Reflectance confocal microscopy for the in vivo detection of Treponema pallidum in skin lesions of secondary syphilis - 08/08/11
Reprint requests: Piergiacomo Calzavara-Pinton, MD, Department of Dermatology, Spedali Civili Hospital, P.le Spedali Civili 1, 25123 Brescia, Italy.Abstract |
Background |
Secondary syphilis is a diagnostic challenge that relies on microscopic and laboratory tests.
Objective |
We sought to assess the usefulness of in vivo reflectance confocal microscopy (RCM) to detect Treponema pallidum in lesions suggestive of secondary syphilis.
Methods |
Macular and papular skin lesions from 3 patients clinically suggestive of secondary syphilis were imaged by RCM and confirmed by skin punch biopsy.
Results |
In all lesions RCM demonstrated elongated small bright particles with a spiral shape intermingled with the keratinocytes. These features corresponded with immunohistochemical findings that revealed several spirochetes infiltrating the epidermis.
Limitations |
Unlike immunohistochemistry, RCM did not visualize T pallidum in the dermis and vascular walls because of limited imaging depth. The specificity and sensitivity of this technique need to be assessed.
Conclusion |
RCM may be an effective diagnostic tool for in vivo real-time imaging of T pallidum in skin lesions of secondary syphilis, and seems to correlate well with immunohistochemistry.
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| Funding sources: None. |
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| Conflicts of interest: None declared. |
Vol 60 - N° 4
P. 639-642 - avril 2009 Retour au numéro
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