Perivascular Cuff and Spread of <i>Treponema pallidum</i>

Abstract

Background: The incidence of syphilis is on the rise in many cities worldwide. Both the clinical and histopathological changes do not always fulfil the typical diagnostic criteria. Immunohistochemistry is available to identify and localize Treponema pallidum. Two main patterns of T. pallidum distribution were described in the skin, namely heavy intraepidermal infiltration and scattered pattern inside the lichenoid cell infiltrate. Objective: To search for a third pattern consistent with dissemination of the disease. Methods: Immunohistochemistry using an antispirochete (T. pallidum and Borrelia) antibody was used in all cases of syphilis submitted to our laboratory. In addition, deposits of immunoglobulins and complement indicative of immune complexes were searched for. Results: According to the cases, T. pallidum was disclosed in a combination of three patterns. The previously described epidermal and lichenoid patterns were confirmed, and a third pattern predominating in a perivascular location throughout the dermis was clearly identified in primary syphilis. The microorganisms were abundant in extracellular and intracellular locations, particularly inside endothelial cells. No deposits of immunoglobulins and complement were disclosed. Conclusion: The perivascular cuff of T. pallidum throughout the dermis might be representative of the dissemination phase of T. pallidum.

Primary Anal Canal Syphilis in Men: The Clinicopathologic Spectrum of an Easily Overlooked Diagnosis

“…Histologic features of primary syphilis involving the site of contact in the skin have been well characterized and include (1) a prominent bandlike inflammatory infiltrate, often rich in plasma cells and mixed with lymphocytes and histiocytes at the dermoepidermal junction; (2) a dermal and perivascular chronic inflammatory infiltrate, often rich in plasma cells and mixed with lymphocytes and histiocytes; and (3) sometimes poorly formed granulomas. [10][11][12][13] The patterns of inflammation in all 3 of our anal canal ulcer cases were very similar to what is described in skin, with a bandlike chronic inflammatory infiltrate rich in plasma cells, beneath the squamous epithelium, with prominent perivascular inflammation. Two of our cases had poorly formed granulomas.…”

“…In the skin, histochemical silver stains are limited by the presence of melanin in the epidermis, staining of reticulin fibers in the dermis, and high levels of background staining, particularly in cases with few organisms. 10,11,[13][14][15] Melanin/melanocytes can also be present in the squamous zone of the anal canal, limiting the utility of histochemical silver stains in this region. Treponema pallidum IHC stain has improved the accuracy of the histologic diagnosis of syphilis, with higher sensitivity and specificity than histochemical stains alone.…”

IFNγ Enhances CD64-Potentiated Phagocytosis of Treponema pallidum Opsonized with Human Syphilitic Serum by Human Macrophages

“…We, like others, observed Tp infiltrating the epidermis by immunohistologic analysis of secondary syphilitic skin lesions (24, 25). Additionally, CD68 + histiocytes were poised throughout the dermis, at the dermal-epidermal juncture and, in some cases, a few histiocytes were observed in the epidermis.…”

Enhanced immune response and protective efficacy of aTreponema pallidumTp92 DNA vaccine vectored by chitosan nanoparticles and adjuvanted with IL-2

“…1,2 Although most Tp isolates are not drug-tolerant clinically, in recent years, syphilis has a very high incidence of disease. 3,4 Approximately aims: In this study, the immune-modulatory and protective efficacy of using an interleukin-2 (IL-2) expression plasmid as a genetic adjuvant and chitosan (cs) nanoparticles as vectors to enhance a Tp92 DNa vaccine candidate were investigated in a Treponema pallidum (Tp) rabbit challenge model.…”