Disease sexually transmitted:

Early congenital syphilis

Visceral syphilis

  • What is Visceral syphilis
  • What triggers / Causes Visceral syphilis
  • Pathogenesis (what is happening) during Visceral syphilis
  • Symptoms of Visceral syphilis
  • Diagnosis of Visceral syphilis
  • Treatment of Visceral syphilis
  • Prevention of Visceral syphilis
  • Which doctors should be consulted if You have Visceral syphilis

What is Visceral syphilis -

As the infection of the whole organism, syphilis in the early stages of development affects many internal organs and systems. Late forms of syphilis, including tertiary syphilis, may occur as gummy processes in various internal organs, and diseases, which can be attributed both to a truly visceral syphilis.

What triggers / Causes Visceral syphilis:

The causative agent of syphilis is Treponema pallidum (Treponema pallidum) , belonging to the order Spirochaetales, family Spirochaetaceae, the genus Treponema. Morphologically Treponema pallidum (Treponema pallidum) is different from saprofitiruyuschem spirochetes (Spirochetae buccalis, Sp. refringens, Sp. balanitidis, Sp. pseudopallida). Under the microscope pale Treponema is a spiral-shaped microorganism resembling a corkscrew. It has an average of 8-14 uniform curls of equal size. The total length of Treponema varies from 7 to 14 microns, a thickness of 0.2 to 0.5 μm. For Treponema pallidum characterized by severe mobility unlike saprofitiruyuschem forms. Her inherent progressive, swinging, pendulum, contractile and rotatory (around its axis) movement. Using electron microscopy revealed the complex structure of the morphological structure of Treponema pallidum. It turned out that Treponema covered with a thick cover of three-layer membrane, cell wall and mukopolisaharidnyh capsule substance. Under cytoplasmic membrane fibrils are thin filaments, with a complex structure and contributing to a diverse movement. Fibrils are attached to the end coils and separate sections of the cytoplasmic cylinder with blefaroplastia. The cytoplasm milagrosa, it contains the nuclear vacuole, nucleolus and mesosoma. It is established that a variety of the influence of exogenous and endogenous factors (in particular, previously used preparations of arsenic, and in present - antibiotics) have influenced the pallidum pale, changing some of its biological properties. So, it turned out that Treponema pallidum can turn into cysts, spores, L-shape, grain, by reducing the activity of the immune reserves of the patient can be reversed in a spiral virulent species and cause active disease manifestations. Antigenic mosaic acyanotic proven by the presence in the serum of patients with syphilis multiple antibodies: protein, complimentative, polysaccharide, reagin, immobilizing, agglutinins, lipid, etc.
Using the electron microscope has shown that Treponema pallidum in the lesions often located in the intercellular gaps, perinatalnom space, blood vessels, nerve fibers, especially in early forms of syphilis. Finding acyanotic in peripherie still is not proof of damage to the nervous system. Often such an abundance of treponem occurs with symptoms of septicemia. In the process of phagocytosis is often a state of endocytobiosis, wherein the Treponema in leukocytes consist in phagosome. The fact of conclusion of treponemes in premembrane phagosomas - a phenomenon quite unfavorable, as being in a state of endocytobiosis, Treponema pallidum long remain protected from the effects of antibodies and antibiotics. At the same time the cage was formed such phagosome, as if protecting the body from infection and disease progression. This fragile balance can be maintained for a long time, describing latent course of syphilitic infection.
Experimental observations N. M. Ovchinnikov and V. V. Delectorskaya are consistent with the works of authors who believe that when infection with syphilis and possibly prolonged asymptomatic course (if available in the patient L-forms acyanotic) and "accidental" detection of infection in the latent stage of syphilis (lues latens seropositiva, lues ignorata), i.e. in the period of the presence of treponemes in the body, probably in the form of a cyst-forms that possess antigenic properties and, consequently, lead to the production of antibodies is confirmed by positive serological reactions for syphilis in the blood of patients without apparent clinical manifestations of the disease. In addition, some patients find stage neuro - and viscerosomatic, i.e., the disease develops as if "bypassing" of the active form.
For culture acyanotic required complex conditions (special environment, anaerobic conditions, etc.). However, the culture of Treponema quickly lose morphological and pathogenic properties. In addition to the above forms of treponemes, it was assumed the existence of granular and invisible filterable forms acyanotic.
Outside the organism Treponema pallidum is highly sensitive to external influences, chemicals, desiccation, heat, sunlight influence. On the Housewares Treponema pallidum retains its virulence to dry. The temperature of 40-42°C first increases the activity of treponemes, and then leads to their death - heated to 60°C kills them within about 15 minutes to 100°C immediately. Low temperatures do not have a devastating impact on a pale pallidum, and in present possession of treponemes in an oxygen-free environment at a temperature of from -20 to -70°C or dried from the frozen state is a common method of preservation of pathogenic strains.Висцеральный сифилис

Pathogenesis (what is happening) during Visceral syphilis:

Reaction of the patient to the introduction of Treponema pallidum complex, multifaceted and poorly understood. Infection occurs as a result of penetration of Treponema pallidum through the skin or mucosa, the integrity of which is usually broken. However, some authors admit the possibility of the introduction of Treponema through the intact mucosa. At the same time, we know that in the serum of healthy individuals, there are also factors with immobilized activity against the pale treponemes. Along with other factors, they provide an opportunity to explain why after contact with a sick person is not always a infection. Domestic ifiledialog M. V. milich based on own data and analysis of the literature considers that the infection may not occur in 49-57 cases. The variation is explained by the frequency of sexual contacts, the nature and localization syphiloderm, the presence of the entrance gate of the partner and the number of acyanotic, has penetrated the body. Thus, an important pathogenetic factor in the occurrence of syphilis is the state of the immune system, the tension and the activity of which varies depending on the degree of virulence of the infection. Therefore, discussed not only the possibility of the absence of infection, but the possibility of healing, which is considered to be theoretically valid.

Symptoms of Visceral syphilis:

Late syphilitic visceropathies
Thanks to successful treatment and prevention in patients with various forms of syphilis have become rare to meet expressed and clearly defined clinical symptoms of lesions of the internal organs.
The most important of these late visceropathies.
Changes of internal organs in patients with tertiary syphilis are
its core characteristic of syphilitic infection endo-, meso -, and perivasculitis, until complete obliteration of the vessels. Especially intensively appears specific pathology in the tissues of the heart, blood vessels, gastrointestinal tract, liver and lungs. Syphilitic heart and blood vessels often manifests specific gummy syphilitic myocarditis and mesarthim. Gummy proliferates of the myocardium can be isolated (like a solitary gummas of the skin) or have the appearance of diffuse gummy infiltration. Often these processes are combined. Symptoms of lesions does not have specific features. Observed cardiac hypertrophy with enlargement of the heart, weakening of the heart sounds, pain
diffuse nature. Diagnosis is based more clearly on ECG data and serological tests - are particularly important indicators of REEF and RIBT. More often than myocardium, is affected aorta - specific masorti occurs in patients with tertiary syphilis with disease duration over 10 years. In the initial phase of infiltration and minor seal intimal and medial shell of the ascending part of the aortic arch thickens, which clearly recorded the x - ray- the subjective symptoms may be absent. Further stages in the formation of Mesaoria depend on the degree of allergic reactivity of the test body and the intensity of syphilitic lesions. If hyperarchi develop necrotic destructive changes, until the complete destruction of the aortic wall, ending in death. At low
allergic tension proliferative process ends
seals, fibrotic foci of degeneration and calcification that
more favorable for the prognosis of life and therapeutic effect.
The transition process on the valves of the aorta leading to aortic insufficiency,
which is the pulsation of the neck vessels, shortness of breath, nausea,
fatigue, allocation of rusty sputum. Can also be
amazed main arteries and veins of the brain, upper and
of the lower extremities. They found separately located small
Gumma, followed by compaction of the fibrous or diffuse permeation by
type of sclerotic lesions, without destruction and necrosis.
Syphilitic aortitis is the most common form of visceral syphilis is characterized by the difference of the pulse on both hands, a kind of "ringing" accent II tone of the aorta, the identification of the phenomenon create - Kukoverov - systolic murmur heard over the sternum in the raising of hands as a result of displacement of the great vessels when aortitis, radiographically detectable expansion shadow of the ascending part of the aortic arch. Syphilitic aneurysm of the aorta when x-rays revealed saccular, rarely fusiform, extensions with clear ripple. It is necessary to exclude syphilitic aneurysm of the aorta in patients with superior Vena cava syndrome, occurring with compression of her, as well as the trachea and bronchi. When x-rays in the anterior mediastinum revealed a large, relatively homogeneous, without
petrifikatov, shadow. For exceptions often cause the specified syndrome
malignant neoplasms spend aortic angiography,
tomography, serology.
Late syphilis gastrointestinal tract characterized by the same specific infiltrative lesions bugorkova-gummy nature, reflecting the intensity of allergic reactivity. Separate, spaced focal tubercles or Gumma can be detected in the esophagus, stomach, small intestine and colon. Due to a more pronounced
traumatizing influence of food and enzymatic action of gastric
contents gummy-infiltrative processes occur more frequently in the esophagus and
the stomach. Separate, solitary, Gumma and diffuse gummy infiltration
are formed in combination with each other or separately. In the event of
solitary Gumma of the esophagus or stomach, the process remains for a long time
unrecognized due to the weak intensity of subjective and objective
symptoms. Diffuse gummy infiltration frequently detected in the stomach.
Superficial infiltrative lesion of the mucous membrane in the beginning
manifested by symptoms of gastritis with acute diarrhoea
disorders, gipacidnyh or anatsidnyh condition. Deep
infiltrative changes of the esophagus and stomach causing severe phenomena
dysphagia, indigestion, similar to the symptoms of these tumors
bodies.
With the defeat of the intestine syphilitic gummy-infiltrative elements
localized, usually in the jejunum. Symptoms of syphilitic
enteritis is very unspecific. Diffuse proliferates, totalsaudio wall
the small intestine, give less symptoms than focused Gumma,
altering the natural peristaltic motion and accompanied
symptoms of obstruction (at considerable infiltration). Ulceration or Gumm
gummy infiltration aggravate the course of the process and bleeding
peritoneal symptoms. The rectum is rarely affected in tertiary
stage of syphilis. During the period of infiltration observed defecation disorders, and when ulceration and scarring symptoms similar to severe proctitis, differing less pronounced soreness and unusually small amount of purulent discharge. Diagnosis of syphilitic gastrointestinal processes is hampered by false-positive DAC in tumors, as well as difficulties in interpreting the results of radiographic studies. Yet the data RIBT, REEF, medical history, the results of the test protevoepilepticescoe treatment given, as a rule, the possibility of correct diagnosis.
Syphilitic lesions of the liver observed in various embodiments, due to the localization of the proliferative process and its nodular or diffuse in nature. In accordance with the classification of A. L. Myasnikov (1981) among chronic syphilitic hepatitis is classified into the following clinical types: chronic syphilitic epithelial hepatitis, chronic interstitial hepatitis, miliary gummy hepatitis gummy and limited hepatitis. The earliest changes of liver function that occurs in the secondary period of syphilis, may occur ikterichnost, skin itching and other symptoms of acute syphilitic hepatitis. As a result of rational protevoepilepticescoe treatment or even without it, the latter was allowed, leaving the altered cell responsiveness. In the tertiary period of syphilis, when phenomena hyperergic reactivity increase, or spontaneously occurs secondary to chronic epithelial hepatitis, as it is the most reactive epithelium in infectious and allergic processes. Symptoms are non-specific: malaise, pain and heaviness in region of liver, anorexia, nausea, vomiting, pronounced itching. The liver is somewhat enlarged, speaks at 4-5 cm from under the costal margin, plotnovato, but painless.
Chronic syphilitic interstitial hepatitis develops due to diffuse-proliferative lesions of the cells of the interstitial tissue. As epithelial hepatitis, it can be formed even in the secondary period as a result of direct penetration acyanotic. However, interstitial hepatitis may have and infectious-allergic nature. Even a small number of acyanotic, but for a long time, drastically changes the reactivity of cells of the interstitial tissue, and in the tertiary period again already formed interstitial hepatitis
productive-infiltrative nature, accompanied by phenomena of necrosis.
For this clinical varieties characterized by intense pain in the
the liver, the increased density on palpation, but jaundice is not on
the early stages of the disease. In the later period, when the growing
syphilitic cirrhosis, join jaundice and sudden itchy skin.
Miliary gummy gummy and limited hepatitis characterized by formation of nodular infiltrates. Hypertrophy of the liver, with gummy hepatitis is uneven, the tuberosity, the lobulation. Miliary gummas are smaller, are located around blood vessels and less striking in hepatic tissue. Therefore miliary gummy hepatitis is manifested by pain in liver area, it is a uniform increase with a smooth surface. The functional activity of liver cells long-term remains, and jaundice is usually absent.
Limited gummy hepatitis, due to the formation of large nodes with involvement of secretory and interstitial sites, accompanied by severe pain, fever, chills. Ikterichnost sclera and skin, other disorders of liver function is expressed slightly in the initial stages of the disease jaundice occurs only due to mechanical obstruction of the bile ducts. Around Gumm formed zone of perifocal nonspecific inflammation. In the final stages there are marked sclerosis gummy atrophic, scars.
Syphilitic lesion of the kidney is a rare phenomenon and is chronically. In the secondary period of syphilis reactive inflammatory changes in the vessels of the glomeruli spontaneously regress. In the tertiary period as a result of hyperergic reaction of the endothelium of the glomeruli arise miliary or large Gumma, and diffuse infiltration. Gummy lesion caused by focal nature of inflammation (nodular infiltrates) on the main symptoms - albuminuria, pyuria and hematuria - similar to the neoplastic process. Syphilitic nephrosis with or amyloid lipid
degeneration ends with nephrosclerosis. Because amyloidosis and lipoid
degeneration of the renal parenchyma is characteristic of other chronic infections,
the differential diagnosis of syphilitic lesions of the kidneys requires
a thorough analysis of anamnestic information, data, CEB, REEF and RIBT,
survey results I related professionals (for the purpose of detecting or
exceptions syphilitic process with other localizations). A trial of treatment with
kidney disease is not recommended because bismuth preparations such patients
contraindications and penicillin therapy is not always allows diagnostic
difficulties.
Syphilis of the bronchi and lungs is manifested extremely diverse symptomatology because of the peculiar localization gummy and productive-infiltrative lesions. Gummy seals, both single and multiple (miliary Gumma), usually located in the lower or middle lobe of the lung. The process manifests itself as shortness of breath, feeling of tightness in the chest, vague pain. Seal lung tissue when syphilis has
focal nature, as with tumors, most often it is asymmetric. From
the tuberculous process Gumma of the lung differentiate on the basis of good
patients ' health. In syphilis, as a rule, no feverish
state, asthenia, absent in sputum Mycobacterium tuberculosis.
Diffuse productive-infiltrative inflammation syphilitic etiology
often localized at the bifurcation of the trachea or in the peribronchial tissue.
Gumma of the lung and diffuse gummy infiltration can occur with
ulceration, purulent sputum, and even bleeding. But a more frequent outcome is a fibrous seal with the development of pulmonary fibrosis and bronchiectasis. In the diagnosis of syphilitic lesions of the lungs is crucial data history, the presence of syphilitic process in the skin, mucous membranes or in the bones, serological results, and sometimes a trial of treatment.
N. Schibli and I. Harms (1981) reported tumor-like lesions
the lungs during the tertiary and even secondary syphilis. When x-rays of bodies
chest find round retrocardiac darkening at the root
lung. Sometimes patients with such lesions, simulating a tumor,
undergo thoracotomy. Syphilitic nature of lung lesions
is established by excluding other etiologies and a positive influence
protevoepilepticescoe therapy. However, it is possible to simultaneously
the existence of syphilis and tuberculosis, Gumma and lung tumors.
Syphilitic lesions of the endocrine glands in the tertiary period is manifested by formation of gummy lesions or diffuse productive inflammation. Men, apparently, are most often recorded gummy orchitis and gummy epididymitis. The testicle and its appendages increase in size, acquire a pronounced density and uneven surface. In
unlike orchitis and epididymitis tuberculous etiology of pain is absent,
temperature no reaction, serological tests for syphilis are positive,
a sample pirok and Mantoux test were negative. The resolution process occurs with
phenomena of scarring. When the Gumma of the testis is possible ulceration with subsequent
education deforming scar. Women often affects the pancreas
iron, which is manifested by dysfunction of the islet apparatus and
the formation of syphilitic diabetes.
Syphilitic thyroiditis observed in 25 patients with early forms of syphilis. E. V. Bush (1913) divided thyroid disease in tertiary syphilis into 3 groups:
- enlargement of the thyroid gland without changing the function
- syphilitic thyroiditis with hyperthyroidism and
- hypothyroidism scar after permission syphilitic thyroiditis.
V. M. Kogan-Clear (1939) divided syphilitic thyroiditis into early and late forms.
In the secondary period of syphilis observed diffuse enlargement of the thyroid gland hyperfunction. In the tertiary period develops gummy or interstitial lesion with subsequent scarring. As an example, specific lesions of the thyroid gland the following observation. Full recovery of the structure of any endocrine gland after treatment does not occur, and therefore syphilitic endocrinopathy are not accompanied by restoration of the functional activity of the gland.
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Visceral syphilis

Diagnosis of Visceral syphilis:

The fundamental in the diagnosis of visceral syphilis is a conclusion based on a comprehensive examination of the internal organs and nervous system. Positive serological tests in blood and a history of the disease syphilis confirm the clinical diagnosis.

Treatment of Visceral syphilis:

Providing specialized medical care for patients with syphilis is physicians dermatologists.
At the outpatient stage the detection, diagnosis, treatment and follow-up of patients, and carry out preventive measures for the prevention of syphilis.
Inpatient treatment of patients with syphilis is carried out in venereal offices of specialized hospitals or in specialized units in hospitals for infectious diseases. Mandatory subject to hospitalization of children, socially maladjusted adolescents, pregnant women, patients with syphilis. Hospitalization is also indicated in cases of intolerance to the patient of penicillins in the presence of somatic predisposition, the complicated course of syphilis, late forms of the disease, and patients older than 60 years.
Providing medical care to patients of congenital syphilis is physicians dermatologists, obstetricians and neonatologists, nurses with the necessary skills and training. ru/" target="_blank">Treatment of patients with congenital syphilis is only stationary in specialized maternity wards in hospitals for infectious diseases, infectious departments of children's hospitals, and also in dermatological pediatric wards of hospitals. This stage includes the identification, diagnosis and treatment of patients. Outpatient care to patients of congenital syphilis consists of clinico-serological monitoring after treatment and is based on dermatovenerologic dispensaries.
Specific treatment administered to patients with syphilis after diagnosis. The main direction in treatment - the use of antimicrobial agents active against Treponema pallidum. For treatment using drugs penicillin. When their intolerance used Ceftriaxone, doxycycline, tetracycline, erythromycin.

Prevention of Visceral syphilis:

Prevention of visceral syphilis provides timely
diagnosis and early proper treatment because visceral forms
are the result of inadequate therapy of active forms of syphilis or
the complete absence of it.
As strictly pathognomonic signs characteristic of syphilitic visceral lesions no, when the diagnosis should be guided by the clinical and laboratory data, the clinical dynamics of the impact of specific therapy, commonly using a complex serological
reactions: RIT, REEF, TPHA, ELISA, PCR.
Research in inpatient medical, surgical, obstetric, neurological diseases it is advisable to spend with the production of serological reactions. A comprehensive survey of persons who had syphilis, after treatment and when deregistration is the prevention of visceral syphilis. It consists of a thorough clinical examination with x-ray, according to testimony
liquorologic and ECG studies to assess the usefulness
performed treatment. Targeted therapeutic survey shows patients with neurosyphilis, which are often found specific internal organ.
For timely diagnosis of visceral syphilis is very important active detection of latent forms of syphilis, which in 50-70 of cases that result in a late specific lesions of the internal organs. For the purpose of timely detection of early forms of visceral syphilis used 100 a survey of patients in therapeutic, neurological, neuropsychiatric, surgical hospitals, ENT-offices with the production of BT. Filed M. V. Milich, V. A. Blokhin, positive serological reactions are found in 0,01 surveyed in somatic hospitals, and they are more common late forms of syphilis: late latent - 31, hidden, unspecified - 11.5, late neurosyphilis - 3.6, late visceral - 0.7.

Which doctors should be consulted if You have Visceral syphilis:

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