Syphilis: presentations in general medicine

Nyatsanza, Farai; Tipple, Craig

doi:10.7861/clinmedicine.16-2-184

Cited by 40 publications

(45 citation statements)

References 15 publications

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“…In a study by Zuckerman (), the same pattern, that younger adults exhibited a higher average concentration than older adults, was noted. Mercurial treatments usually began with the emergence of dermatological lesions (Zuckerman, ), which normally occur during the primary and secondary stages of syphilis (Baughn & Musher, ; Nyatsanza & Tipple, ). It is therefore possible that older adults, who may have entered the latent or tertiary stages (e.g., latent stage may last for more than 30 years; Nyatsanza & Tipple, ), were no longer receiving mercurial treatments at the time of death.…”

Section: Resultsmentioning

confidence: 99%

“…Mercurial treatments usually began with the emergence of dermatological lesions (Zuckerman, ), which normally occur during the primary and secondary stages of syphilis (Baughn & Musher, ; Nyatsanza & Tipple, ). It is therefore possible that older adults, who may have entered the latent or tertiary stages (e.g., latent stage may last for more than 30 years; Nyatsanza & Tipple, ), were no longer receiving mercurial treatments at the time of death. Again, this difference is also likely connected with the small sample size, but it is important to note that the lower average could potentially reflect advanced bone remodelling and the elimination of mercury over time.…”

Section: Resultsmentioning

confidence: 99%

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Volcanoes, medicine, and monasticism: Investigating mercury exposure in medieval Iceland

Walser

Kristjánsdóttir

Gowland

et al. 2018

Intl J of Osteoarchaeology

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This study aimed to evaluate the possible use of mercury as a medical treatment at the medieval monastic hospital Skriðuklaustur (ad 1494–1554) in eastern Iceland. The individuals excavated from Skriðuklaustur exhibited a wide range of pathological conditions, including the only skeletal evidence of venereal syphilis in Iceland. Skeletal remains from the Skeljastaðir cemetery (ca. ad 1000–1104) in southern Iceland were also analysed in light of the site's proximity to the mercury emitting volcano Hekla. The eruption produced a severe toxic fallout resulting in the mass mortality of livestock and is believed to have caused the abandonment of Skeljastaðir and the other farms in the region. The skeletal analyses and sampling were conducted according to standard anthropological methods. Mercury concentrations were determined in human (n = 50), faunal (n = 23), and soil (n = 22) samples using inductively coupled plasma mass spectrometry. Individuals from both sites exhibited elevated mercury concentrations. At Skriðuklaustur, some individuals showed normal concentrations, but those with pathological conditions (e.g., hydatidosis, syphilis, tuberculosis, and other non‐specific infections) had the highest concentrations overall. On the other hand, all the individuals analysed from Skeljastaðir exhibited elevated mercury concentrations, some of which were remarkably high. A few of the individuals buried at Skeljastaðir post‐date the eruption, possibly indicating that some of them experienced heavy exposure to volcanic emissions. The less extreme concentrations at Skriðuklaustur may be a result of attention to dosage and the temporary nature of mercurial treatments. None of the faunal and soil samples presented with concentrations exceeding the normal limit, implying that diagenesis was not a concern in this research. The conclusion is that a variety of factors from medical treatment to scholarly work lead to mercury exposure at Skriðuklaustur, whereas at Skeljastaðir, volcanogenic emissions are implicated.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Volcanoes, medicine, and monasticism: Investigating mercury exposure in medieval Iceland

Walser

Kristjánsdóttir

Gowland

et al. 2018

Intl J of Osteoarchaeology

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“…It is estimated by the World Health Organization (WHO) that there are 12 million new cases of syphilis annually and the aggregated cases of yaws, bejel, and pinta (the endemic treponematoses) are approximately 2.5 million globally, although good surveillance data is not available. The infections caused by T. pallidum are characterized by periods of active clinical disease interrupted by episodes of asymptomatic latent infection and may cause life-long infections in untreated individuals [4,5]. Treponema pallidum is a Gram-negative, motile, spirochete human pathogen.…”

Section: Introductionmentioning

confidence: 99%

The pan-genome of Treponema pallidum reveals differences in genome plasticity between subspecies related to venereal and non-venereal syphilis

et al. 2020

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Background: Spirochetal organisms of the Treponema genus are responsible for causing Treponematoses. Pathogenic treponemes is a Gram-negative, motile, spirochete pathogen that causes syphilis in human. Treponema pallidum subsp. endemicum (TEN) causes endemic syphilis (bejel); T. pallidum subsp. pallidum (TPA) causes venereal syphilis; T. pallidum subsp. pertenue (TPE) causes yaws; and T. pallidum subsp. Ccarateum causes pinta. Out of these four high morbidity diseases, venereal syphilis is mediated by sexual contact; the other three diseases are transmitted by close personal contact. The global distribution of syphilis is alarming and there is an increasing need of proper treatment and preventive measures. Unfortunately, effective measures are limited. Results: Here, the genome sequences of 53 T. pallidum strains isolated from different parts of the world and a diverse range of hosts were comparatively analysed using pan-genomic strategy. Phylogenomic, pan-genomic, core genomic and singleton analysis disclosed the close connection among all strains of the pathogen T. pallidum, its clonal behaviour and showed increases in the sizes of the pan-genome. Based on the genome plasticity analysis of the subsets containing the subspecies T pallidum subsp. pallidum, T. pallidum subsp. endemicum and T. pallidum subsp. pertenue, we found differences in the presence/absence of pathogenicity islands (PAIs) and genomic islands (GIs) on subsp.-based study. Conclusions:In summary, we identified four pathogenicity islands (PAIs), eight genomic islands (GIs) in subsp. pallidum, whereas subsp. endemicum has three PAIs and seven GIs and subsp. pertenue harbours three PAIs and eight GIs. Concerning the presence of genes in PAIs and GIs, we found some genes related to lipid and amino acid biosynthesis that were only present in the subsp. of T. pallidum, compared to T. pallidum subsp. endemicum and T. pallidum subsp. pertenue.

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“…Syphilis is caused by the bacterium Treponema pallidum. This motile, gram-negative spirochete can be transmitted both sexually and from mother to child and can invade virtually any organ or structure in the human body (Nyatsanza and Tipple 2016;Radolf et al 2016). Syphilis is a multistage disease, and the clinical stages of syphilis are divided to primary, secondary, and tertiary syphilis, where the tertiary stage is classified as neurosyphilis, cardiovascular syphilis, or gummatous syphilis (Radolf et al 2016;Bai et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Autopsy case of acute pulmonary thromboembolism with neurosyphilis

Kondo

Takahashi

Kuse

et al. 2018

Egypt J Forensic Sci

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Background: Syphilis is caused by the bacterium Treponema pallidum. Syphilis is a multistage disease, and the clinical stages of syphilis are divided to primary, secondary, and tertiary syphilis, where the tertiary stage is classified as neurosyphilis, cardiovascular syphilis, or gummatous syphilis. Here, we describe an autopsy case of acute pulmonary thromboembolism with neurosyphilis. Case presentation: A male in his early 40s began to complain of hallucinations. He was admitted to a psychiatric hospital as an emergency case 4 days before death. He was physically restrained to control agitation and aggressiveness. The patient was severely obese (BMI 36.45). At autopsy, large thromboembolic masses filled the pulmonary trunk and both pulmonary arteries. Thrombi were also noted in the right popliteal vein and bilateral gastrocnemius and soleus veins, suggesting bilateral lower extremity deep vein thrombosis. Dissection of the brain, which weighed 1457 g, revealed no noteworthy macroscopic findings. Histological examination showed lymphocyte infiltration into the perivascular space of the brain tissue with no vasculitis. Immunohistochemical staining of T. pallidum was negative, the fluorescent treponemal antibody-absorption test was positive, the rapid plasma reagin titer was 1:4, and the T. pallidum hemagglutination assay titer was 1:10,240. Real-time PCR assay of the brain tissue detected low copy numbers of T. pallidum genes. Altogether, the cause of death was acute pulmonary thromboembolism resulting from bilateral lower extremity deep vein thrombosis. The patient also had early-stage meningovascular neurosyphilis. Conclusion: An autopsy case of acute pulmonary thromboembolism with meningovascular neurosyphilis is presented, including histopathological examination, serological assessment, and genetic testing. Forensic pathologists should pay attention to a myriad of syphilitic manifestations. The contributing factors for thrombosis in the present case included severe obesity, probable dehydration, and physical restraints implemented to control meningovascular neurosyphilisinduced neuropsychiatric symptoms.

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Syphilis: presentations in general medicine

Cited by 40 publications

References 15 publications

Volcanoes, medicine, and monasticism: Investigating mercury exposure in medieval Iceland

Volcanoes, medicine, and monasticism: Investigating mercury exposure in medieval Iceland

The pan-genome of Treponema pallidum reveals differences in genome plasticity between subspecies related to venereal and non-venereal syphilis

Autopsy case of acute pulmonary thromboembolism with neurosyphilis

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