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10.
Ann Dermatol Venereol ; 140(10): 619-22, 2013 Oct.
Artigo em Francês | MEDLINE | ID: mdl-24090892

RESUMO

BACKGROUND: Syphilis has been making a comeback over the last 10 years. Neurosyphilis can occur at any stage of the infection but is difficult to diagnose because of the existence of misleading forms, of which we describe an example below. PATIENTS AND METHODS: A 56-year-old woman presented symptoms evoking polymyalgia rheumatica and giant-cell arteritis in a context of ibuprofen treatment for a few weeks. She also had myodesospsia, syphilids and syphilitic roseola, together with laboratory indicators of inflammation. A lumbar puncture revealed lymphocytic meningitis and a positive Treponema Pallidum Haemagglutination Assay (TPHA) for cerebrospinal fluid, thus confirming the diagnosis of neurosyphilis. Moreover, the ophthalmologic examination showed optic neuritis with papilla lesions of syphilitic origin. This was successfully treated with a 3-week course of penicillin G infusions. CONCLUSION: Symptoms evocative of Horton's disease and polymyalgia rheumatica can reveal syphilis, a disease dubbed "the great simulator" on account of the variety of clinical forms it can take.


Assuntos
Arterite de Células Gigantes/diagnóstico , Neurossífilis/diagnóstico , Polimialgia Reumática/diagnóstico , Astenia/etiologia , Biópsia , Diagnóstico Diferencial , Feminino , Testes de Hemaglutinação , Humanos , Pessoa de Meia-Idade , Morbidade/tendências , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/complicações , Neurossífilis/tratamento farmacológico , Neurossífilis/microbiologia , Neurite Óptica/etiologia , Penicilina G/uso terapêutico , Sífilis/diagnóstico , Sífilis/epidemiologia , Artérias Temporais/patologia , Treponema pallidum/isolamento & purificação
11.
Clin Infect Dis ; 57(3): 370-80, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23633111

RESUMO

BACKGROUND: Cutaneous leishmaniasis (CL) is a disfiguring but not life-threatening disease. Because antileishmanial drugs are potentially toxic, the World Health Organization (WHO) recommends simple wound care or local therapy as first-line treatment, followed or replaced by systemic therapy if local therapy fails or cannot be performed. METHODS: To determine the feasibility and impact of the recommended approach, we analyzed the results of a centralized referral treatment program in 135 patients with parasitologically proven CL. RESULTS: Infections involved 10 Leishmania species and were contracted in 29 different countries. Eighty-four of 135 patients (62%) were initially treated without systemic therapy. Of 109 patients with evaluable charts, 23 of 25 (92%) treated with simple wound care and 37 of 47 (79%) treated with local antileishmanial therapy were cured by days 42-60. In 37 patients with large or complex lesions, or preexisting morbidities, or who had not been cured with local therapy, the cure rate with systemic antileishmanial agents was 60%. Systemic adverse events were observed in 15 patients, all receiving systemic therapy. CONCLUSIONS: In this population of CL patients displaying variable degrees of complexity and severity, almost two-thirds of patients could be initially managed without systemic therapy. Of these, 60 were cured before day 60. The WHO-recommended stepwise approach favoring initial local therapy therefore resulted in at least 44% of all patients being cured without exposure to the risk of systemic adverse events. Efforts are needed to further simplify local therapy of CL and to improve the management of patients with complex lesions and/or preexisting comorbidities.


Assuntos
Antiprotozoários/uso terapêutico , Bandagens , Leishmaniose Cutânea/terapia , Viagem , Administração Tópica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
15.
Ann Dermatol Venereol ; 135(6-7): 451-8, 2008.
Artigo em Francês | MEDLINE | ID: mdl-18598794

RESUMO

BACKGROUND: The usual presentation of secondary syphilis is with cutaneous and mucosal symptoms. However, systematic symptoms can also occur. The purpose of this study was to describe non-mucocutaneous manifestations of secondary syphilis. PATIENTS AND METHODS: Patients from the Infectious Diseases Department of Tourcoing Hospital in whom secondary syphilis was diagnosed between January 2000 and December 2006 were enrolled in this study. Patients with secondary syphilis had the typical cutaneous and mucosal symptoms and a VDRLgreater than or equal to one quarter (or a fourfold increase in the VDRL if previously positive). RESULTS: Seventy-seven patients presenting a total of 80 cases of secondary syphilis were enrolled, 50 of whom were HIV-positive. Of these patients, 21 (26.3 p. 100) had neurological symptoms with three cases (3.8 p. 100) of uveitis, four (5 p. 100) of papillitis, two (2.5 p. 100) of retinitis and one (1.25 p. 100) of otosyphilis. In 14 of these 21 patients (67 p. 100), lumbar puncture was performed, confirming the diagnosis of neurosyphilis in six cases. Three patients (3.8 p. 100) had diarrhoea, four (5 p. 100) had abdominal pain and six (7.5 p. 100) had hepatomegaly. Seven (11.5 p. 100) patients had alanine aminotransferase levels above twice the normal upper limit and two above 10 times the normal upper limit. Three patients had bone pain and in one patient, osteitis was confirmed by technetium and gallium scintigraphy (osteolysis). CONCLUSION: In patients with secondary syphilis, clinicians should search for non-mucocutaneous symptoms. In the presence of these symptoms, appropriate syphilis treatment should be initiated.


Assuntos
Sífilis/complicações , Sífilis/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Cardiolipinas , Colesterol , Estudos de Coortes , Interpretação Estatística de Dados , Oftalmopatias/diagnóstico , Oftalmopatias/etiologia , Feminino , França/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Soropositividade para HIV , Hepatomegalia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/diagnóstico , Osteíte/diagnóstico , Osteíte/etiologia , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/etiologia , Fosfatidilcolinas , Estudos Prospectivos , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Punção Espinal , Sífilis/epidemiologia , Sorodiagnóstico da Sífilis/métodos
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