Vol 91, No 2 (2015)

CLINICAL CASE REPORTS

A case of tertiary syphilis manifested with multiple skin gummas

Krasnoselskikh T.V., Mikheev G.N., Grigorian A.E., Yastrebov V.V., Sokolovskiy E.V.

Abstract

The tertiary cutaneous syphilis has become extremely rare as a result of the effective treatment of early syphilis with penicillin and occasional antibiotic therapy for concomitant infections. We report a case of tertiary gummatous syphilis associated with asymptomatic neurosyphilis that was initially misdiagnosed as basal cell carcinoma of the skin. A 67-year-old woman presented with the 18-month history of multiple, firm, bluish-red asymptomatic nodes on the parietal scalp, chin and lateral part of the trunk that had developed without preceding trauma. One node on the trunk had small central ulceration covered with dry yellowish crust. On the left retroauricular area the brownish-purple atrophic scar was observed. Blood tests revealed reactive VDRL, ELISA and TPHA assays. Skin biopsy has showed endarteritis with endothelial swelling and caseating granulomas along with plasmocytic infiltrate in the dermis and subcutaneous tissue. Increased lymphocyte count and the positive VDRL test with cerebrospinal fluid have confirmed the diagnosis of asymptomatic syphilitic meningitis in this patient. The treatment with aqueous penicillin intravenously has lead to resolution of the skin infiltrates and progressive more than 4-fold reduction of follow-up serum VDRL titers. This case is reported as a reminder of the possibility of tertiary syphilis with misleading clinical patterns in patients infected during the epidemics of 1995-2000. We would like to emphasize the necessity to perform timely serological and pathomorphological study to prevent misdiagnosis and mistreatment.
Vestnik dermatologii i venerologii. 2015;91(2):84-93
pages 84-93 views

A neurosyphilis case study: results of a five-year follow-up

Novikov Y.A., Novikov A.I., Okhlopkov V.A., Filippova T.I., Kidalov M.B., Filippov S.O.

Abstract

The authors describe a case study of the long-term follow-up of a patient with symptomatic neurosyphilis. The article describes the patient management process on the basis of close interaction between physicians of allied specialties. Remote consequences of the specific therapy are described. The authors specify key problems of allied diagnostics related to similar cases.
Vestnik dermatologii i venerologii. 2015;91(2):94-100
pages 94-100 views

Neurosyphilis in HIV-infected patients

Krasnoselskikh T.V., Sokolovskiy E.V.

Abstract

A review article is addressed the issue of the diagnosis and treatment of neurosyphilis that is developing against the background of HIV-infection. HIV-infected patients are at higher risk of neurologic, ocular and auricular manifestation of syphilis as well as treatment failures and relapses. Diagnosis of neurosyphilis in HIV-positive patients is complicated because both infections cause similar changes in the cerebrospinal fluid (CSF). The effectiveness of neurosyphilis treatment in patients with HIV co-infection is difficult to estimate, since the normalization of their CSF goes slower comparing to HIV-negatives. The increase in incidence of syphilis and HIV co-infection is anticipated in the coming years. This necessitates a comprehensive study of the problem and requires the development of new approaches to neurosyphilis diagnosis and treatment in co-infected patients.
Vestnik dermatologii i venerologii. 2015;91(2):49-57
pages 49-57 views

Biofilms of microorganisms and their role for the formation of resistance to anti-bacterial drugs

Rakhmatulina M.R., Nechayeva I.A.

Abstract

The article describes current concepts of mechanisms of the formation of biofilms - a supracellular colonial prokaryotic form of microorganisms causing infectious urogenital pathologies. The authors describe the role of signal molecules and extracellular genetic material for the biofilm formation as well as synergy and antagonism between different types of bacteria. The article presents possible mechanisms of existence of prokaryotes causing torpidity to the therapy and resulting in a longterm chronic infection.
Vestnik dermatologii i venerologii. 2015;91(2):58-62
pages 58-62 views

Risk factors causing the development of infection and inflammation of the lower urinary tract

Kamalov A.A., Khodyreva L.A., Dudareva A.A., Nizov A.N.

Abstract

Persistence as well as high survival rate and resistance of microorganisms belong to the key reasons promoting symptoms of lower urinary tract diseases. They can stay active for a long time and can substantially deteriorate the life quality of patients suffering from chronic infections and inflammations in the wall of the urinary bladder even after the eradication of the pathogen. Recent studies in the field of clinical microbiology reflect serious qualitative and quantitative changes in the infection incidence structure, which is mainly related to changes in the bacterial pathogenicity. Pathogenicity island genes control the synthesis of different adhesins, invasins, hemolysins and toxins (hemolysin, cytotoxic necrotizing factor type 1, etc.) as well as iron ion absorption system, which are essential for the pathogen propagation and activity in tissues. The determination of genetic determinants will provide a new insight into the bacterial evolution process and will help to understand the reason of prompt formation and propagation of virulent strains as well as fast development of the infection and inflammation in the lower urinary tract, which may explain different severity of the pathology and symptoms of the lower urinary tract.
Vestnik dermatologii i venerologii. 2015;91(2):63-67
pages 63-67 views

LABORATORY DIAGNOSTICS of STI and Dermatoses

Duration of the determination of specific Igm antibodies in primary syphilis patients after treatment

Rotanov S.V., Ermatova F.A.

Abstract

It was carried out a study with ALISAIgM of 341 samples of the blood, obtained from the patients with the early forms of syphilis 3-36 months later the end of adequate antibacterial therapy with the purpose for studying the duration of circulation in the blood of specific antibodies IgM to the antigens T. pallidum after the treatment. It was shown gradual reduction of the levels of the anti-treponema antibodies of the class M in the blood with an increase of the period of observation and their total elimination to the period of 36 months. It was not established reliable differences within the dynamics of a decrease in the levels of specific IgM and the periods of negativation of the ALISAIgM results depending on the adequate method of antibacterial therapy.
Vestnik dermatologii i venerologii. 2015;91(2):116-121
pages 116-121 views

Vaginal candidal infection: clinical features of diagnostics methods

Rakhmatuuna M.R., Gushchin A.Y., Tsoi Y.G.

Abstract

Goal. To study clinical features of the vaginal candidal infection and carry out a comparative analysis of the microscopy, cultural and real-time PCR methods for identifying Candida fungi. Materials and methods. The study involved 107 female subjects: Group 1: 56 women with Candida fungi found in their vaginal secrets by laboratory tests; Group 2: 51 women with absent clinical and laboratory signs of the urogenital infection. The laboratory test methods were as follows: microscopy, cultural and biomolecular (real-time PCR (RT PCR) - Florocenosis-Candida). Key findings. Pathologic vaginal secretion (76.8%) and hyperemia of vaginal and vulvar mucous tunic (41.1%) belong to the key clinical manifestations of the vaginal candidal infection. Caseous vaginal discharge was revealed in 33.9% of patients from Group 1, homogenous creamy discharge - in 42.9%, and homogenous mucous non-transparent vaginal discharge - in 23.2% of patients from Group 1. The patients had the following etiologic agents: C. albicans (94.6%), C. glabrata, (3.6%) and C. krusei (1.8%). Candida spp. identification results using the cultural and microscopy methods coincided in 78.6% of all cases, RT PCR and microscopy - in 66.1%, and RT PCR and cultural methods - in 87.5% of all cases. There were no reliable differences in the quantitative results for Candida fungi by the cultural and RT PCR methods: below 102 CFU/mL and below 102 GE/mL - 12.2 and 8.9%, respectively, 103-104 CFU/mL and 103-104 GE/mL - 44.9% and 33.9%, over 104 CFU/mL and over 104 GE/mL - 42.9 and 57.2%, respectively(p > 0.05). Conclusion. Candidal colonization of the vaginal mucous tunic was accompanied by specific clinical manifestations of urogenital candidosis in 76.8% of all cases; C. albicans was revealed in most of the subjects (94.6%). The real-time PCR method used for Candida spp. identification and quantitative determination demonstrated higher sensitivity and specificity vs. microscopy as well as sensitivity and specificity being comparable to the cultural diagnostics method.
Vestnik dermatologii i venerologii. 2015;91(2):122-129
pages 122-129 views

GUIDELINES FOR PRACTITIONERS

Urogenital chlamydia infection in women: patient management tactics according to present-day foreign and Russian recommendations

Khryanin A.A.

Abstract

The article present data on current approaches to laboratory diagnostics and treatment of urogenital chlamydia infection in women. According to Russian and foreign guidelines, azithromycin, josamycin and doxycycline monohydrate belong to the most efficient antimicrobial drugs for the treatment of urogenital chlamydia infection in non-pregnant women. As for the treatment of pregnant patients suffering from this pathology, azithromycin and josamycin are the most optimal drugs in terms of safety and treatment efficacy according to both Russian and foreign guidelines.
Vestnik dermatologii i venerologii. 2015;91(2):101-110
pages 101-110 views

Current concept of the diagnostics and treatment of vulvovaginal candidosis

Malbakhova Y.T., Arzumanyan V.G.

Abstract

In spite of high prevalence of vulvovaginal candidosis (VVC), its diagnostics and treatment pose a serious problem. Factors such as accessibility of antimycotic drugs, their uncontrolled application by patients and absence of any appropriate laboratory diagnostics result in the growth of the incidence rate, in particular, of recurrent forms related to a steady growth in the number of fungi of clinical importance as well as strains resistant to antifungal drugs. Discussion and conclusion. Today the problem of the need to develop VVC prevention drugs is increasingly urgent because reduced immunity results in relapses of the disease. Clinical trials of drugs for immune system correction are ongoing, and some of them have reached Phase 2. Based on the present-day research data, it is possible to conclude that the key standards for VVC diagnostics and treatment are as follows: mandatory diagnostics with the use of microbiological tests to determine the sensitivity to antifungal medicines, in particular, in case of recurrent VVC, and collection of detailed medical history data and physical examination to determine the form and severity of the disease (acute, recurrent, complicated or uncomplicated) and treatment duration: 1-7 days for acute uncomplicated forms and 7-14 days for recurrent complicated forms. The specific drug and route of administration are to be selected based on the physician’s preferences, patient’s convenience and cost of the drug provided the drug sensitivity is determined by laboratory tests. The administration of probiotics for VVC prevention and treatment is disputable today.
Vestnik dermatologii i venerologii. 2015;91(2):111-115
pages 111-115 views

Justification of the efficacy of antibacterial therapy for the treatment of chronic endometritis

Tapilskaya N.I., Karpeyev S.A., Gaidukov S.N.

Abstract

A review of studies on chronic endometritis enables the authors to conclude that bacterially contaminated endometrium is the reason causing reduced fertility in case of confirmed subclinical inflammation. Chronic subclinical inflammation of the endometrium is often associated with genital endometriosis, which apparently leads to abnormal uterine bleedings. The identification of a microbial agent in case of endometritis in the routine outpatient practice is not mandatory because global experience including high-level evidence-based studies confirms the expediency of an empirical therapy based on minimum clinical criteria; otherwise, there may be irreversible consequences for the reproductive system. A preventive antibacterial therapy during the pre-conception period in infertile patients suffering from recurrent miscarriages is an efficient method to prevent reproductive losses.
Vestnik dermatologii i venerologii. 2015;91(2):130-138
pages 130-138 views

MEDICAL HISTORY

Trends in Russian and USSR Venerology Development (1950-1959)

Belova-Rakhimova L.V., Prokhorenkov V.I., Gusey T.N.

Abstract

The article presents the history of venerology in Russia and USSR in 1950-1959.
Vestnik dermatologii i venerologii. 2015;91(2):141-147
pages 141-147 views

CLINICAL GUIDELINES

Current standards for diagnosis of syphilis: comparing the russian and foreign guidelines (part I)

Krasnoselskikh T.V., Sokolovskiy E.V.

Abstract

Despite the abundance of existing laboratory methods the diagnosis of syphilis still faces many challenges. Though direct detection of T. pallidum plays an important role in early manifest forms of the disease, serological tests remain the mainstay of diagnosis. Traditional syphilis screening algorithm based on nontreponemal tests with subsequent confirmation using treponemal tests is a standard worldwide. Recently, the ability to automate the treponemal tests promotes the increasingly widespread implementation of reverse algorithm when these tests are used for syphilis screening. None of the current serological algorithms are able to reliably differentiate between active and previously treated syphilis, which causes uncertainty in the management of patients. There is no «gold standard» for the diagnosis of neurosyphilis, ocular, auricular and visceral syphilis. The interpretation of serological tests in children born to seropositive mothers is also complicated. Diagnosis of congenital syphilis in newborns and, consequently, the prescription of antibiotic therapy often depends on assessment of the adequacy of maternal treatment during pregnancy, which leads to subjective decisions. This article provides a comparative analysis of the «Federal guidelines for the management of patients with syphilis» and their foreign analogues, discusses significant peculiarities of these guidelines and reviews current concerns and controversies in syphilis diagnosis.
Vestnik dermatologii i venerologii. 2015;91(2):11-22
pages 11-22 views

Current standards for syphilis treatment: comparing the russian and foreign guidelines (part II)

Krasnoselskikh T.V., Sokolovskiy E.V.

Abstract

The introduction of penicillin has been a breakthrough in the treatment of syphilis. For 70 years, penicillin remains the preferred drug for the treatment of all forms of the disease; its effectiveness has been proven by wide experience gained from clinical observations. However, a very limited number of published meta-analyzes, systematic reviews and data from randomized controlled trials on the comparative assessment of the effectiveness of various antibiotics and treatment regimens are currently available. Some aspects of syphilis treatment are insufficiently developed, particularly, the treatment schedules for neurosyphilis, syphilis in pregnancy, syphilis in HIV-infected individuals and persons allergic to penicillin. There are disagreements in the assessment of the clinical significance of serofast state after a course of antibiotic therapy. There is no uniform approach to the management of patients with treatment failures. This article compares the Russian standards for syphilis treatment set out in the «Federal guidelines for the management of patients with syphilis» with the current European recommendations of the International Union against Sexually Transmitted Infections (IUSTI) and the recommendations of the US Centers for Disease Control and Prevention (CDC). The peculiarities of these guidelines, their strengths and shortcomings, as well as controversial issues of syphilis therapy are discussed. The differences between the domestic and foreign recommendations are more significant in the section concerning the treatment of syphilis than in the section of diagnosis.
Vestnik dermatologii i venerologii. 2015;91(2):23-40
pages 23-40 views

Gonococcal infection: diagnostics and therapy tactics according to russian and foreign clinical recommendations

Rakhmatulina M.R.

Abstract

The article discusses current approaches to management of adult patients suffering from the gonococcal infection according to federal (national) clinical recommendations of the Russian Society of Dermatovenerologists and Cosmetologists (2013), European Guideline on the Diagnoses and Treatment of Gonorrhoeae in Adults (2012) and Sexually Transmitted Diseases Treatment Guidelines (CDC, 2010). The article describes indications for gonococcal infection examinations and diagnostics methods presented in Russian and foreign recommendations. The article describes the treatment regimen based on N. gonorrhoeae antibacterial resistance monitoring results.
Vestnik dermatologii i venerologii. 2015;91(2):41-48
pages 41-48 views

SEIFADDIN GASHIMOVICH MARDANLY On the 60th anniversary

Article E.
Vestnik dermatologii i venerologii. 2015;91(2):139-140
pages 139-140 views

Current features of the clinical course of urogenital candidosis and analysis of antifungal sensitivity of Candida fungi

Malova I.O., Kuznetsova Y.A.

Abstract

Based on the results of a study and treatment of 100 female patients suffering from chronic recurrent vulvovaginal candidosis (CRVC) and 50 patients suffering from concomitant CRVC and candidal intestinal dysbiosis (CID), the authors analyzed particular features of clinical manifestations of the disease, species composition and sensitivity of Candida fungi cultures sampled from vagina and bowels, and discuss the results of the treatment suggested based on the aforesaid study.
Vestnik dermatologii i venerologii. 2015;91(2):68-75
pages 68-75 views

Genetic variability of genital mycoplasmas and its clinical value

Plakhova K.I.

Abstract

The article presents data on genetic variability of genital mycoplasmas. The author presents the results of genetic variability studies for M. hominis, gene vaa, U. parvum, gene mba, and M. genitalium, gene mg192, sampled from women with different clinical manifestations of inflammatory diseases of the urogenital system. Based on the molecular typing results for 138 samples of genital mycoplasmas, the author revealed a relationship between clinical manifestations of inflammatory diseases of the urogenital system caused by U. parvum and different U. parvum serovars as well as different genetic variations of M. hominis.Infection with 6 U. parvum serovar results in the development of inflammatory diseases of the urogenital tract accompanied by subjective manifestations (р < 0.05). Genetic variant II of М. hominis was revealed more often in patients with clinical manifestations of inflammatory diseases while variant I was revealed more often in patients infected with М. hominis without any signs of inflammation (р < 0.05). Genetic variants of M. genitalium were determined; no significant differences in terms of their prevalence in the examined patients were revealed.
Vestnik dermatologii i venerologii. 2015;91(2):76-83
pages 76-83 views

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