Published - Tue, 15 Nov 2022

All you need to know about Syphilis

ETIOLOGY: Syphilis is caused by T. pallidum.

INCIDENCE: Each year, there are 29,000 new cases of syphilis. This figure represents probably only 10% of actual cases.

CLINICAL FEATURES

1. Primary syphilis: After an average incubation period of approximately 3 weeks, a smooth, painless ulcer called a chancre appears at the site of primary inoculation. The chancre heals without treatment in approximately 3 to 6 weeks; at about the same time, a painless uni- or bilateral regional adenopathy develops.

2. Secondary syphilis represents disseminated disease and occurs in all patients with untreated primary infection. The lesions of secondary syphilis are papulosquamous lesions that occur over the entire trunk, extremities, penis, and buttocks. Fever and weight loss occur in 70% of patients.

3. Tertiary syphilis occurs at least 10 years after the primary infection in at least 30% to 35% of untreated patients. The two most important manifestations of tertiary syphilis are cardiovascular syphilis, causing thoracic aneurysms, and neurosyphilis, causing meningitis, stroke, seizures, dementia, general weakness, and posterior column dysfunction.

DIFFERENTIAL DIAGNOSES

— Chancroid

— HSV type 1 infection

— Lymphogranuloma venereum

— Tinea, sarcoid

— Lichen planus

— Seborrhea dermatitis

— Molluscum contagiosum

— Traumatic ulcer

— Furuncle

— Carcinoma

EVALUATION: The clinical diagnosis can be confirmed by darkfield microscopic examination or more commonly serologic testing.

THERAPY

1. The standard treatment for primary, secondary, and early tertiary syphilis is benzathine penicillin G (2.4 million U administered intramuscularly as a single dose).

2. For late tertiary syphilis or neurosyphilis, benzathine penicillin G (2.4 million U, three doses administered intramuscularly 1 week apart) is used. Doxycycline (100 mg orally twice daily for 14 days) can be given to patients who are allergic to penicillin.

DISPOSITION

1. Primary and secondary syphilis can be treated on an outpatient basis.

2. Patients with neurosyphilis or major cardiovascular manifestations require admission for intravenous therapy.

Created by

Dr. Prashant Raj

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All you need to know about Syphilis

ETIOLOGY: Syphilis is caused by T. pallidum.INCIDENCE: Each year, there are 29,000 new cases of syphilis. This figure represents probably only 10% of actual cases.CLINICAL FEATURES1. Primary syphilis: After an average incubation period of approximately 3 weeks, a smooth, painless ulcer called a chancre appears at the site of primary inoculation. The chancre heals without treatment in approximately 3 to 6 weeks; at about the same time, a painless uni- or bilateral regional adenopathy develops.2. Secondary syphilis represents disseminated disease and occurs in all patients with untreated primary infection. The lesions of secondary syphilis are papulosquamous lesions that occur over the entire trunk, extremities, penis, and buttocks. Fever and weight loss occur in 70% of patients.3. Tertiary syphilis occurs at least 10 years after the primary infection in at least 30% to 35% of untreated patients. The two most important manifestations of tertiary syphilis are cardiovascular syphilis, causing thoracic aneurysms, and neurosyphilis, causing meningitis, stroke, seizures, dementia, general weakness, and posterior column dysfunction.DIFFERENTIAL DIAGNOSES— Chancroid— HSV type 1 infection— Lymphogranuloma venereum— Tinea, sarcoid— Lichen planus— Seborrhea dermatitis— Molluscum contagiosum— Traumatic ulcer— Furuncle— CarcinomaEVALUATION: The clinical diagnosis can be confirmed by darkfield microscopic examination or more commonly serologic testing.THERAPY1. The standard treatment for primary, secondary, and early tertiary syphilis is benzathine penicillin G (2.4 million U administered intramuscularly as a single dose).2. For late tertiary syphilis or neurosyphilis, benzathine penicillin G (2.4 million U, three doses administered intramuscularly 1 week apart) is used. Doxycycline (100 mg orally twice daily for 14 days) can be given to patients who are allergic to penicillin.DISPOSITION1. Primary and secondary syphilis can be treated on an outpatient basis.2. Patients with neurosyphilis or major cardiovascular manifestations require admission for intravenous therapy.

Tue, 15 Nov 2022

What is Pemphigus Vulgaris?

Pemphigus Vulgaris is a rare disease that affects elderly patients. The mortality rate is 10%; most deaths result from steroid complications, secondary infection, dehydration, or thromboembolism. Pemphigus Vulgaris is caused by the attachment of immunoglobulin G autoantibodies to the epidermis. It has been associated with D -penicillamine and captopril administration.CLINICAL FEATURES1. Mucosal lesions and erosions are very common. Examination of all mucosal sites is warranted.2. Non-pruritic, painful, flaccid bullae appear that rupture easily. Blisters can be extended or new bullae formed by applying firm tangential pressure on the intact epidermis.3. Weakness, weight loss, and dysphagia may be presenting complaints.DIFFERENTIAL DIAGNOSES— Erythema multiforme— Bullous impetigo— Herpes zosterEVALUATION: Biopsy of lesions shows eosinophils, intraepidermal bullae, and acantholysis. Indirect immunofluorescent staining shows immunoglobulin G antibodies. Serum titers can be followed to evaluate the effectiveness of therapy.THERAPY1. Prednisone (200 to 350 mg/day) for 5 to 10 weeks is used until the cessation of new blister formation occurs. The dosage is then reduced to 40 mg on alternative days and tapered over 1 year.2. Azathioprine (100 mg/day) is added to the regimen and the dosage is reduced over a 4- to 6-month period. Methotrexate and cyclophosphamide can be used instead of azathioprine.3. Topical analgesics (e.g., viscous lidocaine) can be used to alleviate the pain associated with oral lesions.DISPOSITION: Patients with severe cases and oral lesions may require hospital admission for intravenous hydration. Others can be treated as outpatients with close follow-up.

Tue, 15 Nov 2022

Know about Scorpion Stings

Introduction: A nocturnal arachnid that lives in the Southwest of the United States is the scorpion. It has two venom glands and a stinger in its tail. The majority of species are rather benign, and they often only create a limited reaction similar to that brought on by a bee sting. The bark scorpion (Centruroides sculpturatus) venom, on the other hand, has neurotoxic that can result in a serious reaction. This dangerous scorpion is found on trees in Arizona and New Mexico.CLINICAL FEATURES1. Local effects: The C. sculpturatus scorpion bite causes immediate, excruciating pain at the stung site, as well as swelling and ultimately, numbness. The area that was hurt is extremely sensitive, and the implicated extremity could become paralyzed.2. Systemic effects: The neurotoxin is strongly cholinergic and can cause excessive salivation, blurred vision, muscular spasms, hypertension, and respiratory difficulties.DIFFERENTIAL DIAGNOSES — Snakebite— A puncture wound or other trauma— Insect or spider bite— Drug intoxicationEVALUATION: Typically, the offending scorpion is seen or assumed by history; if safety allows the scorpion to be brought in, this is best. Due to the wide range of symptoms and quick progression, a thorough history and physical examination are necessary.THERAPY1. Pre-hospital management includes rapid transportation of the patient, application of an ice pack to the sting site, and safe transport of the scorpion for identification. When serious symptoms appear, life-saving procedures should be started.2. ED managementa) Antivenin should be administered in all cases of severe envenomation.b) Ventilatory support may be required, with intubation and oxygen for patients with severe systemic response or anaphylaxis.c) Atropine may be required to counteract the cholinergic effects; the dose is titrated to relieve the cholinergic signs.d) Benzodiazepines may be used for seizures and muscle spasms.DISPOSITION: All victims should be observed for 24 hours, especially children. Symptomatic patients should be transferred to the intensive care unit if symptoms are severe.

Sat, 12 Nov 2022

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All you need to know about Syphilis

Created by

Dr. Prashant Raj

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