| JWissmille 2004-10-17, 7:09 pm |
| I have not read any article on Lyme being spread through kissing but the
information in the following article makes one wonder if it is a possibility.
[syphilis and Lyme are both caused by spirochetes]
georgia
source: Mandell, Douglas and Bennett's Principles and Practice of
Infectious Diseases fourth edition
pg. 2119- ..."Syphilis can be aquired by sexual contact, by passage
through the placenta (congenital syphilis), by kissing, by transfusion of
fresh human blood, or by accidental direct inoculation..........Syphilis
can be spread by kissing or touching a person who has an active lesions on
the lips, oral cavity, breasts or genitals. Conversly, an infected patient
may inoculate syphilis to the area on the body that is kissed. (Wet nurses
often spread the disease to infants, especially those from upper-class
European families for whom the use of a wet nurse was a socially recognized
status symbol.)..............Accidental direct inoculation can occur by a
neddle prick or when handling infected clinical material. Indeed, syphilis
of the fingers is most common in medical personnel......some of these
contacts will have no evidence of active disease............Within hours to
days after T. pallidum penetrates the intact mucous membrane or gains
access through abraded skin, it........disseminates throughout the body.
This occurs soon......as evidenced by the fact that patients who have
received blood transfusions from syphilitic donors in the seronegative
incubation period have become infected. Virtually any organ in the body can
be invaded, including the CNS.....as few as four spirochetes can establish
an infection. The organism divides every 30-33 hours.....A prospective
study involving 431 black men with seropositive latent syphilis of 3 or
more years duration was undertaken in 1932 (the infamous Tuskeegee study,
1932-1962). ......As a result of these studies, the variable waxing and
waning course and the unpredictable progression to late syphilis was
documented......................
Clinical Manifestations- It was once an adage of medicine that "he who
knew syphilis knew medicine." Penicillin therapy changed all that, but one
of its legacies is the frequency of DELAYED and/or ERRONEOUS DIAGNOSES that
occurs today................
Secondary syphilis-......It is remarkable that, at a time when the host's
local immune process appears to be bringing the primary lesions under
control the spirochete disseminates widely and achieves its greatest
numbers..........All the different rashes may be present at one time and
become widely distributed to involve the entire body, especially on the
palms and soles.............Constitutional symptomatology is also commonly
manifested in secondary syphilis. ........low-grade fever, malaise,
pharyngitis, laryngitis, anorexia, weight loss,arthralgias, and generalized
painless lymphadenopathy. Enlargement of the epitrochlear lymph nodes is a
unique finding that should always suggest the diagnosis.............CNS
becomes involved in up to 40% of patients.....Headache and meningismus are
common, increased cerebrospinal fluid.....acute aseptic
meningitis......Spirochetes have also been isolated from the CSF of
patients with no CSF abnormalities. Individual cranial nerves, especially
II-VIII, can be involved......Virtually any organ in the body can be
involved. The gastrointestinal tract may also become extensively
infiltrated and/or ulcerated and can be misdiagnosed as a lymphoma or
other cancer. Anterior uveitis, usually mild and asymptomatic, occurs
.......uveitis is made worse by steroid treatment. .....Synovitis, osteitis
and periosteitis can also occur. These cases are often characterized by
nocturnal pain that is increased by heat........The differential diagnosis
of SECONDARY syphilis is extensive, and the appellation "The Great
Imitator" is appropriate...............a pregnant woman with latent
syphilis can infect her fetus in utero, and an infection can be transmitted
via transfused contaminated blood......Late syphilis is a slowly
progressive inflammatory disease that can affect any organ in the body and
can produce clinical illness years after the initial infection......The
differential diagnosis of systemic diseases includes tuberculosis,
rheumatoid arthritis, sarcoidosis, and ocular Toxocara canis
infections.....The conditions from which neurosyphilis must be
differentiated are numerous. They include any degenerative neurologic
process, disorders that cause chronic inflammation ( e.g. tuberculosis,
fungal or sarcoid meningitis, tumors, subdural hematoma, Alzheimer's
disease, multiple sclerosis, chronic alcoholism), or any disorder affecting
the vasculature of the CNS. The axiom that syphilis can mimic any disease
is particularly apropos with regard to the CNS.........the diagnosis can be
very difficult to make.....T. pallidum cannot be cultured in
vitro............protean manifestations are the hallmark of syphilis.
Older clinicians were never surprised by "unusual findings," and today's
clinician should not be either.........One of the more difficult situations
to interpret is the persistent positive.... test (chronic persister") after
apparently adequate therapy. This may be a biologically false reaction or
indicates persistent active infection or reinfection.............." The
article goes on to explain the problems with testing and the problems are
not minor. The spirochete that causes syphilis enters the CNS early and can
hide in areas sequestered from the immune system "in areas where adequate
levels of penicillin are not easily achieved, for example, the anterior
chamber of the eye, the CNS, and the labyrinth of the inner ear. ........
However, there ....is now little doubt that T. pallidum may persist after
treatment, particularly in the CNS......All patients with ....neurosyphilis
must be carefully followed .....at least 5 years.........Re-treatment
should be considered whenever (1) clinical signs and symptoms persist or
recur............ numerous treatment failures have been recorded........
Therefore, it can be implied that the most effective antibiotic treatment
would be to ensure an adequate blood level over a prolonged period of
time.... an increasing number of clinicians now treat syphilis with a
combination of prolonged therapy to ensure the most devastating sequela of
syphilis, neurosyphilis, does not occur. This is especially true when
there is evidence to suggest that the host may be
immunocompromised...........Treponema pallidum has evolved mechanisms to
evade host immune defenses and establish chronic infection............"
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