Lesions of syphilisSyphilis - a sexually transmitted disease with a chronic course of cyclical, affecting all organs and tissues. French physician Ambroise Pare disease called «lues Venerae» - «Love the plague." The causative agent of the disease was discovered by F. Schaudinn and E. Hoffmann In 1905, the Etiology and characterization of the causative agent. The causative agent of syphilis, Treponema pallidum belongs to the genus Treponema (Gk. Trepo - rotate, nema - thread) family Spirochaetaceae (Gk. Speira - spiral, chaite - hair) of Gracilicutes order Spirochaetales. T. pallidum - spiral bacteria size 6-14 x 0.2-0.3 microns. Spiral curls are the same height and width, this number can be 8-14. Capable of forming an L-shape. Propagate by dividing the cross. Treponema badly stained with aniline dyes (hence the name "pale treponema"). With prolonged staining with Romanovsky-Giemsa acquire a pale pink color. In domestic practice prevalent method of silvering by Morozov when Treponema painted in black or dark brown color. Also used for negative staining Burri. T. pallidum demanding on the culture conditions, poorly growing on nutrient media. Biochemical characteristics are not well understood. Some strains decompose glucose, galactose, sucrose, maltose and mannitol to produce an acid to form hydrogen sulfide and indole, liquefy gelatin. We highlighted the pathogen protein, polysaccharide and lipid Ag. Pathogen maloustoychiv in the environment and are killed by drying, but the cold is kept up to 50 days. Epidemiology. Disease were recorded throughout. The reservoir of the pathogen - a sick man. The mode of transmission - sexual contact, through blood, parenteral, can be transmitted from mother to fetus pathogen transfer or when passing through the birth canal. Infection can occur through and medical instruments, including dental (tips, mirror), if not made enough of them decontamination. Prerequisite of infection in this case is the damage of the stratum corneum of the skin or the surface epithelium of the mucosa. Infection can occur through direct contact with the pathogen in the blood, for example, through a wound in the hands of a doctor during operations. Gynecologists and dentists can become infected during the inspection and treatment of patients with syphilis. The pathogenesis of lesions. In the human pathogen penetrates microtrauma mucous membranes (mouth, genital tract, rectum) or skin, migrate to the lymph nodes, and then into the bloodstream and is disseminated generalized. Incubation period ranges from 10 to 90 days (average 21-24 days). At the point of introduction of T. pallidum within 2-4 weeks developing hard chancre (primary syphiloma) - painless ulcer with compacted edges (see Fig. 21). With the appearance of the chancre of primary syphilis begins. 7-10 days develops polyadenylation. In the first 3 weeks of serological tests are negative (primary seronegative syphilis), with the 4th week they become positive (seropositive primary syphilis). 6-7 weeks after the appearance of solid chancre develops secondary "fresh" syphilis - phase generalized spirohetemii visceral and nervous system. Characteristic symptom - pinkish-red rozeolёzno-papular-pustular eruptions on the skin and mucous membranes (syphilides). Under the action of the majority of immune responses treponemes dies, and the part is retained in the lymph nodes and internal organs. By reducing the activity of protective reactions rash reappear - secondary recurrent syphilis. If untreated, 3-4 years developing tertiary syphilis. During this period, in the skin, bone, nervous system formed granulomas (gumma). Granulomas tend to decay and scarring, which can cause serious abnormalities in the internal organs (visceral syphilis). Gummi contain a small amount of treponemes, but exclude the contagiousness of patients with tertiary syphilis can not, especially in the localization of granulomas in the mouth or on the genitals. When conducting inadequate treatment the disease becomes quaternary syphilis - neurosyphilis in which there is heavy CNS (syphilis of the brain, spinal tabes, progressive paralysis). When infection of the fetus from the sick mother congenital syphilis, often leading to miscarriage and stillbirth. In the case of the birth of a viable child clinical manifestations of the disease can be observed immediately after birth (early congenital syphilis), or between the ages of 5 and 15 years (late congenital syphilis). For early forms are characteristic-papular rash rozeolёznye, syphilitic pemphigus, osteochondritis, internal organ (liver, spleen) and nervous system (meningitis, meningoencephalitis). Typical manifestation of the late form - Hutchinson triad - parenchymatous keratitis, "barrel-shaped teeth" and deafness (due to destruction of the labyrinth); often observe changes tibia ("saber shin"). Lesions in the oral cavity. In the mouth, hard chancre, which is a manifestation of primary syphilis, occurs more often in the red border, the mucosa of the lips and tongue, but can also be formed on the gums, cheeks and tonsils. Development of chancre in the mouth begins with the appearance of redness limited in the mucosa that goes into the seal of 2-3 cm in diameter due to the formation of an inflammatory infiltrate. Fully formed chancre - a painless towering cartilaginous formation density in the center of which is erosion, not covered by a crust or coating. When injury and secondary infection joining erosion can go deep with ulceration, covers dirty gray necrotic bloom and destroying most of the infiltrate, which is an ulcer. Form lesions can be different: in the lips and tongue, usually round or oval; on the gums - preferentially localized in the elongated incisors (chancre is located in a crescent-shaped or parallel to the line between the teeth, grabbing a few of the interdental papillae); the mucous membrane in the corner of the mouth - a bleeding fracture infiltrated edges. Chancre language almost always solitary, located mostly on the front third of the dorsum of the tongue, at least - on the tip, very rarely - on the sides of the tongue. Primary syphiloma on the gums always single. Tonsillar hard chancre is almost always one-sided. There are three forms of solid chancre on the tonsils: erosive, ulcerative and anginopodobnuyu. However, the classical picture of the formation of hard chancre is not always observed. Often observed the appearance of very small ulcers with low infiltration (dwarf chancre), which makes them look like traumatic erosion that has developed after the damage the sharp edge of carious tooth prosthesis or any hard object. In the language of hard chancre can sometimes develop into thicker mucosa without erosion or ulcer formation (sclerosis form). In these cases, some of the language on which the primary syphiloma thickens. An important feature - Regional lymphadenopathy observed in all types of lesions. In nesanirovannoy oral hygiene in poor chancre may be complicated by infection or stafilostreptokokkovoy fuzospirohetozom. Develop severe inflammation, the clinical picture of syphilis obscured, there tenderness, purulent or necrotic plaque ulcer deepens. In secondary syphilis manifestations of infection in the oral cavity are presented papules and roseola. Most often on the oral mucosa papules appear with the location of the lips, tongue, tonsils, and the bow. Papules may have significant infiltration and rise above the mucosa. Center papules covered with whitish-gray bloom, and on the periphery is bluish-red infiltrate. Papules may coalesce into infiltrated plaques that on the bow of the soft palate may be located arches and garlands, significantly compressing the palatal curtain and tongue. Papules on the gums form the shape of an arc, infiltrating the gums and interdental papillae, often exposed to erosion and even ulceration. On the lower lip of plaque can cause significant swelling and sealing lips and the corners of the mouth to form a massive infiltration with painful deep cracks. Such hypertrophic papules may also be localized in any part of the oral mucosa. On eroded papule sometimes occurs and deeper infiltration decay, which leads to the formation of ulcer-papular syphiloderm. Typically, in these cases, joins a secondary infection, and then izyazvivshiesya papules covered with purulent touch of yellow-gray with distinct inflammatory phenomena. However, at the base of the ulcer and its periphery can detect specific dense infiltrate. On the mucous membrane of the cheeks papules located more on the line between the teeth, forming a dense grayish toothed belt. On tonsils white dense raids cover the entire surface, and deep infiltration specific causes slight inflammation (papular syphilitic angina), somewhat resembling catarrhal angina and diphtheria. In the language of the papules are located mostly at the tip or on the sides. Superficial papules round or oval shape can hardly rise; filiform and fungiform papillae in the tongue papules disappear, thereby forming a smooth shiny plaque bright red, sharply demarcated from the healthy tongue mucosa. Syphilitic roseola on the soft palate and the bow have a view sharply limited spots of bright red color, often merging into erythema (erythematous syphilitic angina). Roseola may occur in relapses of secondary syphilis in the form of a sharply limited spots without acute inflammation and subjective sensations. Without treatment, roseola stored for 1 month or more, with little change roseola in color and form. Secondary syphilides in the mouth - the most contagious. Most infections occur in the secondary period of syphilis, of which syphilides oral accounts for a significant proportion of cases. Tertiary syphilis is manifested in the mouth and gummy papulose syphilis. Papulose syphilis can be localized in the oral cavity, most commonly on the lips. Bluish-red dense painless bumps are arranged in groups. On the mucous membrane of the mouth bumps quickly disintegrate, forming a small deep ulcers with nepodrytymi edges. After healing papulose syphilis are scars that remain for life. Syphiloma in the oral cavity can be single or multiple, ranging in size from small nut to a pigeon egg and more. Gummy plague has infiltrated nepodrytye smooth edges that are covered with fine granulation and surrounded by a dense bottom roller bluish-red color. Without treatment, develops gummy perforation hard and soft palate. Sometimes Gunma opened 1-2 narrow fistula. Even with significant destruction of the tongue, perforation of hard and soft palate, perforation of the soft palate, the destruction of a large part of the tongue and lips patients do not notice a strong pain that distinguishes gummas from tuberculous ulcers in the mouth. The most characteristic gummy lesions occur on the tongue. They are characterized by the emergence and development of isolated gummas skleroznogo glossitis - formations in the language of continuous deep interstitial infiltrate. In congenital syphilis oral mucosa is affected at different rates depending on the age of the child. When clinical forms of early congenital syphilis in infants syphilitic rash watch no more than 30%. Syphilides have the form of papules, similar to those in secondary syphilis. The most common manifestation of early congenital syphilis - diffuse syphilitic infiltration of the skin on the palms, soles, buttocks and around the mouth, where it forms the characteristic perioral scars. Syphilitic infiltration also captures the red border of the lips, and often the mucous membrane of the lips and cheeks in the corner of the mouth. Deep infiltration in the skin and mucous membrane, continuous stretch lips at the screaming and sucking along with raunchy content oral create favorable conditions for the formation of linear scars, perpendicular to the line of the mouth and in the corners of the mouth (scars Robinson-Fournier). As a result of secondary infection can be deep cracks and leave scars for life. Microbiological diagnosis. Bacterioscopic method. Material for the study - chancre discharge, punctate lymph nodes, roseola scrapings, blood, CSF. Most optimal microscopy native smears - dark-field and phase contrast. Can also paint strokes with Romanovsky-Giemsa and Morozov. For rapid diagnosis of early used immunofluorescence. Serological. Use non-specific and specific tests. To include non-specific tests, which are used for the formulation of a non-specific cardiolipin-lecithin-cholesterol Az. This RAC proposed A. Wasserman, and VDRL-reaction (English. Venereal Disease Research Laboratory - Laboratory study of sexually transmitted diseases) or the so-called microreaction. Of specific tests are the most important RHS (Treponema pallidum immobilization reaction) and the reaction of microagglutination. Causative treatment. Before the discovery of antibiotics in the treatment of syphilis used mercury salts, potassium iodide, arsenic derivatives. The introduction of mercury into the therapy of syphilis, which took place under the influence of Paracelsus, has given rise to the well-known saying in the future of syphilis - "One night with Venus and the whole life with Mercury (symbol Hg)." Currently basis antisyphyllitic means comprise penicillins and bismuth preparations. Prevention. General measures for the prevention of sexually transmitted infections. Tests: 1. syphilis belongs to the genus: 1. Borrelia 2. Bordetella 3.Treponema 4. Leptospira 5. Mycobacterium 2. TR.PALLIDUM:. 1.Imeet 10-12 curls 2. Gramnegative 3. The mobile 4. Poor accepts dyes 5. has drawn up the core 3. In difficult environments, Treponema pallidum form cysts, which are: 1. is localized in the walls of blood vessels 2. Obespechivaeyut preservation of the pathogen in remission 3. indicates the development of DTH 4. Confirm primary syphilis 5. connected with the development of cell-mediated immunity 4. FOR syphilis is characterized by: 1. The incubation period of 24 days 2. Education chancre 3. Source - a sick man 4. Airborne transmission path 5. shock syndrome 5. based on incremental and painful inguinal lymph node EDUCATION chancre, was diagnosed - SYPHILIS. WHAT IS THE PERIOD DISEASE: 1.Pervichny 2. Incubation 3. Secondary 4. Tertiary 5. Quaternary 6. Immunity in syphilis: 1. non-sterile 2. Shankerny 3. Phagocytic 4. Antivirus 5. antitoxic 7. LABORATORY DIAGNOSIS Primary syphilis: 1 Reaction of precipitation 2. ELISA 3. Microscopy 4. Wasserman 5. Reaction Wright Gram-positive anaerobic 8.SPOROVYMI STICKS ARE: 1. Bacteroides 2.Clostridium 3. Eubacterium 4. Veilonella 5. Campilobacter 9. to the pathogen GAS anaerobic infections include: 1. Cl.tetani 2. Cl.perfringens 3. Cl.histolyticum. 4. Cl.septicum 5. Cl.novyi 10. GAS rapid diagnosis of anaerobic infections: 1: Method Yermolyeva 2. Gas-Liquid Chromatography 3. reveals the presence of a clostridial 4. neutralization 11.PROFILAKTIKA wound anaerobic infections is to use: 1., timely and comprehensive surgical care 2. DTP 3. antitoxic serum 4. Antimicrobial serum 5. BCG 12. clostridial TETANUS: 1.Imeyut-terminally located spores 2. Gram-positive 3. unencapsulated 4. Peritrihii 5. blood agar - hemolysis 13 FOR tetanus bacillus characterized by the formation: 1.Endotoksina 2. Tetanolizina 3. hyaluronidase 4. Plazmokoagulazy 5. fibrinolizin 14. STICKS FOR characterized by the formation of botulism: 1. hyaluronidase 2. Plazmokoagulazy 3. neurotoxin 4. tetanospazmin 5. Endotoxin 15 for the laboratory diagnosis of botulism, use: 1.Reaktsiyu neutralization on white mice 2 The reaction of agglutination 3. PHA 4. allergy tests 5. The reaction of Ascoli 16. FOR THE TREATMENT OF USE botulism: 1. Bacteriophage 2. Antimicrobial serum 3.Polivalentnuyu antitoxic serum 4. Antibiotics 5. autovaccine
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