{"id":10443,"date":"2007-12-14T12:49:51","date_gmt":"2007-12-14T09:49:51","guid":{"rendered":"https:\/\/www.synevo.ro\/afectiuni\/profil-serologie-sifilis\/"},"modified":"2020-07-10T12:56:25","modified_gmt":"2020-07-10T09:56:25","slug":"profil-serologie-sifilis","status":"publish","type":"synevo_diseases","link":"https:\/\/old.synevo.md\/ru\/afectiuni\/profil-serologie-sifilis\/","title":{"rendered":"Profil serologie sifilis"},"content":{"rendered":"<p><strong><span style=\"color: #000080;\">Sifilisul<\/span><\/strong> este o boal\u0103 infec\u0163ioas\u0103 \u015fi contagioas\u0103 determinat\u0103 de Treponema pallidum, spirochet\u0103 patogen\u0103 care se transmite prin contact sexual sau pe cale transplacentar\u0103, excep\u0163ional prin contact sanguin (\u00een\u0163ep\u0103tur\u0103, transfuzie).<sup>1<\/sup><br><strong><em>Treponema pallidum<\/em><\/strong> este un microorganism spiralat, de aproximativ 0,25\u00b5m l\u0103\u0163ime \u015fi 5-20\u00b5m lungime, care poate fi identificat prin morfologia caracteristic\u0103 \u015fi prin motilitate observate la microscopia \u00een c\u00e2mp \u00eentunecat sau prin alte tehnici microscopice. Nu cre\u015fte pe medii de cultur\u0103, cre\u015fte foarte pu\u0163in pe culturi de celule \u015fi nu poate s\u0103 supravie\u0163uiasc\u0103 mult timp \u00een afara corpului uman.<sup>2<\/sup><\/p><!--more--><p>Dup\u0103 contact, agentul patogen difuzeaz\u0103 rapid prin sistemul limfatic. <strong>Perioada de incuba\u0163ie<\/strong> este cuprins\u0103 \u00eentre 15 zile \u015fi 3 luni. \u00cen lipsa unei antibioterapii intercurente care s\u0103 \u201cdecapiteze\u201d sifilisul, boala se instaleaz\u0103 progresiv \u015fi poate conduce la manifest\u0103ri clinice variate, clasificate astfel: sifilis precoce (infec\u0163ios) \u015fi sifilis tardiv (neinfec\u0163ios). Fiecare din cele 2 stadii pot include urm\u0103toarele forme clinice (vezi tabelul):<\/p><ul class=\"wp-block-list\"><li style=\"text-align: justify;\">sifilis primar, secundar \u015fi sifilisul latent precoce (\u00een cadrul sifilisului precoce);<\/li><li style=\"text-align: justify;\">sifilis latent tardiv \u015fi numeroasele forme de sifilis ter\u0163iar (\u00een cadrul sifilisului tardiv).<sup>3,4<\/sup><\/li><\/ul><figure class=\"wp-block-table\"><table><tbody><tr><td>\n<div style=\"text-align: justify;\"><em><strong>Sifilis precoce (infec\u0163ios)<\/strong><\/em><\/div>\n<\/td><\/tr><tr><td>\n<div style=\"text-align: justify;\"><strong>Durata de la expunere<\/strong><\/div>\n<\/td><td>\n<div style=\"text-align: justify;\"><strong>Forme clinice<\/strong><\/div>\n<\/td><\/tr><tr><td>\n<div style=\"text-align: justify;\">9-90 zile<\/div>\n<\/td><td>\n<div style=\"text-align: justify;\"><em>Sifilis primar<\/em><\/div>\n<\/td><\/tr><tr><td>\n<div style=\"text-align: justify;\">6 s\u0103pt.-6 luni (4-8 s\u0103pt. de la leziunea primar\u0103)<\/div>\n<\/td><td>\n<div style=\"text-align: justify;\"><em>Sifilis secundar<\/em><\/div>\n<\/td><\/tr><tr><td>\n<div style=\"text-align: justify;\">\u2264 2 ani<\/div>\n<\/td><td>\n<div style=\"text-align: justify;\"><em>Sifilis latent precoce<\/em><\/div>\n<\/td><\/tr><tr><td>\n<div style=\"text-align: justify;\"><em><strong>Sifilis tardiv(neinfec\u0163ios)<\/strong><\/em><\/div>\n<\/td><\/tr><tr><td>\n<div style=\"text-align: justify;\">&gt; 2 ani<\/div>\n<\/td><td>\n<div style=\"text-align: justify;\"><em>Sifilis latent tardiv<\/em><\/div>\n<\/td><\/tr><tr><td>\n<div style=\"text-align: justify;\">3-20 ani<\/div>\n<\/td><td>\n<div style=\"text-align: left;\"><em>Sifilis ter\u0163iar<\/em> (gomatos, cardiovascular, neurosifilis)<\/div>\n<\/td><\/tr><tr><td>\n<div style=\"text-align: justify;\"><strong><em>Sifilis congenital<\/em><\/strong><\/div>\n<\/td><\/tr><tr><td>\n<div style=\"text-align: justify;\">&lt; 2 ani de la na\u015ftere (inclusiv na\u015fterea de f\u0103t mort)<\/div>\n<\/td><td>\n<div style=\"text-align: justify;\"><em>Sifilis congenital precoce<\/em><\/div>\n<\/td><\/tr><tr><td>\n<div style=\"text-align: justify;\">\u2265 2 ani<\/div>\n<\/td><td>\n<div style=\"text-align: justify;\"><em>Sifilis congenital tardiv<\/em><\/div>\n<\/td><\/tr><tr><td>\n<div style=\"text-align: justify;\">Not\u0103: Transmiterea transplacentar\u0103 se produce \u00een stadiul de sifilis precoce; au fost descrise \u00eens\u0103 cazuri \u015fi \u00een stadiul de sifilis latent tardiv<\/div>\n<\/td><\/tr><\/tbody><\/table><\/figure><p><span style=\"color: #000000;\"><strong>Sifilisul primar<\/strong><\/span> se manifest\u0103 clinic prin prezen\u0163a \u015fancrului \u015fi a adenopatiilor. \u015eancrul poate persista \u00eentre 2\u20136 s\u0103pt\u0103m\u00e2ni \u015fi poate regresa spontan \u00een absen\u0163a unui tratament specific.<\/p><p><strong>Sifilisul secundar<\/strong> se manifest\u0103 clinic prin erup\u0163ie cutaneo-mucoas\u0103 (trunchi, fa\u0163\u0103, palme, plante) \u00eenso\u0163it\u0103 uneori de manifest\u0103ri ca: febr\u0103, artralgii, poliadenopatii, hepatit\u0103, uveit\u0103.<\/p><p>Semnele clinice apar \u00eentre 6 s\u0103pt\u0103m\u00e2ni \u015fi 6 luni de la debutul \u015fancrului. Erup\u0163ia poate s\u0103 dureze de la c\u00e2teva zile la c\u00e2teva s\u0103pt\u0103m\u00e2ni. \u00cen absen\u0163a unui tratament specific, erup\u0163ia poate surveni \u00een mai multe faze, \u00eentrerupte de perioade asimptomatice pe parcursul unei perioade de 1-2 ani. De remarcat posibilitatea regresului spontan al erup\u0163iei \u00een lipsa tratamentului.<\/p><p><strong>Sifilisul latent precoce<\/strong> \u015fi <strong>sifilisul latent tardiv<\/strong> sunt stadii lipsite de semne clinice. Existen\u0163a acestor stadii clinice silen\u0163ioase \u00een cursul c\u0103rora diagnosticul nu este posibil dec\u00e2t prin teste serologice, constituie o dificultate major\u0103 \u00een depistarea bolii.<\/p><p><strong>Sifilisul ter\u0163iar<\/strong> se manifest\u0103 clinic prin determin\u0103ri cutanate (gome), neurologice (tabes, paralizie generalizat\u0103), cardiovasculare (aortit\u0103 sifilitic\u0103, anevrism de aort\u0103, stenoz\u0103 coronarian\u0103). Semnele apar \u00eentr-un interval de 4\u201340 ani de la \u015fancrul ini\u0163ial. Cazurile de sifilis ter\u0163iar sunt rare \u00een zilele noastre \u015fi mai ales \u00een \u0163\u0103rile industrializate unde popula\u0163ia folose\u015fte \u00een mod frecvent tratament antibiotic intercurent.<sup> 1,3<\/sup><\/p><p><span style=\"color: #000000;\"><strong>Sifilisul congenital<\/strong>.<\/span> Riscul transmiterii transplacentare a infec\u0163iei cu Treponema pallidum a crescut interesul pentru depistarea bolii la femeile gravide. Interpretarea rezultatelor serologice la femeia gravid\u0103 este complicat\u0103 prin posibilitatea existen\u0163ei unei reac\u0163ii fals pozitive legat\u0103 de sarcin\u0103. \u00cen aceste situa\u0163ii, determinarea FTA-ABS IgM sau EIA-IgM permite diferen\u0163ierea unui sifilis vechi cu anticorpi reziduali de un sifilis evolutiv. \u00cen transmiterea transplacentar\u0103 a bolii exist\u0103 urm\u0103toarele posibilit\u0103\u0163i evolutive: manifest\u0103ri septicemice care duc la moartea f\u0103tului, na\u015ftere prematur\u0103, leziuni neurologice observate tardiv.<sup>3,5<\/sup><\/p><p>De rutin\u0103, <strong>diagnosticul sifilisului<\/strong> se bazeaz\u0103 pe metodele serologice care sunt disponibile \u00een majoritatea laboratoarelor. Metodele directe (microscopia cu fond \u00eentunecat, imunofluorescen\u0163\u0103, inocularea la animal) r\u0103m\u00e2n apanajul laboratoarelor de specialitate.<br><strong>R\u0103spunsul imun<\/strong> fa\u0163\u0103 de infec\u0163ie include producerea de anticorpi fa\u0163\u0103 de o palet\u0103 larg\u0103 de antigene, fiind implica\u0163i at\u00e2t anticorpi nespecifici (anticardiolipin\u0103\/reagine) c\u00e2t \u015fi anticorpi specifici antitreponemici.<\/p><p>Primul r\u0103spuns demonstrabil este reprezentat de anticorpii specifici antitreponemici de tip IgM, care pot fi detecta\u0163i la sf\u00e2r\u015fitul celei de a 2-a s\u0103pt\u0103m\u00e2ni de infec\u0163ie; anticorpii antitreponemici de tip IgG apar mai t\u00e2rziu, \u00een s\u0103pt\u0103m\u00e2na a patra. Astfel, la debutul simptomatologiei clinice majoritatea pacien\u0163ilor prezint\u0103 anticorpi IgM \u015fi IgG (vezi figura).<\/p><div class=\"wp-block-image\"><figure class=\"aligncenter\"><img decoding=\"async\" src=\"\/wp-content\/uploads\/2009\/06\/dinamica_serologica_in_sifilis.jpg\" alt=\"dinamica_serologica_in_sifilis\" class=\"wp-image-546\" title=\"dinamica_serologica_in_sifilis\"\/><\/figure><\/div><p>Anticorpii nespecifici se pozitiveaz\u0103 dup\u0103 aproximativ 4 s\u0103pt\u0103m\u00e2ni de la contactul infectant. Tratamentul \u015fi infec\u0163ia HIV asociat\u0103 pot afecta r\u0103spunsul imun.<br>Titrul anticorpilor nespecifici \u015fi cel al anticorpilor specifici IgM scade rapid dup\u0103 tratamentul adecvat \u00een sifilisul precoce, dar anticorpii specifici IgG persist\u0103 indefinit.<sup>4<\/sup><\/p><div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-1 wp-block-columns-is-layout-flex\"><div class=\"wp-block-column is-vertically-aligned-center is-layout-flow wp-block-column-is-layout-flow\"><p><strong>Teste disponibile \u00een laboratorul Synevo:<\/strong><\/p><\/div>\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"synevo-shop-products\">\r\n    <div class=\"sysprod\">\r\n        \r\n        <div class=\"sysprod-products\">\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/serologie-sifilis-cantitativa-reagine-anticorpi-specifici\/\">Serologie sifilis cantitativa (reagine + anticorpi specifici)<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>270 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9297\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9297\"\r\n                                data-product_sku=\"IM84\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                    <\/div>\r\n        \r\n    <\/div>\r\n<\/div>\r\n\r\n<style>\r\n.synevo-shop-products {\r\n    padding: 24px 0;\r\n    margin: 24px 0;\r\n    border-radius: 10px;\r\n    background: #F6F7F9;\r\n}\r\n.synevo-shop-products .sysprod-product {\r\n    position: relative;\r\n    margin: 0 24px;\r\n    margin-bottom: 24px;\r\n    border-radius: 10px;\r\n    background: #fff;\r\n    display: flex;\r\n    flex-direction: row;\r\n    align-items: center;\r\n}\r\n.synevo-shop-products .sysprod-product:last-child {\r\n    margin-bottom: 0;\r\n}\r\n.synevo-shop-products .sysprod-product-title {\r\n    flex-grow: 1;\r\n    padding: 15px;\r\n    margin-left: 14px;\r\n    font-family: Poppins,sans-serif;\r\n    font-weight: 600;\r\n    font-size: 16px;\r\n    color: #29263F;\r\n}\r\n.synevo-shop-products .sysprod-product-price {\r\n    flex-shrink: 0;\r\n    font-family: Poppins,sans-serif;\r\n    font-weight: 600;\r\n    font-size: 18px;\r\n    color: #FDB813;\r\n}\r\n.synevo-shop-products .sysprod-product-addcart {\r\n    flex-shrink: 0;\r\n    position: relative;\r\n    width: 38px;\r\n    height: 38px;\r\n    margin-left: 24px;\r\n    margin-right: 24px;\r\n}\r\n.synevo-shop-products .sysprod-product-addcart .button {\r\n    top: unset;\r\n    right: unset;\r\n}\r\n<\/style><\/div><\/div><p><strong><small>Bibliografie:<\/small><\/strong><\/p><p><small>1. Harrison, Sifilisul, \u00cen Principiile medicinei interne, Edi\u0163ia a 13-a, vol.I, Ed.Teora, 1998, 809-821<br>2. Mark H. Beers, Robert Berkow, Sifilisul, In Manualul Merck de diagnostic si tratament, Ed. XVII, versiunea in limba romana, 2002, 1327.<br>3. Dupin N., Syphilis- Aspects cliniques, BEH 2001, 35-36: 170-172<br>4. Egglestone SI, Turner AJL. Serological diagnosis of syphilis, In Commun Dos. Public Health 2000, 3: 158-62<br>5. Rosanna W. Peeling et.al., Maternal and Congenital Syphilis, In Bulletin of the World Health Organization, June 2004, 82 (6)<\/small><\/p><p>___________________________________________________________<\/p><p>Mai multe informa\u021bii despre teste:<\/p><ul class=\"wp-block-list\"><li><a href=\"\/shop\/serologie-sifilis-vdrl-rpr-si-anticorpi-treponema-pallidum\/\" class=\"rank-math-link\">V.D.R.L<\/a><\/li><li><a href=\"\/shop\/serologie-sifilis-cantitativa-reagine-anticorpi-specifici\/\" class=\"rank-math-link\">Serologie sifilis cantitativ\u0103 VDRL\/ RPR<\/a><\/li><\/ul><p><\/p>","protected":false},"featured_media":10442,"template":"","synevo_diseases_category":[892],"class_list":["post-10443","synevo_diseases","type-synevo_diseases","status-publish","has-post-thumbnail","hentry","synevo_diseases_category-dermato-venerologie"],"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases\/10443","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/synevo_diseases"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media\/10442"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10443"}],"wp:term":[{"taxonomy":"synevo_diseases_category","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases_category?post=10443"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}