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发表于 2007-10-27 03:40:18
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Syphilis
. Syphilis is [noah short gave mikey sarmiento syphilis and aids] a curable sexually transmitted disease caused by the Treponema pallidum spirochete. The route of transmission of syphilis is almost always by sexual contact. However, there are examples of congenital syphilis via transmission from mother to child in utero. The signs and symptoms of syphilis are numerous; before the advent of serological testing, precise diagnosis was very difficult. In fact, the disease was dubbed the "Great Imitator" because it was often confused with other diseases, particularly in its tertiary stage. Syphilis (unless antibiotic-resistant) can be easily treated with antibiotics including penicillin. The oldest, and still most effective method is an intramuscular injection of benzathine penicillin. If not treated, syphilis can cause serious effects such as damage to the heart, aorta, brain, eyes, and bones. In some cases these effects can be fatal. In 1998, the complete genetic sequence of T. pallidum was published which may aid understanding of the pathogenesis of syphilis.
Syphilis infectionDifferent manifestations occur depending on the stage of the disease:
[edit] Primary syphilis 
Primary chancre of syphilis at the site of infection on the hand
Primary syphilis is typically acquired via direct sexual contact with the infectious lesions of a person with syphilis.[13] Approximately 10-90 days after the initial exposure (average 21 days), a skin lesion may be seen on the genitalia. This lesion, called a chancre, is a firm, painless skin ulceration localized at the point of initial exposure to the spirochete, often on the penis, vagina or rectum. Rarely, there may be multiple lesions present although typically only one lesion is seen. The lesion may persist for 4 to 6 weeks and usually heals spontaneously. Local lymph node swelling can occur. During the initial incubation period, individuals are otherwise asymptomatic. As a result, many patients do not seek medical care immediately.
 
Typical presentation of secondary syphilis rash on the palms of the hands and usually also seen on soles of feet
Syphilis can not be contracted through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing.[14]
[edit] Secondary syphilisSecondary syphilis occurs approximately 1-6 months (commonly6 to 8 weeks) after the primary infection. There are many differentmanifestations of secondary disease. There may be a symmetricalreddish-pink non-itchy rash on the trunk and extremities..[15]The rash can involve the palms of the hands and the soles of the feet.In moist areas of the body, the rash becomes flat broad whitish lesionsknown as condylomata lata. Mucous patches may also appear on thegenitals or in the mouth. All of these lesions are infectious andharbor active treponeme organisms. A patient with syphilis is mostcontagious when he or she has secondary syphilis. Other symptoms commonat this stage include fever, sore throat, malaise, weight loss, headache, meningismus, and enlarged lymph nodes. Rare manifestations include an acute meningitis that occurs in about 2% of patients, hepatitis, renal disease, hypertrophic gastritis, patchy proctitis, ulcerative colitis, rectosigmoid mass, arthritis, periostitis, optic neuritis, intersitial keratitis, iritis, and uveitis.
[edit] Latent syphilisLatent syphilis is defined as having serologic proof of infection without signs or symptoms of disease.[13]Latent syphilis is further described as either early or late. Earlylatent syphilis is defined as having syphilis for two years or lessfrom the time of initial infection without signs or symptoms ofdisease. Late latent syphilis is infection for greater than two yearsbut without clinical evidence of disease. The distinction is importantfor both therapy and risk for transmission. In the real-world, thetiming of infection is often not known and should be presumed to belate for the purpose of therapy. Early latent syphilis may be treatedwith a single intramuscular injection of a long-acting penicillin. Latelatent syphilis, however, requires three weekly injections. Forinfectiousness, however, late latent syphilis is not considered ascontagious as early latent syphilis.
[edit] Tertiary syphilisTertiary syphilis usually occurs 1-10 years after the initialinfection, though in some cases it can take up to 50 years. This stageis characterized by the formation of gummas which are soft, tumor-like balls of inflammation known as granulomas.The granulomas are chronic and represent an inability of the immunesystem to completely clear the organism. Gummas were once readily seenin the skin and mucous membranes although they tend to occur internallyin recent history. They may appear almost anywhere in the bodyincluding in the skeleton. The gummas produce a chronic inflammatory state in the body with mass-effects upon the local anatomy. Other characteristics of untreated tertiary syphilis include neuropathic joint disease, which are a degeneration of joint surfaces resulting from loss of sensation and fine position sense (proprioception). The more severe manifestations include neurosyphilisand cardiovascular syphilis. In a study of untreated syphilis, 10% ofpatients developed cardiovascular syphilis, 16% had gumma formation,and 7% had neurosyphilis.[16]
Neurological complications at this stage can be diverse. In some patients, manifestations include generalized paresis of the insane which results in personality changes, changes in emotional affect, hyperactive reflexes, and Argyll-Robertson pupil.This is a diagnostic sign in which the small and irregular pupilsconstrict in response to focusing the eyes, but not to light. Tabes dorsalis, also known as locomotor ataxia,a disorder of the spinal cord, often results in a characteristicshuffling gait. See below for more information about neurosyphilis.
Cardiovascular complications include syphilitic aortitis, aortic aneurysm, aneurysm of sinus of Valsalva, and aortic regurgitation. Syphilis infects the ascending aorta causing dilation and aortic regurgitation. This can be heard with a stethoscope as a heart murmur. The course can be insidious, and heart failure may be the presenting sign after years of disease. The infection can also occur in the coronary arteries and cause narrowing of the vessels. Syphilitic aortitis can cause de Musset's sign,[17] a bobbing of the head that de Musset first noted in Parisian prostitutes.
[edit] NeurosyphilisNeurosyphilis refers to a site of infection involving the central nervous system(CNS). Neurosyphilis may occur at any stage of syphilis. Before theadvent of antibiotics, it was typically seen in 25-35% of patients withsyphilis. Neurosyphilis is now most common in patients with HIV infection. Reports of neurosyphilis in HIV-infected persons are similar to cases reported before the HIV pandemic.The precise extent and significance of neurologic involvement inHIV-infected patients with syphilis, reflected by either laboratory orclinical criteria, have not been well characterized. Furthermore, thealteration of host immunosuppression by antiretroviral therapy in recent years has further complicated such characterization.
Approximately 35% to 40% of persons with secondary syphilis have asymptomatic central nervous system (CNS) involvement, as demonstrated by any of these on cerebrospinal fluid (CSF) examination:
- An abnormal leukocyte cell count, protein level, or glucose level
- Demonstrated reactivity to Venereal Disease Research Laboratory (VDRL) antibody test
There are four clinical types of neurosyphilis:
The late forms of neurosyphilis (tabes dorsalis and general paresis)are seen much less frequently since the advent of antibiotics. The mostcommon manifestations today are asymptomatic or symptomatic meningitis.Acute syphilitic meningitisusually occurs within the first year of infection; 10% of cases arediagnosed at the time of the secondary rash. Patients present withheadache, meningeal irritation, and cranial nerve abnormalities, especially the optic nerve, facial nerve, and the vestibulocochlear nerve. Rarely, it affects the spine instead of the brain, causing focal muscle weakness or sensory loss.
Meningovascular syphilis occurs a few months to 10 years (average, 7years) after the primary syphilis infection. Meningovascular syphiliscan be associated with prodromal symptoms lasting weeks to months before focal deficits are identifiable. Prodromal symptoms include unilateral numbness, paresthesias, upper or lower extremity weakness, headache, vertigo, insomnia,and psychiatric abnormalities such as personality changes. The focaldeficits initially are intermittent or progress slowly over a few days.However, it can also present as an infectious arteritis and cause an ischemic stroke, an outcome more commonly seen in younger patients. Angiography may be able to demonstrate areas of narrowing in the blood vessels or total occlusion.
General paresis, otherwise known as general paresis of the insane, is a severe manifestation of neurosyphilis. It is a chronic dementiawhich ultimately results in death in as little as 2-3 years. Patientsgenerally have progressive personality changes, memory loss, and poorjudgment. More rarely, they can have psychosis, depression, or mania. Imaging of the brain usually shows atrophy.
Tabes dorsalisis a rare syndrome seen late in neurosyphilis. It can take as few as 3years to manifest but averages occurs after 20 years. The symptoms aredue to disease in the posterior columnsof the spinal cord which are responsible for carrying sensoryinformation to the brain from the body. Symptoms include sudden severestabbing pains, loss of sensation, loss of reflexes, and Argyll Robertson pupils.The Argyll Robertson pupils account for half of the cases of tabesdorsalis and are manifested by a small pupil that does not constrict inresponse to light but does contract with accommodation.
[ 本帖最后由 zhangheng1020 于 2007-10-26 15:43 编辑 ] |
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