Review

Authors: Rosanna W Peeling, David Mabey, Mary L Kamb...

Treponema pallidum subspecies pallidum (T. pallidum) causes syphilis via sexual exposure or via vertical transmission during pregnancy. T. pallidum is renowned for its invasiveness and immune-evasiveness; its clinical manifestations result from local inflammatory responses to replicating spirochaetes and often imitate those of other diseases. The spirochaete has a long latent period during which individuals have no signs or symptoms but can remain infectious. Despite the availability of simple diagnostic tests and the effectiveness of treatment with a single dose of long-acting penicillin, syphilis is re-emerging as a global public health problem, particularly among men who have sex with men (MSM) in high-income and middle-income countries. Syphilis also causes several hundred thousand stillbirths and neonatal deaths every year in developing nations. Although several low-income countries have achieved WHO targets for the elimination of congenital syphilis, an alarming increase in the prevalence of syphilis in HIV-infected MSM serves as a strong reminder of the tenacity of T. pallidum as a pathogen. Strong advocacy and community involvement are needed to ensure that syphilis is given a high priority on the global health agenda. More investment is needed in research on the interaction between HIV and syphilis in MSM as well as into improved diagnostics, a better test of cure, intensified public health measures and, ultimately, a vaccine.

Topics: Algorithms; Humans; Syphilis

PubMed: 29022569
DOI: 10.1038/nrdp.2017.73

Review

Authors: Senaka Rajapakse

Leptospirosis is one of the most important zoonotic bacterial diseases worldwide, commonly affecting resource-poor populations and resulting in significant morbidity and mortality. This article provides an overview of the epidemiology, clinical manifestations, diagnosis and treatment of human leptospirosis.

Topics: Humans; Leptospira; Leptospirosis

PubMed: 35078790
DOI: 10.7861/clinmed.2021-0784

Authors: Jane E Sykes, Thierry Francey, Simone Schuller...

Since publication of the last consensus statement on leptospirosis in dogs, there has been revision of leptospiral taxonomy and advancements in typing methods, widespread use of new diagnostic tests and vaccines, and improved understanding of the epidemiology and pathophysiology of the disease. Leptospirosis continues to be prevalent in dogs, including in small breed dogs from urban areas, puppies as young as 11 weeks of age, geriatric dogs, dogs in rural areas, and dogs that have been inadequately vaccinated for leptospirosis (including dogs vaccinated with 2-serovar Leptospira vaccines in some regions). In 2021, the American College of Veterinary Internal Medicine (ACVIM) Board of Regents voted to approve the topic for a revised Consensus Statement. After identification of core panelists, a multidisciplinary group of 6 experts from the fields of veterinary medicine, human medicine, and public health was assembled to vote on the recommendations using the Delphi method. A draft was presented at the 2023 ACVIM Forum, and a written draft posted on the ACVIM website for comment by the membership before submission to the editors of the Journal of Veterinary Internal Medicine. This revised document provides guidance for veterinary practitioners on disease in dogs as well as cats. The level of agreement among the 12 voting members (including core panelists) is provided in association with each recommendation. A denominator lower than 12 reflects abstention of ≥1 panelists either because they considered the recommendation to be outside their scope of expertise or because there was a perceived conflict of interest.

Topics: Animals; Dogs; Humans; United States; Dog Diseases; Leptospirosis; Leptospira; Consensus; Vaccines

PubMed: 37861061
DOI: 10.1111/jvim.16903

Review

Authors: Irene A Stafford, Kimberly A Workowski, Laura H Bachmann...

Topics: Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Syphilis; Syphilis, Congenital

PubMed: 38231625
DOI: 10.1056/NEJMra2202762

Review

Authors: B Chomel

Lyme disease is among the most frequently diagnosed zoonotic tick-borne diseases worldwide. The number of human cases has been on the increase since the first recognition of its aetiological agent. Lyme disease is caused by spirochete bacteria belonging to the genus Borrelia, with B. burgdorferi sensu stricto (s.s.) found in the Americas, and B. afzelii and B. garinii, in addition to B. burgdorferi s.s., in Europe and Asia. Environmental factors, such as human encroachment onto habitats favourable to ticks and their hosts, reduced deforestation, increased human outdoor activities, and climatic factors favouring a wider distribution of tick vectors, have enhanced the impact of the disease on both humans and animals. Clinical manifestations in humans include, in the early phases, erythema migrans, followed several weeks later by neuro-borreliosis (meningo-radiculitis, meningitis or meningo-encephalitis), Lyme arthritis and/or Borrelia lymphocytoma. In dogs, acute signs include fever, general malaise, lameness, lymph node enlargement and polyarthritis, as well as neuro-borreliosis in the chronic form. Diagnosis is mainly serological in both humans and animals, based on either a two-tier approach (an immunoenzymatic test followed by a Western blot confirmatory test) in humans or C(6) peptide, only in dogs. Early treatment with antibiotics, such as doxycycline or amoxicillin, for three weeks usually reduces the risk of chronic disease. Tick control, including the use of tick repellents for both humans and animals, particularly dogs, is highly reliable in preventing transmission. Vaccines are not available to prevent human infection, whereas several vaccines are available to reduce transmission and the clinical manifestations of infection in dogs.

Topics: Animals; Anti-Bacterial Agents; Global Health; Humans; Lyme Disease

PubMed: 26601457
DOI: 10.20506/rst.34.2.2380

Review

Authors: Ana Fátima Braga Rocha, Maria Alix Leite Araújo, Valéria Lima de Barros...

OBJECTIVES

to identify the scientific evidence about the clinical complications and manifestations of congenital syphilis and aspects related to its prevention.

METHODS

integrative review after a search in the databases LILACS and MEDLINE, carried out in March 2018, using the descriptors "syphilis, congenital", "complications", and "signs and symptoms", leading to the selection of 27 researches.

RESULTS

the publications found were published from 1966 to 2017, and most of them were from Latin America and Africa. Negative outcomes, laboratory changes, and the clinical manifestations in congenital syphilis, whether early or delayed, were, respectively: low weight at birth, anemia, hepatosplenomegaly, and dental alterations. The lack of treatment of the pregnant women in the prenatal was the most common occasion in which the opportunity to prevent the complications of congenital syphilis was lost.

CONCLUSIONS

the scientific evidences analyzed showed serious complications of congenital syphilis that could be avoided if early opportunities of diagnosing and treating the pregnant women are not lost during the prenatal.

Topics: Female; Humans; Infant, Newborn; Parturition; Pregnancy; Pregnancy Complications, Infectious; Syphilis; Syphilis, Congenital

PubMed: 34287560
DOI: 10.1590/0034-7167-2019-0318

Review

Authors: Andrea Murillo, Marga Goris, Ahmed Ahmed...

GLOBAL IMPORTANCE

Leptospirosis is the most widespread zoonosis worldwide. Mammals (eg, rats, horses, cows, pigs, dogs, cats and aquatic species, such as sea lions and northern elephant seals) can all be infected by leptospires. Infection in animals occurs through contact with urine or water contaminated with the bacteria. In people, the disease is acquired mainly from animal sources or through recreational activities in contaminated water.

PRACTICAL RELEVANCE

Literature on the clinical presentation of leptospirosis in cats is scarce, although it has been demonstrated that cats are susceptible to infection and are capable of developing antibodies. The prevalence of antileptospiral antibodies in cats varies from 4% to 33.3% depending on the geographical location. Urinary shedding of leptospires in naturally infected cats has been reported, with a prevalence of up to 68%. Infection in cats has been associated with the consumption of infected prey, especially rodents. Thus, outdoor cats have a higher risk of becoming infected.

CLINICAL CHALLENGES

Clinical presentation of this disease in cats is rare and it is not known what role cats have in the transmission of leptospirosis. Ongoing work is needed to characterise feline leptospirosis.

AUDIENCE

This review is aimed at all veterinarians, both general practitioners who deal with cats on a daily basis in private practice, as well as feline practitioners, since both groups face the challenge of diagnosing and treating infectious and zoonotic diseases.

EVIDENCE BASE

The current literature on leptospirosis in cats is reviewed. To date, few case reports have been published in the field, and information has mostly been extrapolated from infections in people and dogs. This review is expected to serve as a guide for the diagnosis and management of the disease in cats.

Topics: Animals; Cat Diseases; Cats; Leptospirosis

PubMed: 32093581
DOI: 10.1177/1098612X20903601

Review

Authors: Helle Kiellberg Larsen, Simone Elisabeth Grim, Kirsten Salado-Rasmussen...

This review focuses on typical and atypical manifestations of neurosyphilis. The manifestations of neurosyphilis are manyfold and may involve many specialties. Today, clinicians have limited experience with the well-described manifestations of neurosyphilis. Many screening opportunities for men who have sex with men might catch the majority of cases of syphilis in this group. However, a concern could be if disclosure about heterosexuality or, in general, monosymptomatic neurosyphilis constitute a risk for delayed diagnosis.

Topics: Homosexuality, Male; Humans; Male; Neurosyphilis; Sexual and Gender Minorities; Syphilis

PubMed: 35499222
DOI: No ID Found

Authors: Geraldo Duarte, Patrícia Pereira Dos Santos Melli, Angélica Espinosa Miranda...

•Although congenital syphilis has a known etiological agent, accessible diagnosis and low-cost, effective treatment with low fetal toxicity, it continues to challenge obstetric and antenatal care services. •The increasing rates of syphilis in the general population have direct repercussions on the increase in cases of congenital syphilis, a situation of objective interest for public health. •Although transforming the recording of syphilis and congenital syphilis into notifiable diseases improved the records and has made it possible to measure the occurrence of these diseases and create solutions, no effects on reducing their frequency have been reached yet. •The failure to control syphilis/congenital syphilis is multifactorial, and associates variables that range from the deficiency in teaching about these diseases in schools and in the training system of the various health professional segments, as well as the lack of rigid policies for quality control from antenatal care until the clinical follow-up of children exposed to during pregnancy. •To date, benzathine penicillin is the only antimicrobial accepted as effective by the main health authorities on the planet for the treatment of syphilis in pregnant women. •The fear of anaphylaxis in response to the treatment of syphilis with benzathine penicillin is an important factor hindering the prompt and correct treatment of pregnant women with syphilis, even though health authorities have made efforts to face the problem with solid arguments, still insufficient to resolve the question. •Although specific protocols are published, the failure to control the treatment of syphilis in pregnant women is still observed with high frequency, indicating and reinforcing a failure in the quality control of these care principles. The National Specialized Commission on Infectious Diseases of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) endorses this document. Content production is based on scientific evidence on the proposed topic and the results presented contribute to clinical practice.

Topics: Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Prenatal Care; Syphilis; Syphilis, Congenital

PubMed: 39380581
DOI: 10.61622/rbgo/2024FPS09

Authors: Julia E Poje, Jose F Azevedo, Nisha Nair...

Lyme disease, caused by Borrelia burgdorferi sensu stricto and most commonly transmitted by Ixodes scapularis Say (Ixodida: Ixodidae), is the most common tick-borne disease in Maryland. Because B. burgdorferi s.s. is maintained in enzootic cycles among wild mice (Peromyscus spp) and Ixodes spp ticks, differing patterns of parasitism of ticks on mice could impact the infection prevalence with B. burgdorferi. We determined the infection prevalence of Peromyscus spp as well as questing and partially engorged nymphal ticks collected at six sites on private land in five counties in Maryland from May to August 2020. Questing nymph infection prevalence (NIP) was 14%. We trapped 1258 mice and collected 554 ticks and 413 ear tissue samples. The prevalence of infested Peromyscus spp varied based on host age and sex, with older and male mice more likely to be infested. We detected a significant difference amongst the proportion of attached Ixodes and the location of trapping. Similarly, the prevalence of B. burgdorferi infected Peromyscus spp mice varied between locations (average mouse infection prevalence was 40%), with the highest prevalence in locations where Ixodes were the most commonly found ticks. The B. burgdorferi infection prevalence in partially engorged I. scapularis nymphs retrieved from Peromyscus spp was ~36% which lends further support to the host infection prevalence. Local differences in distribution of infected vectors and reservoirs are important factors to consider when planning interventions to reduce Lyme disease risk.

Topics: Animals; Borrelia burgdorferi; Ixodes; Lyme Disease; Male; Maryland; Nymph; Peromyscus; Prevalence; Rodent Diseases; Spirochaetaceae

PubMed: 34971369
DOI: 10.1093/jme/tjab206