Sexual abuse leading to secondary syphilis in an intellectually disabled person: a case report

<p class="abstract">Syphilis is a sexual transmitted infection (STI) caused by a spirochete, <em>Treponema pallidum</em>. Condylomata lata is a characteristic lesion seen in secondary syphilis. Here we reported a case of 24 year old unmarried male with intellectual disability who presented with condyloma lata over the scrotum, prepuce and perianal region and with moth eaten alopecia over scalp since 1 month. Here the patients mother revealed he had promiscuous relationship with multiple friends, which is a sexual abuse since the patient is intellectually disabled. Clinically diagnosed as secondary syphilis. Venereal disease research laboratory (VDRL) test titre was reactive at 1:32 and <em>Treponema pallidum </em>hemagglutination test (TPHA) was positive. Biopsy was also done, which confirmed diagnosis. Single dose of injection benzathine penicillin G, 2.4 million units was administered intramuscularly. Patient did not develop a Jarisch-herxheimer reaction. On follow up his lesions healed and VDRL titres also came down and non-reactive at 3 months. Here in this case sexual abuse lead to secondary syphilis since patient was intellectually disabled so he couldn’t address his complaints clearly. Hence counselling was done to the patient and family members by dermatologist and psychiatrist.</p><p class="abstract"> </p>

Letter to Editor: Fatal outcome of intravenous injection of benzathine penicillin G in a neonate – A case report

No Abstract.

A 42-year-old man with nodular skin lesions

Nodular skin lesions are infrequently reported among patients with syphilis. We describe a 42-year-old man with secondary syphilis who presented with a nodular cutaneous eruption involving his neck, upper chest, back, arms, and legs. Because there was uncertainty regarding the diagnosis at presentation, the patient underwent a punch biopsy of one of the lesions. Spirochetes were not seen with a Steiner silver stain, but they were visualized on subsequent immunohistochemical staining. The diagnosis was confirmed with serology, and the patient responded well to treatment with benzathine penicillin G. Given the current increase in syphilis cases across North America, it is critical that clinicians become familiar with some of the less common dermatologic manifestations of this infection so that the diagnosis is entertained and appropriate serologic testing is ordered in a timely fashion.

High risk of early sub-therapeutic penicillin concentrations after intramuscular benzathine penicillin G injections in Ethiopian children and adults with rheumatic heart disease

Introduction Intramuscular benzathine penicillin G (BPG) injections are a cornerstone of secondary prophylaxis to prevent acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Uncertainties regarding inter-ethnic and preparation variability, and target exposure profiles of BPG injection are key knowledge gaps for RHD control. Methods To evaluate BPG pharmacokinetics (PK) in patients receiving 4-weekly doses in Ethiopia, we conducted a prospective cohort study of ARF/RHD patients attending cardiology outpatient clinics. Serum samples were collected weekly for one month after injection and assayed with a liquid chromatography-mass spectroscopy assay. Concentration-time datasets for BPG were analyzed by nonlinear mixed effects modelling using NONMEM. Results A total of 190 penicillin concentration samples from 74 patients were included in the final PK model. The median age, weight, BMI was 21 years, 47 kg and 18 kg/m2, respectively. When compared with estimates derived from Indigenous Australian patients, the estimate for median (95% confidence interval) volume of distribution (V/F) was lower (54.8 [43.9–66.3] l.70kg-1) whilst the absorption half-life (t1/2-abs2) was longer (12.0 [8.75–17.7] days). The median (IQR) percentage of time where the concentrations remained above 20 ng/mL and 10 ng/mL within the 28-day treatment cycle was 42.5% (27.5–60) and 73% (58.5–99), respectively. Conclusions The majority of Ethiopian patients receiving BPG as secondary prophylaxis to prevent RHD do not attain target concentrations for more than two weeks during each 4-weekly injection cycle, highlighting the limitations of current BPG strategies. Between-population variation, together with PK differences between different preparations may be important considerations for ARF/RHD control programs.

Psoriasiform Secondary Syphilis: A Pitfall in Diagnosis

Secondary syphilis in Acquired Immune Deficiency Syndrome (AIDS) patient’s have variety of skin manifestations. Failure to recognize the manifestations of secondary syphilis can cause delaying the therapy. The recognition of the characteristics of skin lesions as well as serology examination and histopathology help the physicians for making the diagnosis. A 24-year-old male who was diagnosed with HIV previously came with chief complaint of scaly red plaques on the palms and soles. The similar lesions were also notedover the face especially the perioral region.Patient also noted to have also alopecia on the eyebrows and eyelashes. Patient was diagnosed with psoriasis vulgaris from previous physician and treated with unknown therapy. Serological examination revealed reactive TPHA and high titer of VDRL. Skin biopsy was done and it has features of psoriasis but without pathognomonic signs. The patient then was treated with single dose of benzathine penicillin G 2,4 million units which provided excellent improvement.Secondary syphilis is called "great imitator" because of its broad manifestations. It has been widely reported that secondary syphilis has been misdiagnosed as psoriasis and seborrheic dermatitis. Characteristics of the lesion, serological examination and histopathology play significant role in establishing the diagnosis.

Challenges in the management of recurrent streptococcal pharyngotonsillitis

Streptococcus pyogenes infections are a challenge for the current activity of the family doctor not only in terms of the variety of symptoms in the acute phase of the infection, but especially in terms of post-infection sequelae. The clinical manifestations of rheumatic fever, with great variability, may cause the patient to consult a cardiologist, neurologist, rheumatologist or nephrologist when complications of in­fec­tion occur. The correct approach and treatment of the acute infection can prevent these complications and main­tain the health of the patient who, even in this case, has been en­dan­gered by the malfunctions of the system in pro­vi­ding the first-line treatment. The primary prophylaxis of strep­to­coc­cal infection requires its correct treatment, while se­con­da­ry prophylaxis aims to reduce recurrences after the onset of post-streptococcal complications. For secondary prophylaxis, the only recommendation, according to the Romanian Cardiology Society, the World Heart Federation and the American Heart Association, is benzathine penicillin G.

Non adherence to secondary prophylaxis for rheumatic fever

Background: Secondary prophylaxis with benzathine penicillin G (BPG) is a cost-effective intervention for preventing morbidity and mortality related to rheumatic fever (RF). There is no reliable data available with regards to adherence to secondary prophylaxis and rates of recurrent RF in many developing countries, including Bangladesh. So, aim of this study was to estimate rate of non-adherence and find out risk of non-adherence to secondary prophylaxis for rheumatic fever.Methods: Total 230, 5-30 years patients of both sexes with definite previous history of RF taking secondary prophylaxis with injection benzathine penicillin G (BPG) were enrolled by simple random fashion. Last one-year injection profile of the patient was collected from the injection card. Patients were then classified as “non-adherent” when the rate of adherence was <80% of the expected injections and as “adherent” when it was ≥80%. After collection of data selective patients were invited for blood tests and echocardiography to identify recurrence of rheumatic fever. Results: Out of 230 patients, male were 96 (41.7%) and female were 134 (58.3%). Male and female ratio were 0.7. 173 (75.2%) were adherent with benzathine penicillin and 57 (24.8%) patients not adherent with benzathine penicillin. In adherent group only 5 (2.2%) and in non-adherent group 19 (8.3%) patients develop rheumatic recurrence and this finding was statistically significant (p-value 0.001). Conclusions: Non adherence to secondary prophylaxis with BPG was found a major risk factor for recurrent rheumatic fever. The main reasons of non-adherence were lack of counselling, fare of pain and fail to remember.