SYPHILIS IN ENT DISEASE

PREPARED BY: ISYAFIQ QAMAAL AHMADI (GROUP 36)

INTRODUCTION
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema Pallidum The primary route of transmission is through sexual contact may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis

GENERAL SIGNS AND SYMPTOMS

Primary syphilis
patients develop a skin lesion called a chancre at the site of exposure Syphilitic chancres are typically non tender, hard, non-purulent ulcers The chancres typically heal without therapy.

Secondary syphilis
begins 4-10 weeks after the chancre rash is the main complaint often affects the hands and or soles can cause neurologic, renal, ophthalmologic, gastrointestinal and hepatic disease typically resolves without treatment.

Tertiary syphilis
cardiovascular symptoms (such as aortitis), gumma's, and neurosyphilis. Neurosyphilis may include general paresis (a type of dementia) and tabes dorsalis (a spinal cord disease)

OTOLOGIC SYPHILIS

SIGNS AND SYMPTOMS

Otosyphilis can closely resemble 1. Meniere's disease 2. perilymph fistula 3. sudden hearing loss 4. autoimmune inner ear disease 5. bilateral vestibular loss. Otosyphilis is a variety of neurosyphilis and neurological symptoms are also possible. Early neurosyphilis mainly presents as: meningitis with or without cranial nerve involvement meningovascular disease or stroke Hearing symptoms of early neurosyphilis might be a sudden hearing loss. Late neurosyphilis may affect the brain (general paresis), or spinal cord (tabes dorsalis) In the ear, late neurosyphilis may present as I. hearing loss II. fluctuating hearing III. vestibular imbalance/weakness (vertigo).

RHINOLOGIC SYPHILIS

SIGNS AND SYMPTOMS

Usually see the tertiary lesions

Severe and extensive lesions involving the mucous, cartilaginous and bony parts
There are gummatous nodules or diffuse inflammatory process in the submucosa Untreated, the gumma breaks down, fouls and deep erosion take place Bones and cartilage become spongy, honeycombed, filled with granulations, the bone being cast off (saddle nose) Nasal polypi combined with antral suppuration due to syphilitic necrosis in the ethmoid cells

A photograph of a patient with tertiary syphilis resulting in gummas seen here on the nose. This patient presented with tertiary syphilitic gummas of the nose mimicking basal cell carcinoma. The gummatous tumors are benign and if properly treated, will heal and the patient will recover in most cases.

This patient presented with a gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection. Without treatment, an infected person still has syphilis even though there are no signs or symptoms. It remains in the body, and it may begin to damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.

ORAL SYPHILIS

GUMMA FORMATION
Gummas tend to arise on the hard palate and tongue very rarely they may occur on the soft palate, lower alveolus, and parotid gland A gumma manifests initially as 1 or more painless swelling When multiple, they tend to coalesce, giving rise to serpigninous lesions The swellings eventually develop into areas of ulceration, with areas of breakdown and healing There may be eventual bone destruction, palatal perforation, and oro-nasal fistula formation The areas of ulceration eventually heal, although the resultant scarring can, at least on the tongue, cause fissuring.

SIGNS AND SYMPTOMS

Primary Syphilis
manifests as a solitary ulcer usually of the lip or, more rarely, the tongue The upper lip is more commonly affected than the lower in males, while the opposite occurs in females The ulceration is usually deep, with a red, purple, or brown base and an irregular raised border An indurate ulceration of the tongue dorsum, accompanied by hyperplasic foliate papillae, may be the only clinical signs of the disease Erythema, edema, and petechial hemorrhage with or without the presence of a chancre may occur in the soft palate Asymmetry of the uvula or tonsillar pillar may be evident Crateriform intra-oral ulcerations with a yellow-colored transudate accompanied by nontender regional lymphadenopathy should be viewed with suspicion in patients at risk of acquiring sexually-transmitted diseases Differential diagnosis for intraoral syphilis includes 1. herpetic or fungal infections 2. Tuberculosis 3. Histoplasmosis 4. squamous cell carcinoma 5. trauma adenopathy

Secondary Syphilis Oral lesions are of two basic types: Macular eruption papular eruption or the mucous patches (more common) tend to be oval or serpiginous, slightly raised erosions or shallow ulcers with an erythematous border On the distal and lateral tongue, lesions tend to be more ulcerated and irregular fissures may appear Differential diagnosis: infectious and non-infectious conditions with accentuated eruption

Tertiary Syphilis the gumma is often seen on the hard palate as a chronic, progressive, granulomatous lesion that may perforate through the palatal bone into the nasal septum. The tongue appears atrophic, fissured, or lobulated, and leukoplakic plaque is usually present dorsally. Follow up every three to six months and biopsy are recommend because literature related possible malignant transformation of the lesion It is important to know that tertiary syphilis is not infectious.

This patient with congenital syphilis has developed a perforation of hard palate due to gummatous destruction. These destructive tumors can also attack the skin, long bones, eyes, mucous membranes, throat, liver, or stomach lining

This patient presented with a primary syphilitic chancre of the lip. The primary stage of syphilis is usually marked by the appearance of a sore called a chancre. The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body, and lasts 36 weeks, healing on its own.

This patient presented with secondary syphilitic lesions of the lips. Note the split papules at the angles of the mouth. Second-stage symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. A person can easily pass the disease to sex partners during the primary or secondary stage of the disease

This image depicts a lingual mucous patch on the tongue of a patient who was subsequently diagnosed with secondary syphilis

TREATMENT
aqueous penicillin G 18-24 million units/day administered as 3-4 million units IV every 4 hours or continuously, for 10-14 days. procaine penicillin 2.4 million units may be given IM daily plus probenicid 500 mg by mouth, 4 times/day, both for 10-14 days. Persons with non-life threatening allergies to PCN should ideally be desensitized.

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