Section of Dermatology, Department of Health Sciences, San Martino University Hospital IRCCS, University of Genoa, Genoa, Italy.
Section of Dermatology, Department of Health Sciences, San Martino University Hospital IRCCS, University of Genoa, Genoa, Italy -
G Ital Dermatol Venereol. 2019 Oct;154(5):573-580. doi: 10.23736/S0392-0488.17.05830-8. Epub 2017 Dec 1.
During syphilis a compelling fight is engaged between the host's humoral and cellular immune responses that work to eliminate the infection and Treponema pallidum (T. pallidum) that manages to evade eradication and cause chronic infection. Different mechanisms are utilized by treponemes to overcome immunological response. Although penicillin (BPG) proved to be effective in quelling the early manifestations of the disease and consequently its contagiousness, questions remain about its ability to prevent the late complications and to provide a microbiological eradication in vivo. In fact, both serological and microbiological failures have been reported following conventional treatment.
We reviewed some biologic properties of T. pallidum in order to establish a relationship with the persistence of the infection and the alleged treatment resistance.
The host humoral response, sometimes, may not protect completely against T. pallidum and accounts for the persistent infection and tertiary damages. In fact, the cell mediated response during infection may be downregulate in response to pathogen-derived molecules, or indirectly by generating Treg cells. It is also possible that there are strain types of T. pallidum with higher ability of evasion determining neurosyphilis. In addition, apart the impressive results that BPG has made on the syphilis cutaneous lesions, concerns still remain on its efficacy in preventing late complications.
Understanding the biology of the T. pallidum may help researchers in this field to develop future target therapies in order to prevent persistent infection and progression of the disease.
在梅毒感染过程中，宿主的体液免疫和细胞免疫反应会与梅毒螺旋体（T. pallidum）展开激烈斗争，前者试图消灭后者，后者则设法逃避并导致慢性感染。梅毒螺旋体利用不同机制来克服免疫反应。青霉素（BPG）已被证明能有效抑制疾病的早期表现，从而降低其传染性，但仍存在一些疑问，例如其是否能预防晚期并发症并在体内实现微生物学清除。事实上，在常规治疗后，都有血清学和微生物学失败的报道。
我们回顾了 T. pallidum 的一些生物学特性，以确定其与感染持续存在和所谓的治疗耐药性之间的关系。
宿主的体液免疫反应有时可能无法完全保护机体免受 T. pallidum 的侵害，从而导致持续感染和三期损害。事实上，感染期间的细胞介导反应可能会因病原体衍生分子的作用而被下调，或通过产生 Treg 细胞而间接下调。也有可能存在逃避能力更强的梅毒螺旋体菌株类型，从而导致神经梅毒。此外，尽管 BPG 在梅毒皮肤病变方面取得了显著成效，但人们仍对其预防晚期并发症的疗效存在担忧。
了解 T. pallidum 的生物学特性可能有助于该领域的研究人员开发未来的靶向治疗方法，以预防持续感染和疾病进展。
