Syphilis and Toxo Flashcards
What other treponemes can cross react with syphilis serology?
Treponema pallidum subsp. pertenue (yaws)
Treponema pallidum subsp. edemicum (bejel)
What are the symptoms of primary syphilis?
Painless chancre at site of infection - resolves in 3-8 w
When does secondary syphilis occur and what are the symptoms?
Occurs 2-10 weeks post chancre in 25% of patients
Systemic disease
Maculopapular rash, fever, lymphadenopathy
Can affect palms and soles, not usually itchy
Resolves in 3-12 weeks
What is latent stage and tertiary syphilis?
Latent syphilis = no signs or symptoms (early 1-2 y, >2 y)
Tertiary syphilis = 10-20 years post infection:
Gummatous
Cardiac
Neurological
When does neurosyphilis occur?
What are the symptoms?
How do you diagnose?
What is the treatment?
Can occur at any stage (includes eye disease)
Numbness, abnormal gait, meningitis, tremors, weakness, tabes dorsalis
Paired serum and CSF for RPR (avoid blood contamination) If CSF RPR pos, or TPHA >1:320 diagnostic of neurosyphilis. PCR not used as low sensitivity
Treatment for:
Syphilis
Tertiary syphilis
Neurosyphilis
Congenital syphilis
IM benzathine penicillin
3 doses benzathine penicillin, once per week
Procaine penicillin IM plus probenecid for 14 d
Benzylpenicillin IV for 10 d
When is the highest risk for congenital syphilis?
In primary or secondary infection
Greatest risk of transmission in second half of pregnancy
When is treatment required in pregnancy to avoid congenital syphilis?
Treatment required 30 days before delivery
How likely is a neonate to get syphilis if mum is untreated? What is the fatality rate?
100%
40% will be stillborn or die in the neonatal period
Symptoms of congenital syphilis
Early: low birth weight, snuffles, adenopathy, hepatosplenomegaly, bone abnormalities
Late: saddle nose, frontal bossing, high palate, Hutchisons triad (keratitis, peg shaped incisors, deafness)
What tests should be performed for congenital syphilis?
IgM and RPR at birth (paired RPR from mum)
If IgM pos or 2x RPR 4-fold higher than mum is diagnostic
For symptomatic neonate - IgM, EIA, RPR and PCR of appropriate samples
Can organs, tissues, gametes and blood be donated from syphilis EIA positive donors?
Organ and cell donations permitted
Tissues and gametes can be considered based on lab results
No blood donation, even if treated (as exclusion based on EIA)
Who is at risk of severe disease in toxoplasma infection?
Immunocompromised
Pregnant women (risk to foetus)
What treatment can be given in pregnancy to Toxo infected mum?
Spiromycin
Symptoms of congenital Toxo
Chorioretinitis
Hydrocephalus
Convulsions
Intracerebral calcifications
