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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neurosyphilis, a sexually transmitted disease that can cause neurologic damage, has become increasingly prevalent in the AIDS era. HIV carriers can contract neurosyphilis without the presence of other concurrent opportunistic infections. Because MR findings of neurosyphilis are seldom reported, we retrospectively reviewed and evaluated contrast-enhanced MR images of six young (average age, 33 years) HIV-positive men with high serum and CSF VDRL titers indicative of neurosyphilis. All six patients tested negative for concurrent opportunistic infections. Five patients had acute or subacute strokelike symptoms involving the basal ganglia or middle cerebral arteries; one had a parietal convexity mass mimicking meningioma with headache and ataxia. Contrast-enhanced MR images showed patchy enhancement involving the basal ganglia and middle cerebral artery territories in the first five patients and the convexity mass in the sixth patient. On the basis of brain biopsy, a convexity mass was diagnosed in the patient with syphilitic gumma. The imaging findings of the remaining five patients represented ischemic infarct caused by meningovascular syphilis. After penicillin treatment, serum and CSF VDRL titers decreased, and neurologic signs and symptoms improved in all six patients. A follow-up MR study in the patient with the gumma showed that the lesion resolved almost completely. In young HIV patients with stroke symptoms or a convexity mass, neurosyphilis should be considered. Contrast-enhanced MR can reveal the extent of involvement by neurosyphilis and should be used to facilitate diagnosis and proper treatment.
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PMID:Neurosyphilis in HIV carriers: MR findings in six patients. 159 Jan 35

Syphilitic spinal cord gumma Syphilitic gummas of the central nervous system are exceptional and are in general described in the brain. We report the case of a Brown-Sequard syndrome in a 25-year-old patient. The cervical myelography and the brain CT as well as the vertebro-occipital junction were normal. The diagnosis of multiple sclerosis was evoked and corticosteroid therapy was initiated. The patient experienced clinical improvement. Two years later, the patient was readmitted. Immunological reactions for syphilis were positive, in serum and CSF. Tests for HIV were negative. The MRI showed a cervical spinal cord process at the C3 level with adhesive spinal associated arachnoiditis. Penicillin therapy was started prior to surgery for the spinal process. The syphilitic nature was confirmed by pathology. To our knowledge, the MR appearance of a syphilitic gumma of the spinal cord has not been described previously in the scientific literature.
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PMID:[Syphilitic spinal cord gumma]. 1110 71

Prior to the emergence of venereal syphilis, treponema disease was widespread in Africa either in the form of yaws or in the form of endemic, i.e., non-venerally transmitted syphilis. In much of Africa, venereal syphilis started to increase following the highly successful yaws eradication campaigns of the 1950s and the 1960s. One prospective study reported no increase in CNS infection by Treponema pallidum in syphilis patients with HIV compared to those without HIV. However, HIV infection may modulate the clinical expressions of syphilis, in particular, making cutaneous manifestations more florid (luens maligna, giant primary chancre, early appearance of gumma) and neurosyphilis and eye complications (uveitis, papillitis, vitreitis, optic neuritis) more common. Thus, serological tests may give false positives or false negatives in HIV-infected individuals. WHO guidelines for the management of syphilis advocate the use of a single dose of benzathine penicillin for primary and secondary syphilis and syphilis in pregnancy, and 10-day courses of crystalline or procaine penicillin for congenital syphilis. In Lusaka, Zambia, 12.5% of 202 antenatal clinic attenders were RPR and TPHA positive. 42% of women delivering stillbirths were positive and 6.5% of 469 infants delivered in a hospital were positive. 8.6% of children admitted to a hospital aged more than 3 months were positive. Mortality was 54% in 65 cases aged more than 4 weeks. For treatment, a 2nd test later in pregnancy or administration of penicillin to all mothers in the final trimester and again to all newborns has been suggested. In addition, the results of testing ought to be made available to women attending clinics on the day of attendance so that testing and treatment are carried out on the same day. Syphilis can be transmitted by blood transfusion, but storing blood for 5 days at 4 degrees Celsius assures safety.
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PMID:Syphilis control: new challenges. 1228 83

The incidence of sexually transmitted diseases recently increased in the United States and Europe due to migration, increase in high-risk behavior, and abandonment of safer sex practices at the advent of anti-retroviral combination therapy for human immunodeficiency virus infection. This article presents four cases of primary oral anti perioral syphilis with differential diagnoses. It is important to bear this reappearing infection in mind to avoid latent infection. Resembling common oral infections, the primary affect disappears spontaneously, and the infection enters the second stage. The patient remains infected, may further spread the disease, and risks severe organ damage from long-standing infection. The antibiotic cure is inexpensive and safe and spares the patient mucous patches and gumma residuals, apart from severe general sequelae such as thoracic aorta aneurysm and neurosyphilis. However, compliance problems jeopardize clinical and serologic follow-up. The growing syphilis incidence prompts the commemoration of Dr Moriz Kaposi and his dispositive 1891 book Pathology and Therapy of the Syphilis. Moriz Kaposi is acknowledged as one of the heads of the Vienna School of Dermatology, a superb clinician, and renowned teacher.
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PMID:Aspects of oral syphilis. 1547 Sep 96

The brain gumma is a rare manifestation of the tertiary stage of syphilis. A case of neurosyphilitic gumma was confirmed by the Treponema pallidum polymerase chain reaction in a 46-year-old HIV-positive homosexual man. The patient presented with a severe headache and was hospitalized. A computed tomography scan was performed which revealed a left frontal lobe mass. Lymphoma was suspected. However, infectious disease diagnostics were performed on the cerebrospinal fluid that included investigations for syphilis and other microbiological agents such as Toxoplasma gondii. This revealed a reactive venereal disease research laboratory test, a reactive syphilis rapid plasma reagin and a reactive T. pallidum particle agglutination test. The patient was treated for syphilis till complete recovery.
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PMID:Neurosyphilitic gumma in a homosexual man with HIV infection confirmed by polymerase chain reaction. 1866 50

The involvement of the central nervous system by Treponema pallidum has increased in the past 20 years, particularly as a result of the human immunodeficiency virus (HIV) pandemic. However, tertiary forms, and especially syphilitic gumma, are increasingly rare as a result of the widespread use of penicillin. Spinal cord compromise due to syphilitic gumma is an exceptional event; only two cases were found in the literature review. We present the case of a female 47 year-old patient, without HIV infection, with sudden paraplegia and sensation at the T8 level. Surgical resection was performed by means of dorsal laminectomy. The diagnosis of syphilitic gumma was confirmed with microscopic exam and polymerase chain reaction.
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PMID:[Spinal cord compression due to intraspinal syphilitic gumma in one patient. Clinical case]. 2332 Mar 18

We report the case of an HIV-infected man returning from Thailand with secondary syphilis with general symptoms, hepatitis and a pulmonary mass lesion. A cerebrospinal fluid examination showed no signs of neurosyphilis. Two months after successful treatment with benzathine penicillin he presented with a mass lesion in the brain suspected to be a glioma or glioblastoma, which turned out to be a syphilitic gumma. Syphilis remains a great imitator in clinical medicine. Syphilitic brain gummata can develop within a few months.
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PMID:Chameleons everywhere. 2542 29

Cerebral syphilitic gumma is extremely rare and easily misdiagnosed. We illustrate a case of a cerebral syphilitic gumma developed in just a few months mimicking a brain tumor in a HIV-negative patient and Treponema pallidum was detected in the cerebral syphilitic gumma.
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PMID:A case of a cerebral syphilitic gumma developed in a few months mimicking a brain tumor in a human immunodeficiency virus-negative patient. 2708 40

A 47-year-old man with HIV infection presented 10 years after initial secondary syphilis diagnosis and treatment for routine follow-up. His HIV was well controlled on antiretroviral therapy. Rapid plasma reagin was 1:1, and TP-PA was reactive. Physical examination revealed a wide pulse pressure, a systolic murmur, and an early diastolic decrescendo murmur. Echocardiogram revealed moderate to severe aortic regurgitation, and subsequent computed tomography angiogram showed a 6.8-cm fusiform aneurysm of the proximal ascending aorta. Aortic valve and ascending hemiarch replacement were performed. Pathology showed adventitial inflammation with plasma cells, gumma-like amorphous areas surrounded by histiocytes, and giant cells with calcified plaques. Cardiovascular syphilis, while rare, remains a relevant cause of aortic aneurysm, even in previously treated patients. The physical exam can be critical in identifying this potentially fatal complication.
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PMID:Asymptomatic Cardiovascular Syphilis With Aortic Regurgitation Requiring Surgical Repair in an HIV-Infected Patient. 2918 18

Although cerebral syphilitic gummas are generally considered to be rare manifestations of tertiary syphilis, many reports exist of early cerebral syphilitic gumma. Our finding of cerebral syphilitic gumma in an HIV-negative man within 5 months after syphilis infection suggests that this condition should be considered in syphilis patients who have neurologic symptoms.
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PMID:Cerebral Syphilitic Gumma in Immunocompetent Man, Japan. 2935 Jan 64


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