Acquired syphilis in children: 14 case reports / 中华皮肤科杂志

Objective To analyze the clinical manifestations and treatment of acquired syphilis in children.Methods A retrospective analysis was conducted.The clinical data on 14 patients with acquired syphilis collected from July 2007 to December 2010 were assessed.Results Among the 14 cases,10 were secondary syphilis,2 early latent syphilis,and 2 late latent syphilis.Seven of the patients had been misdiagnosed as other diseases.All the patients had a history of close contact with syphilis patients or having mouth-to-mouth feeding history after chewing food by adult patients with syphilis.Both rapid plasma reagin (RPR) test and Treponema pallidum haemagglutination assay (TPHA) were positive in all the patients.The skin lesions were mainly located in the oral cavity mucosa and rarely in the trunk,which included leukoplakia,mucosal wet papules,and pustules.Conclusions Acquired syphilis in children is often clinically misdiagnosed or ignored.For children presenting with atypical skin rashes,especially for those having close contact with active syphilis patients,acquired syphilis should be suspected.

Secondary syphilis with ocular impairment as the initial symptom / 中华皮肤科杂志

Objective To retrospectively assess the clinical manifestations and treatment of secondary syphilis with ocular impairment as the initial symptom. Methods Clinical data were retrospectively analyzed on secondary syphilis with ocular impairment as the initial symptom collected from September 1998 to October 2008. Results There were 11 syphilitic patients presenting acute ocular impairment as their initial manifestation. Skin eruptions developed simultaneously with ocular impairment in 2 patients, following ocular impairment in 9 patients. All patients were positive for rapid plasma reagent test (RPR) and treponema pallidum haemagglutination assay (TPHA), but negative for HIV. Of these patients, 9 suffered from uveitis (iridocyclitis, choroiditis or panuveitis), 2 from optic neuritis; 3 had unilateral ocular involvement, 8 had bilateral ocular involvement. After treatment with injected penicillin or ceftriaxone sodium, 9 patients experienced complete visual recovery, 2 partial visual recovery. Conclusions Ocular impairment occurs in patients with secondary syphilis at a low incidence, with no characteristic clinical manifestations. For patients who have no response to conventional ocular therapy, ocular syphilis should be considered and serological examination for syphilis is recommended.

Neurosyphilis with mania as the first manifestation: report of 20 cases / 中华皮肤科杂志

Objective To assess the clinical presentations and treatment of neurosyphilis with mania as the first manifestation. Methods A retrospective study was performed. Clinical data on neurosyphilis patients with mania as the first manifestation collected from July 2009 to June 2010 were analyzed. Results Twenty cases of neurosyphilis were included in this study, which were all misdiagnosed as schizophrenia, anxiety,cerebral infarction, etc. All the patients had manic symptoms at onset, such as irritability, bad temper, impulsive behavior, disturbance in thinking, and so on. Some patients also suffered from a marked decrease in memory, calculation and cognitive ability. Rapid plasma reagin (RPR) test, Treponema pallidum hemagglutination (TPHA)test and cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL) test were positive in all the patients. Varying degrees of symptomatic improvement was achieved after anti-syphilis and anti-psychotic treatment. CSF was retested in 13 patients 3 months after the end of treatment, and CSF VDRL titer decreased in 10 patients, remained unchanged in 2 patients, and turned negative in 1 patient. Conclusions Neurosyphilis lacks distinctive clinical characteristics. For patients with poor response to conventional antipsychotic therapy,neurosyphilis should be considered, and serology and cerebrospinal fluid tests for syphilis are warranted.

CD4+ CD25high regulatory T cell frequency in cerebrospinal fluid of patients with neurosyphilis / 中华微生物学和免疫学杂志

Objective To analyze the phenotypes of lymphocytes in cerebrospinal fluid derived from the patients with neurosyphilis. Methods Samples of cerebrospinal fluid from 12 patients with neurosyphilis and 20 patients with latent syphilis were collected and analyzed by flow cytometry for CD4 and CD25 expression. Results There was a significant increase in the number of white blood cells in the cerebrospinal fluid of patients with neurosyphilis. FACS analysis showed that most leukocytes were lymphocytes predominated with CD4 + T cells in neurosyphilis patients which were almost 4 times more than that in latent syphilis. However, there was a significant decrease in the proportion of CD4+ CD25high regulatory T cells (Tr) in neurosyphilis patients compared with that in latent syphilis patients. Conclusion A dramatic increase in CD4+ T cell frequency suggested its pathogenic role in neurosyphilis, whereas a decrease in CD25high Tr frequency indicated that CD4 + CD25high Tr cells might play an important role in immune homeostasis of central nervous system.