Search

Jia-Wen Xie,1,2 Yin-Feng Guo,1,2 Ya-Wen Zheng,1,3 Mao Wang,1,2 Qiu-Yan Xu,1,2 Yu-Yan Chen,1,2 Li-Rong Lin1,2,4 1Center of Clinical Laboratory, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China; 2Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, People’s Republic of China; 3Prenatal Diagnosis Center, Zhangzhou Municipal Hospital Affiliated to Fujian Medical University, Zhangzhou, People’s Republic of China; 4Department of Basic Medical Science, Xiamen Medical College, Xiamen, People’s Republic of ChinaCorrespondence: Yu-Yan Chen; Li-Rong Lin, Centre of Clinical Laboratory, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University, Xiamen, 361004, People’s Republic of China, Tel +86-592-2993041, Fax +86-592-2993043, Email chenyuyan@xmu.edu.cn; linlirong@xmu.edu.cnPurpose: Accurate differentiation between early and late latent syphilis stages is pivotal for patient management and treatment strategies. Nontreponemal IgM antibodies have shown potential in discriminating latent syphilis staging by differentiating syphilis activity. This study aimed to develop a predictive nomogram model for latent syphilis staging based on nontreponemal IgM antibodies.Patients and Methods: We explored the correlation between nontreponemal IgM antibodies and latent syphilis staging and developed a nomogram model to predict latent syphilis staging based on 352 latent syphilis patients. Model performance was assessed using AUC, calibration curve, Hosmer–Lemeshow χ 2 statistics, C-index, Brier score, decision curve analysis, and clinical impact curve. Additionally, an external validation set was used to further assess the model’s stability.Results: Nontreponemal IgM antibodies correlated with latent syphilis staging. The constructed model demonstrated a strong discriminative capability with an AUC of 0.743. The calibration curve displayed a strong fit, key statistics including Hosmer–Lemeshow χ² at 2.440 (P=0.486), a C-index score of 0.743, and a Brier score of 0.054, all suggesting favorable model calibration performance. Decision curve analysis and clinical impact curve highlighted the model’s robust clinical applicability. The external validation set yielded an AUC of 0.776, Hosmer–Lemeshow χ² statistics of 2.440 (P=0.486), a C-index score of 0.767, and a Brier score of 0.054, further underscored the reliability of the model.Conclusion: The nontreponemal IgM antibody-based predicted model could equip clinicians with a valuable tool for the precise staging of latent syphilis and enhancing clinical decision-making.Keywords: syphilis, latent syphilis, latent syphilis staging, nontreponemal IgM antibody, predictive model

Syphilis is a re-emerging sexually transmitted infection. According to the definition, latent syphilis is characterized by seroreactivity without clinical manifestations. Here, we reported an atypical case of syphilis in a patient with HIV naïve to the antiretroviral treatment characterized by mucocutaneous relapse that occurred in the late latent stage. The patient reported his last sexual intercourse about 18 months ago and had self-healing genital and palmoplantar lesions more than 1 year before the presentation. He denied any other types of sexual relationship. He presented with mucocutaneous scattered lesions on his face, neck, palms, soles, penis, and scrotum. He was compliant with arthralgias, myalgias, asthenia, new onset stypsis, and mild anorectal pain. Testing for Syphilis and HIV returned positive. Opportunistic infections were excluded, and antiretroviral therapy with a bictegravir-based regimen was started. Syphilis was treated successfully with three doses of 2.4 million units of benzathine penicillin.

Xiaodong Wang,1 Paride Abliz,1 Shuwen Deng2 1Department of Dermatology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China; 2Department of Medical Microbiology, People’s Hospital of Suzhou New District, Suzhou, Jiangsu, People’s Republic of ChinaCorrespondence: Shuwen Deng, Department of Medical Microbiology, People’s Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu, People’s Republic of China, Email shuwen.deng@gmail.com Paride Abliz, Department of Dermatology, the First Affiliated Hospital of Xinjiang Medical University, No. 393, Xinyi Road, Urumqi, Xinjiang, People’s Republic of China, Email palidae@aliyun.comBackground: Macrolide resistance in Treponema pallidum (T. pallidum) has been increasing in recent years worldwide. However, few data are available on macrolide resistance in T. pallidum from Xinjiang province, located in the western part of China, which is an area with a high incidence of syphilis. In this study, we investigated the molecular characteristics of macrolide resistance in T. pallidum from patients with latent syphilis in Xinjiang, China.Methods: In total, 204 whole blood samples were collected from patients with latent syphilis during 2016 to 2017, in the First Hospital of Xinjiang Medical University. Genomic DNA of blood samples was extracted using a QIAamp DNA Mini Kit and T. pallidum was detected by PCR with the specific polA gene of T. pallidum. The 23S rRNA gene of T. pallidum was amplified among the T. pallidum-positive samples by nested PCR, and macrolide resistance-associated mutation sites A2058G and A2059G in the 23S rRNA gene were identified using restriction enzymes MboII and BsaI.Results: The specific polA gene of T. pallidum (T. pallidum positive) was detected in 27 blood samples (13.2%) from 204 patients with latent syphilis. The 23S rRNA gene was then amplified in all 27 T. pallidum-positive samples, among which 24/27 samples (88.9%) harbored the A2058G mutation in the 23S rRNA gene and 3/27 (11.1%) had the A2059G mutation.Conclusion: Our results indicated that T. pallidum macrolide resistance should not be ignored in Xinjiang, China, and that A2058G was the predominant macrolide resistance mechanism. Blood may be a suitable specimen for the detection of resistant mutations of T. pallidum in patients with latent syphilis who do not show any clinical symptoms.Keywords: macrolide resistance, Treponema pallidum, latent syphilis, 23S rRNA

Yumei Ge,1,&ast; Xiaoyu Gou,1,&ast; Xiaoyan Dong,1,2 Yumeng Peng,1,3 Fangfang Yang4 1Department of Laboratory Medicine Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, People’s Republic of China; 2The Second Medical College, Zhejiang Chinese Medical University, Hangzhou, 310014, People’s Republic of China; 3Department of Clinical Laboratory Diagnostics, Bengbu Medical College, Bengbu, 233030, People’s Republic of China; 4Department of Clinical Laboratory, The Third Hospital of Mianyang (Sichuan Mental Health Center), Mianyang, 621000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fangfang Yang, Department of Clinical Laboratory, The Third Hospital of Mianyang (Sichuan mental health center), Mianyang, Sichuan, 621000, People’s Republic of China, Email yhge2159@163.comPurpose: At present, there is no gold standard or unified standard for the diagnosis of neurosyphilis, and the rate of misdiagnosis is high. The diagnosis of neurosyphilis is still challenging. This study compared the clinical indicators between neurosyphilis and latent syphilis infection in the central nervous system. The purpose of this study was to provide evidence for the differential diagnosis and prognosis of patients with neurosyphilis and latent syphilis infection of the central nervous system.Methods: The clinical data of 59 patients with neurosyphilis and 30 patients with latent syphilis infection in the nervous system from 2008 to 2021 were analyzed. The cerebrospinal fluid and serum biochemical markers were evaluated for all patients.Results: CSF-nucleated cells, CSF-TRUST, CSF-totalprotein and CSF-IgG (P< 0.001) were significantly different between neurosyphilis and latent syphilis infection in the central nervous system. CSF-TRUST titer was positively correlated with D-D concentration (r = 0.274, P < 0.05), sodion (r =0.251, P < 0.05), respectively. Glucose concentration is the most unreliable in the diagnosis of neurosyphilis (AUC=0.445, P=0.395), and TRUST combined with nucleated cells and total protein is the most accurate in the diagnosis of neurosyphilis (AUC=0.989, P< 0.001).Conclusion: The combination of TRUST, nucleated cell count and totalprotein detection in CSF can distinguish the patients with neurosyphilis and latent syphilis infection in the central nervous system, which has a significant diagnostic value.Keywords: neurosyphilis, latent syphilis infection, diagnosis, detection index

The objective of this work is to study nonspecific protective factors in patients with latent early syphilis. The results of the study are based on the data of a comprehensive examination before treatment of 142 patients with early latent syphilis and 20 patients of the comparison group. Methods of investigation: serological methods for the diagnosis of syphilis complex of serological reactions, enzyme-linked immunosorbent assay (IgM, IgG), Indirect immunofluorescence reaction (RIF) RIF-200, RIF-abs; determination of cytokines IL-2, IL-6, IL-10, TNFα and INFγ in blood serum by enzyme-linked immunosorbent assay; determination of the phenotype of lymphocytes (CD-receptors), the concentration of circulating immune complexes, phagocytic number, phagocytic index, Nitroblue tetrazolium test. In the blood serum of patients the concentration of IL-2, IL-6, IL-10 and TNFα, INFγ was significantly increased. The concentration of IL-10 and IL-6 was also significantly increased in patients with more than 1 year of infection. The most significant disorders of the parameters of the metabolic activity of neutrophils were found in patients with an infection of more than 1 year; an imbalance in the circulating immune complexes concentration was also established. Under the increasing duration of the infection, the concentration of CD16+ in the blood serum progressively decreases. The content of pro-inflammatory and anti-inflammatory cytokines in the blood serum of patients with early latent syphilis was significantly increased and depended on the timing of infection. This relationship was most pronounced for IL-6 and IL-10. In patients with early latent syphilis there is also an imbalance between CD25+ and late activation factor HLA-DR against the background of a progressive decrease in the number of CD16+ lymphocytes. A direct relationship was established between the time of infection and the number of NK-cells. The revealed disorders may be the consequence of significant disorders on the part of neutrophils and may be one of the factors of the latent course of syphilitic infection.

Syphilis is a re-emerging sexually transmitted infection. According to the definition, latent syphilis is characterized by seroreactivity without clinical manifestations. Here, we reported an atypical case of syphilis in a patient with HIV naïve to the antiretroviral treatment characterized by mucocutaneous relapse that occurred in the late latent stage. The patient reported his last sexual intercourse about 18 months ago and had self-healing genital and palmoplantar lesions more than 1 year before the presentation. He denied any other types of sexual relationship. He presented with mucocutaneous scattered lesions on his face, neck, palms, soles, penis, and scrotum. He was compliant with arthralgias, myalgias, asthenia, new onset stypsis, and mild anorectal pain. Testing for Syphilis and HIV returned positive. Opportunistic infections were excluded, and antiretroviral therapy with a bictegravir-based regimen was started. Syphilis was treated successfully with three doses of 2.4 million units of benzathine penicillin., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Syphilis is a chronic and systemic sexually transmitted infection caused by Treponema pallidum. The prevalence of syphilis according to the World Health Organization (WHO) is around 12 million cases worldwide and in pregnant women around 1.8 million cases. Syphilis screening in pregnancy is important to break the chain of transmission of congenital syphilis. We reported Mrs. S, 33 years old, 18 weeks pregnant, came with history of itchy patches appeared 8 months ago along with her husband and abortion 1 year ago. The plantar pedis dextra et sinistra showed multiple hyperpigmented macules and no clinical founding in the vagina. Serological tests, reactive Venereal Disease Research Laboratory (VDRL) 1:32, Treponema pallidum hemagglutination (TPHA) >1:5120 and non-reactive human immunodeficiency virus (HIV), support the diagnosis of latent syphilis. Patients were injected with benzathine penicillin 2.4 million units 3 times (1 week apart). Serological test evaluated at months 1, 3 and 6. At month 6, there was a decrease in VDRL value 4 times the initial value, indicating successful therapy in laten syphilis and had received therapy according to the guidelines for late latent syphilis. Syphilis in pregnancy can cause congenital syphilis in the fetus, although latent syphilis has no symptoms. The patient's VDRL titer was reactive in early latent syphilis (>1:8), but based on history and duration of infection more than 1 year including late latent syphilis. Based on this case report, we found that the VDRL titer value did not always correspond to the duration of infection.

We aimed to investigate the CXCL13 concentration of the serum and cerebral spinal fluid (CSF) in human immunodeficiency virus (HIV)-negative latent syphilis patients with treatment failure and explore the change in CXCL13 after treatment. Sixty-eight latent syphilis patients with treatment failure (failure group), 68 syphilis patients with successful treatment (seroconversion group) and 18 patients with non-inflammatory diseases of the nervous system (control group) were included and serum and CSF were collected. Enzyme-linked immunosorbent assay was employed to detect the CXCL13 in the serum and CSF. Results showed that the serum CXCL13 concentration was comparable among three groups, and the CSF leukocyte count, IgG index and CXCL13 concentration in the failure group were significantly higher than those in the seroconversion group and control group (P < 0.05, P < 0.01). CSF CXCL13 concentration in the failure group was positively related to the CSF leukocyte count (r = 0.3594, P < 0.001). Of the 68 patients in the treatment failure group, neurosyphilis was found in 17 (25.0%). In conclusion, involvement of nervous system is one of the reasons for the treatment failure in patients with latent syphilis. Detection of CSF CXCL13 concentration is helpful for the diagnosis and therapeutic evaluation of HIV-negative latent syphilis patients with treatment failure and neurosyphilis.

Syphilis is an important global health threat and little has changed in its treatment since the mid-20th century. For late-latent or syphilis infection of unknown duration, the standard treatment of multiple intramuscular injections of benzathine penicillin G (BPG) are associated with significant pain and distress to clients and caregivers, negatively impacting on treatment completion. Based on pharmacokinetic modelling from a Phase I study of subcutaneous infusion of high dose BPG (SCIP), we present its feasibility, safety and tolerability for treatment of syphilis in a single infusion. SCIP leads to more sustained penicillin concentrations above the desired target with less reported pain and reduced clinic visits.

Treponema pallidum infection has emerged in recent years as an important community threat and burden to the health care system. Here, we report the case of a patient with cholestatic liver disease secondary to late latent syphilis. A 41 year-old male patient was referred to the clinic for assessment of an abnormal liver function panel. Ultrasound of the abdomen demonstrated an intense liver echogenicity, normal bile ducts, and no ascites. Virologic study revealed negative results for antibodies against common viral hepatitis and metabolic and autoimmune disease. The patient was tested for syphilis and a positive result was reported. The patient was diagnosed with late latent syphilis and syphilitic hepatitis and initiated benzathine penicillin at G 7.2 million units total, delivered as three doses of 2.4 million units intramuscular each at one-week intervals. He was assessed monthly and by the end of the sixth month, he had nonreactive VDRL (seroconversion), which confirmed recovery. Syphilitic hepatitis is an overlooked type of hepatitis and should be kept in mind as a differential diagnosis in an abnormal liver panel of uncertain etiology. Health care providers should be advised that higher levels of ALP may be the single landmark in cases of syphilitic hepatitis.

The purpose of this study was to study the change in the content of the most active cytokines (interleukins 6 and 10) during the formation of the immune response in patients with latent early syphilis, as well as to study the possible relationship between the concentrations of these cytokines and the duration of the disease. In 50 patients with early latent syphilis, the concentration of interleukins 6 and 10 in serum was studied. The serum level of interleukins was studied by the enzyme immunoassay. A statistically significant increase in the concentration of interleukin 6 in the blood of patients with latent syphilis and decrease in the interleukin 10 concentration in comparison with healthy people was established. At the same time, in patients with latent syphilis with term of infection for more than 1 year, interleukin 10 has been expressed, as compared with healthy people and, especially, with patients with syphilis with a duration of infection of up to 1 year. Along with this, a lower degree of increase in the concentration of interleukin 6 in patients with latent syphilis with a duration of infection over 1 year has been established, as compared with patients with latent syphilis with a term of infection up to 1 year, against the background of its increased concentration as compared with a group of healthy individuals.

Goal. To conduct a comparative assessment of the results of regulated serological tests obtained as a result of blood tests in patients suffering from latent syphilis. Materials and methods. The authors examined 187 patient medical records with newly diagnosed latent syphilis in FGBU GNTsDK (State Research Center for Dermatology, Venereology and Cosmetology), Health Ministry of the Russian Federation, in 2006-2015. The results of patient blood tests were analyzed with the use of non-treponemal (microprecipitation test/RPR) and treponemal (passive hemagglutination test, immune-enzyme assay (IgA, IgM, IgG), IFabs, immunofluorescence test and Treponema pallidum immobilization test) serology tests. Results. According to the results of blood tests of latent syphilis patients, the largest number of positive results was obtained as a result of treponemal serology tests such as immune-enzyme assay (100%), passive hemagglutination test (100%) and IFabs (100%). The greatest number of negative results was observed in non-treponemal (microprecipitation test/RPR) serology tests: in 136 (72.7%) patients; evidently positive results (4+) test results were obtained in 8 (4.3%) patients only. According to the results of a comparative analysis of blood tests in patients suffering from latent syphilis obtained with the use of treponemal serology tests, the greatest number of evidently positive results (4+) was noted for the passive hemagglutination test (67.9%). Negative treponemal test results were obtained with the use of the immunofluorescence test and Treponema pallidum immobilization test (21.9% and 11.8% of cases, respectively). Moreover, weakly positive results prevailed for the immunofluorescence test: in 65 (34.7%) patients. Conclusion. These data confirm that the following treponemal tests belong to the most reliable ones for revealing patients suffering from latent syphilis: immune-enzyme assay, passive hemagglutination test and IFabs.

ObjectivesWe investigated people with HIV (PWH) receiving combination antiretroviral therapy (cART) for latent syphilis infection prevalence, risk factors, treatment response, and neurosyphilis.MethodsA prospective follow-up study was conducted on PWH and latent syphilis. The cases were randomly assigned to receive either benzathine penicillin G (BPG) or doxycycline (DOXY), and the posttreatment response was evaluated after 12 and 24 months. The traditional algorithm was used for serodiagnosis, and a semi-quantitative rapid plasma reagin (RPR) test monitored disease activity and treatment effectiveness.ResultsOf the 823 participants, 64.8% were women, and the mean age was 41.7±10 years. Thirty-one (3.8%) of the participants (22 males and nine females) had latent syphilis. The risk factors were male sex (aOR = 3.14), increasing age (aOR = 1.04 per year), and cART duration (aOR = 1.01 per month). Baseline RPR titers were: ≤1:4 in 19 (61.3%), between 1:8 and 1:32 in 10 (32.2%), and >1:32 in 2 (6.4%). None of the seven cerebrospinal fluid analyses supported a neurosyphilis diagnosis. In the 12th month of treatment, 27 (87.1%) had adequate serological responses, three (9.7%) had serological nonresponse, and one (3.2%) had treatment failure. Syphilis treatment was repeated in the last four cases with the alternative drug. In terms of adequate serologic response, both therapies were comparable at the 12th month, p = 0.37. All cases responded to treatment in the 24th month.ConclusionIn PWH receiving cART, latent syphilis occurred more in men than women, suggesting an investigation of sexual practices and the impact of antenatal syphilis screening. Syphilis disease activity reduces in the latent stage. Therefore, the routine cerebrospinal fluid analysis contributes little to the diagnosis of asymptomatic neurosyphilis and the treatment success of latent syphilis. DOXY is an alternative to BPG, and cART improves serologic response to latent syphilis treatment.

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. It is of special concern during pregnancy because can lead to adverse pregnancy outcomes and congenital syphilis. We retrospectively included female patient with laboratory-confirmed syphilis in East Java. Demographic, pregnancy record, clinical, radiological, laboratory, and treatment data were reviewed from medical record and health of both mother and child book. Clinical characteristics and outcome of patient were described. The patient was 40-year-old multiparous pregnant women was referred to the hospital at 40 weeks of gestation due to early latent syphilis. The patient was diagnosed during the last trimester and had not been treated, but no vulvar and anal genital wart was found. Patient was scheduled to urgent section caesarean but 1 hour after admitted to the hospital, patient had spontaneous delivery. A healthy son was born (3400 g /50 cm, 10 points Apgar score). Due to the lack of documentation regarding treatment of maternal syphilis, crystalline penicillin was administered to the newborn. Screening and early penicillin treatment are the most important factors that can eliminate complications related to the prenatal contagion with Treponema pallidum. Yet despite the lack of treatment or its inappropriate administration, the pregnancy complicated with maternal syphilis may end in a completely different way.

Purpose: To investigate the effect of the combination of benzathine penicillin and ceftriaxone in the treatment of latent syphilis in the elderly. Methods: A total of 70 elderly patients with latent syphilis treated in the First People’s Hospital of Yichang from March 2020 to March 2021 were enrolled in this study. Control group (CG) comprised thirty-two patients treated with benzathine penicillin, while 38 patients received the combination of benzathine penicillin and ceftriaxone were placed in the study group (SG). Therapeutic efficacy and adverse reactions in both groups were assessed. The difference in toludine red unheated serum test (TRUST) negative conversion rate at different periods of treatment (3, 6, and 12 months) after treatment was observed. Dermatological quality of life index (DLQI), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores were also determined before and after treatment. Results: Total efficacy in the study group was significantly higher than that in the control group after treatment (p < 0.05), but there was no significant difference in the total incidence of adverse reactions between both groups (p > 0.05). The TRUST negative conversion rate at 6 and 12 months in SG was higher than that in CG (p < 0.05), while DLQI, SAS and SDS scores in SG were significantly lower after treatment (p < 0.05). Conclusion: Treatment of elderly patients with latent syphilis with the combination of benzathine penicillin and ceftriaxone effectively controls the disease and improves patients’ negative emotions and quality of life with few adverse drug reactions. Further clinical trials are required prior to application in clinical practice. [ABSTRACT FROM AUTHOR]

Objective – to study the concentration of pro- and anti-inflammatory cytokines in patients with early latent syphilis before and after treatment. The study was conducted in 112 patients with early latent syphilis (52 men and 60 women) and 15 healthy persons of the control group – all aged 18-43. Serological tests were used: the classical complex of serological reactions (CSR), ELISA, the reaction of passive hemagglutination (RPGA), immunofluorescence reaction with absorption (RIF-abs) and RIF-200. Using ELISA, the levels of cytokines IL-2, IL-6, IL-10, TNFα, and INFγ were determined in serum (in patients with latent syphilis, before and after treatment). The analysis of the received data was carried out with application of the program package Statistics 6.0. To identify the relationships between the indices, Friedman's nonparametric variance analysis with the definition of χ2 was used. The concentration of IL-10 before treatment in patients with early latent syphilis was significantly increased by 3.7 (14.9±0.9 pg/ml compared to the control group 4.11±0.5 pg/ml). The dependence of the content of this cytokine on the period of infection was established. It was found that one year after treatment concentration of IL-10 remained 1.8 times higher. The concentration of IL-6 was increased by 6.5 times in patients with latent early syphilis and was also dependent on the period of the infection, and also even 1.5-2 years after treatment the IL-6 content remained elevated. It was also found that in patients with latent early syphilis the concentration of IL-2 was increased by 2.3 times and it did not normalize in 24.5% of patients even two years after treatment. In patients with latent early syphilis, the concentration of TNFα was increased by 3.6 times. After treatment, the concentration of TNFα decreased, but exceeded the control values by 1.55 times. Further analysis of the concentration of TNFα revealed that, with a disease period of up to one year, the concentration of this cytokine was normal during ten months after treatment, and in patients with the disease period of more than one year, after treatment normalization of the TNFα level was absent in 64.5% even after 18 months. It was found that the concentration of INFγ in patients with early latent syphilis before treatment was increased by 3.8 times in comparison with the control group. After treatment, almost 25 % of patients with the duration of the infection more than one year revealed no normalization of INFγ and it was increased by 1.5 times. In patients with latent early syphilis there was a significant increase in the concentration of cytokines TNFα and INFγ, an imbalance of IL-2, IL-6, IL-10 as well as. The dependence of the cytokine concentration on the period of infection is noted. Based on the study of the cytokine status in patients with early latent syphilis with periods of infection of more than one year, the use of immunomodulatory therapy may be recommended. Increasing the concentration of such cytokines as TNFα, IL-6, IL-10 after treatment can be used as prognostic tests of serological resistance.

Neuromyelitis optica spectrum disorder (NMOSD) in elderly patients is an uncommon but severely disabling disease. Rapid diagnosis and treatment are warranted. However, due to the different comorbidities present in the elderly, it is likely to result in misdiagnosis or delayed diagnosis. Herein, we report a case of very-late-onset NMOSD with latent syphilis misdiagnosed as lumbosacral spondylolisthesis in an 80-year-old woman. Our case highlights that timely treatment of co-existing latent syphilis and aquaporin-4 antibody(AQP4-Ab)-positive NMOSD results in an excellent prognosis. NMOSD should be considered in the differential diagnosis of elderly patients with transverse myelitis. In addition, comprehensive investigation and treatment of diseases co-existing with NMOSD are essential. [ABSTRACT FROM AUTHOR]

The objective of this work is to study nonspecific protective factors in patients with latent early syphilis. The results of the study are based on the data of a comprehensive examination before treatment of 142 patients with early latent syphilis and 20 patients of the comparison group. Methods of investigation: serological methods for the diagnosis of syphilis complex of serological reactions, enzyme-linked immunosorbent assay (IgM, IgG), Indirect immunofluorescence reaction (RIF) RIF-200, RIF-abs; determination of cytokines IL-2, IL-6, IL-10, TNFα and INFγ in blood serum by enzyme-linked immunosorbent assay; determination of the phenotype of lymphocytes (CD-receptors), the concentration of circulating immune complexes, phagocytic number, phagocytic index, Nitroblue tetrazolium test. In the blood serum of patients the concentration of IL-2, IL-6, IL-10 and TNFα, INFγ was significantly increased. The concentration of IL-10 and IL-6 was also significantly increased in patients with more than 1 year of infection. The most significant disorders of the parameters of the metabolic activity of neutrophils were found in patients with an infection of more than 1 year; an imbalance in the circulating immune complexes concentration was also established. Under the increasing duration of the infection, the concentration of CD16+ in the blood serum progressively decreases. The content of pro-inflammatory and anti-inflammatory cytokines in the blood serum of patients with early latent syphilis was significantly increased and depended on the timing of infection. This relationship was most pronounced for IL-6 and IL-10. In patients with early latent syphilis there is also an imbalance between CD25+ and late activation factor HLA-DR against the background of a progressive decrease in the number of CD16+ lymphocytes. A direct relationship was established between the time of infection and the number of NK-cells. The revealed disorders may be the consequence of significant disorders on the part of neutrophils and may be one of the factors of the latent course of syphilitic infection. [ABSTRACT FROM AUTHOR]

Цель: определить характер зрительных нарушений у больных латентным сифилисом, оценить возможности исследования зрительных вызванных потенциалов (ЗВП), оптической когерентной томографии (ОКТ) и лазерной конфокальной томографии (ЛКТ) в диагностике и уточнении формы нейросифилиса. Материал и методы. Обследованы 133 больных скрытым сифилисом на предмет выявления признаков поражения нервной системы и органа зрения. Результаты. Рутинное офтальмологическое обследование позволяет обнаружить нарушения зрения у 48 % больных латентным сифилисом. При нейросифилисе наиболее часто встречается ангиопатия сетчатки и первичная атрофия дисков зрительных нервов. Исследование ЗВП, использование ОКТ и ЛКТ позволяют выявлять признаки поражения органа зрения в 66 – 79 % случаев латентного сифилиса, нередко — до появления симптомов и признаков заболевания. Заключение. Офтальмологическое обследование должно быть обязательным не только при установленном диагнозе «нейросифилис», но и во всех случаях латентного сифилиса.