https://wikem.org/w/api.php?action=feedcontributions&feedformat=atom&user=Jmnelson86 2026-05-13T13:26:25Z User contributions MediaWiki 1.38.2 https://wikem.org/w/index.php?title=Syphilis&diff=27563 2014-12-23T02:41:10Z

<p>Jmnelson86: </p> <hr /> <div>==Background==<br /> *Syphilis is caused by the spirochete Treponema pallidum. &lt;ref&gt;Lukehart SA. Chapter 169. Syphilis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.New York, NY: McGraw-Hill; 2012.&lt;/ref&gt;<br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ===Pathogenesis===<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation&lt;ref&gt;Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110. &lt;/ref&gt;<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> [[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumb|Primary syphalis on penile shaft]]<br /> ===Primary Syphilis===<br /> *Primary lesion appears after an incubation of 2-6 weeks<br /> **Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation <br /> **Minority of patients can have multiple lesions or atypical appearance<br /> **Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia <br /> **Heals in 4-6 weeks <br /> *Regional lymphadenopathy that is painless and firm<br /> ===Secondary Syphilis===<br /> *Characterized by generalized mucocutaneous lesions and lymphadenopathy but can also be found in other tissues&lt;ref&gt;Chapel TA. The signs and symptoms of secondary syphilis. Sex Transm Dis. 1980;7(4):161–164.1.&lt;/ref&gt;<br /> *Skin lesions are usually maculopapular, pale red or pink, non-pruritic, discrete, and distributed on the trunk and proximal extremities. They may be subtle.<br /> *They progress to more wide spread papular lesions that frequently involve the palms and soles.<br /> **Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks<br /> **Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients. &lt;ref&gt;Chesson HW, Heffelfinger JD, Voigt RF, Collins D. Estimates of primary and secondary syphilis rates in persons with HIV in the United States, 2002. Sex Transm Dis 2005; 32:265. &lt;/ref&gt;<br /> **In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata <br /> *CSF abnormalities are detected in as many as 40% during this stage. CNS involvement can be symptomatic or asymptomatic. <br /> *Constitutional symptoms may accompany or precede secondary syphilis. Can include: sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus<br /> *Less common complications include: hepatitis, nephropathy, gastritis, proctitis, rectosigmoid mass arthritis, periositis, optic neuritis, iritis, uveitis, pupillary abnormalities<br /> ===Latent Syphilis===<br /> *Detectable by serologic testing only<br /> *May intermittently be present in the bloodstream and transmitted through blood transfusion or organ donation<br /> *Spontaneous cure is rare<br /> ===Tertiary Syphilis===<br /> *Characterized by progressively destructive mucocutaneous, musculoskeletal, or parenchymal lesions, aortitis or CNS manifestations<br /> *The most common manifestation in the US today is neurosyphilis in HIV infected persons.<br /> *Historical manifestations: <br /> **Gumma: granulomatous lesion <br /> **Cardiovascular syphilis: involves the vasa vasorum of the ascending aorta and can result in aneurysm formation<br /> **Late symptomatic neurosyphilis: tabes dorsalis and paresis<br /> ===System Specific===<br /> '''CNS'''<br /> *Continuum of involvement from asymptomatic patient with CSF abnormalities to meningitis and focal neurologic deficits <br /> *RPR titers of ≥ 1:32 are at higher risk of having neurosyphilis, even higher if HIV infected.<br /> *Demonstrable in up to 25% of patients with latent infection and up to 40% of primary or secondary cases &lt;ref&gt;Lukehart SA. Chapter 169. Syphilis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.New York, NY: McGraw-Hill; 2012&lt;/ref&gt;<br /> **Patients with early syphilis who have CSF findings may need to be treated as with neurosyphilis, especially in the setting of HIV<br /> *'''Meningeal:''' Headache, nausea, vomiting, neck stiffness, cranial nerve involvement, seizures, changes in mental status, uveitis, iritis or hearing loss <br /> *'''Meningovascular:''' Meningitis together with inflammatory vasculitis leading to stroke syndrome <br /> **Subacute encephalitic prodrome of headaches, vertigo, insomnia, and psychological abnormalities<br /> *'''Parenchymal:''' Paresis, hyperactive reflexes, Argyll Robertson pupils, illusions/delusions/hallucinations, memory defects, speech changes. <br /> **Argyll Robertson pupil: small, irregular pupil that reacts to accommodation but not to light<br /> **Tabes dorsalis presents with a wide based gait ataxia, foot drop, paresthesias, bladder dysfunction, impotence, areflexia, loss of positional, deep pain and temperature sensations• Cardiovascular<br /> <br /> '''Cardiovascular'''<br /> *10-40 years after infection<br /> *Endarteritis obliterans of the vasa vasorum leads<br /> *Aortitis, aortic regurgitation, saccular aneurysm (usually ascending), coronary ostial stenosis<br /> <br /> '''Gumma'''<br /> *Commonly involves skin and skeletal system<br /> *Solitary lesions ranging from microscopic to several centimeters<br /> *Granulomatous inflammation with central area of necrosis due to endarteritis obliterans<br /> *Painless, indurate nodular or ulcerative lesions<br /> <br /> '''Congenital Syphilis'''<br /> *Transmission across the placenta may occur at any stage of pregnancy&lt;ref&gt;Rosenberg AA, Grover T. The Newborn Infant. In: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds. CURRENT Diagnosis &amp; Treatment: Pediatrics, 22e.New York, NY: McGraw-Hill; 2013.&lt;/ref&gt;<br /> *Treatment before the 16th week of pregnancy should prevent fetal damage<br /> *Treatment before the third trimester should treat the infected fetus<br /> *Most common clinical problem is a healthy-appearing baby with a positive serologic test<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> *[[Genital Herpes]]<br /> *[[Chancroid]]<br /> *[[Behcet’s Disease]]<br /> *[[Lymphogranuloma Venereum]] <br /> *[[Gonorrhea]]<br /> *[[Candidiasis]]<br /> *[[Chlamydia]]<br /> *[[Granuloma Inguinale]]<br /> *[[HIV]]<br /> *[[Bacteremia]]<br /> *[[Aortic Insufficiency]]<br /> *[[Dementia]]<br /> *[[Diabetic Retinopathy]]<br /> *[[Sepsis]]<br /> *[[Alopecia]]<br /> *[[Tuberculosis]]<br /> *Immunodeficiency<br /> *[[Rocky Mountain Spotted Fever]]<br /> *[[Myocarditis]]<br /> *[[Measles]]<br /> *[[Rubella]]<br /> *[[Meningitis]]<br /> *[[Tularemia]]<br /> *[[Lyme Disease]]<br /> <br /> ==Workup==<br /> '''Nontreponemal Tests:'''&lt;ref name=&quot;test&quot;&gt;Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.&lt;/ref&gt;<br /> *Rapid Plamsa Reagin (RPR)*<br /> **Faster and easier to perform<br /> *Venereal Disease Research Laboratory (VDRL)*<br /> **Standard for CSF examination<br /> *Toludine Red Unheated Serum Test (TRUST)<br /> <br /> '''Most commonly in the ED, the VDRL and RPR will be the ordered screening test'''<br /> <br /> '''Treponemal Test:'''&lt;ref name=&quot;test&quot;&gt;&lt;/ref&gt;<br /> *Fluorescent treponemal antibody absorption (FTA-ABS)<br /> *Microhemagglutination test for antibodies to Treponema pallidum (MHA-TP)<br /> *Treponemal pallidum particle agglutination assay (TP-PA)<br /> *Treponema pallidum enzyme immunoassay (TP-EIA)<br /> <br /> '''CSF'''<br /> *Pleocytosis (&gt;5 WBC/uL), increased protein (&gt;45 mg/dL) or VDRL reactivity<br /> *May be confounded by HIV infection&lt;ref&gt;Ghanem KG1, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Lumbar puncture in HIV-infected patients with syphilis and no neurologic symptoms. Clin. Infect Dis. 2009 Mar 15;48(6):816-21.&lt;/ref&gt; <br /> *CSF VDRL test is highly specific but is relatively insensitive. Further testing with treponemal antibodies may be necessary. <br /> <br /> '''HIV-infected patients'''<br /> *All newly diagnosed HIV patients should be tested for syphilis and vice versa<br /> *RPR titer and CD4 count can be used to identify patients at higher risk for neurosyphilis for lumbar puncture<br /> <br /> ==Management==<br /> Treatment is primary with penicillin with dosing and type of penicillin determined by the stage of disease&lt;ref&gt;Kaplan JE, Benson C, Holmes KH, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1–207&lt;/ref&gt; <br /> <br /> '''Treat those exposed within the past 3 months.'''<br /> <br /> ===Early Stage===<br /> This is classified as primary, secondary, and early latent syphilis less than one year.<br /> <br /> Treatment Options:<br /> <br /> {{Early Syphilis Treatment}}<br /> <br /> ===Late Stage===<br /> Late stage is greater than one year duration, presence of gummas, or cardiovascular disease<br /> <br /> Treatment Options:<br /> <br /> {{Late Syphilis Treatment}}<br /> ===Neurosyphilis===<br /> There are 3 Major options with none showing greater efficacy than others:<br /> <br /> {{Neurosyphilis Treatment }}<br /> <br /> *Desensitization to the penicillin allergy is still the preferred method of treatment for patients with early and late stage disease (especially during pregnancy)<br /> <br /> ===Pregnancy===<br /> *Penicillin, dosage depends on stage &lt;ref&gt;Mackay G. Chapter 43. Sexually Transmitted Diseases &amp; Pelvic Infections. In:DeCherney AH, Nathan L, Laufer N, Roman AS. eds. CURRENT Diagnosis &amp; Treatment: Obstetrics &amp; Gynecology, 11e. New York, NY: McGraw-Hill; 2013&lt;/ref&gt;<br /> <br /> ===Jarisch-Herxheimer Reaction===<br /> *Reaction to treatment consisting of fever, chills, myalgias, headache, tachycardia, increased respiratory rate, leukocytosis, vasodilation with mild hypotension<br /> *Usually resolves within 12-24 hours <br /> *Symptom based treatment<br /> <br /> ==Disposition==<br /> *Primary and late stage syphilis can be discharge however close follow up should be provided for each with primary care or health department<br /> *Neurosyphilis should be admitted <br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27562 2014-12-23T02:39:49Z

<p>Jmnelson86: </p> <hr /> <div>==Background==<br /> *Syphilis is caused by the spirochete Treponema pallidum. &lt;ref&gt;Lukehart SA. Chapter 169. Syphilis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.New York, NY: McGraw-Hill; 2012.&lt;/ref&gt;<br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ===Pathogenesis===<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation&lt;ref&gt;Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110. &lt;/ref&gt;<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> [[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumb|Primary syphalis on penile shaft]]<br /> ===Primary Syphilis===<br /> *Primary lesion appears after an incubation of 2-6 weeks<br /> **Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation <br /> **Minority of patients can have multiple lesions or atypical appearance<br /> **Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia <br /> **Heals in 4-6 weeks <br /> *Regional lymphadenopathy that is painless and firm<br /> ===Secondary Syphilis===<br /> *Characterized by generalized mucocutaneous lesions and lymphadenopathy but can also be found in other tissues&lt;ref&gt;Chapel TA. The signs and symptoms of secondary syphilis. Sex Transm Dis. 1980;7(4):161–164.1.&lt;/ref&gt;<br /> *Skin lesions are usually maculopapular, pale red or pink, non-pruritic, discrete, and distributed on the trunk and proximal extremities. They may be subtle.<br /> *They progress to more wide spread papular lesions that frequently involve the palms and soles.<br /> **Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks<br /> **Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients. &lt;ref&gt;Chesson HW, Heffelfinger JD, Voigt RF, Collins D. Estimates of primary and secondary syphilis rates in persons with HIV in the United States, 2002. Sex Transm Dis 2005; 32:265. &lt;/ref&gt;<br /> **In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata <br /> *CSF abnormalities are detected in as many as 40% during this stage. CNS involvement can be symptomatic or asymptomatic. <br /> *Constitutional symptoms may accompany or precede secondary syphilis. Can include: sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus<br /> *Less common complications include: hepatitis, nephropathy, gastritis, proctitis, rectosigmoid mass arthritis, periositis, optic neuritis, iritis, uveitis, pupillary abnormalities<br /> ===Latent Syphilis===<br /> *Detectable by serologic testing only<br /> *May intermittently be present in the bloodstream and transmitted through blood transfusion or organ donation<br /> *Spontaneous cure is rare<br /> ===Tertiary Syphilis===<br /> *Characterized by progressively destructive mucocutaneous, musculoskeletal, or parenchymal lesions, aortitis or CNS manifestations<br /> *The most common manifestation in the US today is neurosyphilis in HIV infected persons.<br /> *Historical manifestations: <br /> **Gumma: granulomatous lesion <br /> **Cardiovascular syphilis: involves the vasa vasorum of the ascending aorta and can result in aneurysm formation<br /> **Late symptomatic neurosyphilis: tabes dorsalis and paresis<br /> ===System Specific===<br /> '''CNS'''<br /> *Continuum of involvement from asymptomatic patient with CSF abnormalities to meningitis and focal neurologic deficits <br /> *RPR titers of ≥ 1:32 are at higher risk of having neurosyphilis, even higher if HIV infected.<br /> *Demonstrable in up to 25% of patients with latent infection and up to 40% of primary or secondary cases &lt;ref&gt;Lukehart SA. Chapter 169. Syphilis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.New York, NY: McGraw-Hill; 2012&lt;/ref&gt;<br /> **Patients with early syphilis who have CSF findings may need to be treated as with neurosyphilis, especially in the setting of HIV<br /> *'''Meningeal:'''Headache, nausea, vomiting, neck stiffness, cranial nerve involvement, seizures, changes in mental status, uveitis, iritis or hearing loss <br /> *'''Meningovascular:'''Meningitis together with inflammatory vasculitis leading to stroke syndrome <br /> **Subacute encephalitic prodrome of headaches, vertigo, insomnia, and psychological abnormalities<br /> *'''Parenchymal:'''Paresis, hyperactive reflexes, Argyll Robertson pupils, illusions/delusions/hallucinations, memory defects, speech changes. <br /> **Argyll Robertson pupil: small, irregular pupil that reacts to accommodation but not to light<br /> **Tabes dorsalis presents with a wide based gait ataxia, foot drop, paresthesias, bladder dysfunction, impotence, areflexia, loss of positional, deep pain and temperature sensations• Cardiovascular<br /> <br /> '''Cardiovascular'''<br /> *10-40 years after infection<br /> *Endarteritis obliterans of the vasa vasorum leads<br /> *Aortitis, aortic regurgitation, saccular aneurysm (usually ascending), coronary ostial stenosis<br /> <br /> '''Gumma'''<br /> *Commonly involves skin and skeletal system<br /> *Solitary lesions ranging from microscopic to several centimeters<br /> *Granulomatous inflammation with central area of necrosis due to endarteritis obliterans<br /> *Painless, indurate nodular or ulcerative lesions<br /> <br /> '''Congenital Syphilis'''<br /> *Transmission across the placenta may occur at any stage of pregnancy&lt;ref&gt;Rosenberg AA, Grover T. The Newborn Infant. In: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds. CURRENT Diagnosis &amp; Treatment: Pediatrics, 22e.New York, NY: McGraw-Hill; 2013.&lt;/ref&gt;<br /> *Treatment before the 16th week of pregnancy should prevent fetal damage<br /> *Treatment before the third trimester should treat the infected fetus<br /> *Most common clinical problem is a healthy-appearing baby with a positive serologic test<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> *[[Genital Herpes]]<br /> *[[Chancroid]]<br /> *[[Behcet’s Disease]]<br /> *[[Lymphogranuloma Venereum]] <br /> *[[Gonorrhea]]<br /> *[[Candidiasis]]<br /> *[[Chlamydia]]<br /> *[[Granuloma Inguinale]]<br /> *[[HIV]]<br /> *[[Bacteremia]]<br /> *[[Aortic Insufficiency]]<br /> *[[Dementia]]<br /> *[[Diabetic Retinopathy]]<br /> *[[Sepsis]]<br /> *[[Alopecia]]<br /> *[[Tuberculosis]]<br /> *Immunodeficiency<br /> *[[Rocky Mountain Spotted Fever]]<br /> *[[Myocarditis]]<br /> *[[Measles]]<br /> *[[Rubella]]<br /> *[[Meningitis]]<br /> *[[Tularemia]]<br /> *[[Lyme Disease]]<br /> <br /> ==Workup==<br /> '''Nontreponemal Tests:'''&lt;ref name=&quot;test&quot;&gt;Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.&lt;/ref&gt;<br /> *Rapid Plamsa Reagin (RPR)*<br /> **Faster and easier to perform<br /> *Venereal Disease Research Laboratory (VDRL)*<br /> **Standard for CSF examination<br /> *Toludine Red Unheated Serum Test (TRUST)<br /> <br /> '''Most commonly in the ED, the VDRL and RPR will be the ordered screening test'''<br /> <br /> '''Treponemal Test:'''&lt;ref name=&quot;test&quot;&gt;&lt;/ref&gt;<br /> *Fluorescent treponemal antibody absorption (FTA-ABS)<br /> *Microhemagglutination test for antibodies to Treponema pallidum (MHA-TP)<br /> *Treponemal pallidum particle agglutination assay (TP-PA)<br /> *Treponema pallidum enzyme immunoassay (TP-EIA)<br /> <br /> '''CSF'''<br /> *Pleocytosis (&gt;5 WBC/uL), increased protein (&gt;45 mg/dL) or VDRL reactivity<br /> *May be confounded by HIV infection&lt;ref&gt;Ghanem KG1, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Lumbar puncture in HIV-infected patients with syphilis and no neurologic symptoms. Clin. Infect Dis. 2009 Mar 15;48(6):816-21.&lt;/ref&gt; <br /> *CSF VDRL test is highly specific but is relatively insensitive. Further testing with treponemal antibodies may be necessary. <br /> <br /> '''HIV-infected patients'''<br /> *All newly diagnosed HIV patients should be tested for syphilis and vice versa<br /> *RPR titer and CD4 count can be used to identify patients at higher risk for neurosyphilis for lumbar puncture<br /> <br /> ==Management==<br /> Treatment is primary with penicillin with dosing and type of penicillin determined by the stage of disease&lt;ref&gt;Kaplan JE, Benson C, Holmes KH, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1–207&lt;/ref&gt; <br /> <br /> '''Treat those exposed within the past 3 months.'''<br /> <br /> ===Early Stage===<br /> This is classified as primary, secondary, and early latent syphilis less than one year.<br /> <br /> Treatment Options:<br /> <br /> {{Early Syphilis Treatment}}<br /> <br /> ===Late Stage===<br /> Late stage is greater than one year duration, presence of gummas, or cardiovascular disease<br /> <br /> Treatment Options:<br /> <br /> {{Late Syphilis Treatment}}<br /> ===Neurosyphilis===<br /> There are 3 Major options with none showing greater efficacy than others:<br /> <br /> {{Neurosyphilis Treatment }}<br /> <br /> *Desensitization to the penicillin allergy is still the preferred method of treatment for patients with early and late stage disease (especially during pregnancy)<br /> <br /> ===Pregnancy===<br /> *Penicillin, dosage depends on stage &lt;ref&gt;Mackay G. Chapter 43. Sexually Transmitted Diseases &amp; Pelvic Infections. In:DeCherney AH, Nathan L, Laufer N, Roman AS. eds. CURRENT Diagnosis &amp; Treatment: Obstetrics &amp; Gynecology, 11e. New York, NY: McGraw-Hill; 2013&lt;/ref&gt;<br /> <br /> ===Jarisch-Herxheimer Reaction===<br /> *Reaction to treatment consisting of fever, chills, myalgias, headache, tachycardia, increased respiratory rate, leukocytosis, vasodilation with mild hypotension<br /> *Usually resolves within 12-24 hours <br /> *Symptom based treatment<br /> <br /> ==Disposition==<br /> *Primary and late stage syphilis can be discharge however close follow up should be provided for each with primary care or health department<br /> *Neurosyphilis should be admitted <br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27561 2014-12-23T02:34:39Z

<p>Jmnelson86: </p> <hr /> <div>==Background==<br /> *Syphilis is caused by the spirochete Treponema pallidum. &lt;ref&gt;Lukehart SA. Chapter 169. Syphilis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.New York, NY: McGraw-Hill; 2012.&lt;/ref&gt;<br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ===Pathogenesis===<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation&lt;ref&gt;Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110. &lt;/ref&gt;<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> [[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumb|Primary syphalis on penile shaft]]<br /> ===Primary Syphilis===<br /> *Primary lesion appears after an incubation of 2-6 weeks<br /> **Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation <br /> **Minority of patients can have multiple lesions or atypical appearance<br /> **Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia <br /> **Heals in 4-6 weeks <br /> *Regional lymphadenopathy that is painless and firm<br /> ===Secondary Syphilis===<br /> *Characterized by generalized mucocutaneous lesions and lymphadenopathy but can also be found in other tissues&lt;ref&gt;Chapel TA. The signs and symptoms of secondary syphilis. Sex Transm Dis. 1980;7(4):161–164.1.&lt;/ref&gt;<br /> *Skin lesions are usually maculopapular, pale red or pink, non-pruritic, discrete, and distributed on the trunk and proximal extremities. They may be subtle.<br /> *They progress to more wide spread papular lesions that frequently involve the palms and soles.<br /> **Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks<br /> **Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients. &lt;ref&gt;Chesson HW, Heffelfinger JD, Voigt RF, Collins D. Estimates of primary and secondary syphilis rates in persons with HIV in the United States, 2002. Sex Transm Dis 2005; 32:265. &lt;/ref&gt;<br /> **In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata <br /> *CSF abnormalities are detected in as many as 40% during this stage. CNS involvement can be symptomatic or asymptomatic. <br /> *Constitutional symptoms may accompany or precede secondary syphilis. Can include: sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus<br /> *Less common complications include: hepatitis, nephropathy, gastritis, proctitis, rectosigmoid mass arthritis, periositis, optic neuritis, iritis, uveitis, pupillary abnormalities<br /> ===Latent Syphilis===<br /> *Detectable by serologic testing only<br /> *May intermittently be present in the bloodstream and transmitted through blood transfusion or organ donation<br /> *Spontaneous cure is rare<br /> ===Tertiary Syphilis===<br /> *Characterized by progressively destructive mucocutaneous, musculoskeletal, or parenchymal lesions, aortitis or CNS manifestations<br /> *The most common manifestation in the US today is neurosyphilis in HIV infected persons.<br /> *Historical manifestations: <br /> **Gumma: granulomatous lesion <br /> **Cardiovascular syphilis: involves the vasa vasorum of the ascending aorta and can result in aneurysm formation<br /> **Late symptomatic neurosyphilis: tabes dorsalis and paresis<br /> ===System Specific===<br /> '''CNS'''<br /> Continuum of involvement from asymptomatic patient with CSF abnormalities to meningitis and focal neurologic deficits <br /> *RPR titers of ≥ 1:32 are at higher risk of having neurosyphilis, even higher if HIV infected.<br /> *Demonstrable in up to 25% of patients with latent infection and up to 40% of primary or secondary cases &lt;ref&gt;Lukehart SA. Chapter 169. Syphilis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.New York, NY: McGraw-Hill; 2012&lt;/ref&gt;<br /> **Patients with early syphilis who have CSF findings may need to be treated as with neurosyphilis, especially in the setting of HIV<br /> *'''Meningeal:'''<br /> **Headache, nausea, vomiting, neck stiffness, cranial nerve involvement, seizures, changes in mental status, uveitis, iritis or hearing loss <br /> *'''Meningovascular:'''Meningitis together with inflammatory vasculitis leading to stroke syndrome <br /> **Subacute encephalitic prodrome of headaches, vertigo, insomnia, and psychological abnormalities<br /> *'''Parenchymal:'''Paresis, hyperactive reflexes, Argyll Robertson pupils, illusions/delusions/hallucinations, memory defects, speech changes. <br /> **Argyll Robertson pupil: small, irregular pupil that reacts to accommodation but not to light<br /> **Tabes dorsalis presents with a wide based gait ataxia, foot drop, paresthesias, bladder dysfunction, impotence, areflexia, loss of positional, deep pain and temperature sensations<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> *[[Genital Herpes]]<br /> *[[Chancroid]]<br /> *[[Behcet’s Disease]]<br /> *[[Lymphogranuloma Venereum]] <br /> *[[Gonorrhea]]<br /> *[[Candidiasis]]<br /> *[[Chlamydia]]<br /> *[[Granuloma Inguinale]]<br /> *[[HIV]]<br /> *[[Bacteremia]]<br /> *[[Aortic Insufficiency]]<br /> *[[Dementia]]<br /> *[[Diabetic Retinopathy]]<br /> *[[Sepsis]]<br /> *[[Alopecia]]<br /> *[[Tuberculosis]]<br /> *Immunodeficiency<br /> *[[Rocky Mountain Spotted Fever]]<br /> *[[Myocarditis]]<br /> *[[Measles]]<br /> *[[Rubella]]<br /> *[[Meningitis]]<br /> *[[Tularemia]]<br /> *[[Lyme Disease]]<br /> <br /> ==Workup==<br /> '''Nontreponemal Tests:'''&lt;ref name=&quot;test&quot;&gt;Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.&lt;/ref&gt;<br /> *Rapid Plamsa Reagin (RPR)*<br /> **Faster and easier to perform<br /> *Venereal Disease Research Laboratory (VDRL)*<br /> **Standard for CSF examination<br /> *Toludine Red Unheated Serum Test (TRUST)<br /> <br /> '''Most commonly in the ED, the VDRL and RPR will be the ordered screening test'''<br /> <br /> '''Treponemal Test:'''&lt;ref name=&quot;test&quot;&gt;&lt;/ref&gt;<br /> *Fluorescent treponemal antibody absorption (FTA-ABS)<br /> *Microhemagglutination test for antibodies to Treponema pallidum (MHA-TP)<br /> *Treponemal pallidum particle agglutination assay (TP-PA)<br /> *Treponema pallidum enzyme immunoassay (TP-EIA)<br /> <br /> '''CSF'''<br /> *Pleocytosis (&gt;5 WBC/uL), increased protein (&gt;45 mg/dL) or VDRL reactivity<br /> *May be confounded by HIV infection&lt;ref&gt;Ghanem KG1, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Lumbar puncture in HIV-infected patients with syphilis and no neurologic symptoms. Clin. Infect Dis. 2009 Mar 15;48(6):816-21.&lt;/ref&gt; <br /> *CSF VDRL test is highly specific but is relatively insensitive. Further testing with treponemal antibodies may be necessary. <br /> <br /> '''HIV-infected patients'''<br /> *All newly diagnosed HIV patients should be tested for syphilis and vice versa<br /> *RPR titer and CD4 count can be used to identify patients at higher risk for neurosyphilis for lumbar puncture<br /> <br /> ==Management==<br /> Treatment is primary with penicillin with dosing and type of penicillin determined by the stage of disease&lt;ref&gt;Kaplan JE, Benson C, Holmes KH, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1–207&lt;/ref&gt; <br /> <br /> '''Treat those exposed within the past 3 months.'''<br /> <br /> ===Early Stage===<br /> This is classified as primary, secondary, and early latent syphilis less than one year.<br /> <br /> Treatment Options:<br /> <br /> {{Early Syphilis Treatment}}<br /> <br /> ===Late Stage===<br /> Late stage is greater than one year duration, presence of gummas, or cardiovascular disease<br /> <br /> Treatment Options:<br /> <br /> {{Late Syphilis Treatment}}<br /> ===Neurosyphilis===<br /> There are 3 Major options with none showing greater efficacy than others:<br /> <br /> {{Neurosyphilis Treatment }}<br /> <br /> *Desensitization to the penicillin allergy is still the preferred method of treatment for patients with early and late stage disease (especially during pregnancy)<br /> <br /> ===Pregnancy===<br /> *Penicillin, dosage depends on stage &lt;ref&gt;Mackay G. Chapter 43. Sexually Transmitted Diseases &amp; Pelvic Infections. In:DeCherney AH, Nathan L, Laufer N, Roman AS. eds. CURRENT Diagnosis &amp; Treatment: Obstetrics &amp; Gynecology, 11e. New York, NY: McGraw-Hill; 2013&lt;/ref&gt;<br /> <br /> ===Jarisch-Herxheimer Reaction===<br /> *Reaction to treatment consisting of fever, chills, myalgias, headache, tachycardia, increased respiratory rate, leukocytosis, vasodilation with mild hypotension<br /> *Usually resolves within 12-24 hours <br /> *Symptom based treatment<br /> <br /> ==Disposition==<br /> *Primary and late stage syphilis can be discharge however close follow up should be provided for each with primary care or health department<br /> *Neurosyphilis should be admitted <br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27560 2014-12-23T02:25:34Z

<p>Jmnelson86: </p> <hr /> <div>==Background==<br /> *Syphilis is caused by the spirochete Treponema pallidum. &lt;ref&gt;Lukehart SA. Chapter 169. Syphilis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.New York, NY: McGraw-Hill; 2012.&lt;/ref&gt;<br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ===Pathogenesis===<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation&lt;ref&gt;Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110. &lt;/ref&gt;<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> [[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumb|Primary syphalis on penile shaft]]<br /> ===Primary Syphilis===<br /> *Primary lesion appears after an incubation of 2-6 weeks<br /> **Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation <br /> **Minority of patients can have multiple lesions or atypical appearance<br /> **Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia <br /> **Heals in 4-6 weeks <br /> *Regional lymphadenopathy that is painless and firm<br /> ===Secondary Syphilis===<br /> *Characterized by generalized mucocutaneous lesions and lymphadenopathy but can also be found in other tissues&lt;ref&gt;Chapel TA. The signs and symptoms of secondary syphilis. Sex Transm Dis. 1980;7(4):161–164.1.&lt;/ref&gt;<br /> *Skin lesions are usually maculopapular, pale red or pink, non-pruritic, discrete, and distributed on the trunk and proximal extremities. They may be subtle.<br /> *They progress to more wide spread papular lesions that frequently involve the palms and soles.<br /> **Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks<br /> **Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients. &lt;ref&gt;Chesson HW, Heffelfinger JD, Voigt RF, Collins D. Estimates of primary and secondary syphilis rates in persons with HIV in the United States, 2002. Sex Transm Dis 2005; 32:265. &lt;/ref&gt;<br /> **In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata <br /> *CSF abnormalities are detected in as many as 40% during this stage. CNS involvement can be symptomatic or asymptomatic. <br /> *Constitutional symptoms may accompany or precede secondary syphilis. Can include: sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus<br /> *Less common complications include: hepatitis, nephropathy, gastritis, proctitis, rectosigmoid mass arthritis, periositis, optic neuritis, iritis, uveitis, pupillary abnormalities<br /> ===Latent Syphilis===<br /> *Detectable by serologic testing only<br /> *May intermittently be present in the bloodstream and transmitted through blood transfusion or organ donation<br /> *Spontaneous cure is rare<br /> ===Tertiary Syphilis===<br /> *Characterized by progressively destructive mucocutaneous, musculoskeletal, or parenchymal lesions, aortitis or CNS manifestations<br /> *The most common manifestation in the US today is neurosyphilis in HIV infected persons.<br /> *Historical manifestations: <br /> **Gumma: granulomatous lesion <br /> **Cardiovascular syphilis: involves the vasa vasorum of the ascending aorta and can result in aneurysm formation<br /> **Late symptomatic neurosyphilis: tabes dorsalis and paresis<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> *[[Genital Herpes]]<br /> *[[Chancroid]]<br /> *[[Behcet’s Disease]]<br /> *[[Lymphogranuloma Venereum]] <br /> *[[Gonorrhea]]<br /> *[[Candidiasis]]<br /> *[[Chlamydia]]<br /> *[[Granuloma Inguinale]]<br /> *[[HIV]]<br /> *[[Bacteremia]]<br /> *[[Aortic Insufficiency]]<br /> *[[Dementia]]<br /> *[[Diabetic Retinopathy]]<br /> *[[Sepsis]]<br /> *[[Alopecia]]<br /> *[[Tuberculosis]]<br /> *Immunodeficiency<br /> *[[Rocky Mountain Spotted Fever]]<br /> *[[Myocarditis]]<br /> *[[Measles]]<br /> *[[Rubella]]<br /> *[[Meningitis]]<br /> *[[Tularemia]]<br /> *[[Lyme Disease]]<br /> <br /> ==Workup==<br /> '''Nontreponemal Tests:'''&lt;ref name=&quot;test&quot;&gt;Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.&lt;/ref&gt;<br /> *Rapid Plamsa Reagin (RPR)*<br /> **Faster and easier to perform<br /> *Venereal Disease Research Laboratory (VDRL)*<br /> **Standard for CSF examination<br /> *Toludine Red Unheated Serum Test (TRUST)<br /> <br /> '''Most commonly in the ED, the VDRL and RPR will be the ordered screening test'''<br /> <br /> '''Treponemal Test:'''&lt;ref name=&quot;test&quot;&gt;&lt;/ref&gt;<br /> *Fluorescent treponemal antibody absorption (FTA-ABS)<br /> *Microhemagglutination test for antibodies to Treponema pallidum (MHA-TP)<br /> *Treponemal pallidum particle agglutination assay (TP-PA)<br /> *Treponema pallidum enzyme immunoassay (TP-EIA)<br /> <br /> '''CSF'''<br /> *Pleocytosis (&gt;5 WBC/uL), increased protein (&gt;45 mg/dL) or VDRL reactivity<br /> *May be confounded by HIV infection&lt;ref&gt;Ghanem KG1, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Lumbar puncture in HIV-infected patients with syphilis and no neurologic symptoms. Clin. Infect Dis. 2009 Mar 15;48(6):816-21.&lt;/ref&gt; <br /> *CSF VDRL test is highly specific but is relatively insensitive. Further testing with treponemal antibodies may be necessary. <br /> <br /> '''HIV-infected patients'''<br /> *All newly diagnosed HIV patients should be tested for syphilis and vice versa<br /> *RPR titer and CD4 count can be used to identify patients at higher risk for neurosyphilis for lumbar puncture<br /> <br /> ==Management==<br /> Treatment is primary with penicillin with dosing and type of penicillin determined by the stage of disease&lt;ref&gt;Kaplan JE, Benson C, Holmes KH, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1–207&lt;/ref&gt; <br /> <br /> '''Treat those exposed within the past 3 months.'''<br /> <br /> ===Early Stage===<br /> This is classified as primary, secondary, and early latent syphilis less than one year.<br /> <br /> Treatment Options:<br /> <br /> {{Early Syphilis Treatment}}<br /> <br /> ===Late Stage===<br /> Late stage is greater than one year duration, presence of gummas, or cardiovascular disease<br /> <br /> Treatment Options:<br /> <br /> {{Late Syphilis Treatment}}<br /> ===Neurosyphilis===<br /> There are 3 Major options with none showing greater efficacy than others:<br /> <br /> {{Neurosyphilis Treatment }}<br /> <br /> *Desensitization to the penicillin allergy is still the preferred method of treatment for patients with early and late stage disease (especially during pregnancy)<br /> <br /> ===Pregnancy===<br /> *Penicillin, dosage depends on stage &lt;ref&gt;Mackay G. Chapter 43. Sexually Transmitted Diseases &amp; Pelvic Infections. In:DeCherney AH, Nathan L, Laufer N, Roman AS. eds. CURRENT Diagnosis &amp; Treatment: Obstetrics &amp; Gynecology, 11e. New York, NY: McGraw-Hill; 2013&lt;/ref&gt;<br /> <br /> ===Jarisch-Herxheimer Reaction===<br /> *Reaction to treatment consisting of fever, chills, myalgias, headache, tachycardia, increased respiratory rate, leukocytosis, vasodilation with mild hypotension<br /> *Usually resolves within 12-24 hours <br /> *Symptom based treatment<br /> <br /> ==Disposition==<br /> *Primary and late stage syphilis can be discharge however close follow up should be provided for each with primary care or health department<br /> *Neurosyphilis should be admitted <br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27559 2014-12-23T02:03:49Z

<p>Jmnelson86: </p> <hr /> <div>==Background==<br /> *Syphilis is caused by the spirochete Treponema pallidum. <br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ===Pathogenesis===<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation&lt;ref&gt;Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110. &lt;/ref&gt;<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> [[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumb|Primary syphalis on penile shaft]]<br /> ===Primary Syphilis===<br /> *Primary lesion appears after an incubation of 2-6 weeks<br /> **Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation <br /> **Minority of patients can have multiple lesions or atypical appearance<br /> **Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia <br /> **Heals in 4-6 weeks <br /> *Regional lymphadenopathy that is painless and firm<br /> ===Secondary Syphilis===<br /> *Characterized by generalized mucocutaneous lesions and lymphadenopathy but can also be found in other tissues&lt;ref&gt;Chapel TA. The signs and symptoms of secondary syphilis. Sex Transm Dis. 1980;7(4):161–164.1.&lt;/ref&gt;<br /> *Skin lesions are usually maculopapular, pale red or pink, non-pruritic, discrete, and distributed on the trunk and proximal extremities. They may be subtle.<br /> *They progress to more wide spread papular lesions that frequently involve the palms and soles.<br /> **Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks<br /> **Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients. &lt;ref&gt;Chesson HW, Heffelfinger JD, Voigt RF, Collins D. Estimates of primary and secondary syphilis rates in persons with HIV in the United States, 2002. Sex Transm Dis 2005; 32:265. &lt;/ref&gt;<br /> **In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata <br /> *CSF abnormalities are detected in as many as 40% during this stage. CNS involvement can be symptomatic or asymptomatic. <br /> *Constitutional symptoms may accompany or precede secondary syphilis. Can include: sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus<br /> *Less common complications include: hepatitis, nephropathy, gastritis, proctitis, rectosigmoid mass arthritis, periositis, optic neuritis, iritis, uveitis, pupillary abnormalities<br /> ===Latent Syphilis===<br /> *Detectable by serologic testing only<br /> *May intermittently be present in the bloodstream and transmitted through blood transfusion or organ donation<br /> *Spontaneous cure is rare<br /> ===Tertiary Syphilis===<br /> *Characterized by progressively destructive mucocutaneous, musculoskeletal, or parenchymal lesions, aortitis or CNS manifestations<br /> *The most common manifestation in the US today is neurosyphilis in HIV infected persons.<br /> *Historical manifestations: <br /> **Gumma: granulomatous lesion <br /> **Cardiovascular syphilis: involves the vasa vasorum of the ascending aorta and can result in aneurysm formation<br /> **Late symptomatic neurosyphilis: tabes dorsalis and paresis<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> *[[Genital Herpes]]<br /> *[[Chancroid]]<br /> *[[Behcet’s Disease]]<br /> *[[Lymphogranuloma Venereum]] <br /> *[[Gonorrhea]]<br /> *[[Candidiasis]]<br /> *[[Chlamydia]]<br /> *[[Granuloma Inguinale]]<br /> *[[HIV]]<br /> *[[Bacteremia]]<br /> *[[Aortic Insufficiency]]<br /> *[[Dementia]]<br /> *[[Diabetic Retinopathy]]<br /> *[[Sepsis]]<br /> *[[Alopecia]]<br /> *[[Tuberculosis]]<br /> *Immunodeficiency<br /> *[[Rocky Mountain Spotted Fever]]<br /> *[[Myocarditis]]<br /> *[[Measles]]<br /> *[[Rubella]]<br /> *[[Meningitis]]<br /> *[[Tularemia]]<br /> *[[Lyme Disease]]<br /> <br /> ==Workup==<br /> '''Nontreponemal Tests:'''&lt;ref name=&quot;test&quot;&gt;Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.&lt;/ref&gt;<br /> *Rapid Plamsa Reagin (RPR)*<br /> **Faster and easier to perform<br /> *Venereal Disease Research Laboratory (VDRL)*<br /> **Standard for CSF examination<br /> *Toludine Red Unheated Serum Test (TRUST)<br /> <br /> '''Most commonly in the ED, the VDRL and RPR will be the ordered screening test'''<br /> <br /> '''Treponemal Test:'''&lt;ref name=&quot;test&quot;&gt;&lt;/ref&gt;<br /> *Fluorescent treponemal antibody absorption (FTA-ABS)<br /> *Microhemagglutination test for antibodies to Treponema pallidum (MHA-TP)<br /> *Treponemal pallidum particle agglutination assay (TP-PA)<br /> *Treponema pallidum enzyme immunoassay (TP-EIA)<br /> <br /> '''CSF'''<br /> *Pleocytosis (&gt;5 WBC/uL), increased protein (&gt;45 mg/dL) or VDRL reactivity<br /> *May be confounded by HIV infection<br /> *CSF VDRL test is highly specific but is relatively insensitive. Further testing with treponemal antibodies may be necessary. <br /> <br /> '''HIV-infected patients'''<br /> *All newly diagnosed HIV patients should be tested for syphilis and vice versa<br /> *RPR titer and CD4 count can be used to identify patients at higher risk for neurosyphilis for lumbar puncture<br /> <br /> ==Management==<br /> Treatment is primary with penicillin with dosing and type of penicillin determined by the stage of disease&lt;ref&gt;Kaplan JE, Benson C, Holmes KH, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1–207&lt;/ref&gt; Treatment requires antimicrobial therapy. Advanced stages require a prolonged course due to the slow growth time of T. pallidum.<br /> <br /> ===Early Stage===<br /> This is classified as primary, secondary, and early latent syphilis less than one year.<br /> <br /> Treatment Options:<br /> <br /> {{Early Syphilis Treatment}}<br /> <br /> ===Late Stage===<br /> Late stage is greater than one year duration, presence of gummas, or cardiovascular disease<br /> <br /> Treatment Options:<br /> <br /> {{Late Syphilis Treatment}}<br /> ===Neurosyphilis===<br /> There are 3 Major options with none showing greater efficacy than others:<br /> <br /> {{Neurosyphilis Treatment }}<br /> <br /> *Desensitization to the penicillin allergy is still the preferred method of treatment for patients with early and late stage disease (especially during pregnancy)<br /> <br /> ==Disposition==<br /> *Primary and late stage syphilis can be discharge however close followup should be provided for each<br /> *Neurosyphilis should be admitted<br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27558 2014-12-23T01:58:22Z

<p>Jmnelson86: </p> <hr /> <div>==Background==<br /> *Syphilis is caused by the spirochete Treponema pallidum. <br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ===Pathogenesis===<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation&lt;ref&gt;Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110. &lt;/ref&gt;<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> [[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumb|Primary syphalis on penile shaft]]<br /> ===Primary Syphilis===<br /> *Primary lesion appears after an incubation of 2-6 weeks<br /> **Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation <br /> **Minority of patients can have multiple lesions or atypical appearance<br /> **Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia <br /> **Heals in 4-6 weeks <br /> *Regional lymphadenopathy that is painless and firm<br /> ===Secondary Syphilis===<br /> *Characterized by generalized mucocutaneous lesions and lymphadenopathy but can also be found in other tissues&lt;ref&gt;Chapel TA. The signs and symptoms of secondary syphilis. Sex Transm Dis. 1980;7(4):161–164.1.&lt;/ref&gt;<br /> *Skin lesions are usually maculopapular, pale red or pink, non-pruritic, discrete, and distributed on the trunk and proximal extremities. They may be subtle.<br /> *They progress to more wide spread papular lesions that frequently involve the palms and soles.<br /> **Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks<br /> **Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients. &lt;ref&gt;Chesson HW, Heffelfinger JD, Voigt RF, Collins D. Estimates of primary and secondary syphilis rates in persons with HIV in the United States, 2002. Sex Transm Dis 2005; 32:265. &lt;/ref&gt;<br /> **In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata <br /> *CSF abnormalities are detected in as many as 40% during this stage. CNS involvement can be symptomatic or asymptomatic. <br /> *Constitutional symptoms may accompany or precede secondary syphilis. Can include: sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus<br /> *Less common complications include: hepatitis, nephropathy, gastritis, proctitis, rectosigmoid mass arthritis, periositis, optic neuritis, iritis, uveitis, pupillary abnormalities<br /> ===Latent Syphilis===<br /> *Detectable by serologic testing only<br /> *May intermittently be present in the bloodstream and transmitted through blood transfusion or organ donation<br /> *Spontaneous cure is rare<br /> ===Tertiary Syphilis===<br /> *Characterized by progressively destructive mucocutaneous, musculoskeletal, or parenchymal lesions, aortitis or CNS manifestations<br /> *The most common manifestation in the US today is neurosyphilis in HIV infected persons.<br /> *Historical manifestations: <br /> **Gumma: granulomatous lesion <br /> **Cardiovascular syphilis: involves the vasa vasorum of the ascending aorta and can result in aneurysm formation<br /> **Late symptomatic neurosyphilis: tabes dorsalis and paresis<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> *[[Genital Herpes]]<br /> *[[Chancroid]]<br /> *[[Behcet’s Disease]]<br /> *[[Lymphogranuloma Venereum]] <br /> *[[Gonorrhea]]<br /> *[[Candidiasis]]<br /> *[[Chlamydia]]<br /> *[[Granuloma Inguinale]]<br /> *[[HIV]]<br /> *[[Bacteremia]]<br /> *[[Aortic Insufficiency]]<br /> *[[Dementia]]<br /> *[[Diabetic Retinopathy]]<br /> *[[Sepsis]]<br /> *[[Alopecia]]<br /> *[[Tuberculosis]]<br /> *Immunodeficiency<br /> *[[Rocky Mountain Spotted Fever]]<br /> *[[Myocarditis]]<br /> *[[Measles]]<br /> *[[Rubella]]<br /> *[[Meningitis]]<br /> *[[Tularemia]]<br /> *[[Lyme Disease]]<br /> <br /> ==Workup==<br /> There are nontreponemal and treponemal tests. The major difference is that the treponemal test measures the antibody directed against the treponemal antigens and are more specific however often more expensive and less available. Definitive diagnosis is darkfield microscopy.<br /> <br /> '''Nontreponemal Tests:'''&lt;ref name=&quot;test&quot;&gt;Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 1995;8(1):1–21.&lt;/ref&gt;<br /> *Venereal Disease Research Laboratory (VDRL)*<br /> *Rapid Plamsa Reagin (RPR)*<br /> *Toludine Red Unheated Serum Test (TRUST)<br /> <br /> '''Most commonly in the ED, the VDRL and RPR will be the ordered screening test'''<br /> <br /> '''Treponemal Test:'''&lt;ref name=&quot;test&quot;&gt;&lt;/ref&gt;<br /> *Fluorescent treponemal antibody absorption (FTA-ABS)<br /> *Microhemagglutination test for antibodies to Treponema pallidum (MHA-TP)<br /> *Treponemal pallidum particle agglutination assay (TP-PA)<br /> *Treponema pallidum enzyme immunoassay (TP-EIA)<br /> <br /> ==Management==<br /> Treatment is primary with penicillin with dosing and type of penicillin determined by the stage of disease&lt;ref&gt;Kaplan JE, Benson C, Holmes KH, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1–207&lt;/ref&gt; Treatment requires antimicrobial therapy. Advanced stages require a prolonged course due to the slow growth time of T. pallidum.<br /> <br /> ===Early Stage===<br /> This is classified as primary, secondary, and early latent syphilis less than one year.<br /> <br /> Treatment Options:<br /> <br /> {{Early Syphilis Treatment}}<br /> <br /> ===Late Stage===<br /> Late stage is greater than one year duration, presence of gummas, or cardiovascular disease<br /> <br /> Treatment Options:<br /> <br /> {{Late Syphilis Treatment}}<br /> ===Neurosyphilis===<br /> There are 3 Major options with none showing greater efficacy than others:<br /> <br /> {{Neurosyphilis Treatment }}<br /> <br /> *Desensitization to the penicillin allergy is still the preferred method of treatment for patients with early and late stage disease (especially during pregnancy)<br /> <br /> ==Disposition==<br /> *Primary and late stage syphilis can be discharge however close followup should be provided for each<br /> *Neurosyphilis should be admitted<br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27460 2014-12-22T15:19:42Z

<p>Jmnelson86: </p> <hr /> <div>==Background==<br /> *Syphilis is caused by the spirochete Treponema pallidum. <br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ==Pathogenesis==<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> ===Primary Syphilis===<br /> *Primary lesion appears after an incubation of 2-6 weeks<br /> **Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation <br /> **Minority of patients can have multiple lesions or atypical appearance<br /> **Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia <br /> **Heals in 4-6 weeks <br /> *Regional lymphadenopathy that is painless and firm<br /> ===Secondary Syphilis===<br /> *Characterized by generalized mucocutaneous lesions and lymphadenopathy but can also be found in other tissues<br /> *Skin lesions are usually maculopapular, pale red or pink, non-pruritic, discrete, and distributed on the trunk and proximal extremities. They may be subtle.<br /> *They progress to more wide spread papular lesions that frequently involve the palms and soles.<br /> **Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks<br /> **Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients. <br /> **In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata <br /> *CSF abnormalities are detected in as many as 40% during this stage. CNS involvement can be symptomatic or asymptomatic. <br /> *Constitutional symptoms may accompany or precede secondary syphilis. Can include: sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus<br /> *Less common complications include: hepatitis, nephropathy, gastritis, proctitis, rectosigmoid mass arthritis, periositis, optic neuritis, iritis, uveitis, pupillary abnormalities<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> <br /> ==Workup==<br /> <br /> ==Management==<br /> *Benzathine penicillin G 2.4 million units IM x 1 (for primary or secondary infection) <br /> <br /> ==Disposition==<br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> *Emedicine<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27459 2014-12-22T15:18:33Z

<p>Jmnelson86: </p> <hr /> <div>==Background==<br /> *Syphilis is caused by the spirochete Treponema pallidum. <br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ==Pathogenesis==<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> ===Primary Syphilis===<br /> *Primary lesion appears after an incubation of 2-6 weeks<br /> **Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation <br /> **Minority of patients can have multiple lesions or atypical appearance<br /> **Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia <br /> **Heals in 4-6 weeks <br /> *Regional lymphadenopathy that is painless and firm<br /> ===Secondary Syphilis===<br /> *Characterized by generalized mucocutaneous lesions and generalized lymphadenopathy but can also be found in many tissues such as the CNS and aqueous humor <br /> *Skin lesions are usually maculopapular, pale red or pink, non-pruritic, discrete, and distributed on the trunk and proximal extremities. They may be subtle.<br /> *They progress to more wide spread papular lesions that frequently involve the palms and soles.<br /> **Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks<br /> **Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients. <br /> **In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata <br /> *CSF abnormalities are detected in as many as 40% during this stage. CNS involvement can be symptomatic or asymptomatic. <br /> *Constitutional symptoms may accompany or precede secondary syphilis. Can include: sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus<br /> *Less common complications include: hepatitis, nephropathy, gastritis, proctitis, rectosigmoid mass arthritis, periositis, optic neuritis, iritis, uveitis, pupillary abnormalities<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> <br /> ==Workup==<br /> <br /> ==Management==<br /> *Benzathine penicillin G 2.4 million units IM x 1 (for primary or secondary infection) <br /> <br /> ==Disposition==<br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> *Emedicine<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27457 2014-12-22T15:06:46Z

<p>Jmnelson86: </p> <hr /> <div>==Background==<br /> *Syphilis is caused by the spirochete Treponema pallidum. <br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ==Pathogenesis==<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> [[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumbnail|Chancres on the penile shaft due to a primary syphilitic infection]<br /> ===Primary Syphilis===<br /> *Primary lesion appears after an incubation of 2-6 weeks<br /> **Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation <br /> **Minority of patients can have multiple lesions or atypical appearance<br /> **Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia <br /> **Heals in 4-6 weeks <br /> *Regional lymphadenopathy that is painless and firm<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> <br /> ==Workup==<br /> <br /> ==Management==<br /> *Benzathine penicillin G 2.4 million units IM x 1 (for primary or secondary infection) <br /> <br /> ==Disposition==<br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> *Emedicine<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27456 2014-12-22T15:06:10Z

<p>Jmnelson86: </p> <hr /> <div>==Background==<br /> *Syphilis is caused by the spirochete Treponema pallidum. <br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ==Pathogenesis==<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> [[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumbnail|Chancres on the penile shaft due to a primary syphilitic infection]<br /> =Primary Syphilis=<br /> *Primary lesion appears after an incubation of 2-6 weeks<br /> **Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation <br /> **Minority of patients can have multiple lesions or atypical appearance<br /> **Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia <br /> **Heals in 4-6 weeks <br /> *Regional lymphadenopathy that is painless and firm<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> <br /> ==Workup==<br /> <br /> ==Management==<br /> *Benzathine penicillin G 2.4 million units IM x 1 (for primary or secondary infection) <br /> <br /> ==Disposition==<br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> *Emedicine<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27455 2014-12-22T15:05:19Z

<p>Jmnelson86: </p> <hr /> <div>==Background==<br /> *Syphilis is caused by the spirochete Treponema pallidum. <br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ==Pathogenesis==<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> [[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumbnail|Chancres on the penile shaft due to a primary syphilitic infection]<br /> =Primary Syphilis=<br /> *Primary lesion appears after an incubation of 2-6 weeks<br /> *Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation <br /> **Minority of patients can have multiple lesions or atypical appearance<br /> **Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia <br /> **Heals in 4-6 weeks but ranges from 2-12<br /> *Regional lymphadenopathy that is painless and firm<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> <br /> ==Workup==<br /> <br /> ==Management==<br /> *Benzathine penicillin G 2.4 million units IM x 1 (for primary or secondary infection) <br /> <br /> ==Disposition==<br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> *Emedicine<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27454 2014-12-22T15:03:04Z

<p>Jmnelson86: </p> <hr /> <div>==Background==<br /> *Syphilis is caused by the spirochete Treponema pallidum. <br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ==Pathogenesis==<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> [[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumbnail|Chancres on the penile shaft due to a primary syphilitic infection]]<br /> *single '''nonpainful''' lesion with punched out base and rolled edges <br /> **lesion is highly infectious<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> <br /> ==Workup==<br /> <br /> ==Management==<br /> *Benzathine penicillin G 2.4 million units IM x 1 (for primary or secondary infection) <br /> <br /> ==Disposition==<br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> *Emedicine<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27453 2014-12-22T15:01:37Z

<p>Jmnelson86: </p> <hr /> <div>==Etiology==<br /> *Syphilis is caused by the spirochete Treponema pallidum. <br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> <br /> ==Epidemiology==<br /> *There are an estimated 12 million new infections annually worldwide.<br /> **The most affected regions include Saharan Africa, South America, China and Southeast Asia. <br /> *Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection<br /> <br /> ==Pathogenesis==<br /> *Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions. <br /> *Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation<br /> *Blood from a patient with incubating or early syphilis is infectious.<br /> *Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary<br /> <br /> ==Clinical Features==<br /> [[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumbnail|Chancres on the penile shaft due to a primary syphilitic infection]]<br /> *single '''nonpainful''' lesion with punched out base and rolled edges <br /> **lesion is highly infectious<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> <br /> ==Workup==<br /> <br /> ==Management==<br /> *Benzathine penicillin G 2.4 million units IM x 1 (for primary or secondary infection) <br /> <br /> ==Disposition==<br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> *Emedicine<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Syphilis&diff=27452 2014-12-22T14:57:23Z

<p>Jmnelson86: </p> <hr /> <div>==Etiology==<br /> *Syphilis is caused by the spirochete Treponema pallidum. <br /> *Usually sexually transmitted<br /> *Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency<br /> <br /> ==Clinical Features==<br /> [[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumbnail|Chancres on the penile shaft due to a primary syphilitic infection]]<br /> *single '''nonpainful''' lesion with punched out base and rolled edges <br /> **lesion is highly infectious<br /> <br /> ==Differential Diagnosis==<br /> *[[Ulcerative STDs]]<br /> *[[Proctitis]]<br /> <br /> ==Workup==<br /> <br /> ==Management==<br /> *Benzathine penicillin G 2.4 million units IM x 1 (for primary or secondary infection) <br /> <br /> ==Disposition==<br /> <br /> ==See Also==<br /> *[[Ulcerative STDs]]<br /> <br /> ==Source==<br /> *Emedicine<br /> &lt;references/&gt;<br /> [[Category:Derm]]<br /> [[Category:GU]]<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Histoplasmosis&diff=27119 2014-12-12T00:10:55Z

<p>Jmnelson86: additions to original article</p> <hr /> <div>==Background==<br /> [[File:Histo-xray.png|thumb|Histoplasmosis after return from Pennsylvania, United States]]<br /> *Fungal infection caused by Histoplasma capsulatum&lt;ref&gt;Lowell JR. Diagnosis of histoplasmosis. Ann Intern Med. Feb 1983;98(2):260&lt;/ref&gt;<br /> *Endemic to the Ohio, Missouri, and Mississippi River valleys in the United States&lt;ref&gt;Outbreak of histoplasmosis among travelers returning from El Salvador--Pennsylvania and Virginia, 2008. MMWR Morb Mortal Wkly Rep. Dec 19 2008;57(50):1349-53&lt;/ref&gt;<br /> *Exposure from disruption of soil containing organisms leads to aerosolization&lt;ref&gt;Hage, Chadi A., and L. Joseph Wheat. &quot;Chapter 199. Histoplasmosis.&quot; Harrison's Principles of Internal Medicine, 18e. Eds. Dan L. Longo, et al. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 4 Dec. 2014&lt;/ref&gt;<br /> *Activities associated with high-level exposure include spelunking, excavation, and demolition of old buildings<br /> <br /> ==Pathogenesis==<br /> *Infection occurs via inhalation&lt;ref&gt;“Histoplasmosis.” CDC. (2014, Sept. 25) Web 4 Dec. 2014. http://www.cdc.gov/fungal/diseases/histoplasmosis&lt;/ref&gt;<br /> *In immunocompetent patients: <br /> **Phagocytes and epithelial cells eventually organize and form granulomas that go on to fibrose and calcify <br /> *In immunocompromised patients: <br /> **The infection is not contained and can disseminate<br /> <br /> ==Clinical Features==<br /> *Disease manifestation depends on intensity of exposure, immune status, and underlying lung architecture<br /> ===Acute Pulmonary Histoplasmosis===<br /> *90% asymptomatic, and usually self-limited<br /> *Symptoms 1-4 weeks after exposure and consist of flu-like illness&lt;ref&gt;http://www.ncbi.nlm.nih.gov/pubmed/24528944&lt;/ref&gt;<br /> **Fever/chills<br /> **Headache<br /> **Malaise<br /> **Myalgias<br /> **Abdominal pain<br /> **Arthralgias<br /> **Dyspnea<br /> **Cough, hemoptysis<br /> *Hilar/mediastinal lymphadenopathy on CXR<br /> ===Chronic Pulmonary Histoplasmosis===<br /> *Mostly older patients or smokers with underlying structural lung disease&lt;ref&gt;http://www.ncbi.nlm.nih.gov/pubmed/23664715&lt;/ref&gt;<br /> *Symptoms: <br /> **Cough<br /> **Weight loss<br /> **Low-grade fever<br /> **Malaise<br /> **Night sweats<br /> **Sometimes hemoptysis, sputum production, dyspnea<br /> *CXR may show: <br /> **Upper lobe infiltrates<br /> **Fibrosis, scarring<br /> **Cavitations<br /> ===Progressive Disseminated Histoplasmosis===<br /> *Seen in immunocompromised patients<br /> *SIRS <br /> *Acute form: <br /> **Diffuse interstitial or reticulonodular lung infiltrates<br /> **Respiratory failure<br /> **Coagulopathy<br /> **Multiorgan failure<br /> *Subacute form depends on focal organ system affected: <br /> **Fever<br /> **Weight loss<br /> **Hepatosplenomegaly<br /> **Meningitis, brain lesions<br /> **Mucosal or GI ulcerations<br /> **Adrenal insufficiency<br /> **Pericarditis<br /> *Chronic form: constitutional sx<br /> ===Mediastinitis===<br /> *Enlarged lymph nodes that may undergo necrosis<br /> *This leads to granulomatous mediastinitis <br /> *Can lead to: <br /> **Superior vena cava syndrome<br /> **Obstruction of pulmonary vessels<br /> **Airway obstruction<br /> **Recurrent pneumonia<br /> **Hemoptysis <br /> **Respiratory failure<br /> <br /> ==Differential Diagnosis==<br /> *Aspergillosis<br /> *Blastomycosis<br /> *Carcinoid Lung Tumors<br /> *[[Chlamydophila psittaci]]<br /> *[[Coccidioidomycosis]]<br /> *[[Legionella]] pneumonias<br /> *Lung Cancer, Small Cell<br /> *Lymphoma, Mediastinal<br /> *Mediastinal Cysts<br /> *[[Lung Abscess]]<br /> *[[Mycoplasma pneumoniae|Mycoplasma Infections]]<br /> *Pancoast Syndrome<br /> *Pneumococcal Infections<br /> *Pneumocystis Carinii Pneumonia<br /> *[[Aspiration Pneumonia]]<br /> *[[Pneumonia]] <br /> *[[Sarcoidosis]]<br /> *[[Tuberculosis]]<br /> <br /> ==Workup==<br /> *CXR<br /> **Normal in 40-70% of cases<br /> **Pneumonitis with hilar adenopathy<br /> **Focal pulmonary infiltrates with light exposure<br /> **Diffuse infiltrates with heavy exposure<br /> *CBC (mild anemia in chronic disease)<br /> *Alkaline phosphatase (elevated in disseminated and chronic disease)<br /> *LDH (elevated in AIDS patients with disseminated disease)<br /> *Definitive diagnosis by:<br /> **Sputum cultures<br /> **Blood cultures<br /> **Antibody testing<br /> **Serum/urine antigen testing<br /> *Further imaging if concerned for specific organ involvement in disseminated disease (head CT, abdominal CT or lumbar puncture)<br /> <br /> ==Treatment==<br /> ===Acute Pulmonary Histoplasmosis===<br /> *Do not treat if asymptomatic<br /> **Not progressive, resolves without tx, only rarely reactivates<br /> ===Progressive Disseminated Histoplasmosis===<br /> *Pulmonary cases: Itraconazole x 6-12 weeks&lt;ref&gt;Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45:807-825&lt;/ref&gt;<br /> *Severe disease: Amphotericin B x 1 week then Itraconazole x 1 year&lt;ref&gt;Hospenthal DR, Becker SJ. Update on Therapy for Histoplasmosis. Infect Med. April 13 2009;26:121-124&lt;/ref&gt;<br /> *Surgical intervention may be necessary in some cases<br /> ===Chronic Pulmonary Histoplasmosis===<br /> *Itraconazole x 1 year<br /> <br /> ==Disposition==<br /> *Discharge asymptomatic cases<br /> *Discharge mildly symptomatic immunocompetent patients with primary care follow up<br /> *Admit severe symptoms or symptomatic immunocompromised patients<br /> <br /> ==Sources==<br /> &lt;references/&gt;<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Histoplasmosis&diff=27118 2014-12-12T00:01:02Z

<p>Jmnelson86: additions to existing</p> <hr /> <div>==Background==<br /> [[File:Histo-xray.png|thumb|Histoplasmosis after return from Pennsylvania, United States]]<br /> *Fungal infection caused by Histoplasma capsulatum&lt;ref&gt;Lowell JR. Diagnosis of histoplasmosis. Ann Intern Med. Feb 1983;98(2):260&lt;/ref&gt;<br /> *Endemic to the Ohio, Missouri, and Mississippi River valleys in the United States&lt;ref&gt;Outbreak of histoplasmosis among travelers returning from El Salvador--Pennsylvania and Virginia, 2008. MMWR Morb Mortal Wkly Rep. Dec 19 2008;57(50):1349-53&lt;/ref&gt;<br /> *Exposure from disruption of soil containing organisms leads to aerosolization&lt;ref&gt;Hage, Chadi A., and L. Joseph Wheat. &quot;Chapter 199. Histoplasmosis.&quot; Harrison's Principles of Internal Medicine, 18e. Eds. Dan L. Longo, et al. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 4 Dec. 2014&lt;/ref&gt;<br /> *Activities associated with high-level exposure include spelunking, excavation, and demolition of old buildings&lt;ref&gt;Hage, Chadi A., and L. Joseph Wheat. &quot;Chapter 199. Histoplasmosis.&quot; Harrison's Principles of Internal Medicine, 18e. Eds. Dan L. Longo, et al. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 4 Dec. 2014&lt;/ref&gt;<br /> <br /> ==Clinical Features==<br /> *Disease manifestation depends on intensity of exposure, immune status, and underlying lung architecture&lt;ref&gt;Hage, Chadi A., and L. Joseph Wheat. &quot;Chapter 199. Histoplasmosis.&quot; Harrison's Principles of Internal Medicine, 18e. Eds. Dan L. Longo, et al. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 4 Dec. 2014&lt;/ref&gt;<br /> ===Acute Pulmonary Histoplasmosis===<br /> *90% asymptomatic, and usually self-limited<br /> *Symptoms 1-4 weeks after exposure and consist of flu-like illness <br /> **Fever/chills<br /> **Headache<br /> **Malaise<br /> **Myalgias<br /> **Abdominal pain<br /> **Arthralgias<br /> **Dyspnea<br /> **Cough, hemoptysis<br /> *Hilar/mediastinal lymphadenopathy on CXR<br /> ===Chronic Pulmonary Histoplasmosis===<br /> *Mostly older patients or smokers with underlying structural lung disease<br /> *Symptoms: <br /> **Cough<br /> **Weight loss<br /> **Low-grade fever<br /> **Malaise<br /> **Night sweats<br /> **Sometimes hemoptysis, sputum production, dyspnea<br /> *CXR may show: <br /> **Upper lobe infiltrates<br /> **Fibrosis, scarring<br /> **Cavitations<br /> ===Progressive Disseminated Histoplasmosis===<br /> *Seen in immunocompromised patients<br /> *SIRS <br /> *Acute form: <br /> **Diffuse interstitial or reticulonodular lung infiltrates<br /> **Respiratory failure<br /> **Coagulopathy<br /> **Multiorgan failure<br /> *Subacute form depends on focal organ system affected: <br /> **Fever<br /> **Weight loss<br /> **Hepatosplenomegaly<br /> **Meningitis, brain lesions<br /> **Mucosal or GI ulcerations<br /> **Adrenal insufficiency<br /> **Pericarditis<br /> *Chronic form: constitutional sx<br /> ===Mediastinitis===<br /> *Enlarged lymph nodes that may undergo necrosis<br /> *This leads to granulomatous mediastinitis <br /> *Can lead to: <br /> **Superior vena cava syndrome<br /> **Obstruction of pulmonary vessels<br /> **Airway obstruction<br /> **Recurrent pneumonia<br /> **Hemoptysis <br /> **Respiratory failure<br /> <br /> ==Differential Diagnosis==<br /> *Aspergillosis<br /> *Blastomycosis<br /> *Carcinoid Lung Tumors<br /> *[[Chlamydophila psittaci]]<br /> *[[Coccidioidomycosis]]<br /> *[[Legionella]] pneumonias<br /> *Lung Cancer, Small Cell<br /> *Lymphoma, Mediastinal<br /> *Mediastinal Cysts<br /> *[[Lung Abscess]]<br /> *[[Mycoplasma pneumoniae|Mycoplasma Infections]]<br /> *Pancoast Syndrome<br /> *Pneumococcal Infections<br /> *Pneumocystis Carinii Pneumonia<br /> *[[Aspiration Pneumonia]]<br /> *[[Pneumonia]] <br /> *[[Sarcoidosis]]<br /> *[[Tuberculosis]]<br /> <br /> ==Workup==<br /> *CXR<br /> **Normal in 40-70% of cases<br /> **Pneumonitis with hilar adenopathy<br /> **Focal pulmonary infiltrates with light exposure<br /> **Diffuse infiltrates with heavy exposure<br /> *CBC (mild anemia in chronic disease)<br /> *Alkaline phosphatase (elevated in disseminated and chronic disease)<br /> *LDH (elevated in AIDS patients with disseminated disease)<br /> *Definitive diagnosis by:<br /> **Sputum cultures<br /> **Blood cultures<br /> **Antibody testing<br /> **Serum/urine antigen testing<br /> *Further imaging if concerned for specific organ involvement in disseminated disease (head CT, abdominal CT or lumbar puncture)<br /> <br /> ==Treatment==<br /> ===Acute Pulmonary Histoplasmosis===<br /> *Do not treat if asymptomatic<br /> **Not progressive, resolves without tx, only rarely reactivates<br /> ===Progressive Disseminated Histoplasmosis===<br /> *Pulmonary cases: Itraconazole x 6-12 weeks&lt;ref&gt;Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45:807-825&lt;/ref&gt;<br /> *Severe disease: Amphotericin B x 1 week then Itraconazole x 1 year&lt;ref&gt;Hospenthal DR, Becker SJ. Update on Therapy for Histoplasmosis. Infect Med. April 13 2009;26:121-124&lt;/ref&gt;<br /> *Surgical intervention may be necessary in some cases<br /> ===Chronic Pulmonary Histoplasmosis===<br /> *Itraconazole x 1 year<br /> <br /> ==Sources==<br /> &lt;references/&gt;<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Histoplasmosis&diff=27117 2014-12-11T23:57:26Z

<p>Jmnelson86: addition to existing information</p> <hr /> <div>==Background==<br /> [[File:Histo-xray.png|thumb|Histoplasmosis after return from Pennsylvania, United States]]<br /> *Fungal infection caused by Histoplasma capsulatum&lt;ref&gt;Lowell JR. Diagnosis of histoplasmosis. Ann Intern Med. Feb 1983;98(2):260&lt;/ref&gt;<br /> *Endemic to the Ohio, Missouri, and Mississippi River valleys in the United States&lt;ref&gt;Outbreak of histoplasmosis among travelers returning from El Salvador--Pennsylvania and Virginia, 2008. MMWR Morb Mortal Wkly Rep. Dec 19 2008;57(50):1349-53&lt;/ref&gt;<br /> *Exposure from disruption of soil containing organisms leads to aerosolization&lt;ref&gt;Hage, Chadi A., and L. Joseph Wheat. &quot;Chapter 199. Histoplasmosis.&quot; Harrison's Principles of Internal Medicine, 18e. Eds. Dan L. Longo, et al. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 4 Dec. 2014&lt;/ref&gt;<br /> *Activities associated with high-level exposure include spelunking, excavation, and demolition of old buildings&lt;ref&gt;Hage, Chadi A., and L. Joseph Wheat. &quot;Chapter 199. Histoplasmosis.&quot; Harrison's Principles of Internal Medicine, 18e. Eds. Dan L. Longo, et al. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 4 Dec. 2014&lt;/ref&gt;<br /> <br /> ==Clinical Features==<br /> *Disease manifestation depends on intensity of exposure, immune status, and underlying lung architecture&lt;ref&gt;Hage, Chadi A., and L. Joseph Wheat. &quot;Chapter 199. Histoplasmosis.&quot; Harrison's Principles of Internal Medicine, 18e. Eds. Dan L. Longo, et al. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 4 Dec. 2014&lt;/ref&gt;<br /> ===Acute Pulmonary Histoplasmosis===<br /> *90% asymptomatic, and usually self-limited<br /> *Symptoms 1-4 weeks after exposure and consist of flu-like illness <br /> **Fever/chills<br /> **Headache<br /> **Malaise<br /> **Myalgias<br /> **Abdominal pain<br /> **Arthralgias<br /> **Dyspnea<br /> **Cough, hemoptysis<br /> *Hilar/mediastinal lymphadenopathy on CXR<br /> ===Chronic Pulmonary Histoplasmosis===<br /> *Mostly older patients or smokers with underlying structural lung disease<br /> *Symptoms: <br /> **Cough<br /> **Weight loss<br /> **Low-grade fever<br /> **Malaise<br /> **Night sweats<br /> **Sometimes hemoptysis, sputum production, dyspnea<br /> *CXR may show: <br /> **Upper lobe infiltrates<br /> **Fibrosis, scarring<br /> **Cavitations<br /> ===Progressive Disseminated Histoplasmosis===<br /> *Seen in immunocompromised patients<br /> *SIRS <br /> *Acute form: <br /> **Diffuse interstitial or reticulonodular lung infiltrates<br /> **Respiratory failure<br /> **Coagulopathy<br /> **Multiorgan failure<br /> *Subacute form depends on focal organ system affected: <br /> **Fever<br /> **Weight loss<br /> **Hepatosplenomegaly<br /> **Meningitis, brain lesions<br /> **Mucosal or GI ulcerations<br /> **Adrenal insufficiency<br /> **Pericarditis<br /> *Chronic form: constitutional sx<br /> ===Mediastinitis===<br /> *Enlarged lymph nodes that may undergo necrosis<br /> *This leads to granulomatous mediastinitis <br /> *Can lead to: <br /> **Superior vena cava syndrome<br /> **Obstruction of pulmonary vessels<br /> **Airway obstruction<br /> **Recurrent pneumonia<br /> **Hemoptysis <br /> **Respiratory failure<br /> <br /> ==Differential Diagnosis==<br /> *Aspergillosis<br /> *Blastomycosis<br /> *Carcinoid Lung Tumors<br /> *[[Chlamydophila psittaci]]<br /> *[[Coccidioidomycosis]]<br /> *[[Legionella]] pneumonias<br /> *Lung Cancer, Small Cell<br /> *Lymphoma, Mediastinal<br /> *Mediastinal Cysts<br /> *[[Lung Abscess]]<br /> *[[Mycoplasma pneumoniae|Mycoplasma Infections]]<br /> *Pancoast Syndrome<br /> *Pneumococcal Infections<br /> *Pneumocystis Carinii Pneumonia<br /> *[[Aspiration Pneumonia]]<br /> *[[Pneumonia]] <br /> *[[Sarcoidosis]]<br /> *[[Tuberculosis]]<br /> <br /> ==Workup==<br /> *CXR<br /> **Normal in 40-70% of cases<br /> **Pneumonitis with hilar adenopathy<br /> **Focal pulmonary infiltrates with light exposure<br /> **Diffuse infiltrates with heavy exposure<br /> *CBC (mild anemia in chronic disease)<br /> *Alkaline phosphatase (elevated in disseminated and chronic disease)<br /> *LDH (elevated in AIDS patients with disseminated disease)<br /> *Definitive diagnosis by:<br /> **Sputum cultures<br /> **Blood cultures<br /> **Antibody testing<br /> **Serum/urine antigen testing<br /> *Further imaging if concerned for specific organ involvement in disseminated disease (head CT, abdominal CT or lumbar puncture)<br /> <br /> ==Treatment==<br /> ===Acute Pulmonary Histoplasmosis===<br /> *Do not treat if asymptomatic<br /> *Itraconazole x 6-12 weeks&lt;ref&gt;Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45:807-825&lt;/ref&gt;<br /> *Severe disease: Amphotericin B x 1 week then Itraconazole x 1 year&lt;ref&gt;Hospenthal DR, Becker SJ. Update on Therapy for Histoplasmosis. Infect Med. April 13 2009;26:121-124&lt;/ref&gt;<br /> <br /> ===Chronic Pulmonary Histoplasmosis===<br /> *Itraconazole x 1 year<br /> ===Progressive Disseminated Histoplasmosis===<br /> *See above medical therapy<br /> *Surgical intervention may be needed for some end organ involvement<br /> ==Sources==<br /> &lt;references/&gt;<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Histoplasmosis&diff=27116 2014-12-11T23:53:07Z

<p>Jmnelson86: additions to existing information</p> <hr /> <div>==Background==<br /> [[File:Histo-xray.png|thumb|Histoplasmosis after return from Pennsylvania, United States]]<br /> *Fungal infection caused by Histoplasma capsulatum&lt;ref&gt;Lowell JR. Diagnosis of histoplasmosis. Ann Intern Med. Feb 1983;98(2):260&lt;/ref&gt;<br /> *Endemic to the Ohio, Missouri, and Mississippi River valleys in the United States&lt;ref&gt;Outbreak of histoplasmosis among travelers returning from El Salvador--Pennsylvania and Virginia, 2008. MMWR Morb Mortal Wkly Rep. Dec 19 2008;57(50):1349-53&lt;/ref&gt;<br /> *Exposure from disruption of soil containing organisms leads to aerosolization&lt;ref&gt;Hage, Chadi A., and L. Joseph Wheat. &quot;Chapter 199. Histoplasmosis.&quot; Harrison's Principles of Internal Medicine, 18e. Eds. Dan L. Longo, et al. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 4 Dec. 2014&lt;/ref&gt;<br /> *Activities associated with high-level exposure include spelunking, excavation, and demolition of old buildings&lt;ref&gt;Hage, Chadi A., and L. Joseph Wheat. &quot;Chapter 199. Histoplasmosis.&quot; Harrison's Principles of Internal Medicine, 18e. Eds. Dan L. Longo, et al. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 4 Dec. 2014&lt;/ref&gt;<br /> <br /> ==Clinical Features==<br /> *Disease manifestation depends on intensity of exposure, immune status, and underlying lung architecture&lt;ref&gt;Hage, Chadi A., and L. Joseph Wheat. &quot;Chapter 199. Histoplasmosis.&quot; Harrison's Principles of Internal Medicine, 18e. Eds. Dan L. Longo, et al. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 4 Dec. 2014&lt;/ref&gt;<br /> ===Acute Pulmonary Histoplasmosis===<br /> *90% asymptomatic, and usually self-limited<br /> *Symptoms 1-4 weeks after exposure and consist of flu-like illness <br /> **Fever/chills<br /> **Headache<br /> **Malaise<br /> **Myalgias<br /> **Abdominal pain<br /> **Arthralgias<br /> **Dyspnea<br /> **Cough, hemoptysis<br /> *Hilar/mediastinal lymphadenopathy on CXR<br /> ===Chronic Pulmonary Histoplasmosis===<br /> *Mostly older patients or smokers with underlying structural lung disease<br /> *Symptoms: <br /> **Cough<br /> **Weight loss<br /> **Low-grade fever<br /> **Malaise<br /> **Night sweats<br /> **Sometimes hemoptysis, sputum production, dyspnea<br /> *CXR may show: <br /> **Upper lobe infiltrates<br /> **Fibrosis, scarring<br /> **Cavitations<br /> ===Progressive Disseminated Histoplasmosis===<br /> *Seen in immunocompromised patients<br /> *SIRS <br /> *Acute form: <br /> **Diffuse interstitial or reticulonodular lung infiltrates<br /> **Respiratory failure<br /> **Coagulopathy<br /> **Multiorgan failure<br /> *Subacute form depends on focal organ system affected: <br /> **Fever<br /> **Weight loss<br /> **Hepatosplenomegaly<br /> **Meningitis, brain lesions<br /> **Mucosal or GI ulcerations<br /> **Adrenal insufficiency<br /> **Pericarditis<br /> *Chronic form: constitutional sx<br /> ===Mediastinitis===<br /> *Enlarged lymph nodes that may undergo necrosis<br /> *This leads to granulomatous mediastinitis <br /> *Can lead to: <br /> **Superior vena cava syndrome<br /> **Obstruction of pulmonary vessels<br /> **Airway obstruction<br /> **Recurrent pneumonia<br /> **Hemoptysis <br /> **Respiratory failure<br /> <br /> ==Differential Diagnosis==<br /> *Aspergillosis<br /> *Blastomycosis<br /> *Carcinoid Lung Tumors<br /> *[[Chlamydophila psittaci]]<br /> *[[Coccidioidomycosis]]<br /> *[[Legionella]] pneumonias<br /> *Lung Cancer, Small Cell<br /> *Lymphoma, Mediastinal<br /> *Mediastinal Cysts<br /> *[[Lung Abscess]]<br /> *[[Mycoplasma pneumoniae|Mycoplasma Infections]]<br /> *Pancoast Syndrome<br /> *Pneumococcal Infections<br /> *Pneumocystis Carinii Pneumonia<br /> *[[Aspiration Pneumonia]]<br /> *[[Pneumonia]] <br /> *[[Sarcoidosis]]<br /> *[[Tuberculosis]]<br /> <br /> ==Workup==<br /> *CBC (mild anemia in chronic disease)<br /> *Alkaline phosphatase (elevated in disseminated and chronic disease)<br /> *LDH (elevated in AIDS patients with disseminated disease)<br /> *Sputum cultures<br /> *Blood cultures<br /> *Antibody testing<br /> *Serum/urine antigen testing<br /> *CXR<br /> *Further imaging if concerned for specific organ involvement in disseminated disease (head CT, abdominal CT)<br /> ==Treatment==<br /> ===Acute Pulmonary Histoplasmosis===<br /> *Do not treat if asymptomatic<br /> *Itraconazole x 6-12 weeks&lt;ref&gt;Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45:807-825&lt;/ref&gt;<br /> *Severe disease: Amphotericin B x 1 week then Itraconazole x 1 year&lt;ref&gt;Hospenthal DR, Becker SJ. Update on Therapy for Histoplasmosis. Infect Med. April 13 2009;26:121-124&lt;/ref&gt;<br /> <br /> ===Chronic Pulmonary Histoplasmosis===<br /> *Itraconazole x 1 year<br /> ===Progressive Disseminated Histoplasmosis===<br /> *See above medical therapy<br /> *Surgical intervention may be needed for some end organ involvement<br /> ==Sources==<br /> &lt;references/&gt;<br /> [[Category:ID]]</div>

Jmnelson86 https://wikem.org/w/index.php?title=Histoplasmosis&diff=27115 2014-12-11T23:34:01Z

<p>Jmnelson86: Additional information added</p> <hr /> <div>==Background==<br /> [[File:Histo-xray.png|thumb|Histoplasmosis after return from Pennsylvania, United States]]<br /> *Fungal infection caused by Histoplasma capsulatum&lt;ref&gt;Lowell JR. Diagnosis of histoplasmosis. Ann Intern Med. Feb 1983;98(2):260&lt;/ref&gt;<br /> *Endemic to the Ohio, Missouri, and Mississippi River valleys in the United States&lt;ref&gt;Outbreak of histoplasmosis among travelers returning from El Salvador--Pennsylvania and Virginia, 2008. MMWR Morb Mortal Wkly Rep. Dec 19 2008;57(50):1349-53&lt;/ref&gt;<br /> *Exposure from disruption of soil containing organisms leads to aerosolization&lt;ref&gt;Hage, Chadi A., and L. Joseph Wheat. &quot;Chapter 199. Histoplasmosis.&quot; Harrison's Principles of Internal Medicine, 18e. Eds. Dan L. Longo, et al. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 4 Dec. 2014&lt;/ref&gt;<br /> *Activities associated with high-level exposure include spelunking, excavation, and demolition of old buildings&lt;ref&gt;Hage, Chadi A., and L. Joseph Wheat. &quot;Chapter 199. Histoplasmosis.&quot; Harrison's Principles of Internal Medicine, 18e. Eds. Dan L. Longo, et al. New York, NY: McGraw-Hill, 2012. n. pag. AccessMedicine. Web. 4 Dec. 2014&lt;/ref&gt;<br /> <br /> ==Clinical Features==<br /> ===Acute Pulmonary Histoplasmosis===<br /> *90% asymptomatic, and usually self-limited<br /> *Fever/chills<br /> *Headache<br /> *Malaise<br /> *Myalgias<br /> *Abdominal pain<br /> *Joint pains<br /> *Dyspnea<br /> *Cough<br /> *Hemoptysis<br /> *Hilar/mediastinal lymphadenopathy<br /> ===Chronic Pulmonary Histoplasmosis===<br /> *Mostly older patients with underlying lung disease<br /> *Cough<br /> *Weight loss<br /> *Fever<br /> *Malaise<br /> *Sometimes hemoptysis, sputum production, dyspnea<br /> *CXR may show:<br /> **Upper lobe infiltrates<br /> **Fibrosis, scarring<br /> **Cavitations<br /> ===Progressive Disseminated Histoplasmosis===<br /> *Seen in immunocompromised patients<br /> *Acute form: fever, cough, weight loss, malaise, dyspnea, +/-CNS involvement<br /> *Subacute form: wide variety of symptoms depending on affected organ system<br /> *Chronic form: constitutional sx<br /> ===Mediastinitis===<br /> *Enlarged lymph nodes undergo necrosis<br /> *This leads to granulomatous mediastinitis<br /> ==Differential Diagnosis==<br /> *Aspergillosis<br /> *Blastomycosis<br /> *Carcinoid Lung Tumors<br /> *[[Chlamydophila psittaci]]<br /> *[[Coccidioidomycosis]]<br /> *[[Legionella]] pneumonias<br /> *Lung Cancer, Small Cell<br /> *Lymphoma, Mediastinal<br /> *Mediastinal Cysts<br /> *[[Lung Abscess]]<br /> *[[Mycoplasma pneumoniae|Mycoplasma Infections]]<br /> *Pancoast Syndrome<br /> *Pneumococcal Infections<br /> *Pneumocystis Carinii Pneumonia<br /> *[[Aspiration Pneumonia]]<br /> *[[Pneumonia]] <br /> *[[Sarcoidosis]]<br /> *[[Tuberculosis]]<br /> <br /> ==Workup==<br /> *CBC (mild anemia in chronic disease)<br /> *Alkaline phosphatase (elevated in disseminated and chronic disease)<br /> *LDH (elevated in AIDS patients with disseminated disease)<br /> *Sputum cultures<br /> *Blood cultures<br /> *Antibody testing<br /> *Serum/urine antigen testing<br /> *CXR<br /> *Further imaging if concerned for specific organ involvement in disseminated disease (head CT, abdominal CT)<br /> ==Treatment==<br /> ===Acute Pulmonary Histoplasmosis===<br /> *Do not treat if asymptomatic<br /> *Itraconazole x 6-12 weeks&lt;ref&gt;Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45:807-825&lt;/ref&gt;<br /> *Severe disease: Amphotericin B x 1 week then Itraconazole x 1 year&lt;ref&gt;Hospenthal DR, Becker SJ. Update on Therapy for Histoplasmosis. Infect Med. April 13 2009;26:121-124&lt;/ref&gt;<br /> <br /> ===Chronic Pulmonary Histoplasmosis===<br /> *Itraconazole x 1 year<br /> ===Progressive Disseminated Histoplasmosis===<br /> *See above medical therapy<br /> *Surgical intervention may be needed for some end organ involvement<br /> ==Sources==<br /> &lt;references/&gt;<br /> [[Category:ID]]</div>

Jmnelson86