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Chronic erythematous rash and lesions on trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
If treatment is delayed, patients can go on to develop arthritis (initially intermittent swelling of large joints and later a chronic erosive arthritis), meningoencephalitis, facial nerve palsy and heart problems (conduction defects, myocarditis and pericarditis) weeks or months later. If suspected, the diagnosis can be confirmed by finding antibodies to the spirochaete in the patient's serum. There should be a fourfold rise in antibody titre over 2–3 weeks. The antibody (ELISA) test can be done at your local hospital.
Skin disorders in AIDS, immunodeficiency, and venereal disease
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Indrashis Podder, Rashmi Sarkar
Diagnosis is made by identification of the spirochaete from wet preparations of the chancre or moist secondary-stage lesions (dark ground illumination microscopy) and by serological tests detecting either lipoidal substance liberated by infected tissues (non-treponemal tests) or the presence of antibodies to the microorganism (treponemal tests).
Infections
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Congenital syphilis is rare, but is a cause of abortion, fetal hydrops, or newborns with hepatosplenomegaly and pneumonia. Abundant spirochaetes are present in the lesions. Later, central nervous system, bone, and mucocutaneous lesions may develop.
Lyme Neuroborreliosis Presenting as Multiple Cranial Neuropathies
Published in Neuro-Ophthalmology, 2022
Aishwarya Sriram, Samantha Lessen, Kevin Hsu, Cheng Zhang
In addition to the clinical presentation and imaging, the diagnosis of Lyme disease was made based on serological and CSF studies. For serological testing, a two-tiered approach is recommended: immunofluorescence assay or ELISA, followed by reflexive immunoblotting. This screening test (and confirmatory blot testing) can be falsely negative in early stages of Lyme disease. When positive, however, patients must undergo confirmatory testing. For the two-tiered approach, the sensitivity is 30–40% in early infection and 70–100% in disseminated disease, and the specificity is >95% in all stages.12 Our patient initially had elevated Lyme antibodies by ELISA. Western blot was then performed, which detected two out of three IgM bands, indicating acute infection. The blot also detected 2 out of 10 positive IgG bands. At least 5 of the 10 IgG bands must be detected to be considered positive, but detection of fewer IgG bands can occur in acute infection as the IgG response usually appears after 30 days.12 IgM positivity and IgG negativity a month after symptom onset may be false positive; however, in our case, the testing was performed 1 week after symptom onset. Notably, but rarely, a positive immunoblot can represent exposure to other spirochaetes.
In vivo imaging of Lyme arthritis in mice by [18F]fluorodeoxyglucose positron emission tomography/computed tomography
Published in Scandinavian Journal of Rheumatology, 2018
A Pietikäinen, R Siitonen, H Liljenbäck, O Eskola, M Söderström, A Roivainen, J Hytönen
Lyme borreliosis (LB) is an infectious disease caused by Borrelia burgdorferi sensu lato spirochaetes (later referred to as B. burgdorferi). Dissemination of the spirochaetes from the initial infection focus to the target organs is thought to occur via the blood or lymphatic vasculature. In the late disseminated stage of the disease, symptoms can occur in various organs including the heart, and in the joints and the nervous system (1, 2). Standard antibiotic treatment eradicates the bacteria and cures the infection in most cases, but a subgroup of patients have persisting symptoms after treatment (3). These symptoms are probably caused by infection-induced autoimmunity or sterile inflammatory responses to persisting B. burgdorferi antigens, but not persisting live bacteria. However, there are no proper in vivo imaging techniques to visualize the different manifestations of B. burgdorferi infection in humans.
Double Trouble: Challenges in the Diagnosis and Management of Ocular Syphilis in HIV-infected Individuals
Published in Ocular Immunology and Inflammation, 2020
Rafael de Pinho Queiroz, Derrick P. Smit, Remco P.H. Peters, Daniel Vitor Vasconcelos-Santos
In fact, the spirochetes probably invade the central nervous system (CNS) early during the course of primary infection, but it is thought that the bacteria may be cleared from the cerebrospinal fluid (CSF) without therapy.39 However, reports of neurological relapse after treatment with intramuscular (IM) benzylpenicillin appropriate to their disease stage without probenecid in HIV-infected patients with presumably no OS may suggest that the clearance of the spirochete from CNS might be impaired in these immunosuppressed individuals.40,41