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Fulltext A Case of Congenital Syphilis Presenting with Unusual Skin Eruptions

Leung AKC, Leong KF, Lam JM

Case Rep Pediatr, 2018;2018:1761454.
PMID: 29770234 DOI: 10.1155/2018/1761454

Once believed to be a rare disease in developed countries, recent data suggest that there is a surge in incidence of congenital syphilis in many developed countries. Diagnosis of congenital syphilis can be difficult because more than two-thirds of affected infants are asymptomatic at birth, and signs of symptomatic infants may be nonspecific or subtle. On top of this, some affected infants may have atypical presentations. Familiarity with the diverse presentations is essential to diagnosis. We report a 2-week-old male infant with congenital syphilis whose cutaneous manifestations included diffuse, erythematous keratoderma with desquamation and fissures on his hands and feet, multiple linear scaly fissures at the angles of his mouth, and onychauxis of the fingernails and toenails To our knowledge, diffuse, erythematous keratoderma of the hands and feet and thick nails have not been reported previously in congenital syphilis.

Matched MeSH terms: Syphilis, Congenital
A case of congenital hernia of the lung and tertiary syphilis

Kiramathypathy K

Malayan Medical Journal, 1929;4:12-13.

Matched MeSH terms: Syphilis
Fulltext A case of gumma of the ciliary region

Highet HC

Br Med J, 1896 Nov 7;2(1871):1380-1381.
PMID: 20756574
Matched MeSH terms: Syphilis*
Fulltext A case of syphilitic coma

von Tunzelmann EW

Journal of the Straits Medical Association, 1890;1:36-42.

Matched MeSH terms: Syphilis
A case series with literature review on adjunctive usage of intravitreal ceftazidime in ocular syphilis with human immunodeficiency virus infection

Lim YW, Lott PW, Mohamad NF, Begam Iqbal T

Int J STD AIDS, 2021 09;32(10):968-973.
PMID: 33969754 DOI: 10.1177/09564624211011917

BACKGROUND: Penicillin is the conventional treatment for all stages of syphilis, including ocular and neurosyphilis, according to the recommendations by the Centre for Disease Control and Prevention Sexually Transmitted Disease. This case series highlighted three cases of ocular syphilis which showed prompt treatment response as early as 24 h after the adjunctive intravitreal ceftazidime injection.
METHODS: Case Series.
RESULTS: In case 1, there was significant improvement in the vision and vitritis after 24 h of a single intravitreal ceftazidime injection. In case 2, the patient achieved his best vision after a total of three intravitreal injections in his left eye and one in his right eye. In case 3, there was a further resolution of perivascular sheathing and retinal haemorrhages seen 1 week after a single intravitreal ceftazidime injection.
CONCLUSION: The efficacy of intravitreal ceftazidime injection as a local adjunctive therapy in ocular syphilis treatment is noteworthy. It can be considered in cases which show suboptimal or slower treatment response despite early commencement of systemic penicillin to prevent devastating ocular sequelae.

Matched MeSH terms: Syphilis Serodiagnosis
A criticism of the alleged tolerance of the chinese to syphilis

Galloway DJ

Journal of the Malaya Branch of the British Medical Association, 1905.

Matched MeSH terms: Syphilis
Fulltext A microbiological study of genital ulcers in Kuala Lumpur

Zainah S, Cheong YM, Sinniah M, Gan AT, Akbal K

Med J Malaysia, 1991 Sep;46(3):274-82.
PMID: 1839925

The microbial aetiology of genital ulcers was studied in 249 patients (241 men and 8 women) attending a Sexually Transmitted Disease Clinic in Kuala Lumpur, Malaysia. Herpes simplex virus type 2 was isolated in 48 (19.2%) patients, Haemophilus ducreyi from 22 (8.8%), Neisseria gonorrhoeae from seven (2.8%) and Chlamydia trachomatis from four (1.6%). Syphilis was diagnosed in 18 (7.2%) patients on the basis of dark field microscopy. Two (0.8%) patients were found to have both chancroid and syphilis and one (0.5%) had both gonorrhoea and syphilis. No organism was isolated in the remaining 151 (61.5%) patients. Overall, the accuracy of clinical diagnosis was 58% for single infection, 67% for herpes, 63% for syphilis, 47% for chancroid and 0% for lymphogranuloma venereum. Therefore, our study confirms the need for laboratory tests to diagnose accurately the aetiology of genital ulcer disease.

Matched MeSH terms: Syphilis
An epidemiological study of syphilis and predictors of treatment failure in University Malaya Medical Centre

Mohamed AK, Raja IA, Rukumani DV

Med J Malaysia, 2020 05;75(3):199-203.
PMID: 32467532

INTRODUCTION: There are limited studies on the epidemiology of syphilis in Malaysia. In this study we describe the clinical features and treatment outcomes of patients with syphilis attending a tertiary referral university hospital.
METHODS: We retrospectively reviewed the case records of patients with positive serology findings for syphilis in University Malaya Medical Center (UMMC) from January 2010 to December 2015. Serological positivity was defined as having a positive rapid plasma reagin (RPR) or Venereal Disease Research Laboratory (VDRL) with a confirmatory positive Treponema pallidum particle agglutination assay (TPPA). Treatment outcomes were divided into two, success or failure. Demographic and clinical characteristics associated with predictors of treatment failure were assessed using statistical package for the social science (SPSS). This study also included a neurosyphilis descriptive sub-study.
RESULTS: There were 637 patients identified with positive syphilis serology, but 258 patients were excluded as they did not meet the inclusion criteria. 379 patients were then taken for the demographic study; 14 patients (3.7%) were treated for neurosyphilis; 170 patients with complete data were included. In all 42/170 (24.7%) failed treatment, 12/170 (7.1%) had reinfection and 116/170 (68.2%) had treatment success. A final number of 158 patients were then taken and analyzed for predictors of treatment failure after excluding the 12 reinfection patients. Only low baseline RPR (<1:16) was found to be significant on multivariate logistic regression analysis (p value: 0.007, 95% CI: 1.42, 9.21).
CONCLUSION: Most of the patients were HIV positive and from the MSM (Men who have sex with Men) population. Low baseline RPR titre is a predictor of treatment failure.

Matched MeSH terms: Syphilis/diagnosis; Syphilis/drug therapy; Syphilis/epidemiology*; Syphilis/physiopathology*; Syphilis Serodiagnosis
Fulltext Bilateral vocal cord palsy as the sole presentation of acquired syphilis

Asha'ari ZA, Razali MS, Ahmad RA

Malays J Med Sci, 2010 Apr;17(2):56-60.
PMID: 22135539

Bilateral vocal cord palsy is almost always caused by neck surgery, particularly surgery of the thyroid. We report a case of bilateral vocal cord palsy requiring emergency surgery to relieve the airway obstruction as the sole presentation of acquired syphilis. As the incidence of syphilis worldwide is rising, this unusual presentation may give clinicians a different perspective on the disease.

Matched MeSH terms: Syphilis
Fulltext Case report--a neonate with nonimmune hydrops fetalis

Ram SP, Ariffin WA, Kassim Z

Singapore Med J, 1993 Oct;34(5):459-61.
PMID: 8153701

A post-dated intra-uterine growth retarded male Malay baby was born to a 30-year-old mother gravida II by Caesarean section. Her previous pregnancy ended in still-birth. The baby was severely asphyxiated at birth. He was intubated and immediately admitted to the neonatal intensive care unit. He had anasarca, anaemia, purpura and firm, massive hepatosplenomegaly. X-rays revealed ascites and bilateral metaphysiitis of the long bones. The haemoglobin level was 5.0 gm/dl and PCV 18.3%. Coombs' test was negative. Prothrombin time (PT) and partial thromboplastin time (PTT) were prolonged. The baby and mother were positive for Venereal Disease Research Laboratory (VDRL) and the treponema pallidum haemagglutination assay (TPHA) tests. The baby was actively resuscitated but expired at three and a half hours of life due to overwhelming sepsis associated with severe anaemia and disseminated intravascular coagulation.

Matched MeSH terms: Syphilis, Congenital/complications*
Fulltext Case series of syphilis and HIV co-infections

Abdul Wahab A, Rahman MM, Mohammad M, Hussin S

Pak J Med Sci, 2013 May;29(3):856-8.
PMID: 24353643

Syphilis and HIV co-infection are indeed dangerous combinations. The present communication describes three different cases of syphilis and HIV co-infection in young men. The first case is a 25-year-old medical graduate with a primary and secondary syphilis lesions at time of presentation. The second case is a 24-year-old government officer with right eye posterior uveitis where the serology tests for syphilis were reactive. His HIV tests were also positive. The final case is a 25-year-old homosexual who was admitted to the medical ward because of Mycobacterium tuberculosis infection. The HIV and syphilis serology tests were noted to be positive.

Matched MeSH terms: Syphilis*
Chemotherapy in tropical diseases

Nocht PB

Malayan Medical Journal, 1931;6:38-42.

Matched MeSH terms: Syphilis
Fulltext Clinical Profile and Visual Outcomes of Ocular Syphilis: A Five-year Review in Hospital Universiti Sains, Malaysia

Ghanimi Zamli AK, Irma Ngah NS, Chew-Ean T, Muhammed J, Wan Hitam WH, Hussein A, et al.

Cureus, 2019 Feb 05;11(2):e4015.
PMID: 31007973 DOI: 10.7759/cureus.4015

Introduction Ocular syphilis is a sight-threatening condition. It can occur at any stage of syphilis infection, which present either with acute inflammation during the primary, secondary, and early latent stages or with chronic inflammation during tertiary infection, affecting virtually every ocular structure. This study was to report on the clinical presentation of ocular syphilis that presented to eye clinic Hospital Universiti Sains Malaysia. Methodology This was a retrospective study where medical records of ocular syphilis patients who attended eye clinic in Hospital Universiti Sains Malaysia from January 2013 to June 2017 were reviewed. Results A total of 10 patients (13 eyes) with ocular syphilis were identified out of 106 cases that presented with ocular inflammation. The mean age of presentation was 69.8 ± 6.4 years and seven of them (70%) were female. All patients were Malay and human immunodeficiency virus (HIV) was negative. The ocular manifestations included panuveitis (four eyes, 30.8%), anterior uveitis (two eyes, 15.4%), posterior uveitis (seven eyes, 53.8%) and optic neuritis (two eyes, 15.4%). Seven (53.8%) eyes presented with visual acuity of worse than 6/60, five (38.5%) eyes had visual acuity between 6/15 to 6/60, and one (7.7%) eye had visual acuity of 6/12 or better. Nine patients received an intravenous benzylpenicillin regime and one patient received an intramuscular penicillin injection. Out of 13 eyes affected, 11 (84.6%) eyes had improved visual acuity of at least one Snellen line after treatment. Visual acuity of 6/12 or better increased to four (30.8%) eyes. Conclusions Posterior uveitis was the commonest presentation of ocular syphilis in HIV-negative patients. Early detection and treatment of ocular syphilis can result in resolution of inflammation and improvement of vision.

Matched MeSH terms: Syphilis
Fulltext Early congenital syphilis--a continuing problem in Malaysia

Lim CT, Koh MT, Sivanesaratnam V

Med J Malaysia, 1995 Jun;50(2):131-5.
PMID: 7565181

Between February 1990 and May 1993, 13 cases of early congenital syphilis (ECS) were managed in the Paediatrics Unit, University Hospital, Kuala Lumpur. Twelve mothers were unbooked with 10 inborn babies. Only one mother had antenatal booking at this hospital but she defaulted antenatal follow-up. Several risk factors associated with ECS were identified: inadequate or no prenatal care (5/13), failure to repeat a serological test for syphilis in the third trimester when it was tested negative at first booking (5/13), sexual promiscuity, substance abuse and a past history of contracting sexually transmitted disease. All 10 mothers who had their serological test repeated at delivery were found to have a positive VDRL and TPHA. Adequate antenatal care early referral of infected, expectant mothers for treatment, and a repeat serological test for syphilis could have prevented these cases of ECS.

Matched MeSH terms: Syphilis/epidemiology; Syphilis, Congenital/diagnosis; Syphilis, Congenital/epidemiology*; Syphilis, Congenital/therapy
Fulltext Evaluation of Elecsys Syphilis Assay for Routine and Blood Screening and Detection of Early Infection

Kremastinou J, Polymerou V, Lavranos D, Aranda Arrufat A, Harwood J, Martínez Lorenzo MJ, et al.

J Clin Microbiol, 2016 09;54(9):2330-6.
PMID: 27358468 DOI: 10.1128/JCM.02544-15

Treponema pallidum infections can have severe complications if not diagnosed and treated at an early stage. Screening and diagnosis of syphilis require assays with high specificity and sensitivity. The Elecsys Syphilis assay is an automated treponemal immunoassay for the detection of antibodies against T. pallidum The performance of this assay was investigated previously in a multicenter study. The current study expands on that evaluation in a variety of diagnostic settings and patient populations, at seven independent laboratories. The samples included routine diagnostic samples, blood donation samples, samples from patients with confirmed HIV infections, samples from living organ or bone marrow donors, and banked samples, including samples previously confirmed as syphilis positive. This study also investigated the seroconversion sensitivity of the assay. With a total of 1,965 syphilis-negative routine diagnostic samples and 5,792 syphilis-negative samples collected from blood donations, the Elecsys Syphilis assay had specificity values of 99.85% and 99.86%, respectively. With 333 samples previously identified as syphilis positive, the sensitivity was 100% regardless of disease stage. The assay also showed 100% sensitivity and specificity with samples from 69 patients coinfected with HIV. The Elecsys Syphilis assay detected infection in the same bleed or earlier, compared with comparator assays, in a set of sequential samples from a patient with primary syphilis. In archived serial blood samples collected from 14 patients with direct diagnoses of primary syphilis, the Elecsys Syphilis assay detected T. pallidum antibodies for 3 patients for whom antibodies were not detected with the Architect Syphilis TP assay, indicating a trend for earlier detection of infection, which may have the potential to shorten the time between infection and reactive screening test results.

Matched MeSH terms: Syphilis/diagnosis*
Fulltext Experiences in the diagnosis and prevention of mental retardation of environmental origin in Singapore

Paul FM

Med J Malaysia, 1982 Dec;37(4):357-61.
PMID: 6300621

Consideration. is gzven to the recognition and prevention of carious types of mental retardation due to hazards of environmental origin. Observations are presented on congenital syphilis, congenital toxoplasmosis, congenital rubella, Singapore kernicterus, Japanese B encephalitis, and tuberculous meningitis. Appropriate preventiue measures have resulted in a significant reduction in Singapore of these conditions, and hence in a decreased frequency of environmentally determined mental retardation. and related disabilities.

Matched MeSH terms: Syphilis, Congenital/complications
Gumma of the ciliary body [duplicate2]

Highet HC

Journal of the Malaya Branch of the British Medical Association, 1903.

Matched MeSH terms: Syphilis
Health problems of foreign workers - Microbiological investigations

Ngeow YF, Ng KP, Puthucheary SD, Lam SK

JUMMEC, 2002;7:67-69.

Foreign workers in Malaysia are screened for certain infectious diseases prior to their entry to the country but some escape medical screening and others acquire infection during their stay in the country. The Faculty of Medicine, University of Malaya was commissioned to study the impact of foreign labour on the local health system and, as part of the investigations, 584 foreign workers attending local outpatient clinics were examined for serological evidence of syphilis, HIV infection, viral hepatitis B, C and E, as well as for enteric infections by Salmonella, Shigella and Vibrio cholerae. The results showed that apart from viral hepatitis E, the prevalence rates of the infections looked for were not notably higher than those for the general Malaysian population. The seroprevalence rates obtained were 2.6% for syphilis, 0.2% HIV infection, 3.8% viral hepatitis B, 1.0% viral hepatitis C, 14.4% viral hepatitis E. The detection of HEV IgM in 7.7% of the workers screened indicates that these infections could have been acquired during their stay in Malaysia.

Matched MeSH terms: Syphilis
Healthcare resources are inadequate to address the burden of illness among HIV-infected male prisoners in Malaysia

Bick J, Culbert G, Al-Darraji HA, Koh C, Pillai V, Kamarulzaman A, et al.

Int J Prison Health, 2016 12 19;12(4):253-269.
PMID: 27921633 DOI: 10.1108/IJPH-06-2016-0017

Purpose Criminalization of drug use in Malaysia has concentrated people who inject drugs (PWID) and people living with HIV into prisons where health services are minimal and HIV-related mortality is high. Few studies have comprehensively assessed the complex health needs of this population. The paper aims to discuss these issues. Design/methodology/approach From October 2012 through March 2013, 221 sequentially selected HIV-infected male prisoners underwent a comprehensive health assessment that included a structured history, physical examination, and clinically indicated diagnostic studies. Findings Participants were mostly PWID (83.7 percent) and diagnosed with HIV while incarcerated (66.9 percent). Prevalence of hepatitis C virus (90.4 percent), untreated syphilis (8.1 percent), active (13.1 percent), and latent (81.2 percent) tuberculosis infection was several fold higher than non-prisoner Malaysian adults, as was tobacco use (71.9 percent) and heavy drinking (30.8 percent). Most (89.5 percent) were aware of their HIV status before the current incarceration, yet few had been engaged previously in HIV care, including pre-incarceration CD4 monitoring (24.7 percent) or prescribed antiretroviral therapy (ART) (16.7 percent). Despite most (73.7 percent) meeting Malaysia's criteria for ART (CD4 <350 cells/ μL), less than half (48.4 percent) ultimately received it. Nearly one-quarter (22.8 percent) of those with AIDS (<200 cells/ μL) did not receive ART. Originality/value Drug addiction and communicable disease comorbidity, which interact negatively and synergistically with HIV and pose serious public health threats, are highly prevalent in HIV-infected prisoners. Interventions to address the critical shortage of healthcare providers and large gaps in treatment for HIV and other co-morbid conditions are urgently needed to meet the health needs of HIV-infected Malaysian prisoners, most of whom will soon transition to the community.

Matched MeSH terms: Syphilis/epidemiology; Syphilis/therapy
Heat inactivation of serum potentiates anti-cardiolipin antibody binding in ELISA

Cheng HM, Ngeow YF, Sam CK

J Immunol Methods, 1989 Nov 30;124(2):235-8.
PMID: 2600427

Heat treatment of sera at 56 degrees C for 30 min results in positive ELISA reactions for anti-cardiolipin antibody (aCL) in sera that had undetectable or low levels of aCL before heat inactivation. The positive, potentiated reactivity of the heated sera in the aCL ELISA could be inhibited with the cardiolipin antigen and was abolished by prior IgG depletion using staphylococcal protein A. The heat-potentiating effect of aCL binding in ELISA was evident in both normal human sera and clinical sera including sera from patients with systemic lupus erythematosus and syphilis.

Matched MeSH terms: Syphilis/immunology

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