Lues maligna is a rare ulcerative form of secondary syphilis. This clinical entity is predominantly found in patients living with HIV or AIDS. We report a case of a 32-year-old homosexual man with ...diffuse non-pruritic, papular skin lesions, ulcerated nodules and plaques disseminated on the face, trunk and extremities. The rash was followed by fever, malaise and joint pains. Serological tests for syphilis were positive. The patient was treated with intramuscular penicillin and the lesions resolved completely. Lues maligna was an initial presentation of underlying HIV infection. The HIV seropositivity was confirmed by Western blot analysis. Due to the increased number of syphilis cases and frequent HIV co-infection in Serbia, dermatologists must be able to recognize this condition based on clinical characteristics and risk factors and to diagnose and treat it promptly.
Two feet-one hand syndrome is a superficial fungal infections of the skin which involves both feet and one hand. Trichophyton rubrum and occasionally Trichophyton mentagrophytes are the usual ...causative organisms.
We present a 32-year-old healthy man with sharply demarcated papular erythematous and squamous lesions on dorsal aspect of the feet and diffuse dry scaling lesions of the right palm. In this syndrome, the development of tinea pedis generally precedes the development of tinea manus, which usually occurs on the hand that excoriated the pruritic feet or picked the toenails with onychomycosis. Our patient often used his dominant right hand to scratch the feet.
On mycological examination, fungal spores and mycelia were present and Trichophyton mentagrophytes was isolated. The patient was treated with itraconazole 200 mg daily for two weeks and topical terbinafine cream for four weeks. After the treatment all lesions resolved and fungal culture was negative.
Early diagnoses and treatment of tinea pedis and education about prophylaxis, constant care and regular medical assistance would minimize this problem in predisposed individuals.
Sindrom dva stopala i jedne sake” (eng. two feet and one hand syndrome) je gljivična infekcija stopala i šake, čiji je uzročnik najčešće Trichophyton rubrum, a retko i Trichophyton mentagrophytes.
Prikazuje se bolesnik star 32 godine, koji se obratio dermatologu zbog jasno ograničenog eritemoskvamoznog osipa na dorzalnim stranama oba stopala i difuznih, suvih, skvamoznih promena na dlanu desne ruke. Kod ovog sindroma, gljivična infekcija stopala, tinea pedis, prethodi infekciji šake, tinea manus, koja se obično javlja na ruci, kojom se primarno češu pruriginozne lezije na stopalu i dodiruju inficirane nokatne ploče. Bolesnik je često koristio desnu ruku za češanje promena na stopalima.
Mikološkim pregledom promena na koži nađene su spore i micelska vlakna, a kulturom je izolovan Trichophyton mentagrophytes. Bolesnik je dve nedelje koristio peroralnu terapiju itrakonazolom od 200 mg dnevno i lokalno aplikovao terbinafin krem tokom četiri nedelje, nakon čega su se sve promene povukle, a nalaz kulture na mikoze bio negativan.
Rana dijagnostika i terapija oboljenja tinea pedis, kao i edukacija pacijenata o merama profilakse, neophodni su preduslovi za sprečavanje nastanka ovog oboljenja kod predisponiranih osoba.
Background: The aim of this study was to evaluate some hypotheses about factors related to the development of type 1 diabetes mellitus. Methods: A case–control study was conducted in Belgrade during ...the period 1994–1997. A total of 105 recently onset diabetic and 210 control children, individually matched by age (±1 year), sex and place of residence, were included in the study. Results: According to multivariate regression analysis, the following factors were related to type 1 diabetes: stressful events and symptoms of psychological dysfunction during the 12 months preceding the onset of the disease odds ratio (OR) 3.48, 95% confidence interval (CI) 2.15–5.65; and OR 2.15, 95% CI 1.33–3.48, irregular vaccination (OR 16.98, 95% CI 1.38–208.92), infection during 6 months preceding the onset of the disease (OR 4.23, 95% CI 1.95–9.17), higher education of father (OR 1.50, 95% CI 1.05–2.14), mother's consumption of nitrosoamines-rich food during pregnancy (OR 4.33, 95% CI 1.95–9.61), alcohol consumption by father (OR 3.80, 95% CI 1.64–8.78), insulin-dependent and non-insulin-dependent diabetes mellitus in three generations of children's relatives (OR 20.04, 95% CI 4.73–84.81; and OR 5.52, 95% CI 2.45–12.46), and use of ultrasound diagnostic techniques during pregnancy (OR 0.42, 95% CI 0.17–1.00). Conclusions: Among non-genetic factors, those affecting the child during pregnancy are especially important because of their preventability.
The aim of this study was to analyze the characteristics and clinical manifestations of secondary syphilis among patients registered at the City Institute for Skin and Venereal Diseases in Belgrade, ...during the period from 2010 to 2014. The study was designed as a case-note review. In the five-year period, a total of 62 patients with secondary syphilis were registered. The average patient age was 32 years. There were 45 (72.6%) HIV-negative, and 17 (27.4%) HIV-positive patients. The incidence of HIV–positive patients was significantly different from random distribution (p = 0.016). All HIV-positive patients were unmarried men. A significant percentage of HIV-positive patients were unemployed (p < 0.001), reported unknown source of infection (p = 0.002) and were all homosexuall (p = 0.026). More than 25% of all patients with syphilis had a history of chancres, and it was still present at the time of examination in 11.3% of all patients. The majority of cases (87.1%) had a rash, and lymphadenopathy was found in 20% of patients. However, syphilitic alopecia was detected only in HIV-positive cases (p = 0.004). There were no statistically significant differences between HIV-positive and HIV-negative patients in regard to other clinical manifestations, such as mucous patches and condylomata lata. Being a great imitator, secondary syphilis may manifest in a myriad of diverse morphological entities and clinical manifestations. We review a range of cutaneous manifestations of secondary syphilis and skin diseases it may mimic. Clinicians must be vigilant and consider syphilis in differential diagnosis, and maintain a high index of suspicion, especially when assessing vulnerable populations, such as men who have sex with men and HIV-infected individuals.
The Roma ethnic group is the largest and most marginalized minority in Europe, believed to be vulnerable to sexually transmitted infections.
The purpose of the study was to investigate frequency and ...characteristics of gonorrhea and syphilis among the Roma population in Belgrade.
Data from the City Institute for Skin and Venereal Diseases to which all gonorrhea and syphilis cases are referred were analyzed.
During the period of 2010–2014 sexually transmitted infections were more frequent among Roma than in rest of Belgrade population. Average percentages of Roma among all reported subjects with syphilis and those with gonorrhea were 9.6% and 13.5%, respectively, while the percentage of Roma in the total Belgrade population was about 1.6%. Roma with syphilis and gonorrhea were more frequently men (75%), most frequently aged 20–29 years (43.4%), never married (64.5%), with elementary school or less (59.2%), unemployed (80.3%), and heterosexual (89.5%). Among Roma 10.5% were sex workers and 68.4% did not know the source of their infection. Significant differences between Roma cases and other cases in Belgrade in all characteristics observed were in agreement with differences between Roma population and the total population of Serbia.
The present study confirmed the vulnerability of the Roma population to sexually transmitted infections.
The aim of the paper was to evaluate the clinical presentation, demographic and lifestyle characteristics of men with genital lichen sclerosus (LS). This study examined the cases of 73 men with ...genital LS who appeared at the City Institute for Skin and Venereal Diseases in Belgrade between January 2007 and December 2008. The diagnosis of LS was established by history and physical examination. Data about demographic and lifestyle characteristics were obtained by the use of a questionnaire. Nearly 60% of men with LS were older than 45 years. The most frequent complaint was a tight foreskin which was detected in 70% of men. White atrophic lesions, fissures and cracking were recorded in the majority of the patients. The most frequently affected site was prepuce in 76% of cases. More than 70% of participants had frequent sexual activities and 57.5% were exposed to stress. LS is disease with a wide spectrum of clinical manifestations, such as prepuce lesions, which increases the risk for acquiring some sexually transmitted pathogens. That fact stresses the importance of LS patients counseling on consistent condom use and importance of early diagnosis and early treatment which may prevent further penile lesions, complications and diminish vulnerability to sexually transmitted infections and HIV.
“Contact tracing” or “partner notification” refers to clinicians’ efforts to identify sex partners of infected persons to ensure their medical evaluation and treatment. For many years partner ...notification has been a cornerstone in the management of patients diagnosed with sexually transmitted infections (STIs) and it is the essential component in the control of these infections. Clinicians’ efforts to ensure the treatment of a patient’s sex partners can reduce the risk for re-infection and potentially diminish transmission of STIs. Partner notification includes three different approaches for notifying the sexual partners of the person infected with a STI: provider referral, patient referral, and contract referral. The aim of our study was to evaluate the efficacy of partner notification among syphilis and gonorrhea cases registered at the City Institute for Skin and Venereal Diseases in Belgrade in 2016, and its contribution to prevention and control of these diseases. A retrospective chart review of patients with gonorrhea and early syphilis registered in 2016 was undertaken. We analyzed data about the possible source of infection as well as sexual orientation, provided on the official form for notification of syphilis and gonorrhea. The study included 112 male patients, 67 with gonorrhea and 45 with syphilis. Out of three modalities of partner notification offered to patients, only patient notification of sexual partner/s was accepted. Although all patients accepted this type of partner notification, index patients with gonorrhea notified only 17 partners (25.4%) and index patients with syphilis also notified 17 partners (37.8%). The effectiveness of partner notification for gonorrhea and syphilis cases was only 30.4%, and its contribution to prevention and control of these diseases was lower than we expected. National guidelines offering standardized protocols for partner notification service provision can improve this process, as a novel approach with non-traditional method of partner notification such as patient-delivered partner therapy.
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