary hypoparathyroidism attributed to HIV infection. We suggest that calcium levels should be closely monitored in patients with HIV infection.

Download Full-text

Double Morphology: Tertiary Syphilis and Acquired Immunodeficiency Syndrome—A Rare Association

Case Reports in Dermatological Medicine ◽

10.1155/2017/3843174 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

R. M. Ngwanya ◽

B. Kakande ◽

N. P. Khumalo

Keyword(s):

Past History ◽

Treponema Pallidum ◽

Secondary Syphilis ◽

Penicillin G ◽

Rapid Progression ◽

Tertiary Syphilis ◽

History Of ◽

Generalized Lymphadenopathy ◽

Immunodeficiency Syndrome ◽

Cluster Of Differentiation

Background. Human immunodeficiency virus (HIV) and Treponema pallidum coinfection is relatively common and accounts for about 25% of primary and secondary syphilis. Tertiary syphilis in HIV-uninfected and HIV-infected patients is vanishingly rare. This is most likely due to early treatment of cases of primary and secondary syphilis. There is rapid progression to tertiary syphilis in HIV-infected patients. Case Presentation. A 49-year-old woman diagnosed with HIV Type 1 infection and cluster of differentiation 4 (CD4) count of 482 presented with a four-week history of multiple crusted plaques, nodules, and ulcers on her face, arms, and abdomen. Her past history revealed red painful eyes six months prior to this presentation. She had generalized lymphadenopathy, no alopecia, and no palmar-plantar or mucosal lesions. There were no features suggestive of secondary syphilis. Neurological examination was normal. Her rapid plasma reagin test was positive to a titer of 64. She was treated with Penicillin G 20 mu IVI daily for 2 weeks. Conclusion. Penicillin remains the treatment of choice in syphilitic infected HIV negative and HIV-infected individuals. In neurosyphilis, the dose of Penicillin GIVI is 18–24 mu daily for 10–14 days. This case report demonstrates the importance of excluding syphilis in any HIV-infected patient.

Download Full-text

Characteristics and long-term outcomes of childhood glaucoma: a retrospective-cohort study

F1000Research ◽

10.12688/f1000research.51256.1 ◽

2021 ◽

Vol 10 ◽

pp. 165

Author(s):

Supawan Surukrattanaskul ◽

Pukkapol Suvannachart ◽

Sunee Chansangpetch ◽

Anita Manassakorn ◽

Visanee Tantisevi ◽

...

Keyword(s):

Clinical Characteristics ◽

Secondary Glaucoma ◽

Research Network ◽

Congenital Glaucoma ◽

Long Term Outcomes ◽

History Of ◽

The Mean ◽

Primary Glaucoma

Purpose: To evaluate the clinical characteristics and treatment outcomes of patients with childhood glaucoma. Methods: We retrospectively reviewed the data of patients with childhood glaucoma who visited the glaucoma clinics at the Queen Sirikit National Institute of Child Health and the King Chulalongkorn Memorial Hospital between January 2008 and January 2018. The diagnosis was based on the Childhood Glaucoma Research Network classification. We recorded their clinical characteristics and requirement of any glaucoma interventions. Results: A total of 691 eyes from 423 patients were included in this study. The patients predominantly comprised boys. The average follow-up duration was 71.3±63.8 months. The mean age at presentation was 3.9±4.4 years. Most patients presented with a high initial intraocular pressure (IOP) of 28.5±11.2 mmHg. Glaucoma associated with non-acquired ocular anomalies (22.9%) was the most common subtype, followed by primary congenital glaucoma (20.8%). We recorded a family history of glaucoma in 6.4% of patients. Most patients had bilateral glaucoma (63.4%) and required at least one intervention (51.5%). The average IOP at the latest follow-up visit was 19.1±10.8 mmHg. All glaucoma types had significantly lower IOP, compared to that at their baselines (all p<0.001). Moreover, most patients had an unfavourable visual acuity (49.5%) at their latest visit. Conclusions: Secondary glaucoma associated with non-acquired ocular anomalies is the most common subtype of glaucoma. All subtypes, including primary glaucoma, were sporadic. The majority of patients had unfavourable visual outcomes. These real-world findings are fundamental to acquire a better understanding of childhood glaucoma.

Download Full-text

Lymphomatoid Papulosis in a Case of Atypical Secondary Syphilis

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v14i4.335 ◽

2019 ◽

Vol 14 (4) ◽

pp. e32-e33

Author(s):

Xin (Peter) Mu ◽

Ian Mazzetti

Keyword(s):

Clinical History ◽

Skin Lesions ◽

Secondary Syphilis ◽

Low Grade ◽

Cutaneous Lesions ◽

Syphilis Infection ◽

Lymphomatoid Papulosis ◽

History Of ◽

Skin Biopsies ◽

Syphilis Serology

AbstractLymphomatoid papulosis is an indolent cutaneous lymphoproliferative disorder that presents as recurrent self-resolving papulonodular skin lesions. Currently, there are no known causes for lymphomatoid papulosis and definitive diagnosis is only made histologically. A 64-year-old man presented with a 6-week history of bilateral leg pains, low-grade fevers, and a widespread eruption of painless erythematic papules. Despite testing positive for syphilis serology, he lacked the typical clinical history for classic syphilis and therefore, skin biopsies were performed to confirm the diagnosis. Unexpectedly, the skin biopsies revealed lymphomatoid papulosis which resolved with antibiotic treatments for syphilis. Considering the synchronous resolution of the patient’s syphilis infection and his cutaneous lesions, this is the first report of findings to suggest syphilis as a possible cause for lymphomatoid papulosis. Clinicians should appreciate the possibility of alternative diagnosis for cutaneous presentations in settings of confirmed syphilis infections. RESUMELa papulose lympho-matoïde est un trouble lymphoprolifératif cutané indolent qui se présente sous la forme de lésions cutanées papulonodulaires auto-résolutives récurrentes. Actuellement, il n’y a pas de causes connues de la papulose lymphomatoïde et le diagnostic définitif n’est posé que sur le plan histologique. Un homme de 64 ans a présenté une histoire de 6 semaines de douleurs bilatérales aux jambes, de fièvres de bas grade et d’éruptions généralisées de papules érythémateuses indolores. Malgré un test sérologique positif pour la syphilis, il n’avait pas les antécédents cliniques typiques de la syphilis classique et des biopsies cutanées ont donc été effectuées pour confirmer le diagnostic. De façon inattendue, les biopsies cutanées ont révélé une papulose lymphomatoïde qui s’est résorbée grâce à des traitements antibiotiques contre la syphilis. Compte tenu de la résolution synchrone de l’infection syphilitique du patient et de ses lésions cutanées, il s’agit du premier rapport de résultats suggérant que la syphilis est une cause possible de papulose lymphomatoïde. Les cliniciens devraient apprécier la possibilité d’un diagnostic alternatif pour les présentations cutanées dans les contextes d’infections syphilitiques confirmées.

Download Full-text