Presentation
The 41-year-old homosexual patient presented with meningitis and hydrocephalus. His CD4+ and CD8+ T-lymphocyte counts per microliter were 60 and 71, respectively. [ncbi.nlm.nih.gov]
The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, and tertiary). [icd.codes]
Syphilis: uncommon presentations in adults. Clin Dermatol 2005; 23 : 555–564. [nature.com]
Entire Body System
- Fever
A man with systemic lupus erythematosus receiving chronic steroid therapy presented with headache, fever and panophthalmitis. Cerebrospinal fluid analysis was consistent with syphilitic meningitis. [ncbi.nlm.nih.gov]
Symptoms of syphilitic meningitis may include: Changes in vision, such as blurred vision, decreased vision Fever Headache Mental status changes, including confusion, decreased attention span, and irritability Nausea and vomiting Stiff neck or shoulders [medlineplus.gov]
Descriptive Epidemiology 587 Mechanisms and Routes of Transmission 7 Pathogenesis and Immunity 590 Patterns of Host Response 591 Control and Prevention 592 References 593 Suggested Reading 595 Rocky Mountain Spotted Fever Theodore E Woodward and J Stephen [books.google.com]
The spectrum of JH reaction, other than fever, rashes, or fever with exacerbation of skin rashes, is shown in Table 1. The median time to development of JH reaction was 4 hours (interquartile range, 2–5 hours) for the 2 groups. [doi.org]
The principal symptoms and signs are those of increased intracranial pressure; fever is only low-grade or may be absent. [std-aid.com]
- Lymphadenopathy
The lymphadenopathy disappeared spontaneously and the neurosyphilis responded well to 14 days of penicillin G therapy. [ncbi.nlm.nih.gov]
Early signs are characteristic skin lesions, lymphadenopathy, hepatosplenomegaly, failure to thrive, blood-stained nasal discharge, perioral fissures, meningitis, choroiditis, hydrocephalus, seizures, intellectual disability, osteochondritis, and pseudoparalysis [msdmanuals.com]
A history of a recent chancre or secondary rash or the presence of generalized lymphadenopathy may suggest the diagnosis, but meningitis may be the first clinical manifestation of syphilitic infection, especially in HIV-infected patients. [std-aid.com]
Although regional lymphadenopathy is common in primary syphilis, it is not an essential component in the diagnosis. Without treatment, the chancre usually resolves in three to six weeks. [aafp.org]
[…] starts out as a solitary, raised papule (usually on the genitals) Evolves into painle ss, firm ulcer with indurated borde rs and smooth base Resolves spontaneously within 3–6 weeks, typically without scarring Regional (usually inguinal ; ) nontender lymphadenopathy [amboss.com]
- Falling
Regensburg Fall 1 Rheumatoide Arthritis, Hypothyreose Colocynthis. 12. Fall 2 Psoriasis Syphilitic arthritis Pronounciation. Learn how to say Syphilitic arthritis in English. Rheumatoid Arthritis. [aqigodigo.wapgem.com]
The titers of these antibodies rise as the spirochetal infection progresses and then fall with eradication of infection by treatment or gradual immunologic control when untreated. [clinicaladvisor.com]
The advantage of NTAs is the rise and fall of antibody titers reflect the course of disease including decreasing titers in patients who have been successfully treated. [cancertherapyadvisor.com]
It is not clear how far these titers should be expected to fall, but if they increase or if a high titer does not decrease, treatment should be considered a failure. [aafp.org]
For example, the VDRL titers usually reach 1:32 or higher in secondary syphilis; a persistent fall in titer following treatment of early syphilis provides essential evidence of an adequate response to therapy. [emedicine.medscape.com]
- Infectious Mononucleosis
mononucleosis, malaria), or those with certain chronic conditions (eg, aging, intravenous drug usage, autoimmune disorders, malignancy). [emedicine.medscape.com]
Respiratoric
- Common Cold
So yes, while it can be transferred via sexual intercourse, so can the common cold, influenza, and every other contagious diseases or illnesses. [witchdrtim.com]
Gastrointestinal
- Overeating
There are now over 40 000 reported cases of AIDS, and over 25% have been diagnosed since January 1987. Syphilis also continues as a considerable health care problem with over 15 000 cases diagnosed this year. [annals.org]
Over 5,200 high quality CT, MR, and hybrid technology images in one definitive reference. [books.google.com]
The symptoms also tend to change over time and may come and go. Even if the symptoms do improve, there's still a risk you could pass the infection on or develop serious problems if you don't get treatment. [nhs.uk]
As with the primary chancre, the manifestations of secondary syphilis also will resolve spontaneously over time but over a period of a few years there may be relapses of secondary disease. [cancertherapyadvisor.com]
There are over 12,742,000 records available in CAB Direct | Last updated on May 11, 2019 Get the most out of our new platform Online help Extensive online help - available wherever you are in CAB Direct. [cabdirect.org]
Cardiovascular
- Hypertension
[…] avium-intracellulare complex (DMAC) A318Other mycobacterial infections A319Mycobacterial infection, unspecified PDX Collection 0083:18 codes A33Tetanus neonatorum P290Neonatal cardiac failure P2911Neonatal tachycardia P2912Neonatal bradycardia P292Neonatal hypertension [cms.gov]
Liver, Gall & Pancreas
- Jaundice
Liver function tests should be obtained for infants with jaundice or hepatosplenomegaly. Chest radiography is obtained for signs of lower respiratory tract infection (pneumonia alba). [clinicaladvisor.com]
[…] leading to less common manifestations of secondary syphilis such as: Ocular complications such as scleritis, keratitis, or posterior uveitis Sensorineural deafness or tinnitus Proteinuria, nephrotic, or nephritic syndrome Syphilitic hepatitis leading to jaundice [emdocs.net]
Yellowing of the skin or the whites of the eyes (jaundice). Late congenital syphilis is rare. It can cause symptoms similar to neurosyphilis in an adult. [patient.info]
- Hepatomegaly
Presence of hydrops, hepatomegaly, ascites, or thickened placenta among other signs suggest a higher risk of fetal treatment failure. Evidence to recommend specific therapy in these cases is insufficient. Congenital syphilis can cause fetal demise. [clinicaladvisor.com]
Musculoskeletal
- Arthritis
Regensburg Fall 1 Rheumatoide Arthritis, Hypothyreose Colocynthis. 12. Fall 2 Psoriasis Syphilitic arthritis Pronounciation. Learn how to say Syphilitic arthritis in English. Rheumatoid Arthritis. [aqigodigo.wapgem.com]
Lemarechal H, Allanore Y, Chenevier-Gobeaux C, Kahan A, Ekindjian OG, Borderie D (2006) Serum protein oxidation in patients with rheumatoid arthritis and effects of infliximab therapy. [doi.org]
G039Meningitis, unspecified G042Bacterial meningoencephalitis and meningomyelitis, not elsewhere classified G610Guillain-Barre syndrome G968Other specified disorders of central nervous system G969Disorder of central nervous system, unspecified G980Neurogenic arthritis [cms.gov]
Non-infectious causes such as rheumatoid arthritis and sarcoidosis must also be considered. [std.uw.edu]
- Arthralgia
[…] self-limiting morbilliform maculopapular exanthema ( syphilid ) appears usually on the palms or soles of feet, on trunk, limbs, hands ( stigmata ), neck and forehead (" Venus necklace and crown "), flat condyloma on anus or vulva, symmetric knee and ankle arthralgias [ufrgs.br]
Fever, pharyngitis, arthralgias or generalized lymphadenopathy develop in most patients with secondary syphilis. Systemic involvement can occur in secondary syphilis and anytime thereafter. [aafp.org]
Skin
- Papule
Physical examination showed perianal flesh coloured papules with a verrucous surface (fig 1 ⇓ ). One papule showed partial ulceration. [bmj.com]
References: [3] [4] Pathophysiology Clinical features Primary syphilis Primary lesion ( chancre ) Typically starts out as a solitary, raised papule (usually on the genitals) Evolves into painle ss, firm ulcer with indurated borde rs and smooth base Resolves [amboss.com]
[…] secondary syphilis, infectious) to (4) -6 to 10 - (12) weeks with rashes (usually derived stresses) and Enanthemen with occurrence of angina stomatitis, painless enlargement of the lymph nodes and in the mucous membranes of the mouth, anus and vaginal moist papules [treponemapallidum.org]
(Red papules and nodules covering the body of an individual with secondary syphilis) Stage Four: The Tertiary or Late Stage The tertiary stage of syphilis affects 15 to 30 percent of people with syphilis who do not receive treatment. [soc.ucsb.edu]
Genital mucus lesions typically occur in women and present as condylomata, ulcerations, or papules. [emdocs.net]
- Skin Lesion
Early signs are characteristic skin lesions, lymphadenopathy, hepatosplenomegaly, failure to thrive, blood-stained nasal discharge, perioral fissures, meningitis, choroiditis, hydrocephalus, seizures, intellectual disability, osteochondritis, and pseudoparalysis [msdmanuals.com]
The clinical features, particularly the distinctive skin lesion, and epidemiology of Lyme disease serve to distinguish it from secondary syphilis. [std-aid.com]
Primary lesions form within a few hours after infection, which contain large quantities of the Treponema bacteria. Secondary stage: The bacterium invades tissues, cerebrospinal fluid, skin, and mucus membranes. [dovemed.com]
A darkfield examination of fluid expressed directly from a lesion is the time-honored diagnostic test for patients with the skin lesions of primary and secondary syphilis. [cancertherapyadvisor.com]
- Maculopapular Skin Rash
JH reaction was defined as presence of fever (temperature, >38.0°C) and/or acute exacerbation of maculopapular skin rashes within 24 hours of receipt of penicillin therapy for syphilis. [doi.org]
Urogenital
- Syphilitic Chancre
The variability of syphilitic chancres. Sex Transm Dis 1978 ; 5; 68 – 70. Google Scholar | Crossref | Medline | ISI 42. Mindel, A, Tovey, SJ, Timmins, DJ, Williams, P. Primary and secondary syphilis, 20 years’ experience.2. Clinical features. [doi.org]
Syphilitic chancres are classically described as painless, indurated, clean-based ulcers, unlike chancroid ulcers, which are deep, undermined and purulent, and herpetic ulcers, which are generally multiple, shallow and tender. 3 Nonulcerative lesions [aafp.org]
Primary Syphilis—Oral Chancre This woman with primary syphilis developed an oral chancre at the right corner of her mouth. Syphilitic chancres are typically round, firm, and painless. [std.uw.edu]
Neurologic
- Meningism
DRG Group #097-099 - Non-bacterial infect of nervous system except viral meningitis with MCC. DRG Group #097-099 - Non-bacterial infect of nervous system except viral meningitis with CC. [icd.codes]
Congenital syphilitic meningitis (disorder) tertiary syphilitic meningitis edit English syphilitic meningitis Human disease secondary syphilitic meningitis acute secondary syphilitic meningitis (disorder) acute syphilitic meningitis (secondary) secondary [wikidata.org]
This report examines simultaneous tuberculous and syphilitic meningitis in a patient with human immunodeficiency virus (HIV). The 41-year-old homosexual patient presented with meningitis and hydrocephalus. [ncbi.nlm.nih.gov]
- Headache
A man with systemic lupus erythematosus receiving chronic steroid therapy presented with headache, fever and panophthalmitis. Cerebrospinal fluid analysis was consistent with syphilitic meningitis. [ncbi.nlm.nih.gov]
Symptoms of syphilitic meningitis may include: Changes in vision, such as blurred vision, decreased vision Fever Headache Mental status changes, including confusion, decreased attention span, and irritability Nausea and vomiting Stiff neck or shoulders [medlineplus.gov]
Early chapters present differential diagnosis and management approaches to common overarching problems such as coma, headache, and elevated intracranial pressure, followed by chapters focusing on the evaluation and management of specific conditions including [books.google.com]
Other symptoms may include sore throat, headache, joint pain, fever, and patches of hair loss. [en.wikipedia.org]
Clinical symptoms: mental changes, progressing to dementia; headache 3. Tabes Dorsalis : a. Pathology: Inflammatory lesions involving meninges and vessels in subarachnoid space of dorsal nerve roots. [kobiljak.msu.edu]
- Confusion
The second case was a 55-year-old female with epilepsy, depression, behavioral disorder and confusion. The diagnosis of HIV infection was made after onset of the syphilitic meningitis. [ncbi.nlm.nih.gov]
Confusion and other mental changes may either improve or continue long-term after antibiotic treatment. Late-stage syphilis can cause nerve or heart damage. This can lead to disability and death. [medlineplus.gov]
Detection of Treponema pallidum succeed in the dark field microscope (non-specific, such as confusion with oral, non-pathogenic spirochetes) or specifically by PCR. [treponemapallidum.org]
[…] is common within a few months of primary infection symptoms of meningitis can occur at any time after the infection however, it usually appears within two years symptoms may include headache, stiff neck, cranial nerve palsies, convulsions, and mental confusion [en.wikipedia.org]
Hydrocephalus is a rare complication and confusion, delirium, and papilledema also may be seen in combination with the other symptoms and signs listed above. [cancertherapyadvisor.com]
- Neck Stiffness
[…] patients are asymptomatic and will only have evidence of neurosyphilis in CSF analysis 1,4 occurs weeks to months after infection 3,4 acute syphilitic meningitis clinical features identical to those of a bacterial leptomeningitis, such as headache, neck [radiopaedia.org]
Syphilitic meningitis presents with the same CSF findings, as well as typical meningitic symptoms such as headache, fever, and neck stiffness. (7)(8)(5) Later neurologic manifestations of the tertiary phase include meningovascular syphilis, tabes dorsalis [emdocs.net]
- Cognitive Impairment
Neuropsychological methods to monitor cognitive impairments are more precise, and as patients live longer withdisease more subtle neurological manifestations of disease have emerged. [books.google.de]
Workup
Microbiology
- Treponema Pallidum
The ICD code A51 is used to code Syphilis Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum. [icd.codes]
A reactive Treponema pallidum particle agglutination (TPPA) assay with positive Treponema pallidum -specific IgG/IgM immunofluorescence as well as a highly reactive Veneral diseases research laboratory (VDRL) test confirmed the diagnosis. [bmcinfectdis.biomedcentral.com]
Complete genome sequence of Treponema pallidum, the syphilis spirochaete. Science 1998 ; 281: 375 – 88. Google Scholar | Crossref | Medline | ISI 26. Cumberland, MC, Turner, TB. [doi.org]
The combination of three pathogens, Mycobacterium tuberculosis, Treponema pallidum, and HIV, has a great potential to cause serious CNS damage. [ncbi.nlm.nih.gov]
Treatment
Pre-treatment (D–F) and post-treatment (G–I) coronal images demonstrate complete resolution at 7 months. [doi.org]
Treatment does not reverse existing damage. [medlineplus.gov]
The sooner the treatment is started, better is the outcome. If treatment is delayed or is lacking; it could develop into a serious medical issue with long-term neurological complications. [dovemed.com]
Prognosis
CD4 and CD45RO T cells in CSF are a useful complement in differentially diagnosing SM and TBM; it contributes to further understand the pathogenesis and prognosis of SM and TBM. © 2016 APMIS. Published by John Wiley & Sons Ltd. [ncbi.nlm.nih.gov]
Prognosis is generally good unless there are established non-reversible changes such as cerebral infarction or atrophy 1,10. Related articles: Infections of the central nervous system Promoted articles (advertising) [radiopaedia.org]
[…] symptoms resolve spontaneously, although the course of the disease continues unchanged Please find comprehensive information on regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis [dovemed.com]
Serological tests for cryptococcal antigen PROGNOSIS : Almost always fatal if it goes untreated (90% of patients die within one year). TREATMENT : 1. Amphotericin B injected I.V. and into the subarachnoid space. [atsu.edu]
Etiology
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
Etiology Treponema bacteria (particularly during stages I/II) are highly contagious! Sexual contact with a partner who suffers from active syphilis will lead to infection in 30% of cases! [amboss.com]
Prevalence More common in the preantibiotic era and now most often seen in patients with HIV, with predominance of early neurosyphilis compared with late neurosyphilis Etiology and Pathophysiology T. pallidum, spirochete Meningeal and meningovascular [unboundmedicine.com]
MM 331-337; 586-588, ID 1132-1140 CHRONIC MENINGITIS NAMES OF DISEASE : Fungal meningitis Cryptococcosis Torulosis Tubercular meningitis Amoebic meningitis Syphilitic meningitis ETIOLOGICAL AGENTS : Cryptococcus neoformans (Serotypes A,B,C,D) Treponema [atsu.edu]
(Etiology) Syphilis is a contagious bacterial infection that is transmitted through sex with an affected individual. [dovemed.com]
Epidemiology
Descriptive Epidemiology 587 Mechanisms and Routes of Transmission 7 Pathogenesis and Immunity 590 Patterns of Host Response 591 Control and Prevention 592 References 593 Suggested Reading 595 Rocky Mountain Spotted Fever Theodore E Woodward and J Stephen [books.google.com]
The work includes considerable emphasis onthe epidemiology, psychological and psychiatric aspects of the disease complex. [books.google.de]
Each of these other conditions may have some unique epidemiologic, clinical, and laboratory features pointing to the correct diagnosis. [std-aid.com]
Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. Etiology Treponema bacteria (particularly during stages I/II) are highly contagious! [amboss.com]
Conclusions: This case series illustrates important features currently attributed to neurosyphilis, which remains an important disease in Neurology, especially in some epidemiological risk groups. Disclosure: Dr. Borges has nothing to disclose. Dr. [neurology.org]
Pathophysiology
These include the characteristic neuroimaging appearance of specific bacterial infections, the limitations of neuroimaging, the cerebrospinal fluid analysis, the pathogenesis and pathophysiology of bacterial CNS infections, the developments of specific [books.google.de]
References: [3] [4] Pathophysiology Clinical features Primary syphilis Primary lesion ( chancre ) Typically starts out as a solitary, raised papule (usually on the genitals) Evolves into painle ss, firm ulcer with indurated borde rs and smooth base Resolves [amboss.com]
Prevalence More common in the preantibiotic era and now most often seen in patients with HIV, with predominance of early neurosyphilis compared with late neurosyphilis Etiology and Pathophysiology T. pallidum, spirochete Meningeal and meningovascular [unboundmedicine.com]
The pathophysiology of syringomyelia in syphilitic spinal meningitis remains unclear. [nature.com]
New insights into the pathophysiology of the Jarisch-Herxheimer reaction. J Antimicrob Chemother 1992 ; 29: 613 Google Scholar | Crossref | Medline | ISI 74. Tucker, HA, Robinson, RCV. [doi.org]
Prevention
Descriptive Epidemiology 587 Mechanisms and Routes of Transmission 7 Pathogenesis and Immunity 590 Patterns of Host Response 591 Control and Prevention 592 References 593 Suggested Reading 595 Rocky Mountain Spotted Fever Theodore E Woodward and J Stephen [books.google.com]
There are vaccines to prevent some of the bacterial infections that cause meningitis. [icdlist.com]
Syphilitic meningitis can be life-threatening, but it’s preventable. Early diagnosis and treatment of syphilis can prevent this complication. It takes years, or even decades, for untreated syphilis to cause neurological disease. [healthline.com]
Vaccines are not yet available for the prevention of neonatal meningitis, but other prevention strategies are being promoted. [doi.org]