Acquired nasal syphilis
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Cause of syphilis of the nose
The causative agent is pale treponema, having the form of a thin spiral thread with a length of 4 to 14 microns with fine uniform curls.
Syphilis of the nose in the primary period (6-7 weeks) appears hard chancre, is a very rare localization. According to statistics, in the XX century. Primary extragenital chancre occurred in 5% of cases of all infections, of which 5% only 1% occurred in primary syphilis of the nose. Infection occurs mainly by finger transmission when picking in the nose, so the main localization of the chancre is the eve of the nose.
3-4 weeks after infection at the site of infection, there is a primary affect, including hard chancre and regional (submandibular) lymphadenitis. Hard chancre, or primary syphiloma, is a small, painless erosion (0.5-1 cm) or an ulcer of a round or oval shape, with smooth edges and dense infiltration at the base, with a smooth shiny red surface. Infiltrate contains a large number of lymphocytes and plasma cells. Endarteritis arising at the site of infiltration causes narrowing of the blood vessels and, as a result, necrosis and ulceration of the affected tissue. In 5-7 days after the appearance of hard chancre, the lymph nodes nearest to it, ipsauricular or lower jaw, increase. They are dense, with a diameter of 2-3 cm, painless, not welded to the skin and between themselves, the skin above them is not changed.
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Symptoms of syphilis of the nose
The changes that occur at the site of infection are usually one-sided, are at first acute inflammatory in nature: painful swelling in the nasal vestibule at the level of the anterior lower part of the nasal septum. This is followed by an ulcer with raised edges, a tight bottom and painless to the touch. After a week, regional adenonation occurs.
The diagnosis is made on the basis of epidamy, typical pathoanatomical changes, as well as with the help of Wasserman, Kahn, Sachs-Vitebsky serological reactions, immunofluorescence reactions that become positive only 3-4 weeks after the appearance of solid chancre.
Differential diagnosis is carried out with malignant tumors, furunculosis of the nasal vestibule, lupus and some other inflammatory and productive processes.
The treatment is carried out by means and methods used in the primary period of syphilis. Locally prescribed yellow mercury ointment.
Syphilis of the nose in the secondary period is sometimes manifested by persistent bilateral catarrhal rhinitis, painful, weeping cracks in the skin in the region of the nasal vestibule, which cannot be cured. Syphilitic changes in the nasal mucosa in this period are rare, however, these changes can be observed in the area of the mucous membrane of the oral cavity and pharynx, where they are surrounded by diffuse erythema.
Syphilis of the nose in the tertiary period occurs in 5-7% of cases in 3-4 years in patients who have not received full treatment. Sometimes nasal forms of tertiary syphilis can occur 1-2 years after the initial infection or 20 years after it. The tertiary period is characterized by damage to the skin and mucous membranes, internal organs (most often syphilitic aortitis), bones, and the nervous system (neurosyphilis: syphilitic meningitis, spinal troughs, progressive paralysis, etc.).
In the tertiary period, the mucous membrane of the nasal septum is affected, the process extends to the mucous membrane of the hard and soft palate with the formation of low-painful gummy infiltrates of a bluish-red color. These infiltrates quickly decay and ulcerate, destroying bone and cartilage tissue. The disintegration of the gum begins with its central part and leads to the formation of a deep ulcer with steep, dense edges, the bottom of which is covered with necrotic disintegration. The formation of perforated holes in the nasal septum, soft and hard palate causes severe disturbances in breathing, speech and eating. Necrosis and disintegration of the internal bone and cartilage tissues of the nose leads to the formation of sequesters. Subsequently, pronounced atrophic rhinitis and cicatricial disfigurement of the pyramid of the nose develops.
Clinical course of syphilis of the nose
Patients complain of nasal congestion, headaches, aggravated at night. If gumma is located in the upper part of the nasal septum, then hyperemia, swelling and tenderness on palpation are detected on the back of the nose. If the gumma is located in the lower parts of the nasal septum, then the infiltration after a while appears in the sky in the middle line in the form of a reddish swelling. The most visible external signs of gum are in its localization in the area of the bones of the nose. In the area of the root of the nose, a rapidly increasing infiltration occurs, covered with hyperemized skin, the back of the nose expands, and fistulas form in the skin through which bone sequesters and necrotic masses are secreted.
When anterior rhinoscopy is determined hyperemic, edematous mucous membrane, covered with mucus-hundred-sukrovichnymi secretions. With the disintegration of the gum, the amount of discharge increases, they acquire a dirty gray color with blood, contain bone and cartilage sequesters, have a strong putrid odor. When the gummous disintegration zone is felt, the bare bone is determined by the bell-shaped probe. The development of the process of tissue breakdown leads to a total destruction of the endonasal structures and the lateral walls of the nose with the formation of a single huge cavity that combines the nasal cavity with the maxillary sinus. By this time, the patient develops irreversible anosmia. The process of gummous disintegration is painless, which is an important sign of the diagnosis of syphilis of the nose in the tertiary period, as well as the fact that syphilis of the nose in the tertiary period is not accompanied by adenopathy.
The most dangerous form of syphilis of the nose is the localization of the gummous process in the region of the arch of the nasal cavity. Disintegration of the gum in this area can lead to intracranial complications. The same complications can occur when the syphilitic infiltrate is located in the ethmoid bone region or in the sphenoid sinus.
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Diagnosis of syphilis of the nose
Diagnosis is difficult in the initial stage of nasal syphilis in the tertiary period, because inflammation occurring in the nose has similar features with acute banal rhinitis, therefore in case of causelessly prolonged acute or subacute catarrhal rhinitis with a tendency to the appearance of unusual infiltrate in the nasal cavity, you should always remember "French Shepherd Syphilus disease. The final diagnosis at this stage is set using specific serological reactions.
Differentiate syphilis of the nose in the third period from hypertrophic rhinitis, hematoma of the nasal septum. You should also be aware that necrosis of the bones of the nose occurs only when there is a syphilitic infection and only in the third period of this disease. The resulting sequesters should be differentiated from a foreign body of the nose or rhinoliths. The presence of a disgusting smell of crusts excreted from the nasal cavity and the expansion of its cavities makes us think of ozen. However, the “syphilitic” odor differs from that of the asenous, which is easy to establish with appropriate clinical experience, moreover, with ozen there is never ulceration, disintegrating infiltrates and sequestration. The same differences are characteristic of rhinoscleroma, for which ulceration of the infiltrate is completely uncommon, although a narrowing of the nasal passages is observed. The greatest difficulties arise in the differentiation of the third period syphilis of the nose from a decaying malignant tumor (almost always - a unilateral lesion) and nasal lupus. In the first case, the final diagnosis is established after biopsy and serological diagnosis. In the second case, the difficulty lies in the fact that sometimes tertiary syphilis of the nose acquires the features of a pseudo-lance and proceeds without gummy decay and sequestration. It should also be borne in mind that in all cases of spontaneous perforation of the nasal septum, which occurred against the background of an unidentified infiltrate, one should always assume the presence of a syphilitic infection and carry out appropriate diagnostic measures. In all doubtful cases, conduct a biopsy, and without exception - serological tests. Not the last place in the diagnosis of syphilis of the nose is a trial antisyphilitic treatment.
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Congenital syphilis of the nose
In newborns, a typical manifestation of congenital syphilis of the nose is persistent runny nose, which usually appears 2-6 weeks after birth. Initially, this runny nose is no different from the usual catarrh, then nasal discharge becomes purulent, on the threshold of the nose bleeding cracks appear, and excoriation on the upper lip. There is a violation of nasal breathing, which greatly complicates sucking. Diagnosis is facilitated when skin syphilides and specific lesions of the internal organs are observed simultaneously. Early manifestations of congenital syphilis of the nose are left behind by synechia on the threshold of the nose, atrophy of the nasal mucosa and characteristic scars in the corners of the mouth.
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Diagnosis of congenital syphilis of the nose
Late manifestations of congenital syphilis of the nose practically do not differ from those of syphilis of the nose of the Tertiary period.
Diagnosis is made easier by establishing the triad of Gatchinson's symptoms characteristic of late congenital syphilis:
- deformations of the upper middle incisors (teeth taper downwards like a chisel, the lower edge is in the form of a concave arch, permanent teeth are subject to early caries and enamel hypoplasia;
- parenchymal keratitis;
- sensorineural hearing loss due to damage to the ear labyrinth.
In the latter case, with satisfactory air conduction, the bone conduction of sound may be absent or significantly reduced. In some cases, a nystagmenous reaction from the side of the semicircular canals of the vestibular apparatus may also be absent. Diagnosis is also facilitated by the fact that all women in labor are serologically tested to exclude a syphilitic infection.
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Treatment of congenital syphilis of the nose
Treatment of syphilis of the nose includes a set of measures stipulated by the relevant provisions and instructions for the treatment of patients with congenital syphilis.