2006, Number S4
<< Back
Arch Cardiol Mex 2006; 76 (S4)
Cardiovascular syphilis: Diagnosis, treatment
Carrada-Bravo T
Language: Spanish
References: 45
Page: 189-196
PDF size: 311.81 Kb.
ABSTRACT
Cardiovascular tertiary syphilis may lead to aortitis, aortic aneurism, coronary stenosis, aortic insufficiency and, rarely, to myocarditis. The physician must be familiar with the clinical presentations of this process, including the asymptomatic variety and must be able to have an organized plan for the diagnosis and evaluation to establish or exclude the presence of cardiovascular pathology and the differential diagnosis with other entities. Once the etiologic and topographic diagnosis is established, the patient should be treated with penicillin, doxicycline and other antibiotics, and the consequences of the disorder, both actual and potential, should be considered before deciding weather to recommend surgical intervention. Although late syphilis can be prevented by appropriate therapy of early syphilis, this is a cardiovascular disease that most likely will continue to be diagnosed lately. Understanding of the pathology and pathophysiology of the disease, is most important for its prompt recognition and subsequent management. This paper reviews the natural history, diagnosis and therapy of cardiovascular syphilis.
REFERENCES
Rudolph AH: Sífilis. En: Hoeprich PD: Tratado de Enfermedades Infecciosas. Barcelona: Salvat Ed 1982: 520-538.
Kampmeier RH: Manifestaciones tardías de la sífilis: esqueléticas, viscerales y cardiovasculares. Clin Med Norteamérica 1964; 48: 667-697.
Guadalajara-Boo JF: Sífilis Cardiovascular. En: Guadalajara-Boo JF: Cardiología. México DF: Fco. Méndez-Cervantes 1981: 609-615.
Tramont EC: Treponema pallidum (Syphilis). En: Mandell GL, Bennett JE, Dolin R: Principles and Practice of Infectious Diseases. 5a Ed, Filadelfia: Churchill-Livingstone 2000: 2474-2490.
Handsfield HH, Lukehart SA, Sell S, Norris SJ, Holmes KK: Demonstration of Treponema pallidum in a Cutaneous Gumma by Indirect Immunofluorescence. Arch Dermatol 1983; 119: 677-685.
Carrada-Bravo T: Observaciones sobre el Treponema pallidum y la historia natural de la sífilis en México. Investigación preliminar. Dermatología Rev Mex 1989; 33: 359-366.
Sanchez PJ, Wendel DG Jr, Grimprel E: Evaluation of molecular methodologies and rabbit infectivity testing for diagnosis of congenital syphilis and neonatal central nervous system invasion by Treponema pallidum. J Infect Dis 1993; 167: 148-157.
Horowitz HW, Valsamis MP, Wicher V: Cerebral syphilitic gumma confirmed by the polymerase chain reaction in a man with human immunodeficiency virus infection. N Engl J Med 1994; 331: 1488-1491.
Pillay A, Liu H, Chen CY: Molecular subtyping of Treponema pallidum subspecies pallidum. Sex Transm Dis 1998; 25: 408-414.
Fraser CM, Norris SJ, Weinstock GM: Complete genome sequences of Treponema pallidum, the syphilis spirochete. Science 1998; 281: 375-388.
Clark EG, Danbolt N: The Oslo study of the natural history of untreated syphilis: an epidemiological investigation based on a restudy of Boeck-Bruunsgaard material. J Chronic Dis 1995; 2: 311-344.
Gjestland T: The Oslo study of untreated syphilis: An epidemiologic investigation of the natural course of syphilitic infection based on a restudy of Boeck-Bruunsgaard material. Acta Derm Venereal (Stockh) 1955; 35: Suppl 34: 1-500.
Rosahn PD: Autopsy Studies in Syphilis: A Monograph. U.S.P.H.S. Publication No. 433. 6a Ed, Washington DC: US Government Printing Office 1955.
Montgomery GL: Textbook of Pathology. Vol II. Edinburgh and London: Livingstone Ltd, 1965: 517-737.
Hook EW III, Marra CM: Acquired syphilis in adults. N Engl J Med 1992; 326: 1060-1069.
Sparling PF: Natural history of syphilis. En: Holmes KK, Märdh PA, Sparling PF, Wiesner PJ: Sexually Transmitted Diseases. 2a Ed, Nueva York: McGraw-Hill 1990: 213-219.
Healy BP: Cardiovascular syphilis. En: Holmes KK, Märdh PA, Sparling PF, Wiesner PJ: Sexually Transmitted Diseases. 2a Ed, Nueva York: McGraw-Hill 1990: 247-250.
Warthin AS: The new pathology of syphilis. Am J Syph 1918; 2: 425-432.
Heggveit HA: Syphilitic aortitis. A clinic-pathological autopsy study of 100 cases, 1950 to 1960. Circulation 1964; 29: 346-354.
Webster B: Studies on cardiovascular syphilis III. The natural history of syphilitic aortic insufficiency. Am Heart J 1953; 46: 117-126.
Bruenn HG: Syphilitic Disease of the Coronary Arteries. Am Heart J 1934; 9: 421-430.
Steel D: The roentgenological diagnosis of syphilitic aortitis. A review of forty proved cases. Am Heart J 1930; 6: 59-68.
Saphir O: Syphilitic Myocarditis. Arch Pathol 1932; 13: 266-275.
Larsen SA: Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev 1995; 8: 1-39.
Larsen SA, Hunter EF, Creighton ET: Syphilis. En: Holmes KK, Märdh PA, Sparling PF, Wiesner PJ: Sexually Transmitted Diseases. 2a Ed, Nueva York: McGraw-Hill 1990: 927-934.
Romanowski B: Serologic response to treatment of infectious syphilis. Ann Intern Med 1991; 114: 1005-1009.
Carr JG: The gross pathology of the heart in cardiovascular syphilis. Am Heart J 1930; 6: 30-49.
Harvey WP, Corrado M, Perloff JK: Right Sided Murmur of Aortic Insufficiency. Am J Med Sci 1963; 245: 533-540.
Gould SE: Pathology of the Heart. Sprinfield, Il: Charles C Thomas 1960: 906-908.
Leung JSM, Mok CK, Leong JCY, Chan WC: Syphilitic Aortic Aneurysm with Spinal Erosion. J Bone Joint Surg 1977; 59: 89-97.
Kampmeier RH: Saccular aneurysm of the thoracic aorta: A clinical study of 633 cases. Ann Int Med 1938; 12: 624-639.
Pugh PJ, Grech ED: Syphilitic Aortitis. N Engl J Med 2002; 346: 676-677.
Eisenberg RL: Diagnóstico por imagen, patrones de diagnóstico diferencial. 2a Ed, Madrid: Marban, 1995: 3-1036.
Bulkley BH, Roberts WC: Atherosclerotic narrowing of the left main coronary artery: A necropsy analysis of 152 patients with fatal coronary heart disease and varying degrees of left main narrowing. Circulation 1976; 53: 823-834.
Weinstein A: Complete Heart Block due to Syphilis. Arch Intern Med 1957; 100: 90-96.
Handsfield H: Enfermedades de transmisión sexual. 2a Ed, Madrid: Marban 2002: 37-61.
Weinstein G, Killen DA: Innominate artery-coronary bypass graft in a patient with calcified aortitis. J Thorac Cardiovascular Surg 1980; 79: 312-321.
Grabau W, Emanuel R, Ross D, Parker J, Hegde M: Syphilitic Aortic Regurgitation: An Appraisal of Surgical Treatment. Br J Vener Dis 1976; 52: 366-378.
Nancarrow PA, Higgins CB: Progressive thoracic aortic dilatation after valve replacement. AJR, 1984; 142: 669-680.
Carrada-Bravo T: Lo que usted debe saber sobre la sífilis. Las enfermedades al día (Méx) 1985; 101: 12-14.
Carrada-Bravo T, Duran-Bermúdez H: Observaciones sobre la ultraestructura del chancro sifilítico y su historia natural en México. Dermatología Rev Mex 1990; 34: 32-42.
Carrada-Bravo T: Estudio ultraestructural del Treponema pallidum y de un chancro sifilítico humano. Patología Rev Latinoamer 1991; 29: 167-169.
Uribe-Salas F, Hernández-Avila M, Conde-González C, Juarez-Figueroa L, Uribe-Zuñiga P, Calderon-Jaimes E, et al: Prevalence, incidence and determinants of syphilis in female comercial sex workers in Mexico City. Sex Trans Dis 1996; 23: 120-126.
Juárez-Figueroa LA, Meléndez-Betancourt LA, Conde-González CJ: Hallazgo de sífilis a término del embarazo en mujeres de Cuernavaca, Mor. Rev Invest Clin (Méx) 2001; 53: 375-377.
Calderon JE, Conde GC, Juárez FL, Uribe ZP, Olamendi PM: Prevalencia de anticuerpos antitreponémicos en 3,098 mujeres dedicadas a la prostitución en la Ciudad de México. Rev Invest Clin (Méx) 1994; 46: 431-36.