Esophageal syphilis
Introduction
Introduction to esophageal syphilis Syphilis is a chronic infectious disease caused by Treponemapallidum. It is a kind of sexually transmitted diseases. It is congenital and acquired. It is congenitally transmitted by the mother. The acquired nature is mainly transmitted through sexual contact. The disease has a long course and progress. Slow, mainly invading the skin and mucous membranes, and the heart, central nervous system, bones and internal organs can be damaged in the late stage, and the esophagus can also be affected. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of transmission: congenital infection by the mother, acquired by sexual contact Complications: tracheoesophageal fistula
Cause
Causes of esophageal syphilis
Cause:
Syphilis is a chronic infectious disease caused by Treponema pallidum. It is a kind of sexually transmitted diseases. It is a systemic infection at the beginning. It can affect any organs and tissues during the development process. Esophageal syphilis is extremely rare, mainly for stage III syphilis.
Pathogenesis :
Esophageal syphilis is no different from syphilitic lesions in other parts of the body. Except for gum-like syphilis, syphilis is a vascular disease from beginning to end. Late syphilis is an inflammatory change caused by occlusive endarteritis of the terminal arterioles and arterioles. Necrosis, in general, stage III syphilis lesions are characterized by submucosal gums or diffuse inflammation with tissue destruction, both of which can lead to erosion and ulceration and scarring.
Prevention
Esophageal syphilis prevention
It is strictly forbidden to use condoms. When suffering from other sexually transmitted diseases, the syphilis serum reaction should be routinely checked. The sexual partners of syphilis patients should be observed and checked regularly. Pre-marital physical examination should include syphilis serum reaction.
Complication
Esophageal syphilis complications Complications of tracheoesophageal fistula
1. Esophageal gum-like swelling and invasion of the trachea or bronchus can cause tracheal (bronchial) esophageal spasm.
2. Syphilitic aortic aneurysm can compress the esophagus, but the symptoms are not obvious. There have been reports of meiogenic aortic aneurysm breaking into the esophagus to produce fatal bleeding.
Symptom
Symptoms of esophageal syphilis common symptoms cachexia, epithelial esophageal obstruction, moderate inhalation injury, weight loss, dehydration, dysphagia, cough
Dysphagia is the most common symptom of esophageal syphilis, mostly painless, long course of disease, slow progress is its characteristics, which is different from esophageal cancer, when the disease progresses, the feeding fluid can also have difficulty swallowing and accompanied by sternal pressure. It can cause weight loss, dehydration, anemia and even cachexia due to insufficient intake. Once the gum is swollen, the trachea (bronchial) esophageal fistula will cough every time it eats. In addition, other symptoms of esophagitis and obstruction may occur.
Examine
Esophageal syphilis examination
A positive serum test can confirm the diagnosis.
1. Histopathology can be seen in perivascular inflammatory cell infiltration and changes in endarteritis.
2. Endoscopic performance is non-specific, visible esophageal mucosa congestion, edema, erosion or ulcers, sometimes visible white plaques, common esophageal stricture, severe endoscopy can not pass.
3. Esophageal X-ray examination is common to the esophageal stiffness, narrow lumen and so on.
Diagnosis
Diagnosis and diagnosis of esophageal syphilis
Diagnostic criteria
The diagnosis of esophageal syphilis is based on medical history, laboratory tests, X-ray, endoscopic biopsy and anti-syphilis treatment. The X-ray shows that the wall is stiff, the lumen is narrow, and even obstruction is difficult to distinguish from cancer. Endoscopy depends on The course of disease and severity, generally esophageal mucosa congestion, edema, erosion, ulcers, sometimes visible white plaque, part of the mucosa is granular, brittle, lumens have varying degrees of stenosis, severe cases can not pass the lens, Williams describes the local performance include:
1. Changes in esophageal inflammation are mostly concentrated in the middle segment.
2. The mucosa has longitudinal peeling, which can develop to the complete peeling of the epithelium.
3. White spot formation and a few thickened residual epithelium.
Endoscopic examination should pay attention to biopsy at different sites, such as pathological section for round cell infiltration around the blood vessels and endarteritis suggesting the diagnosis of syphilis.
Esophageal stage III syphilis is extremely rare. If the syphilis or syphilis serum test is positive, the patient should have esophageal syphilis due to chronic obstruction of esophagus. However, in view of the rareness of this specific infection, other more common diseases should be excluded first. Syphilis treatment for the diagnosis.
Differential diagnosis
1. Suppurative esophagitis: Suppurative esophagitis is the most common mechanical damage caused by foreign bodies. The bacteria multiply in the esophageal wall, causing local inflammatory exudation, different degrees of tissue necrosis and pus formation, and can also be more extensive. cellulitis.
2. Esophageal tuberculosis: Patients with esophageal tuberculosis generally have pioneering symptoms of tuberculosis in other organs, especially tuberculosis. The symptoms of esophagus itself are often confused or concealed by other organ symptoms, so that they cannot be discovered in time. According to the pathological process of tuberculosis, the stage of early infiltration can be advanced. There are symptoms of fatigue, low fever, increased erythrocyte sedimentation rate, but also symptoms are not obvious, followed by swallowing discomfort and progressive dysphagia, often accompanied by persistent throat and retrosternal pain, aggravation when swallowing, ulcer-type lesions Most of them are characterized by pain when swallowing. Food spilling into the trachea should consider the formation of tracheal esophageal fistula. Difficulty in swallowing suggests that the fibrosis of the lesion causes scarring.
3. Fungal esophagitis: The clinical symptoms of fungal esophagitis are atypical. Some patients may have no clinical symptoms. Common symptoms are swallowing pain, difficulty swallowing, upper abdominal discomfort, post-sternal pain and burning sensation. It is like a knife-like colic, which can radiate to the back like angina. Candida esophagitis can cause severe bleeding but is not common. Untreated patients may have epithelial shedding, perforation or even disseminated candidiasis, and esophageal perforation can cause Mediastinal inflammation, esophageal tracheal fistula and esophageal stricture, patients with persistent high fever granulocytopenia should be checked for skin, liver, spleen, lung and other disseminated acute candidiasis.
4. Viral esophagitis: HSV infection of the esophagus often has nasal and herpes labia. The main symptom is swallowing pain. The pain is often aggravated when swallowing food. The patient's food is slow in the esophagus after swallowing. A few patients have difficulty swallowing. The main symptoms, mild infection can be asymptomatic.
