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題 名 | Secondary Syphilis-Related Oral Ulcers: Report of Four Cases=與二期梅毒相關口腔潰瘍的診斷與治療:四例報告 |
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作 者 | 盧心玉; 邢福柳; | 書刊名 | 長庚醫學 |
卷 期 | 25:10 2002.10[民91.10] |
頁 次 | 頁683-688 |
分類號 | 415.2752 |
關鍵詞 | 性病; 梅毒; 口腔潰瘍; 愛滋病; Sexually transmitted disease; Syphilis; Oral ulcer; HIV; |
語 文 | 英文(English) |
中文摘要 | 近年來國人感染性病人數倍增,加上梅毒、淋病與愛滋病等都會出現口腔症狀,對牙醫師是一很大的挑戰,但很少牙醫師與其他科別的醫師有從口腔特徵診斷性病的能力。本文報告4例病人因口腔潰瘍而診斷梅毒,其中一例因合併感染口腔念珠菌而診斷出愛滋病。梅毒的口腔病變常位於唇、舌、頰黏膜或上顎黏膜,原發性梅毒的口腔表徵為一淺表性潰瘍,上覆蓋以一層灰白色膜,常因口腔細菌之繼發感染而表現急性炎症反應,腫脹顯著之後成褐色結痂外觀,不治療也會在2至4週內自行癒合,此時會讓病人誤以為病已痊癒。實際狀況卻是在原發病變6至8週後產生第二期梅毒症狀,梅毒螺旋菌侵入血行蔓延全身侵犯任何組織器官,以皮膚出疹及粘膜病變為特徵,口腔病變呈不規則形狀或橢圓形淺潰瘍,灰白或色粘膜斑,潰瘍表面發亮如snail-track ulcers,內含大量的梅毒螺旋菌傳染力很高,可持續數月至3年之間反覆發作。鏡檢之下可看到潰瘍表皮下數量不等的形質細胞浸潤,因為梅毒臨床表現與病理特徵多變,不論梅毒的那一個階段,建立診斷並不容易。本文特別討論梅毒的口腔表徵、診斷與療,並提醒多種性病出現潰瘍的可能,包括應合理懷疑病人可能是愛滋病的高危險群,應提高診斷的警覺性。 |
英文摘要 | Establishing a diagnosis of syphilis, whatever the stage of the disease, can be difficult because syphilis is a great mimic in clinical morphology and histology. Many patients infected with venereal diseases have oral manifestations, but very few dentists and physicians have the proper experience to diagnose syphilis or other STDs from oral lesions. Oral secondary syphilis appears to be very uncommon, and few case have been reported over the recent past. We present 4 patients who developed secondary syphilis-related oral lesions of moist ulcers, irregular linear erosions termed ‘snail-track’ ulcers, or erythematous mucous patches on the labial mucosa, buccal mucosa, palate, or tongue. Concurrent human immunodeficiency virus (HIV) infection was diagnosed in 1 patient. The histological examination in 2 patients showed dense subepithelial inflammatory cell infiltration comprised predominantly of plasma cells, and it was of practical help in the diagnosis of syphilis. The diagnostic value of a histological examination, serologic tests, and treatment of syphilis are discussed. Obviously, confection with HIV will complicate the clinical presentation, diagnosis, and management of syphilis. Concurrent HIV infection should be considered in any patient with a sexually transmitted disease including syphilis. |
本系統中英文摘要資訊取自各篇刊載內容。