Visceral syphilis. Visceral syphilis visceral syphilis clinical picture of diseases. Damage to the nervous system

At visceral syphilis affects the internal organs: often
most of all it is observed in the tertiary period of the disease. Maybe it's time
many organs shrink - the heart and blood vessels, the organs of digestion, respiration,
mammary glands, nervous system, bones, etc., but the greatest value
in the clinic of visceral syphilis have lesions of the cardiovascular
and central nervous (neurosyphilis) systems.

Heart damage in visceral syphilis can manifest itself in
de gummous and chronic interstitial myocarditis and ends with
development of massive cardiosclerosis.

The defeat of the arteries affects the vessels of different calibers, but more often than others
the aorta is involved. Syphilitic mesaortitis often develops
15 - 20 years after infection, usually in men aged 40 - 60 years.
The process is localized in the ascending part and the aortic arch, more often directly
but above the valves. On the intima of the aorta, whitish tuberosities appear with
Cicatricial retractions, giving the aorta the appearance of shagreen skin (Fig. 357).
If atherosclerosis joins, then the picture of specific changes
wobbles. In typical cases, changes break off abruptly in the arc or
in the descending aorta. The abdominal aorta is rarely affected.

With syphilitic mesaortitis, inflammation is found in the aortic wall.
body process spreading from vjasa-vasorum..H adventitia
to the middle shell. There are accumulations of lymphoid, plasma
cells, giant cells of the Pirogov-Langhans type, fibroblasts,
sometimes small foci of necrosis (Fig. 358). Inflammatory infiltrate destroys
shakes the elastic fibers of the middle membrane, as the cells mature
fields of connective tissue appear in it with scraps of elastic hair
con. The strength of the aortic wall decreases, its lumen expands -
syphilitic aortic aneurysm.

Aneurysm of the ascending aorta and arch, increasing in the ventral
direction, can cause usuration of the sternum and adjacent parts of the ribs,
and then protrude through the skin and perforate it.

From the wall of the aorta, inflammation can go to the aortic valve and its
dampers. They become whitish, deformed due to rough
scarring characteristic of syphilis grow together, which leads to
dit to syphilitic aortic defect (insufficiency
valve and orifice narrowing). Syphilitic aortic valve disease
often combined with an aneurysm of the ascending aorta.

Other complications of syphilitic mesaortitis are also possible. Often.
gummy infiltrate passes to the coronary arteries of the heart. In-
the circle of their mouths, a specific inflammation occurs, scarring occurs,
which leads to narrowing of the mouths of the coronary arteries and to coronary insufficiency
ness.

Rice. 357. Syphilitic mesaortitis. Appearance of the aorta.

Rice. 358. Syphilitic mesaortitis. microscopic picture.

Neurosyphilis is a syphilitic process in the nervous
system. It can occur at any stage of the disease, but more often
in the tertiary. There are gummy and simple forms of syphilis of the nervous system.
stems, vascular lesions, progressive paralysis, and tabes dorsalis.

Gummas in the brain have a characteristic structure and size for them.
well - from a millet knot to a pigeon's egg. Sometimes there are differential
fuzzy gummous growths with lesions of the brain tissue and meninges.

A simple form of syphilitic lesion is expressed by inflammation
telny lymphocytic infiltrates both in the brain tissue and in its
shells.

Vascular lesions in neurosyphilis can manifest as syphilis
phylitic obliterating endarteritis and endophle-
bit. Due to circulatory disorders in the tissue of the head and spinal
the brain is formed foci of softening.

Progressive paralysis is a late manifestation
syphilis and is characterized by a decrease in the mass of the brain, thinner
convolutions, atrophy of the basal ganglia and the cerebellum. Ependyma of the stomach
the carpet takes on a grainy appearance. Microscopic examination of tissue
brain revealed inflammatory and dystrophic changes, death
nerve cells, areas of demyelination, disruption of architectonics. Cancellation
glial proliferation occurs, and microglial cells are represented by rod-
prominent forms. In the pia mater of the brain and spinal cord, there are also
inflammatory changes take place. In the spinal cord, the posterior, less often
side pillars.

Dorsal tabes (tabes dorsalis) - a late manifestation of syphilis, with
which affects the spinal cord. On transverse sections, its posterior pillars

look thinned and have a gray color. Usually dystrophic
the process begins in the upper lumbar spinal cord and concerns
initially wedge-shaped bundles (the so-called Burdakh bundles), and in the far
shem extends to the back pillars; posterior roots of the spinal cord
are thinning. In the posterior columns, the myelin sheaths disintegrate, releasing
waiting for neutral fats, which are absorbed by glial elements,
macrophages and are transported to the adventitial vascular spaces
stva. In the pia mater of the spinal cord, inflammatory
changes. In areas of inflammation and in the substance of the spinal cord,
pale treponemas.

congenital syphilis

Congenital syphilis develops during intrauterine infection
fetus through the placenta from a mother with syphilis. This type of syphilis is
is divided into t r and forms: 1) syphilis of stillborn premature
fruits; 2) early congenital syphilis of newborns and infants;
3) late congenital syphilis in children of preschool and school age,
as well as adults.

Tissue changes in congenital syphilis are diverse. One of
some of them are caused by the treponema itself, others are the result of a delay
or developmental disorders (dysplasia) of organs under the influence of a pathogen
syphilis.

With syphilis in stillborn premature babies
the death of the fetus usually occurs between the sixth and seventh lunar months in the morning
be mother. This leads to premature birth with macerated
house. The cause of death is the toxic effect of treponema.

Early congenital syphilis manifests itself most often during
during the first two months of life. It affects the kidneys, lungs,
Chen, bones, CNS. Papular and pustular syphilides appear in the skin
character. Interstitial syphilitic pneumonia develops in the lungs
, leading to compaction of the lung tissue with the development of sclerotic
changes. On the cut, the lungs take on a whitish appearance, which gave rise to
call this process "white pneumonia" (R. Virchow). Defeat pe-
cheni has the character of interstitial hepatitis (Fig. 359) with the death of hepato-
cytes, interstitial round cell infiltration, the formation of "mi-
liar gums” and sclerosis. When cut, it becomes brownish.
color ("flint liver"). In the bones, the process of preliminary
calcification of the epiphyseal cartilage and neoplasms of bone tissue; he
combined with inflammatory changes in the parts adjacent to the epiphysis
bones and syphilitic endoperivasculitis. This process develops into
border of the diaphysis and lower epiphysis of the thigh, in the ribs and sternum and is called
nie syphilitic osteochondritis. Borders of bone and cartilage
do not look like a straight line, but a jagged line. In the CNS, vascular
inflammatory changes with damage to both the substance of the brain and brain
shells - syphilitic encephalitis and meningitis.

With early congenital syphilis, to the changes described above, the organ
a rash of small foci, consisting of
necrosis of organ tissue and decaying leukocytes; these foci,
holding a lot of treponems are called "miliary gumma and".

Late congenital syphilis is characterized by deformation
teeth, which is based on enamel hypoplasia and the formation of a lunate
notches on both upper central incisors or on one of them with a
the next curvature. Teeth become barrel-shaped - at the level

Rice. 359. Liver with congenital syphilis (preparation of A.V. Zinzerling).

a- clusters of treponemas (silver impregnation according to Levaditi); b- interstitial hepatitis, sclerosis
liver.

the neck of the tooth is wider than on the free edge; the size of the teeth is reduced ("teeth
Getchinson"). Parenchymal keratitis, deafness develop, which
in combination with altered teeth make up the so-called triad
Getchinson a, characteristic of late congenital syphilis. Change-
mentia in the organs are similar to the manifestations of acquired tertiary syphilis
period. The differences relate to the thymus gland, in which they can
there are cavities filled with serous fluid with an admixture of neutral
fils and lymphocytes. The cavities are surrounded by a shaft of epithelioid cells.
and are called Dubois abscesses.

The placenta with syphilis of the woman in labor is changed: its mass is increased (up to
2250 g instead of 600 g), yellowish-gray color, leathery texture. Micro-
edema, cellular infiltration, sharp hyperplasia are observed scopically
villi, sometimes the formation of abscesses in them; found in the walls of blood vessels
inflammatory changes.

RELAPSING FEVER

Relapsing fever (typhus recurrens) is an acute infectious disease
nie, the course of which is characterized by seizures (“returns”).

Etiology and pathogenesis. Called by a spirochete, or treponema Borrelia re-
currens, which Obermaier discovered in the blood of patients in 1873.
typhus is transmitted from person to person through insect bites, often
lice, in which treponemas multiply in body cavities and hemolymph and do not
released into the environment. The introduction of treponems occurs when the
itch, accompanied by crushing lice. During attacks of fever
treponema ki circulate freely in the blood, and then disappear, and those of
them, which are found in the blood during the next attack, differ
for their antigenic properties. The question of the role of cellular and humoral

factors in the processes of disappearance of treponema from the blood in interictal
period has not been finally resolved. Immunity after a recurrent
typhus is very persistent and long lasting.

Pathological anatomy. Changes in relapsing fever have been studied
we are mainly domestic researchers (M. N. Nikiforov,
M. V. Voyno-Yasenetsky). The most characteristic changes occur in the se-
ladder. It increases, its mass reaches 400 - 600 g, the consistency
dense, tense capsule, sometimes covered with fibrinous coating; in re-
In rare cases, spleen ruptures with massive bleeding are observed.
Small gray-white or yellow foci appear in the pulp, which are well
visible on the cut. Infarction-like foci are found under the capsule
necrosis caused by vascular lesions (wall necrosis, thrombosis).

Microscopic examination reveals follicular hyperplasia
spleen with the breakdown of lymphocytes and their replacement by neutrophils. Especially
these changes are clearly expressed at the end of the attack, when phago-
treponema cytosis. Foci of necrosis of the follicles of the spleen are called m and -
liar necrosis (see Fig. 30). Later in areas of necrosis
follicles, there is a complete regeneration of lymphoid tissue or development
scars are waving.

In the liver and kidneys, dystrophic changes are observed, sometimes
hemorrhages. In the myocardium, dystrophy of muscle fibers is found and
proliferation of stromal cells. In the walls of small vessels of various organs
new destructive changes occur.

deadly complication relapsing fever is a rupture of the se-
Zenki. In malnourished patients, pneumonia, perichondritis are observed
ber. With the addition of salmonellosis, the disease acquires the character
sepsis with the appearance of many pustules in the kidneys, the development of jaundice, etc.

Visceral syphilis

Lesions in syphilis can develop in any organs and systems of the patient. These
changes are inflammatory or dystrophic in nature, may be asymptomatic or
manifested by various functional disorders. Any specific clinical picture
syphilitic lesions of internal organs do not have. The diagnosis is established on the basis
positive serological reactions, as well as in the presence of syphilitic rashes on the skin and mucous membranes
shells.

Early visceral syphilis

Damage to internal organs that occurs with secondary, early latent, less often with
primary syphilis, proceed, as a rule, favorably and respond well to specific treatment.

Damage to the cardiovascular system. syphilitic myocarditis maybe
be asymptomatic and be detected only on an electrocardiogram or manifest as pronounced
functional disorders. In a significant proportion of patients, the electrocardiogram shows
nonspecific changes in the P, Q and ST segment teeth. Patients complain of rapid fatigue, general
weakness, shortness of breath, dizziness, body temperature may rise. Arterial pressure
moderately reduced, the borders of the heart can shift to the left, the tones are muffled, arrhythmia appears.
An objective sign of heart damage is a systolic murmur at the apex. Possible development
pericarditis and endocarditis.

Syphilitic aortitis is asymptomatic. When localizing the process at the beginning
ascending aorta often develops insufficiency of the aortic and mitral valve.
Specific compaction of the ascending aorta can develop very early, already in the primary
period.

Damage to the digestive tract. Liver damage is early
symptom of visceral syphilis. Clinically, this can be manifested by functional disorders of the liver,
an increase in its size, yellowness of the sclera. With anicteric forms of syphilitic hepatitis, clinical
a sign is only an increase and thickening of the liver, often with a simultaneous increase in the spleen.
Quite rarely, one can observe a picture of acute hepatitis with jaundice, resembling an infectious
hepatitis. The liver is enlarged, painful, its function is disturbed. Often also increases
spleen, the level of bilirubin in the blood rises, in the urine - bile pigments and urobilin. Often
high body temperature, headaches are noted.

In contrast to infectious hepatitis, patients have no or mild
preicteric dyspeptic disorders. Serological reactions in the blood in these patients, as a rule,
sharply positive, which, along with other symptoms of syphilis, makes it possible to determine the etiology of hepatitis.
Most authors note that acute syphilitic hepatitis develops after 6-8 months. after
infections. He is favored by alcohol abuse, malnutrition, concomitant
diseases.

Stomach lesion occurs both in secondary fresh and in recurrent
syphilis. The main clinical manifestations of a specific lesion of the stomach are transient
gastropathy, acute gastritis and syphilitic gastric ulcer. Syphilitic gastritis is caused by
the occurrence of foci of specific inflammation on the gastric mucosa, which, when
X-rays can simulate a peptic ulcer or a neoplasm of the stomach. With functional
indigestion, patients complain of recurrent pain in the epigastric region, nausea,
belching, loss of appetite, weight loss, feeling of fullness in the stomach after eating. Syphilitic gastritis
characterized by a decrease in the acidity of gastric juice, an increase in ESR, a positive reaction to
occult blood in the stool. The diagnosis is established on the basis of a comprehensive examination of patients,
including serological, radiological, fibrogastroscopic and histological methods.

Kidney damage is detected most often at the beginning of the secondary period of syphilis. It
may present as asymptomatic renal dysfunction, benign proteinuria,
specific lipoid nephrosis and glomerulonephritis. The only symptom of benign
proteinuria is the presence of protein in the urine (0.1-0.3 g / l). Specific lipoid nephrosis occurs in two
types: acute and chronic. During the course of the disease, urine is cloudy, is excreted in a small amount, has
high density (up to 1.040 and above), the protein content in the urine exceeds 2-3 g / l. The precipitate contains cylinders,
leukocytes, epithelium, erythrocytes are rare and in small quantities. Blood pressure is not
increases, no changes are noted in the fundus. Latent nephrosis develops slowly,
manifested by moderate albuminuria and minor edema. Syphilitic nephritis by clinic
resembles infectious glomerulonephritis. Kidney damage is based on the primary lesion of small
vessels, gradual death of the glomeruli and progressive wrinkling of the kidney.

Respiratory damage with secondary syphilis is very rare. Can
acute bronchopneumonia, interstitial pneumonia, dry bronchitis occur. Diagnosis of interstitial
pneumonia is established radiographically. Infiltrate in the lungs can be of various sizes,
sometimes be massive, resembling a tumor. Clinical diagnosis of early syphilis of the lungs is very
difficult. Often the diagnosis is established retrospectively, especially in the absence of manifestations of syphilis on
skin.

Late visceral syphilis

Most often, late visceral syphilis affects the cardiovascular
system (90-94%), rarely liver (4-6%) and other organs.

Damage to the cardiovascular system. Most common in late forms of syphilis
the aorta is affected, less often the myocardium, their simultaneous defeat is possible.

Syphilitic aortitis may be uncomplicated or accompanied by narrowing
orifices of the coronary arteries, aortic valve insufficiency and aortic aneurysm. It's believed that
pathological changes occur mainly in its middle part and the process is diagnosed as
mesaortitis. The foci of a specific infection arising in it are subsequently replaced by a connective
tissue, which leads to deformation of the inner shell. The ascending aorta is more commonly affected, less often others
her departments.

Syphilitic aortitis is the most common form of visceral syphilis. Syphilitic
uncomplicated aortitis (the so-called Dele-Geller disease) for a long time proceeds without
subjective feelings. One of the early and characteristic signs is retrosternal pain, which
occurs paroxysmal and radiates like angina pectoris or lasts for a long time, not reaching a large
intensity. Pain of a pressing or burning character appears mainly at night.
Objectively, the expansion of the ascending aorta, determined by percussion, auscultation and
radiographically. In syphilitic aortitis, in most cases, the mouths are affected
both coronary arteries - syphilitic aortitis, complicated by stenosis of the mouths of the coronary arteries.
The process develops slowly, varies from slight narrowing to complete obliteration of one or two
mouths, resulting in a decrease in coronary blood flow, which, in turn, entails a violation
myocardial blood supply. In addition to the pain symptom in aortitis complicated by stenosis of the mouths of the coronary
arteries, angina pectoris syndrome is observed, at first - angina pectoris, later -
rest. Gradually develop symptoms of progressive heart failure, which is associated with
the development of dystrophic and sclerotic changes in the heart muscle due to progressive
narrowing of the coronary arteries.

Syphilitic aortic valve insufficiency due to
expansion of the affected aorta, in the early stages is asymptomatic. The most characteristic feature
of this defect - aortalgia and true angina pectoris. There is a low diastolic pressure.
Shortness of breath develops. Other symptoms may also occur, such as symptomatic hypertension,
hypertrophy and dilatation of the left ventricle with pronounced pulsation.

aortic aneurysm is one of the outcomes of untreated or poorly treated
syphilitic aortitis. Due to the destruction of muscle or elastic fibers, mainly in
ascending aorta and arch, aneurysm develops. It has either a diffuse fusiform shape,
or forms a saccular protrusion, connected to the aorta by a narrow opening. Often an aneurysm
grows, squeezing the organs of the mediastinum, and eventually breaks.

Clinical manifestations depend on dysfunction of the organs being compressed
aneurysm. With pressure on the mediastinum, shortness of breath, a rough cough appear. When squeezing the return
nerve paralysis of one or another vocal fold and aphonia may occur. Compression of the trachea or bronchus
to the development of stenotic breathing. Compression of the sympathetic nerve causes anisocoria and retraction of the ocular
apples. Expansion of the veins, cyanosis and edema of the upper body are observed with compression of the superior vena cava.
veins. Pressure on the esophagus causes dysphagia.

An early symptom is pain in different parts of the chest, depending on
the location of the aneurysm, but there are cases of asymptomatic course of the disease. Pulse on the radial
artery is not the same on both hands in terms of filling and time of appearance. Arterial
pressure does not increase. The diagnosis of an aneurysm is confirmed radiologically.

Syphilitic myocarditis is rare and can occur as an independent
manifestation of late visceral syphilis or as a complication of aortitis. The disease manifests itself
the formation of gum or chronic interstitial (humous) myocarditis.

Liver damage usually develops 5-20 years after infection. Distinguish
four forms of late syphilitic hepatitis: focal gummous, miliary gummous and
chronic epithelial. All forms are characterized by a long process with a gradual
the development of sclerohumous changes leading to cirrhosis and deformation of the liver. syphilitic
hepatitis often occurs with an increase in body temperature, which can be subfebrile, sometimes
remitting and even intermittent. Temperature rises are combined with severe chills. With a long
during syphilitic hepatitis, a decrease and wrinkling of the liver is observed, ascites appears,
collateral veins are formed (atrophic Laennec cirrhosis of the liver). The well-being of the patient
worsens, anemia, malnutrition appear, cachexia develops. Syphilitic chronic
epithelial hepatitis is characterized by general malaise, pain and heaviness in the liver area,
anorexia, nausea, vomiting, severe skin itching. The liver is slightly enlarged, protrudes by 4-5 cm
from under the edge of the costal arch, dense, painless. Jaundice is an early symptom of epithelial
hepatitis. Syphilitic chronic interstitial hepatitis is characterized by intense
pain in the liver, its increase, density on palpation, absence of jaundice in the early stages
diseases. Subsequently, when syphilitic cirrhosis of the liver develops, jaundice and
sharp itching of the skin. Miliary gummous and limited gummous hepatitis is characterized by the formation
nodular infiltrates. Liver hypertrophy in gummous hepatitis is uneven,
tuberosity, lobulation. Miliary gummas are smaller than with limited gummous
hepatitis, are located around the vessels and affect the liver tissue less. Miliary gummous hepatitis
manifested by pain in the liver, its uniform increase with a smooth surface. functional
liver cell activity persists for a long time, and jaundice is usually absent. Limited
gummous hepatitis, due to the formation of large nodes involving secretory and interstitial
areas, accompanied by severe pain, fever, chills. Icteric sclera and skin are pronounced
slightly.

Antibiotic therapy gives a favorable effect in the early stages of syphilitic
hepatitis A. In advanced cases, the process ends with cirrhosis of the liver.

Kidney damage may be in the form of amyloid nephrosis, nephrosclerosis and gummous
processes (limited nodes or diffuse gummy infiltration). The first two forms are clinically
are indistinguishable from similar lesions of other etiologies. Diagnosis is made only on
the basis of other manifestations of syphilis, anamnesis and positive serological reactions. Most
rare gummas isolated or diffuse gummous infiltrate penetrating the renal
the cloth. At the same time, protein, cylinders appear in the urine, sometimes the disease is accompanied by
paroxysmal pain in the lower back. The sclerotic process in the kidney leads to an increase
blood pressure, hypertrophy of the left ventricle of the heart, impaired water metabolism and increased
residual nitrogen.

Lung injury expressed in the formation of individual gums or peribronchial
gummous infiltration. They can dissolve or disintegrate with the formation of cavities. Lung gums,
ranging in size from a pea to a hazelnut or more, are located mainly in the middle and lower parts, which
distinguishes syphilis from tuberculosis. In addition, one should take into account the relatively good overall
condition of patients with syphilis, negative test results for tuberculosis, positive
serological reactions.

Late syphilitic visceropathy

Thanks to successful therapeutic and preventive measures in patients with various forms of syphilis, pronounced and clearly defined by clinical symptoms lesions of internal organs have become rare. The most important of these are late visceropathy.

Changes in the internal organs in patients with tertiary syphilis are based on endo-, meso- and perivasculitis characteristic of syphilitic infection, up to complete obliteration of the vessels. Specific pathology is especially intense in the tissues of the heart, blood vessels, gastrointestinal tract, liver and lungs. Syphilitic damage to the heart and blood vessels often manifests with specific gummy myocarditis and syphilitic mesaortitis. Hummous proliferates of the myocardium can be isolated (like solitary gums of the skin) or have the form of diffuse gummous infiltration. Often these processes are combined. The symptomatology of lesions has no specific features. There is hypertrophy of the myocardium with an increase in the size of the heart, a weakening of the heart tones, pains of a diffuse nature. Diagnosis is based more clearly on ECG data and serological reactions; RIF and RIBT indicators are especially important. More often than the myocardium, the aorta is affected - specific mesaortitis occurs in patients with tertiary syphilis with a disease duration of more than 10 years. In the initial phase of infiltration and slight compaction of the intima and median membrane, the ascending part of the aortic arch thickens, which is clearly recorded on radiographs; subjective symptoms may be absent. Further stages of the formation of mesaortitis depend on the degree of allergic reactivity of the test organ and the intensity of the syphilitic lesion. With hyperergy, necrotic destructive changes develop, up to the complete destruction of the aortic wall, ending in death. At low allergic tension, the process ends with proliferative seals, foci of fibrous degeneration and calcification, which is more favorable for the prognosis regarding life and the therapeutic effect. The transition of the process to the aortic valves leads to aortic insufficiency, which is manifested by pulsation of the cervical vessels, shortness of breath, nausea, increased fatigue, and the release of rusty sputum. Large main arteries and veins of the brain, upper and lower extremities can also be affected. In them, separately located small gummas are found, followed by their fibrous compaction or diffuse impregnation by the type of sclerotic lesions, without destruction and necrosis.

Syphilitic aortitis - the most common form of visceral syphilis; characterized by a difference in the pulse on both hands, a kind of "ringing" accent of the II tone on the aorta, the identification of the phenomenon of Sirotinin - Kukoverov - a systolic murmur heard above the sternum when the arms are raised as a result of displacement of the main vessels in aortitis (Myasnikov A. L., 1981), radiographically detectable extension of the shadow of the ascending aortic arch. Syphilitic aneurysm of the aorta during fluoroscopy is detected as saccular, less often fusiform, extensions with a clear pulsation (Dashtayants G.A., Frishman M.P., 1976). It is necessary to exclude syphilitic aneurysm of the aorta in patients with the syndrome of the superior vena cava, which occurs with compression of it, as well as the trachea and bronchi. X-ray in the anterior mediastinum reveals a large, relatively homogeneous, without petrification, shadow. To exclude a malignant neoplasm that often causes this syndrome, aortic angiography, tomography, and serological examination are performed.

Late syphilis of the gastrointestinal tract it is characterized by the same specific infiltrative foci of a tubercular-hummous nature, reflecting the intensity of immunoallergic reactivity. Individual, focally located tubercles or gummas can be found in the esophagus, stomach, small and large intestine. Due to the more pronounced traumatic effect of food and the enzymatic action of gastric contents, gummy-infiltrative processes occur more often in the esophagus and stomach. Separate, solitary, gummas and diffuse gummous infiltration are formed in combination with each other or separately. In the event of a single gumma of the esophagus or stomach, the process remains unrecognized for a long time due to the weak severity of subjective and objective symptoms. Diffuse gummous infiltration is more often detected in the stomach. Superficial infiltrative lesion of the mucous membrane is initially manifested by symptoms of gastritis with severe dyspeptic disorders, hypacid or anacid state. Deep infiltrative changes in the esophagus and stomach cause severe dysphagia, digestive disorders, similar to the symptoms of a tumor of these organs.

With intestinal damage, syphilitic gummy-infiltrative elements are localized, as a rule, in the jejunum. Symptoms of syphilitic enteritis are very non-specific. Diffuse proliferates, thickening the wall of the small intestine, give less symptoms than focused gummas that change the natural peristaltic movements and are accompanied by obstruction phenomena (with significant infiltration). Ulceration of the gums or gummous infiltration aggravate the course of the process with bleeding and peritoneal symptoms. The rectum is rarely affected in the tertiary period of syphilis. V. Ya. Arutyunov (1972) described gummous infiltration and isolated small gummas, circularly covering the lower part of the rectum. During the period of infiltration, defecation disorders are observed, and with ulceration and scarring, the symptoms are similar to severe proctitis, differing in less pronounced soreness and an unusually small amount of purulent discharge. Diagnosis of syphilitic gastrointestinal processes is hampered by false-positive CSR in tumors, as well as difficulties in interpreting the results of x-ray examination. And yet, the data of RIBT, RIF, anamnesis, the results of trial antisyphilitic treatment, as a rule, make it possible to make a correct diagnosis.

Syphilitic damage to the liver observed in various variants, due to the localization of the proliferative process and its nodular or diffuse character. In accordance with the classification of A. L. Myasnikov (1981), the following clinical varieties are distinguished among chronic syphilitic hepatitis: syphilitic chronic epithelial hepatitis, chronic interstitial hepatitis, miliary gummous hepatitis and limited gummous hepatitis. The earliest changes in liver function that occur in the secondary period of syphilis can be manifested by icterus, skin itching and other symptoms of acute syphilitic hepatitis (Zlatkina A. R., 1966). As a result of rational antisyphilitic treatment, or even without it, the latter is resolved, leaving an altered cellular reactivity. In the tertiary period of syphilis, when the phenomena of hyperergic reactivity increase, chronic epithelial hepatitis occurs secondarily or spontaneously, since it is the epithelium that is most reactive in infectious-allergic processes (AdoAD, 1976). Symptoms of the disease are non-specific: general malaise, pain and heaviness in the liver, anorexia, nausea, vomiting, severe pruritus. The liver is slightly enlarged, protrudes 4-5 cm from under the edge of the costal arch, dense, but painless.

Chronic syphilitic interstitial hepatitis develops as a result of diffuse-proliferative damage to the cells of the interstitial tissue. Just like epithelial hepatitis, it can form even in the secondary period as a result of direct penetration of pale treponema. However, interstitial hepatitis can also have an infectious-allergic nature. Even a small number of pale treponemas, but for a long time, dramatically changes the reactivity of the cells of the interstitial tissue, and in the tertiary period, interstitial hepatitis of a productive-infiltrative nature is already formed for the second time, accompanied by necrosis. This clinical variety is characterized by intense pain in the liver, its increase, density on palpation, but jaundice is absent in the early stages of the disease. In the late period, when syphilitic cirrhosis of the liver develops, jaundice and a sharp itching of the skin join.

Miliary gummous and limited gummous hepatitis are characterized by the formation of nodular infiltrates. Liver hypertrophy in gummous hepatitis is characterized by unevenness, tuberosity, lobulation. Miliary gummas are smaller, located around the vessels and affect the liver tissue less. Therefore, miliary gummous hepatitis is manifested by pain in the liver, its uniform increase with a smooth surface. The functional activity of the liver cells persists for a long time, and jaundice is usually absent.

Limited gummy hepatitis, due to the formation of large nodes involving secretory and interstitial areas, is accompanied by severe pain, fever, chills. Icteric sclera and skin, other disorders of the liver function are expressed slightly; in the initial stages of the disease, jaundice occurs only as a result of mechanical obstruction of the bile ducts. A zone of perifocal nonspecific inflammation is formed around the gums. At the final stages, pronounced sclero-hummous atrophic, deforming scars are observed.

Diagnosis of syphilitic liver damage is based on the history, the presence of other manifestations of syphilitic infection, and the results of a serological study. It should be emphasized that false-positive results of CSR in hepatocholecystitis, liver tumors, alcoholic cirrhosis are observed in 15-20% of cases (Myasnikov A.L., 1981). Therefore, the data of RIF, RIBT and the results of trial treatment are of decisive importance.

Syphilitic kidney disease is rare and chronic. In the secondary period of syphilis, reactive inflammatory changes in the vessels of the glomeruli spontaneously regress. In the tertiary period, as a result of a hyperergic reaction of the endothelium of the glomerular vessels, miliary or large gummas appear, as well as diffuse infiltration. Hummous lesions due to the focal nature of inflammation (nodular infiltrates) according to the main symptoms - albuminuria, pyuria and hematuria - are similar to the blastomatous process. Syphilitic nephrosis with amyloid or lipoid degeneration ends with nephrosclerosis. Since amyloidosis and lipoid degeneration of the renal parenchyma are also characteristic of other chronic infections, the differential diagnosis of syphilitic kidney damage requires a thorough analysis of anamnestic information, data from CSR, RIF and RIBT, and examination results from related specialists (in order to detect or exclude a syphilitic process of other localization). Trial treatment for kidney damage is not recommended because bismuth preparations are contraindicated in such patients, and penicillin therapy does not always resolve diagnostic difficulties.

Syphilis of the bronchi and lungs manifested by extremely diverse symptoms due to the peculiar localization of gummy and productive-infiltrative foci. Gummy seals, both single and multiple (miliary gummas), are located more often in the lower or middle lobe of the lung. The process manifests with shortness of breath, a feeling of tightness in the chest, and vague pains. Compaction of lung tissue in syphilis is focal in nature, as in a tumor, more often it is asymmetric. The lung gummas are differentiated from the tuberculous process on the basis of the well-being of patients. With syphilis, as a rule, there is no fever, asthenia, and mycobacterium tuberculosis is absent in the sputum. Diffuse productive-infiltrative inflammation of syphilitic etiology is more often localized in the area of the tracheal bifurcation or in the peribronchial tissue. Lung gum and diffuse gummous infiltration can occur with ulceration, purulent sputum and even bleeding (Myasnikov A. L., 1981). But a more frequent outcome is fibrous compaction with the development of pneumosclerosis and bronchiectasis. In the diagnosis of syphilitic lesions of the lungs, anamnesis data, the presence of a syphilitic process on the skin, mucous membranes or bones, the results of a serological study, and sometimes trial treatment, are of decisive importance.

N. Schibli and I. Harms (1981) report tumor-like lesions of the lungs in tertiary and even secondary syphilis. Chest x-ray reveals round retrocardial opacities at the root of the lung. Sometimes patients with this kind of lesions, simulating a tumor, undergo thoracotomy. The syphilitic nature of lung lesions is established by excluding other etiologies and the positive effect of antisyphilitic therapy. However, the simultaneous existence of syphilis and tuberculosis, gumma and lung tumors is also possible.

Syphilitic affection of the endocrine glands in the tertiary period it is manifested by the formation of gummous foci or diffuse productive inflammation. In men, apparently, gummatous orchitis and gummatous epididymitis are most often recorded. The testicle and its appendage increase in size, acquire a pronounced density and a bumpy surface. Unlike orchitis and epididymitis of tuberculous etiology, pain is absent, there is no temperature reaction, serological reactions to syphilis are positive, and Pirquet and Mantoux tests are negative. The resolution of the process occurs with the phenomena of scarring. With testicular gumma, ulceration is possible, followed by the formation of a deforming scar. In women, the pancreas is more often affected, which is manifested by a violation of the function of the islet apparatus and the formation of syphilitic diabetes. Syphilitic thyroiditis is observed in 25% of patients with early forms of syphilis. E.V. Bush (1913) subdivided thyroid diseases in tertiary syphilis into 3 groups: an enlarged thyroid gland without a change in function, syphilitic thyroiditis with hyperfunction, and hypofunction of the thyroid gland after cicatricial resolution of syphilitic thyroiditis. V.M. Kogan-Yasny (1939) subdivided syphilitic thyroiditis into early and late forms. In the secondary period of syphilis, there is a diffuse enlargement of the thyroid gland with hyperfunction. In the tertiary period, a gummy or interstitial lesion develops, followed by scarring. We give an observation as an example of a specific lesion of the thyroid gland. There is no complete restoration of the structure of any endocrine gland after treatment, and therefore syphilitic endocrinopathies are not accompanied by the restoration of the functional activity of the gland.

Prevention of visceral syphilis.

Prevention of visceral syphilis provides for its timely diagnosis and early full treatment, since visceral forms are the result of inadequate therapy for active forms of syphilis or its complete absence.

Since there are no strictly pathognomonic signs characteristic of syphilitic visceral lesions, the diagnosis should be guided by a set of clinical and laboratory data, the dynamics of clinical changes under the influence of specific therapy, widely using a set of serological reactions: RIT, RIF, RPHA, ELISA.PCR.

Studies in hospitals of therapeutic, surgical, obstetric-gynecological, neurological profile should be carried out with the formulation of serological reactions. A comprehensive examination of persons with syphilis at the end of treatment and upon deregistration serves to prevent visceral syphilis. It consists of an in-depth clinical examination with X-ray, according to indications of liquorological and ECG studies in order to assess the usefulness of the treatment. A targeted therapeutic examination is also indicated for patients with neurosyphilis, who often have specific lesions of the internal organs.

For the timely diagnosis of visceral syphilis, it is very important to actively detect latent forms of syphilis, which in 50-70% of cases entail the possibility of late specific lesions of internal organs. For the purpose of timely detection of early forms of visceral syphilis, a 100% examination of patients in therapeutic, neurological, psychoneurological, surgical hospitals, ENT departments with the production of RV is used. According to M. V. Milich, V. A. Blokhin (1985), positive serological reactions are found in 0.01% of those examined in somatic hospitals, and late forms of syphilis are more common in them: latent late - in 31%, latent unspecified - in 11.5%, late neurosyphilis - in 3.6%, late visceral - in 0.7%.

Bibliography:

1 .Rodionov A.N. Syphilis 2nd edition . Published: 2000, Peter

2 .Rodionov A.N. Handbook of skin and venereal diseases. 2nd ed.

Published: 2000, Peter

3 .Martin J. Isselbacher C. Braunwald E., Wilson J., Fauci A., Kasper D.,

Harrison's Handbook of Internal Medicine 1st ed. 2001, Peter.

A syphilitic infection from the moment it enters the human body can affect any organ or system. It becomes generalized shortly after infection, when pale treponema enters the lymphatic system (after 2-4 hours), and then into the blood and internal organs (on the first day). Thus, already in the incubation period of the disease, conditions are created for the occurrence of specific visceropathy. However, massive hematogenous dissemination of Tr. pallidum, multiplying in large numbers in the lymphoid tissue, occurs 2-3 months after infection - at the end of Lues I - the beginning of Lues II periods (a kind of treponemal sepsis).

Visceral syphilis is divided into:

1) Early visceral Lues.

2) Late visceral Lues.

Diagnosis of early visceropathy is based on:

1) detection of Tr. pallida in the serous discharge of rashes of the skin and mucous membranes;

2) histological examination - detection in the biopsy of the affected organ of a typical plasmacytic infiltrate;

3) treatment of exuvantibus.

Early visceral syphilis

With Lues I, a gross visceral pathology cannot be detected. More often there may be lesions from the hematopoietic system:

- the number of erythrocytes and platelets decreases;

- the number of leukocytes increases;

- ESR increases;

- monocytosis.

With Louis II:

1) Damage to the cardiovascular system (CVS).

Myocarditis of a toxic-infectious nature. Subjectively - shortness of breath, weakness, fatigue, dizziness. They are unstable and respond well to therapy. Vascular damage in the form of endo- and perivasculitis.

2) Damage to the liver.

Acute hepatitis with symptoms: jaundice, fever, liver enlargement, violation of its functions.

3) Damage to the spleen.

More often it is affected along with the liver - an increase and dysfunction.

4) Damage to the stomach.

Gastritis, specific ulcers. Subjectively - nausea, belching, loss of appetite, decreased acidity of gastric juice.

5) Damage to the kidneys.

- benign syphilitic albuminuria;

- syphilitic lipoid nephrosis;

- syphilitic nephritis.

Late visceral syphilis

According to M.V. Milich, with late visceral syphilis

90 - 94% - is the pathology of the CCC (cardiovascular Lues);

4 - 6% - liver pathology;

1 - 2% - specific pathology of other organs and tissues.

It helps to make a diagnosis of "Visceral syphilis" "+" reactions of RIBT and RIF (in 94-100% of patients), while CSR is often "-".

1. Syphilitic aortitis uncomplicated - the most common manifestation of visceral syphilis.

Complaints of retrosternal pain of a pressing or burning nature without irradiation, not associated with physical or nervous strain and not relieved by antispasmodics.

Auscultatory:

- systolic murmur at the apex;

- accent II tone at the mouth of the aorta with a metallic tint;

On the radiograph:

Consolidation of the walls of the aorta and expansion of its ascending part. Pathological changes occur mainly in the middle layer of the aorta and the process is diagnosed as mesaortitis.

Normal expansion of the ascending part of the aortic arch - 3 - 3.5 cm, with syphilis - 5 - 6 cm

2. Aortic aneurysm is the most formidable complication of aortitis with possible severe consequences. In 2/3 of cases, the aneurysm is localized in the ascending thoracic aorta, in 20% in the area of the arch and in 10% in the area of the abdominal aorta.

Complaints of retrosternal pain, shortness of breath. There is a compression of vital organs, a breakthrough of the aneurysm into the trachea, bronchi, lung, pleural cavity, mediastinum is possible with a rapid death.

3. Syphilitic aortitis, complicated by stenosis of the mouth of the coronary arteries.

There are attacks of angina pectoris of rest and tension, symptoms of heart failure.

4. Syphilitic myocarditis is a rare pathology.

Complaints - pain in the heart, palpitations, shortness of breath.

Auscultatory: deafness of the I tone, systolic murmur at the apex, arrhythmia.

Percussion - expansion of the boundaries of the heart.

5. Syphilitic insufficiency of aortic valves.

An early sign of this pathology is pain like arthralgia or true angina.

6. Liver damage.

It is characterized by a long course with the development of sclerotic changes in the form of cirrhosis or gross deformity of the liver. Liver damage can occur in the form of:

– chronic epithelial hepatitis;

– chronic interstitial hepatitis;

– limited gummy hepatitis;

- diffuse gummous hepatitis.

7. Damage to the spleen is combined with changes in the liver

8. Damage to the stomach.

Runs like this:

- chronic gastritis;

- isolated gum;

- diffuse gummy infiltration of the walls of the stomach.

9. Damage to the esophagus and intestines.

It is rare, there may be diffuse and limited gummous processes.

10. Damage to the kidneys.

It flows like this:

- amyloid nephrosis;

– chronic sclerous nephritis;

– isolated gums;

- diffuse gummy infiltrate.

11. Damage to the lungs.

It flows like this:

– isolated gums;

– chronic intercellular syphilitic pneumonia;

- pulmonary sclerosis.

The defeat of the musculoskeletal system

The skeletal system may be affected in all Lues periods. Bone damage can occur as an exudative-proliferative inflammatory process without clinically pronounced foci of destruction or with destruction with more or less significant destruction of the bone.

More often affected: tibia, bones of the nose and hard palate; less often - skull bones (in 5% of cases); very rarely - bones of the hands, jaw, pelvis, scapula

At the end of Lues I - in 20% of patients there is aches and pains in long tubular bones;

With Lues II, there are:

- periostitis;

- osteoperiostitis;

- synovitis;

- osteoarthritis.

They proceed benignly, without signs of destruction and respond well to ongoing therapy.

With Lues III, lesions of the skeletal system are accompanied by destructive changes.

CM. Rubashev distinguishes:

- non-humous osteopriostitis:

A) limited

B) diffuse;

- gummous osteoperiostitis:

A) limited

B) diffuse;

- osteomyelitis: a) limited;

B) diffuse.

The diagnosis of lesions of the musculoskeletal system in the tertiary period of syphilis is established on the basis of:

1) clinical picture;

2) radiological data;

3) KSR, RIBT, RIF;

4) trial treatment.

Which Doctors Should You See If You Have Visceral Syphilis

What is visceral syphilis

Being an infection of the whole organism, syphilis in the early stages of development affects many internal organs and systems. In late forms of syphilis, including tertiary syphilis, both gummous processes in various internal organs and diseases that can be attributed, as it were, to true visceral syphilis.

What causes visceral syphilis

The causative agent of syphilis is pale treponema (Treponema pallidum) belonging to the order Spirochaetales, family Spirochaetaceae, genus Treponema. Morphologically pale treponema (pallid spirochete) differs from saprophytic spirochetes (Spirochetae buccalis, Sp. refringens, Sp. balanitidis, Sp. pseudopallida). Under the microscope, treponema pallidum is a spiral-shaped microorganism resembling a corkscrew. It has an average of 8-14 uniform curls of equal size. The total length of the treponema varies from 7 to 14 microns, the thickness is 0.2-0.5 microns. Pale treponema is characterized by pronounced mobility, in contrast to saprophytic forms. It is characterized by translational, rocking, pendulum-like, contractile and rotatory (around its axis) movements. Using electron microscopy, the complex structure of the morphological structure of pale treponema was revealed. It turned out that treponema is covered with a powerful cover of a three-layer membrane, cell wall and mucopolysaccharide capsule-like substance. Fibrils are located under the cytoplasmic membrane - thin threads that have a complex structure and cause diverse movement. Fibrils are attached to the terminal coils and individual sections of the cytoplasmic cylinder with the help of blepharoplasts. The cytoplasm is finely granular, containing the nuclear vacuole, nucleolus, and mesosomes. It has been established that various influences of exogenous and endogenous factors (in particular, previously used arsenic preparations, and currently antibiotics) had an effect on treponema pallidum, changing some of its biological properties. So, it turned out that pale treponemas can turn into cysts, spores, L-forms, grains, which, with a decrease in the activity of the patient's immune reserves, can reverse into spiral virulent varieties and cause active manifestations of the disease. Antigenic mosaicity of pale treponemas is proved by the presence of multiple antibodies in the blood serum of patients with syphilis: protein, complement-fixing, polysaccharide, reagins, immobilisins, agglutinins, lipoid, etc.

With the help of an electron microscope, it was found that pale treponema in lesions is more often located in intercellular gaps, periendothelial space, blood vessels, nerve fibers, especially in early forms of syphilis. The presence of pale treponema in the periepineurium is not yet evidence of damage to the nervous system. More often, such an abundance of treponema occurs with symptoms of septicemia. In the process of phagocytosis, a state of endocytobiosis often occurs, in which treponemas in leukocytes are enclosed in a polymembrane phagosome. The fact that treponemas are contained in polymembrane phagosomes is a very unfavorable phenomenon, since, being in a state of endocytobiosis, pale treponemas persist for a long time, protected from the effects of antibodies and antibiotics. At the same time, the cell in which such a phagosome was formed, as it were, protects the body from the spread of infection and the progression of the disease. This unsteady balance can be maintained for a long time, characterizing the latent (hidden) course of a syphilitic infection.

Experimental observations of N.M. Ovchinnikov and V.V. Delektorsky are consistent with the works of the authors, who believe that when infected with syphilis, a long asymptomatic course is possible (in the presence of L-forms of pale treponema in the patient's body) and "accidental" detection of infection in the stage of latent syphilis (lues latens seropositiva, lues ignorata), t i.e. during the presence of treponema in the body, probably in the form of cysts, which have antigenic properties and, therefore, lead to the production of antibodies; this is confirmed by positive serological reactions for syphilis in the blood of patients without visible clinical manifestations of the disease. In addition, in some patients, the stages of neuro- and viscerosyphilis are found, that is, the disease develops, as it were, “bypassing” the active forms.

To obtain a culture of pale treponema, complex conditions are necessary (special media, anaerobic conditions, etc.). At the same time, cultural treponemas quickly lose their morphological and pathogenic properties. In addition to the above forms of treponema, the existence of granular and invisible filtering forms of pale treponema was assumed.

Outside the body, pale treponema is very sensitive to external influences, chemicals, drying, heating, and exposure to sunlight. On household items, Treponema pallidum retains its virulence until it dries. The temperature of 40-42°C first increases the activity of treponemas, and then leads to their death; heating up to 60°C kills them within 15 minutes, and up to 100°C - instantly. Low temperatures do not have a detrimental effect on treponema pallidum, and storage of treponemas in an anoxic environment at -20 to -70°C or dried from a frozen state is currently the accepted method of preserving pathogenic strains.

Pathogenesis (what happens?) during visceral syphilis

The reaction of the patient's body to the introduction of pale treponema is complex, diverse and insufficiently studied. Infection occurs as a result of the penetration of pale treponema through the skin or mucous membrane, the integrity of which is usually broken. However, a number of authors admit the possibility of introducing treponema through an intact mucosa. At the same time, it is known that in the blood serum of healthy individuals there are factors that have immobilizing activity in relation to pale treponema. Along with other factors, they make it possible to explain why contact with a sick person does not always cause infection. Domestic syphilidologist M.V. Milic, based on his own data and analysis of the literature, believes that infection may not occur in 49-57% of cases. The scatter is explained by the frequency of sexual contacts, the nature and localization of syphilides, the presence of an entrance gate in a partner, and the number of pale treponemas that have entered the body. Thus, an important pathogenetic factor in the occurrence of syphilis is the state of the immune system, the intensity and activity of which varies depending on the degree of virulence of the infection. Therefore, not only the possibility of the absence of infection is discussed, but also the possibility of self-healing, which is considered theoretically acceptable.

Symptoms of Visceral Syphilis

Late syphilitic visceropathy
Thanks to successful therapeutic and preventive measures in patients with various forms of syphilis, pronounced and clearly defined by clinical symptoms lesions of internal organs have become rare.

The most important of these are late visceropathy.

Changes in internal organs in patients with tertiary syphilis are
basically endo-, meso- and perivasculitis, characteristic of syphilitic infection, up to complete obliteration of vessels. Specific pathology is especially intense in the tissues of the heart, blood vessels, gastrointestinal tract, liver and lungs. Syphilitic damage to the heart and blood vessels often manifests with specific gummy myocarditis and syphilitic mesaortitis. Hummous proliferates of the myocardium can be isolated (like solitary gums of the skin) or have the form of diffuse gummous infiltration. Often these processes are combined. The symptomatology of lesions has no specific features. There is hypertrophy of the myocardium with an increase in the size of the heart, weakening of the heart tones, pain
spilled nature. Diagnosis is based more clearly on ECG data and serological reactions; RIF and RIBT indicators are especially important. More often than the myocardium, the aorta is affected - specific mesaortitis occurs in patients with tertiary syphilis with a disease duration of more than 10 years. In the initial phase of infiltration and slight compaction of the intima and median membrane, the ascending part of the aortic arch thickens, which is clearly recorded on radiographs; subjective symptoms may be absent. Further stages of the formation of mesaortitis depend on the degree of allergic reactivity of the test organ and the intensity of the syphilitic lesion. With hyperergy, necrotic destructive changes develop, up to the complete destruction of the aortic wall, ending in death. At low
allergic tension process ends with proliferative
seals, foci of fibrous degeneration and calcification, which
more favorable for the prognosis regarding life and therapeutic effect.
The transition of the process to the aortic valves leads to aortic insufficiency,
which is manifested by pulsation of the cervical vessels, shortness of breath, nausea,
increased fatigue, the release of rusty sputum. There may also be
large main arteries and veins of the brain, upper and
lower limbs. They contain separately located small
gums, followed by their fibrous compaction or diffuse impregnation along
type of sclerotic lesions, without destruction and necrosis.

Syphilitic aortitis- the most common form of visceral syphilis; characterized by a difference in the pulse on both hands, a kind of "ringing" accent of the II tone on the aorta, the identification of the phenomenon of Sirotinin - Kukoverov - a systolic murmur heard over the sternum when the arms are raised as a result of displacement of the main vessels in aortitis, radiographically detectable expansion of the shadow of the ascending aortic arch. Syphilitic aortic aneurysm on fluoroscopy is found saccular, rarely spindle-shaped, extensions with a clear pulsation. It is necessary to exclude syphilitic aneurysm of the aorta in patients with the syndrome of the superior vena cava, which occurs with compression of it, as well as the trachea and bronchi. X-ray in the anterior mediastinum reveals a large, relatively homogeneous, without
petrificates, shadow. To exclude the often causing the specified syndrome
malignant neoplasm, aortic angiography is performed,
tomography, serological examination.

Late syphilis of the gastrointestinal tract it is characterized by the same specific infiltrative foci of a tubercular-hummous nature, reflecting the intensity of immunoallergic reactivity. Individual, focally located tubercles or gummas can be found in the esophagus, stomach, small and large intestine. Due to the more pronounced
traumatic effect of food and the enzymatic action of the gastric
contents gummy-infiltrative processes occur more often in the esophagus and
stomach. Isolated, solitary, gummas and diffuse gummous infiltration
formed in combination with each other or separately. In case of occurrence
solitary gumma of the esophagus or stomach, the process remains for a long time
unrecognized due to the weak expression of subjective and objective
symptoms. Diffuse gummous infiltration is more often detected in the stomach.
Superficial infiltrative lesion of the mucous membrane at the beginning
manifested by symptoms of gastritis with severe dyspeptic
disorders, hypacid or anacid state. deep
infiltrative changes in the esophagus and stomach cause severe
dysphagia, digestive disorders similar to the symptoms of a tumor of these
organs.

With intestinal damage, syphilitic gummy-infiltrative elements
localized, as a rule, in the jejunum. Symptoms of syphilitic
enteritis is very nonspecific. Diffuse proliferates thickening the wall
small intestine, give less symptoms than focused gummas,
altering natural peristaltic movements and accompanied by
phenomena of obturation (with significant infiltration). Ulceration of the gums or
gummous infiltration aggravate the course of the process with bleeding and
peritoneal symptoms. The rectum is rarely affected in the tertiary
period of syphilis. During the period of infiltration, defecation disorders are observed, and with ulceration and scarring, the symptoms are similar to severe proctitis, differing in less pronounced soreness and an unusually small amount of purulent discharge. Diagnosis of syphilitic gastrointestinal processes is hampered by false-positive CSR in tumors, as well as difficulties in interpreting the results of x-ray examination. And yet, the data of RIBT, RIF, anamnesis, the results of trial antisyphilitic treatment, as a rule, make it possible to make a correct diagnosis.

Syphilitic damage to the liver observed in various variants, due to the localization of the proliferative process and its nodular or diffuse character. In accordance with the classification of A. L. Myasnikov (1981), the following clinical varieties are distinguished among chronic syphilitic hepatitis: syphilitic chronic epithelial hepatitis, chronic interstitial hepatitis, miliary gummous hepatitis and limited gummous hepatitis. The earliest changes in liver function that occur in the secondary period of syphilis can be manifested by icterus, skin itching and other symptoms of acute syphilitic hepatitis. As a result of rational antisyphilitic treatment, or even without it, the latter is resolved, leaving an altered cellular reactivity. In the tertiary period of syphilis, when the phenomena of hyperergic reactivity increase, chronic epithelial hepatitis occurs secondarily or spontaneously, since it is the epithelium that is most reactive in infectious-allergic processes. Symptoms of the disease are non-specific: general malaise, pain and heaviness in the liver, anorexia, nausea, vomiting, severe pruritus. The liver is slightly enlarged, protrudes 4-5 cm from under the edge of the costal arch, dense, but painless.

Chronic syphilitic interstitial hepatitis develops as a result of diffuse-proliferative damage to the cells of the interstitial tissue. Just like epithelial hepatitis, it can form even in the secondary period as a result of direct penetration of pale treponema. However, interstitial hepatitis can also have an infectious-allergic nature. Even a small number of pale treponemas, but for a long time, dramatically changes the reactivity of the cells of the interstitial tissue, and in the tertiary period, interstitial hepatitis is already formed for the second time.
productive-infiltrative character, accompanied by the phenomena of necrosis.
This clinical variety is characterized by intense pain in the area
liver, its increase, density on palpation, but jaundice is absent on
early stages of the disease. In the late period, when it develops
syphilitic cirrhosis of the liver, jaundice and severe itching of the skin join.

Miliary gummous and limited gummous hepatitis characterized by the formation of nodular infiltrates. Liver hypertrophy in gummous hepatitis is characterized by unevenness, tuberosity, lobulation. Miliary gummas are smaller, located around the vessels and affect the liver tissue less. Therefore, miliary gummous hepatitis is manifested by pain in the liver, its uniform increase with a smooth surface. The functional activity of the liver cells persists for a long time, and jaundice is usually absent.

Limited gummy hepatitis, due to the formation of large nodes involving secretory and interstitial areas, is accompanied by severe pain, fever, chills. Icteric sclera and skin, other disorders of the liver function are expressed slightly; in the initial stages of the disease, jaundice occurs only as a result of mechanical obstruction of the bile ducts. A zone of perifocal nonspecific inflammation is formed around the gums. At the final stages, pronounced sclero-hummous atrophic, deforming scars are observed.

Syphilitic kidney disease is rare and chronic. In the secondary period of syphilis, reactive inflammatory changes in the vessels of the glomeruli spontaneously regress. In the tertiary period, as a result of a hyperergic reaction of the endothelium of the glomerular vessels, miliary or large gummas appear, as well as diffuse infiltration. Hummous lesions due to the focal nature of inflammation (nodular infiltrates) according to the main symptoms - albuminuria, pyuria and hematuria - are similar to the blastomatous process. Syphilitic nephrosis with amyloid or lipoid
degeneration ends with nephrosclerosis. Since amyloidosis and lipoid
degeneration of the renal parenchyma is also characteristic of other chronic infections,
differential diagnosis of syphilitic kidney disease requires
careful analysis of anamnestic information, data from CSR, RIF and RIBT,
examination results from related specialists (in order to detect or
exclusion of the syphilitic process of a different localization). Trial treatment for
kidney damage is not recommended because bismuth preparations in such patients
are contraindicated, and penicillin therapy does not always resolve diagnostic
difficulties.

Syphilis of the bronchi and lungs manifested by extremely diverse symptoms due to the peculiar localization of gummy and productive-infiltrative foci. Gummy seals, both single and multiple (miliary gummas), are located more often in the lower or middle lobe of the lung. The process manifests with shortness of breath, a feeling of tightness in the chest, and vague pains. Thickening of lung tissue in syphilis
focal character, as in a tumor, more often it is asymmetric. From
tuberculous process gummas of the lungs are differentiated on the basis of a good
well-being of patients. With syphilis, as a rule, there is no fever
conditions, asthenia, absent in the sputum of Mycobacterium tuberculosis.
Diffuse productive-infiltrative inflammation of syphilitic etiology
more often localized in the bifurcation of the trachea or in the peribronchial tissue.
Lung gumma and diffuse gummous infiltration can occur with
ulceration, purulent sputum, and even bleeding. But a more frequent outcome is fibrous compaction with the development of pneumosclerosis and bronchiectasis. In the diagnosis of syphilitic lesions of the lungs, anamnesis data, the presence of a syphilitic process on the skin, mucous membranes or bones, the results of a serological study, and sometimes trial treatment, are of decisive importance.

N. Schibli and I. Harms (1981) report tumor-like lesions
lungs with tertiary and even secondary syphilis. On x-rays of organs
chest, round retrocardial opacities are found at the root
lung. Sometimes patients with this kind of lesions, simulating a tumor,
undergo a thoracotomy. Syphilitic nature of lung lesions
established by excluding other etiology and positive influence
antisyphilitic therapy. However, it is also possible to simultaneously
the existence of syphilis and tuberculosis, gumma and lung tumors.

Syphilitic thyroiditis observed in 25% of patients with early forms of syphilis. E.V. Bush (1913) subdivided thyroid diseases in tertiary syphilis into 3 groups:
- Enlargement of the thyroid gland without changing function,
- syphilitic thyroiditis with hyperfunction and
- Hypofunction of the thyroid gland after cicatricial resolution of syphilitic thyroiditis.
V.M. Kogan-Yasny (1939) subdivided syphilitic thyroiditis into early and late forms.

In the secondary period of syphilis, there is a diffuse enlargement of the thyroid gland with hyperfunction. In the tertiary period, a gummy or interstitial lesion develops, followed by scarring. As an example of a specific lesion of the thyroid gland, we present an observation. Complete restoration of the structure of any endocrine gland after treatment does not occur, and therefore syphilitic endocrinopathies are not accompanied by the restoration of the functional activity of the gland.

Diagnosis of visceral syphilis

Fundamental at diagnosis of visceral syphilis is a conclusion based on a comprehensive examination of the internal organs and nervous system. Positive blood serological tests and a history of syphilis confirm the clinical diagnosis.

Treatment of visceral syphilis

The provision of specialized medical care to patients with syphilis is carried out by dermatovenereologists.

At the outpatient stage, patients are identified, diagnosed, treated and followed up, as well as preventive measures are taken to prevent syphilis.

Inpatient treatment of patients with syphilis is carried out in the venereal departments of specialized hospitals, or in specialized departments at infectious diseases hospitals. Children, socially unadapted teenagers, pregnant women, patients with syphilis are subject to compulsory hospitalization. Hospitalization is also indicated in cases of intolerance to penicillin preparations by the patient, in the presence of somatic burden, complicated course of syphilis, late forms of the disease, as well as in patients over 60 years of age.

The provision of medical care to patients with congenital syphilis is carried out by dermatovenereologists, obstetrician-gynecologists and neonatologists, nurses with the necessary qualifications and training. Treatment of patients with congenital syphilis is carried out only in hospitals in specialized maternity hospitals at infectious diseases hospitals, infectious diseases departments of children's hospitals, as well as in children's departments of dermatovenerological hospitals. At this stage, the identification, diagnosis and treatment of patients is carried out. Outpatient care for patients with congenital syphilis consists of clinical and serological control after the treatment and is carried out on the basis of dermatovenerological dispensaries.

Specific treatment is prescribed to a patient with syphilis after the diagnosis is established. The main direction in treatment is the use of antimicrobial drugs active against Treponema pallidum. For treatment, drugs of the penicillin series are used. With their intolerance, ceftriaxone, doxycycline, tetracycline, erythromycin are used.

Prevention of visceral syphilis

Prevention of visceral syphilis provides for its timely
diagnosis and early full treatment, since visceral forms
are the result of inadequate therapy for active forms of syphilis or
its complete absence.

Since there are no strictly pathognomonic signs characteristic of syphilitic visceral lesions, the diagnosis should be guided by a complex of clinical and laboratory data, the dynamics of clinical changes under the influence of specific therapy, widely using a complex of serological
reactions: RIT, RIF, RPGA, ELISA, PCR.

Studies in hospitals of therapeutic, surgical, obstetric-gynecological, neurological profile should be carried out with the formulation of serological reactions. A comprehensive examination of persons with syphilis at the end of treatment and upon deregistration serves to prevent visceral syphilis. It consists of an in-depth clinical examination with an x-ray, according to indications
liquorological and ECG studies in order to assess the usefulness
the treatment carried out. A targeted therapeutic examination is also indicated for patients with neurosyphilis, who often have specific lesions of the internal organs.

For the timely diagnosis of visceral syphilis, it is very important to actively detect latent forms of syphilis, which in 50-70% of cases entail the possibility of late specific lesions of internal organs. For the purpose of timely detection of early forms of visceral syphilis, a 100% examination of patients in therapeutic, neurological, psychoneurological, surgical hospitals, ENT departments with the production of RV is used. According to M. V. Milich, V. A. Blokhin, positive serological reactions are found in 0.01% of those examined in somatic hospitals, and late forms of syphilis are more common in them: latent late - in 31%, latent unspecified - in 11.5 %, late neurosyphilis - in 3.6%, late visceral - in 0.7%. 01/14/2020

At a working meeting in the government of St. Petersburg, it was decided to actively develop a program for the prevention of HIV infection. One of the points is: testing for HIV infection up to 24% of the population in 2020.

Pfizer talks about transthyretin amyloid cardiomyopathy 14.11.2019

Experts agree that it is necessary to attract public attention to the problems of cardiovascular diseases. Some of them are rare, progressive and difficult to diagnose. These include, for example, transthyretin amyloid cardiomyopathy.

14.10.2019

On October 12, 13 and 14, Russia is hosting a large-scale social campaign for a free blood coagulation test - “INR Day”. The action is timed to coincide with World Thrombosis Day.

07.05.2019

The incidence of meningococcal infection in the Russian Federation in 2018 (compared to 2017) increased by 10% (1). One of the most common ways to prevent infectious diseases is vaccination. Modern conjugate vaccines are aimed at preventing the occurrence of meningococcal disease and meningococcal meningitis in children (even very young children), adolescents and adults.

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