title: Cell and tissue interactions of Treponema pallidum in primary and secondary syphilitic skin lesions: an ultrastructural study of serial sections.
abstract: There are limited reports on the ultrastructure of syphilis skin lesions. The aim of this study has been to perform an electron microscopic investigation of the morphology and the tissue distribution of treponemes in primary and secondary cutaneous lesions. Three cases of primary syphilitic chancre and one case of secondary syphilis were included. Prominent epidermal abnormalities in the primary chancre and a perivascular inflammatory infiltrate in the secondary lesion were found by light microscopy. Ultrastructurally, spirochetes were located mainly in the blood vessel walls and dermal tissue of the chancre lesions. In the secondary syphilis case, spirochetes were more abundant between epidermal keratinocytes. Most of them adjusted to the intercellular spaces. Occasionally, the electron microscopy images were highly suggestive of an intracellular location. Both the ultrastructural and immunohistochemical examination of the primary and secondary syphilis lesions showed a paradoxical distribution of the causative microorganisms compared to the light microscopic changes. In addition, the ultrastructural findings strongly suggest that Treponema pallidum subspecies pallidum invades tissues, not only through an intercellular, but also through a transcellular pathway.
authors: Department of Pathology, Hospital del Mar, and Autonomous University of Barcelona, Barcelona, Spain. jonpiter77@hotmail.com
authors: Nuria
authors: N
authors: Juanpere-Rodero
authors: Gemma
authors: G
authors: Martin-Ezquerra
authors: Alejandro
authors: A
authors: Fernandez-Casado
authors: Luis
authors: L
authors: Magan-Perea
authors: Maria A
authors: MA
authors: Garcia-Alguacil
authors: Carlos
authors: C
authors: Barranco-Sanz
authors: Sergio
authors: S
authors: Serrano-Figueras
authors: Ramon M
authors: RM
authors: Pujol-Vallverdu
authors: Josep
authors: J
authors: Lloreta-Trull
mesh_terms: D000328:Adult; D002601:Chancre / Q000382:microbiology / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D011237:Predictive Value of Tests; D012867:Skin / Q000098:blood supply / Q000382:microbiology / Q000648:ultrastructure*; D013144:Spirochaetales / Q000648:ultrastructure; D013587:Syphilis / Q000382:microbiology / Q000473:pathology*; D013591:Syphilis, Cutaneous / Q000382:microbiology / Q000473:pathology*; D014210:Treponema pallidum / Q000472:pathogenicity / Q000648:ultrastructure*; D055815:Young Adult