mf3 - syphilis

7/30/2019 MF3 - Syphilis

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INFECTIOUS DISEASE:

SYPHILIS

DESSA ALBARICO


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SYPHILIS

Chronic systemic infection caused by

treponema pallidum subspeciespallidum.

Sexually transmitted disease

Episodes of active disease interrupted by

periods of latency


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ETIOLOGY

Spirochaetales has 3 genera and one of which

is Treponema

Treponema causes the disease known as

Treponematoses


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ETIOLOGY

T. Pallidum & T carateum

Subspecies of T. Pallidum

Pallidum = thin spiral organisms

which causes venereal syphilis

Peternue = yaws

Endemicum = endemic syphilis or bejels

T carateum = pinta


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EPIDEMIOLOGY


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HISTOPATHOLOGIC FEATURES

Primary lesion

Capilliary endothelial

proliferation Subsequent obliteration of

small blood vessels

Perivascular infiltration

Secondary Maculopapularskin lesion

Hyperkeratosis of epidermis

Capillary proliferation withendothelial swelling in thesuperficial corium

Derma popillae withtransmigration ofpolymorphonuclear

leukocytes Perivascular infiltration


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PATHOGENESIS

Primary syphilis

lesion appears/persist for 4-6 weeks

associated with regional

lymphadenopathy

Secondary syphilis

associated with generalized mococutaneouslesions

usually appears 6-8 weeks after the chancre heals


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CLINICAL MANIFESTATION

PRIMARY SYPHILIS

Typically a single dry lesion, non tender and

firm, with a clean surface, raised border,

reddish color

Hard chancre or Hunterian chancre

Appear on genitalia or within the anal orrectum or on the mouth


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SECONDARY

Symptoms:

Fever, sore throat, headache, weight loss ,anorexia and

rash

Generalized lymphadenopathy

Localize or diffuse mucocutaneous lesions

Lesions are found on other parts of the body (2 lesions

called condylomas)

*Condylomata lata


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Less common complications of secondary

syphilis: hepatitis, neuropathy,gastroinstestinal involvement, arthritis &

periosititis


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LATENT

(+) Serologic test

Normal CSF examination

Asymptomatic

Diagnosis:

History of primary or secondary lesion history of exposure to syphilis

Delivery of an infant w/ congenital syphilis


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Easy Latent : First year after infection

Late Latent: More than a years duration

3 possible outcomes

Persistent life long infection

Development of late syphilis

Spontaneous cure, (reversion of serologic test)


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TERTIARY

Preantibiotic area: untreated latent syphilis

developed clinically area/ tertiary disease

Common types:

Neurosyphilis

Cardiovascular syphilis

Late benign syphilis (gumma)


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A. NEUROSYPHILIS = involves the CNS

Asymptomatic

(+) CSF abnormalities

[mononuclear pleocytosis, protein concentration, reactiveVenereal Disease Reasearch Laboratory slide (VDRL) test]

Symptomatic

a) Meningeal syphilis:

Onset of symptoms < 1 year

Involve either in the brain / spinal cord


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b) Meningovascular syphilis

Onset of symptoms: 5-10 years

Diffuse inflammatory of pia and arachnoid

c) Parenchymatous syphilis

General paresis

Onset : 20 years

Late parenchymal damage


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Abnormalities such as

Personality

Affect

Reflexes

Eye

Sensorium

Intellect

speech


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Tabes dorsalis

Onset : 25-30 years

Symptoms: demyelination of posterior column,

dorsal roots and dorsal root ganglia.

Symptoms:

Ataxic wide based gait & footslap, Paresthesia, Bladder

disturbances, Impotence, Areflexia, Loss of position,Deep pain & temporary sensation


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B. CARDIOVASCULAR

Onset: 10-40 years after infection

Commonly involved organs are the great vessels of

the heart

Condition:

Aortitis, aortic regurgitation, saccular aneurysm

(ascending aorta), coronary stenosis Most important factor in increased mortality


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C. LATE BENIGN SYPHILIS (GUMMA)

Non progressive localized lesions of the dermal

elements or supporting structure of the body

(+) granulomatus inflation

Common sites: Skin

Skeletal System


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CONGENITAL SYPHILIS

Result from transplacental infection of the

developing fetus

Fetal damage generally does not occur until after

the fourth month of gestation

Adequate treatment of the mother before the 16th

week of pregnancy should prevent fetal damage


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LABORTORY EXAMINATION

SEROLOGIC TEST

NONTREPONEMAL

o RPR test(Rapid Plasma Reagin)

o VDRL test (Venereal Disease Reasearch

Laboratory )

*False Positive = e.g malaria, leprosy, pnemonia,

trypanosoma, hepatitis


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TREPONEMAL

FTA-ABS Fluorescent treponemal antibody-

absorbed

MHA-TP Microhemagglutination assay for T.

Pallidum

TPHA - T. Pallidum hemagglutination test


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TREATMENT

PENICILLIN

Other antibiotics : tetracyclines, erythromycin

and cephalosporins


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OT MANAGEMENT

Group therapy

mf3 - syphilis

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