Secondary syphilis: The great imitator can't be forgotten / Sífilis secundária: a grande imitadora não pode ser esquecida

Summary Syphilis is an infection caused by Treponema pallidum, mainly transmitted by sexual contact. Since 2001, primary and secondary syphilis rates started to rise, with an epidemic resurgence. The authors describe an exuberant case of secondary syphilis, presenting with annular and lichen planus-like lesions, as well as one mucocutaneous lesion. Physicians must be aware of syphilis in daily practice, since the vast spectrum of its cutaneous manifestations is rising worldwide.

Resumo A sífilis é uma infecção causada pela espiroqueta Treponema pallidum, transmitida principalmente por contato sexual. Desde 2001, houve o ressurgimento dessa epidemia, com aumento das taxas de sífilis primária e secundária. Os autores descrevem um caso exuberante de sífilis secundária apresentando lesões cutâneas anulares e lesões que lembram líquen plano, além de uma lesão mucocutânea. Médicos de todas as especialidades devem estar cientes das diversas apresentações de sífilis: o vasto espectro de manifestações cutâneas da sífilis secundária e as crescentes taxas dessa patologia representam um desafio.

Clinical Profile and Factors Related to Compliance with Benzathine Penicillin G Prophylaxis among RF/RHD Patients at the Tarlac Provincial Hospital, Philippines.

Rheumatic fever (RF) and Rheumatic heart disease (RHD), despite a documented decrease in their incidence, remain as problems in both industrialized and industrializing countries even at the beginning of the 21st century. The most devastating effects are on children and young adults in their most productive years. To determine the clinical profiles of RF/RHD patients at Pediatric Department of Tarlac Provincial Hospital, Tarlac city, Philippines and the factors related to their compliance with Benzathine Penicillin G Prophylaxis treatment, the ex post-facto research was done using the charts of patients. Out patients and ward patients diagnosed with RF/RHD patients were identified using the Jones Criteria. They served as the subjects of the study. The onset of the RF/RHD was seen in age ranging from 6 years to 17 years old with most of them occurring at 7-15 age range. The male to female ratio was 1.3:1. The RF/RHD patients came from different towns of Tarlac, the most number of which came from the city of Tarlac. The patients, being clientele of a provincial and non- paying hospital, came from poor family with low educational attainment, and low monthly income from skilled or unskilled work. Carditis (55% of the 58 cases) and polyarthritis (43%) were the most frequent manifestations seen among patients. In the minor manifestations of RF, majority had episodes of acute tonsillopharyngitis (82%) and fever (82%). Laboratory results, showed abnormal ESR (55 or 95% of the 58 cases), ASO titers (47 or 81%), PR intervals (18 or 31%), and leukocytosis (30 or 67%). Of the 26 cases who had valvular involvement cases, 7 mitral regurgitation; 2 (7%) had mitral stenosis; and 1 had aortic regurgitation. The rest had combination or triple combinations of valvular involvement. Compliance with Benzathine Penicillin G treatment was 46.6%. Compliance to treatment is related to the occupation of father (x2= 6.643, significant at .0361 level) and family income (x2= 8.088, significant at .0175 levels. Poor families who have low paying jobs are less likely to complete the treatment of their sick children. The Department of Health must find ways to provide the secondary chemoprophylaxis to RF/RHD patients for free to improve the compliance rate, thus, provide bigger chance for the RF/RHD patients to survive their disease.