A Case Of Hard Chancre,secondary Syphilis With Neurological Damage And Genotyping Of Treponema Pallidum

Objective: To analyze a case of syphilis with special disease course and clinical manifestations,and to determine the Treponema pallidum type of the patient by using the CDC genotyping method to explore the Correlation between the specific clinical manifestation of the patient and the genotype of Treponema pallidum.Methods: 1.One patient with neurological damage coexisted with hard chancre and secondary measles rash was selected as the study object.The medical history,physical examination,laboratory examinat ion,and imaging findings were reviewed to understand the systemic damage caused by syphilis infection.2.Taking the patient’s blood as a sample,extract the patient’s DNA from the peripheral venous blood,amplified the trepon emal specific tp47 gene,diagnosed patients infected with Treponema pallidum.PCR was used to amplify arp gene,tpr gene,and they were determined by CDC genotyping method which combining the number of repeats contained in the arp gene and RFLP type of the tpr gene to determin the Treponema pallidum genotype,analysis correletion of the patient’s specific clinical manifestat ions and T.pallidum genotype.Results: 1.The patient’s face,trunk and extremities can be seen in densely distributed and various forms of syphilis;RPR: 1:32+ TPPA: 1:640;laboratory examination about Cerebros pinal fluid revealed: protein positive,increased cell count;brain MRI and MRA prompted: the left basal ganglia,thalamus,medial temporal lobe see patchy infection Lesions;left middle cerebral artery occlusion.CT of the left lower extremity showed a localized cort ical destruction and in the lower segment of the left lower tibia caused by syphilis infection.2.PCR specifically amplifies the tp47 gene and clearly identifies patients infected with Treponema pallidum.3.PCR amplification and agarose gel electrophoresis analysis show that the arp gene fragment size is 1180 bp and arp genotype is “14”;tpr gene is expressed by Mse I.After enzyme digestion,the RFLP typing result was "d" type;tp0548 amplified a non-specific band,and the genotyping of the treponema pallidum was identified by the double genotyping method: 14 d.Conclusions: 1.Combined with clinical data and laboratory tests,the patient suffered damage to the skin,mucous membranes,nervous system and skeletal system after infection with Treponema pallidum.2.The patient’s infected Treponema pallidum genotype is 14 d,this type has obvious correlation with the susceptibility of neurosyphilis,the patient’s special clinical manifestations may be related to the genotype.