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causada pela bact&#233;ria espiroqueta n&#227;o cultiv&#225;vel <span class="elsevierStyleItalic">Treponema pallidum</span> subsp&#46; <span class="elsevierStyleItalic">pallidum</span>&#46; O diagn&#243;stico requer correla&#231;&#227;o entre dados cl&#237;nicos&#44; incluindo infec&#231;&#245;es pr&#233;vias e exposi&#231;&#227;o recente&#44; e testes laboratoriais&#46; O m&#233;todo diagn&#243;stico mais &#250;til para s&#237;filis &#233; o teste sorol&#243;gico&#46; No entanto&#44; considerando as manifesta&#231;&#245;es cl&#237;nicas multifacetadas&#44; o exame histopatol&#243;gico &#233; muito importante quando a s&#237;filis n&#227;o &#233; considerada inicialmente&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Treponema pallidum</span> &#233; classicamente reportado como sendo identificado pelas t&#233;cnicas de impregna&#231;&#227;o por prata como Warthin&#8208;Starry&#44; Levaditi ou Dieterle modificada por Steiner&#46; Entretanto&#44; fundos de marca&#231;&#227;o inespec&#237;fica ou artefatual de elementos teciduais&#44; como fibras reticulares e melanina&#44; representam dificuldades de interpreta&#231;&#227;o que podem originar resultados falso&#8208;positivos ou falso&#8208;negativos&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4&#8211;7</span></a> Recentemente&#44; a marca&#231;&#227;o por imunoperoxidase com anticorpo policlonal anti&#8208;<span class="elsevierStyleItalic">Treponema pallidum</span> tem mostrado ser um m&#233;todo sens&#237;vel e &#250;til para real&#231;ar e identificar a espiroqueta&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">6&#8211;11</span></a> Este estudo foi realizado para avaliar a contribui&#231;&#227;o da imuno&#8208;histoqu&#237;mica &#40;IHQ&#41; e t&#233;cnica de Warthin&#8208;Starry &#40;WS&#41; na visualiza&#231;&#227;o da espiroqueta em amostras de bi&#243;psias de pele&#46; A correla&#231;&#227;o dessa visualiza&#231;&#227;o com achados cl&#237;nicos e histopatol&#243;gicos tamb&#233;m foi investigada&#44; a fim de definir o desempenho esperado em diferentes cen&#225;rios&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Um estudo de acur&#225;cia diagn&#243;stica foi conduzido usando IHQ e t&#233;cnica de WS para detec&#231;&#227;o de espiroquetas nas amostras de bi&#243;psias de pele&#46; Dados cl&#237;nicos e sorol&#243;gicos de pacientes vistos em dois hospitais terci&#225;rios no Rio de Janeiro entre&#160;os anos de 2000 e&#160;2019 foram recuperados de registros m&#233;dicos&#46; Os pacientes foram classificados com s&#237;filis quando os achados cl&#237;nicos foram consistentes e os testes sorol&#243;gicos foram positivos &#40;<span class="elsevierStyleItalic">Veneral Disease Research Laboratory Test</span> &#91;VDRL&#93; com t&#237;tulos maiores que&#160;1&#47;8&#160;ou teste trepon&#234;mico positivo&#41;&#44; ou VDRL foi reagente no l&#237;quor em qualquer titula&#231;&#227;o no momento da bi&#243;psia de pele e da investiga&#231;&#227;o diagn&#243;stica&#46; Os pacientes com uma ou mais amostras de pele foram inclu&#237;dos&#46; Um grupo controle foi formado por amostras de pele de pacientes com testes sorol&#243;gicos n&#227;o reagentes para s&#237;filis e diagnosticados com outras dermatoses que poderiam ser consideradas nos diagn&#243;sticos diferenciais cl&#237;nicos e histopatol&#243;gicos da s&#237;filis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Cortes histol&#243;gicos de 4<span class="elsevierStyleHsp" style=""></span>&#956;m de espessura foram obtidos de blocos de parafina para colora&#231;&#227;o de hematoxilina &#38; eosina e WS&#44; de acordo com protocolo de Luna&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a> Os laudos histopatol&#243;gicos foram revisados e as l&#226;minas&#44; reavaliadas&#46; Padr&#227;o de rea&#231;&#227;o inflamat&#243;ria&#44; distribui&#231;&#227;o do infiltrado&#44; hiperplasia endotelial e semiquantifica&#231;&#227;o dos plasm&#243;citos foram considerados na avalia&#231;&#227;o das amostras de pele de pacientes com s&#237;filis&#46; Plasm&#243;citos foram codificados como &#43;&#43;&#47;&#43;&#43; quando compunham mais de&#160;30&#37; do infiltrado&#59; &#43;&#47;&#43;&#43;&#44; menos do que&#160;30&#37;&#59; e zero quando eram ausentes ou raros&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Cortes histopatol&#243;gicos adicionais foram obtidos para o estudo imuno&#8208;histoqu&#237;mico realizado com pr&#233;&#8208;tratamento de recupera&#231;&#227;o de ep&#237;topo induzido pelo calor&#44; anticorpo prim&#225;rio policlonal contra <span class="elsevierStyleItalic">T&#46; pallidum</span> &#40;BIOCARE Medical&#44; Calif&#243;rnia&#44; EUA&#41; em dilui&#231;&#227;o de&#160;1&#58;200 e sistema de detec&#231;&#227;o polim&#233;rica &#40;Novolink Max Polymer Detection System&#44; Leica Biosystems&#44; Illinois&#44; EUA&#41;&#46; A an&#225;lise IHQ foi cega para o diagn&#243;stico e realizada simult&#226;nea e consensualmente por dois patologistas com ampla experi&#234;ncia em diagn&#243;stico histopatol&#243;gico e imuno&#8208;histoqu&#237;mico de doen&#231;as infecciosas&#44; em microsc&#243;pio &#243;ptico Nikon <span class="elsevierStyleItalic">dual head</span> E200&#46; A an&#225;lise da carga bacteriana foi feita com escala semiquantitativa considerando &#40;3&#43;&#41; numerosas bact&#233;rias em todos os campos&#59; &#40;2&#43;&#41; numerosas bact&#233;rias em alguns campos&#59; e &#40;1&#43;&#41; raras bact&#233;rias&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As an&#225;lises estat&#237;sticas foram realizadas usando o <span class="elsevierStyleItalic">software</span> SPSS vers&#227;o&#160;20&#46; Raz&#245;es de preval&#234;ncia &#40;RP&#41; e seus respectivos intervalos de confian&#231;a &#40;IC&#41; de 95&#37; foram calculados para medir a associa&#231;&#227;o entre a positividade da IHQ e as vari&#225;veis cl&#237;nico&#8208;histopatol&#243;gicas&#46; Os testes de Qui&#8208;quadrado &#40;&#967;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a>&#41; e exato de Fisher foram usados para determinar a signific&#226;ncia estat&#237;stica&#46; O n&#237;vel de signific&#226;ncia de&#160;0&#44;05 foi definido&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Trinta e oito pacientes &#40;29&#160;homens e 9&#160;mulheres&#41; com idades entre&#160;19&#160;e&#160;66&#160;anos &#40;m&#233;dia&#58;&#160;42&#160;anos&#44; mediana&#58;&#160;39&#160;anos&#41; com s&#237;filis e suas&#160;40&#160;amostras de pele foram inclu&#237;dos no estudo&#46; A sorologia anti&#8208;HIV foi positiva em 22 pacientes&#59; 10 pacientes demonstravam carga viral<span class="elsevierStyleHsp" style=""></span>&#62; 1&#46;000&#160;c&#243;pias&#47;mL&#59; sete pacientes apresentavam contagem de CD4 &#60;<span class="elsevierStyleHsp" style=""></span>200&#160;c&#233;lulas&#47;mm<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a>&#44; e seis pacientes tinham ambos&#46; As les&#245;es de pele eram predominantes nos membros superiores&#160;&#40;32&#47;38&#41;&#46; Vinte e seis pacientes exibiam les&#245;es papulares&#44; e 22&#160;em placas&#46; Outras les&#245;es de pele descritas foram exantemas &#40;10&#47;38&#41;&#44; n&#243;dulos &#40;10&#47;38&#41; e p&#250;stulas ou crostas &#40;8&#47;38&#41;&#46; Vinte e nove amostras &#40;72&#44;5&#37;&#41; vieram de pacientes com s&#237;filis secund&#225;ria&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Os laudos histopatol&#243;gicos de 30&#47;40&#160;&#40;75&#37;&#41; amostras de pacientes com s&#237;filis foram considerados compat&#237;veis com o diagn&#243;stico&#46; Farmacodermia&#44; psor&#237;ase&#44; s&#237;ndrome de Reiter e xantogranuloma foram outros diagn&#243;sticos histopatol&#243;gicos sugeridos&#46; Em cinco laudos&#160;&#40;12&#44;5&#37;&#41;&#44; nenhuma sugest&#227;o de diagn&#243;stico histopatol&#243;gico foi feita&#46; Os padr&#245;es de rea&#231;&#227;o tecidual mais comuns foram dermatite perivascular superficial e profunda e de interface &#40;27&#44;5&#37;&#41;&#44; e o achado mais comum foi hiperplasia endotelial &#40;75&#37;&#41; &#8211; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Vinte e seis amostras de pele formaram o grupo controle e eram de pacientes diagnosticados com outras dermatoses &#40;10 farmacodermias&#44; 10 com psor&#237;ase&#44; quatro de l&#250;pus eritematoso&#44; quatro eczemas&#44; duas de hansen&#237;ase&#44; duas eritrodermias&#44; duas vasculites&#44; uma s&#237;ndrome de Sweet&#44; e uma l&#237;quen plano&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A impregna&#231;&#227;o pelo WS foi negativa ou inconclusiva em todas as amostras&#46; Um fundo com impregna&#231;&#227;o de estruturas inespec&#237;ficas e de melanina nos dendritos dos melan&#243;citos tornou imposs&#237;vel identificar definitivamente as espiroquetas &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">A IHQ foi positiva em&#160;24&#160;das&#160;40&#160;amostras de pele de pacientes com s&#237;filis&#44; e foi negativa em todas&#160;as 36 amostras do controle sem s&#237;filis&#44; produzindo sensibilidade de 60&#37; &#40;95&#37;&#160;IC&#160;44&#44;8&#8208;75&#44;2&#41;&#44; especificidade de 100&#37;&#44; valor preditivo positivo de 100&#37;&#44; valor preditivo negativo de 69&#44;2&#37; &#40;95&#37;&#160;IC&#160;56&#44;7&#8208;81&#44;8&#41;&#46; A acur&#225;cia do teste foi de&#160;78&#44;9&#37; &#40;95&#37;&#160;IC&#160;69&#44;8&#8208;88&#44;1&#41;&#46; Os diagn&#243;sticos histol&#243;gicos propostos nas amostras positivas de IHQ foram s&#237;filis&#160;&#40;17&#47;24&#41;&#59; farmacodermia apenas&#160;&#40;4&#47;24&#41;&#59; farmacodermia e s&#237;filis como hip&#243;tese adicional&#160;&#40;2&#47;24&#41;&#59; s&#237;ndrome de Reiter&#160;&#40;1&#47;24&#41;&#59; e nenhuma sugest&#227;o histopatol&#243;gica foi feita em&#160;duas&#160;amostras&#46; A maioria dos nossos casos apresentava espiroquetas tanto na derme &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>A&#41; quanto na epiderme &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>B&#41;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> demonstra os resultados da IHQ&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Os resultados da revis&#227;o dos dados cl&#237;nicos e dos achados histopatol&#243;gicos e suas correla&#231;&#245;es com a IHQ s&#227;o apresentados nas <a class="elsevierStyleCrossRefs" href="#tbl0010">tabelas 2 e 3</a>&#46; A IHQ foi frequentemente positiva nas amostras de pacientes com s&#237;filis secund&#225;ria &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;441&#41; ou com s&#237;filis terci&#225;ria &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;286&#41;&#44; com sorologia anti&#8208;HIV n&#227;o reagente &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;444&#41; ou em imunossupress&#227;o pelo HIV com CD4&#160;&#60;<span class="elsevierStyleHsp" style=""></span>200&#160;c&#233;lulas&#47;mm<span class="elsevierStyleSup">3</span> e CV<span class="elsevierStyleHsp" style=""></span>&#62;1&#46;000&#160;c&#243;pias&#47;mL &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;133&#41;&#46; Os resultados positivos tamb&#233;m foram mais prevalentes em amostras com dermatite perivascular superficial&#44; profunda e de interface &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;582&#41; ou com plasm&#243;citos abundantes &#43;&#43;&#47;&#43;&#43; &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;547&#41;&#46; Amostras com dermatite perivascular superficial e profunda &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;304&#41; ou plasm&#243;citos &#43;&#47;&#43;&#43; &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;619&#41; apresentaram mais resultados negativos na IHQ&#46; Entretanto&#44; essas associa&#231;&#245;es n&#227;o foram consideradas significantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0070" class="elsevierStylePara elsevierViewall">Uma descri&#231;&#227;o cl&#237;nica e histopatol&#243;gica dos casos de s&#237;filis e estudo de acur&#225;cia diagn&#243;stica da IHQ com anticorpo anti&#8208;<span class="elsevierStyleItalic">T&#46; pallidum</span> foi realizada&#46; Nosso estudo mostrou alta frequ&#234;ncia de s&#237;filis adquirida em homens &#40;76&#44;3&#37;&#41;&#44; assim como reportado pela literatura&#44;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1&#8211;3</span></a> especialmente com relatos entre homens que fazem sexo com homens&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1&#44;13</span></a> S&#237;filis tamb&#233;m foi observada em adolescentes e pacientes mais velhos&#44; grupos comumente considerados sem risco ou com baixo risco para a infec&#231;&#227;o&#46; A fase secund&#225;ria da doen&#231;a foi predominante&#44; provavelmente em decorr&#234;ncia da alta frequ&#234;ncia de bi&#243;psias de pele realizadas nessa fase&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A dermatite de interface associada &#224; dermatite perivascular superficial e profunda&#160;&#40;27&#44;5&#37;&#41; e &#224; dermatite perivascular superficial e profunda e perianexial&#160;&#40;20&#37;&#41; destacou a mistura de padr&#245;es de rea&#231;&#227;o tecidual j&#225; reportada&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a> Hiperplasia endotelial tamb&#233;m foi frequente&#160;&#40;75&#37;&#41;&#44; como nos estudos anteriores&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">14&#44;15</span></a> Plasm&#243;citos foram raros ou ausentes em sete amostras de pele&#160;&#40;17&#44;5&#37;&#41;&#44; concordando com relatos da literatura de escassez e aus&#234;ncia de plasm&#243;citos em at&#233;&#160;25&#37;&#8208;33&#37; das amostras&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">16&#8211;18</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">As espiroquetas e sua morfologia t&#237;pica foram facilmente visualizadas pelo m&#233;todo imuno&#8208;histoqu&#237;mico&#46; Resultados semelhantes s&#227;o relatados com os mesmos anticorpos&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> ou anticorpos semelhantes&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">6&#44;8</span></a> A IHQ como teste diagn&#243;stico forneceu diagn&#243;stico espec&#237;fico de s&#237;filis em 60&#37; dos casos&#44; n&#250;mero que se aproxima de estudos anteriores &#40;71&#37;&#8208;100&#37; de sensibilidade&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">6&#44;9</span></a> N&#227;o foi poss&#237;vel determinar a positividade pela&#160;t&#233;cnica&#160;de Warthin&#8208;Starry &#40;WS&#41;&#46; Quatresooz e Pi&#233;rard&#44; em 2009&#44; mostraram achados semelhantes com resultados inconclusivos ou negativos com a t&#233;cnica WS devido ao fundo de melanina na epiderme e fibrilas de reticulina na derme&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> Outros autores&#44; entretanto&#44; encontraram taxas de sensibilidade de 9&#37; e 60&#37; em amostras de pele&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">8&#44;10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">As espiroquetas podem predominar na derme<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> ou na epiderme de les&#245;es de pele da s&#237;filis secund&#225;ria&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">7&#44;8</span></a> A maioria dos nossos casos apresentava espiroquetas tanto na derme quanto na epiderme&#44; e a alta carga bacteriana &#40;3&#43;&#41; foi predominante&#46; Esses resultados indicam que os micro&#8208;organismos ainda est&#227;o difusamente disseminados na pele durante a fase secund&#225;ria da doen&#231;a&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Na epiderme&#44; as espiroquetas localizaram&#8208;se principalmente na camada basal ou suprabasal&#44; e em&#160;62&#44;5&#37; das amostras n&#227;o foram observadas na parte mais alta&#44; ao contr&#225;rio dos resultados de Phelps et al&#46;&#44; que raramente observaram espiroquetas nas por&#231;&#245;es mais baixas da epiderme&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> O achado de espiroquetas no epit&#233;lio folicular e ao redor dos anexos em&#160;58&#44;3&#37; das amostras positivas apoiam ainda mais a teoria de epiteliotropismo do micro&#8208;organismo&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">As altera&#231;&#245;es vasculares s&#227;o componentes importantes da resposta inflamat&#243;ria tecidual na s&#237;filis&#46; Hiperplasia endotelial foi achado comum e evidente&#44; e numerosas espiroquetas imunomarcadas foram detectadas nas paredes dos vasos&#46; Martin&#8208;Ezquerra et al&#46; tamb&#233;m encontraram um padr&#227;o vasculotr&#243;pico &#8211; por&#233;m&#44; principalmente nas les&#245;es de s&#237;filis prim&#225;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhuma correla&#231;&#227;o significante entre IHQ e caracter&#237;sticas cl&#237;nicas ou histopatol&#243;gicas foi observada&#46; No entanto&#44; a preval&#234;ncia de resultados positivos pela IHQ foi alta em amostras de pacientes sem coinfec&#231;&#227;o pelo HIV &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;444&#41; e naqueles com imunossupress&#227;o pelo HIV com CD4&#160;&#60;<span class="elsevierStyleHsp" style=""></span>200&#160;c&#233;lulas&#47;mm<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a> e CV<span class="elsevierStyleHsp" style=""></span>&#62; 1&#44;000&#160;c&#243;pias&#47;mL &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;133&#41;&#46; Esses resultados sugerem que a infec&#231;&#227;o pelo HIV por si s&#243; n&#227;o teve impacto principal na detec&#231;&#227;o de espiroquetas&#44; mas o estado de imunossupress&#227;o pode influenciar a dissemina&#231;&#227;o de espiroquetas nas amostras de s&#237;filis&#46; Similar aos nossos achados&#44; pesquisas anteriores reportaram alta carga bacteriana em amostras de pele de pacientes com contagem de CD4 &#60;<span class="elsevierStyleHsp" style=""></span>250&#160;c&#233;lulas<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a> ou em estados de imunossupress&#227;o associados com s&#237;filis maligna precoce&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">As amostras cut&#226;neas de s&#237;filis com dermatite perivascular superficial e profunda e de interface e com plasm&#243;citos vis&#237;veis no infiltrado &#40;&#43;&#43;&#47;&#43;&#43;&#41; mostraram alta preval&#234;ncia de resultados positivos na IHQ em compara&#231;&#227;o com amostras sem esses achados &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;582&#59; RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;547&#44; respectivamente&#41;&#46; Ao contr&#225;rio&#44; amostras com dermatite perivascular superficial e profunda &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;304&#41; ou poucos plasm&#243;citos &#40;&#43;&#47;&#43;&#43;&#59; RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;619&#41; sugerem que mesmo com resultados negativos na IHQ&#44; o diagn&#243;stico da s&#237;filis n&#227;o pode ser exclu&#237;do&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">A detec&#231;&#227;o de ant&#237;genos no protocolo de IHQ real&#231;ou espiroquetas de <span class="elsevierStyleItalic">Treponema pallidum</span> e possibilitou diagn&#243;stico indubit&#225;vel de s&#237;filis nas amostras teciduais&#46; A impregna&#231;&#227;o por WS foi considerada ineficiente na detec&#231;&#227;o da bact&#233;ria e n&#227;o ofereceu nenhuma contribui&#231;&#227;o para o diagn&#243;stico espec&#237;fico da doen&#231;a&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Comit&#234;s &#233;ticos</span><p id="par0115" class="elsevierStylePara elsevierViewall">Os comit&#234;s &#233;ticos do Hospital Clementino Fraga Filho &#40;HUCFF&#41; da Universidade Federal do Rio de Janeiro &#40;UFRJ&#41; e do Instituto Nacional de Doen&#231;as Infecciosas Evandro Chagas &#40;INI&#41;&#44; Funda&#231;&#227;o Oswaldo Cruz &#40;Fiocruz&#41;&#44; Brasil&#44; aprovaram o estudo&#46; Os comit&#234;s dispensaram informe de consentimento porque nenhuma informa&#231;&#227;o de identifica&#231;&#227;o pessoal foi inclu&#237;da no conjunto de dados usado para an&#225;lise&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Suporte financeiro</span><p id="par0120" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Contribui&#231;&#227;o dos autores</span><p id="par0125" class="elsevierStylePara elsevierViewall">Mariana Freitas de Assis Pereira Rosa&#58; Concep&#231;&#227;o e o desenho do estudo&#59; levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do artigo ou revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Leonardo Pereira Quintella&#58; Concep&#231;&#227;o e o desenho do estudo&#59; levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do artigo ou revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Luiz Claudio Ferreira&#58; Levantamento dos dados&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Tullia Cuzzi&#58; Concep&#231;&#227;o e o desenho do estudo&#59; levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do artigo ou revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflito de interesses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A s&#237;filis&#44; em suas diferentes fases&#44; pode ser diagn&#243;stico dif&#237;cil na &#225;rea cl&#237;nica e histopatol&#243;gica&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a detec&#231;&#227;o e a distribui&#231;&#227;o tecidual de <span class="elsevierStyleItalic">Treponema pallidum</span> nas les&#245;es de pele de s&#237;filis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo cego de acur&#225;cia diagn&#243;stica foi realizado com imuno&#8208;histoqu&#237;mica e impregna&#231;&#227;o por prata de Warthin&#8208;Starry nas amostras de pele de pacientes com s&#237;filis e outras doen&#231;as&#46; Os pacientes foram atendidos em dois hospitais terci&#225;rios entre os anos de&#160;2000&#160;e&#160;2019&#46; Raz&#245;es de preval&#234;ncia &#40;RP&#41; e intervalos de confian&#231;a &#40;IC&#41; de 95&#37; foram calculados para avaliar associa&#231;&#227;o entre positividade da imuno&#8208;histoqu&#237;mica e vari&#225;veis cl&#237;nicas&#8208;histopatol&#243;gicas&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Trinta e oito pacientes com s&#237;filis e suas&#160;40&#160;amostras de bi&#243;psias foram inclu&#237;das para o estudo&#46; Trinta e seis amostras de pele formaram os controles sem s&#237;filis&#46; A t&#233;cnica de Warthin&#8208;Starry foi incapaz de demonstrar de maneira acurada a bact&#233;ria em todas as amostras&#46; A imuno&#8208;histoqu&#237;mica mostrou espiroquetas apenas em amostras de pele de pacientes de s&#237;filis &#40;24&#47;40&#41; com sensibilidade de 60&#37; &#40;95&#37;&#160;IC&#160;44&#44;8&#8208;75&#44;2&#41;&#46; A especificidade foi de 100&#37; e a acur&#225;cia de 78&#44;9&#37; &#40;95&#37;&#160;IC&#160;69&#44;8&#8208;88&#44;1&#41;&#46; A maioria dos nossos casos teve espiroquetas tanto na derme quanto na epiderme&#44; com alta carga bacteriana&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">As correla&#231;&#245;es entre imuno&#8208;histoqu&#237;mica e caracter&#237;sticas cl&#237;nico&#8208;histopatol&#243;gicas foram observadas&#44; mas foram limitadas estatisticamente em decorr&#234;ncia do pequeno tamanho da amostra&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Espiroquetas foram prontamente vistas no protocolo de imuno&#8208;histoqu&#237;mica&#44; o que pode contribuir para o diagn&#243;stico de s&#237;filis em amostras de bi&#243;psias cut&#226;neas&#46; Por outro lado&#44; a t&#233;cnica de Warthin&#8208;Starry mostrou ser de nenhum valor pr&#225;tico&#46;</p></span>"
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                  \t\t\t\t" scope="col">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Epiderme e derme&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18 &#40;75&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;20&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Epiderme &#40;apenas&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;16&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basal&#44; suprabasal e por&#231;&#245;es altas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suprabasal &#40;apenas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basal e por&#231;&#245;es altas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Localiza&#231;&#227;o d&#233;rmica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;95&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extracelular&#44; no infiltrado inflamat&#243;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;87&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parede de vasos d&#233;rmicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;83&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intracelular&#44; no infiltrado inflamat&#243;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;75&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epit&#233;lio anexial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;41&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dentro do vaso d&#233;rmico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perianexial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;16&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;62&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Vari&#225;veis cl&#237;nicas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;filis secund&#225;ria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29 &#40;72&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19 &#40;47&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;213<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;694 &#40;0&#44;345&#8208;1&#44;396&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;filis secundo&#8208;terci&#225;ria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;286 &#40;0&#44;685&#8208;2&#44;413&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;471<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;90&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;52&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;37&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;778 &#40;0&#44;414&#8208;1&#44;460&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;filis terci&#225;ria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;97&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;60&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;37&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;filis maligna precoce</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;536 &#40;0&#44;106&#8208;2&#44;709&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;348<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;92&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;57&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;35&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;865 &#40;0&#44;369&#8208;9&#44;423&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;filis indeterminada</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;5&#41;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;536 &#40;0&#44;106&#8208;2&#44;709&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;348<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;92&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;57&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;35&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;865 &#40;0&#44;369&#8208;9&#44;423&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Coinfec&#231;&#227;o HIV</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;55&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;27&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;27&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;692 &#40;0&#44;417&#8208;1&#44;149&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;45&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;32&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;444 &#40;0&#44;870&#8208;2&#44;397&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CD4 &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">200 c&#233;lulas&#47;mm</span><span class="elsevierStyleSup">3</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;10&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CV</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62; 1&#46;000 c&#243;pias</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;10&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;882 &#40;0&#44;469&#8208;1&#44;660&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Amostras de pele &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IHQ &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41; &#40;&#37;&#41;</th><th class="td" title="\n
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                  \t\t\t\t" scope="col">RP &#40;95&#37;&#160;IC&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Positiva &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41; &#40;60&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Negativa &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Padr&#245;es de rea&#231;&#245;es teciduais perivasculares superficiais apenas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4 &#40;10&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33 &#40;82&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21 &#40;52&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;30&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;485 &#40;0&#44;608&#8208;3&#44;628&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dermatite perivascular superficial e de interface</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Padr&#245;es de rea&#231;&#245;es teciduais perivasculares superficiais e profundas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">33 &#40;82&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">39 &#40;97&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;57&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dermatite perivascular superficial&#44; profunda&#44; de interface e psoriasiforme</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38 &#40;95&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24 &#40;60&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;35&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dermatite perivascular superficial&#44; profunda&#44; de interface&#44; perianexial e psoriasiforme</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;95&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;55&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dermatite espongi&#243;tica&#44; de interface e nodular</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;97&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;57&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">16 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Melan&#243;fagos</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;27&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">9 &#40;22&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;845 &#40;0&#44;508&#8208;1&#44;410&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;519&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;32&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;182 &#40;0&#44;709&#8208;1&#44;969&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Plasm&#243;citos</span> &#43;&#43;&#47;&#43;&#43;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19 &#40;47&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">14 &#40;35&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;547 &#40;0&#44;917&#8208;2&#44;610&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Detecção imuno‐histoquímica de Treponema pallidum em amostras de pele com correlações clínicas e histopatológicas e análise crítica do Warthin‐Starry
Mariana Freitas de Assis Pereira Rosaa,
Autor para correspondência
marianafaprosa@ufrj.br

Autor para correspondência.
, Leonardo Pereira Quintellab, Luiz Claudio Ferreirab, Tullia Cuzzic
a Programa de Pós-Graduação em Anatomia Patológica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
b Serviço de Anatomia Patológica, Instituto Nacional de Doenças Infecciosas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
c Departamento de Patologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Os pacientes com uma ou mais amostras de pele foram inclu&#237;dos&#46; Um grupo controle foi formado por amostras de pele de pacientes com testes sorol&#243;gicos n&#227;o reagentes para s&#237;filis e diagnosticados com outras dermatoses que poderiam ser consideradas nos diagn&#243;sticos diferenciais cl&#237;nicos e histopatol&#243;gicos da s&#237;filis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Cortes histol&#243;gicos de 4<span class="elsevierStyleHsp" style=""></span>&#956;m de espessura foram obtidos de blocos de parafina para colora&#231;&#227;o de hematoxilina &#38; eosina e WS&#44; de acordo com protocolo de Luna&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a> Os laudos histopatol&#243;gicos foram revisados e as l&#226;minas&#44; reavaliadas&#46; Padr&#227;o de rea&#231;&#227;o inflamat&#243;ria&#44; distribui&#231;&#227;o do infiltrado&#44; hiperplasia endotelial e semiquantifica&#231;&#227;o dos plasm&#243;citos foram considerados na avalia&#231;&#227;o das amostras de pele de pacientes com s&#237;filis&#46; Plasm&#243;citos foram codificados como &#43;&#43;&#47;&#43;&#43; quando compunham mais de&#160;30&#37; do infiltrado&#59; &#43;&#47;&#43;&#43;&#44; menos do que&#160;30&#37;&#59; e zero quando eram ausentes ou raros&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Cortes histopatol&#243;gicos adicionais foram obtidos para o estudo imuno&#8208;histoqu&#237;mico realizado com pr&#233;&#8208;tratamento de recupera&#231;&#227;o de ep&#237;topo induzido pelo calor&#44; anticorpo prim&#225;rio policlonal contra <span class="elsevierStyleItalic">T&#46; pallidum</span> &#40;BIOCARE Medical&#44; Calif&#243;rnia&#44; EUA&#41; em dilui&#231;&#227;o de&#160;1&#58;200 e sistema de detec&#231;&#227;o polim&#233;rica &#40;Novolink Max Polymer Detection System&#44; Leica Biosystems&#44; Illinois&#44; EUA&#41;&#46; A an&#225;lise IHQ foi cega para o diagn&#243;stico e realizada simult&#226;nea e consensualmente por dois patologistas com ampla experi&#234;ncia em diagn&#243;stico histopatol&#243;gico e imuno&#8208;histoqu&#237;mico de doen&#231;as infecciosas&#44; em microsc&#243;pio &#243;ptico Nikon <span class="elsevierStyleItalic">dual head</span> E200&#46; A an&#225;lise da carga bacteriana foi feita com escala semiquantitativa considerando &#40;3&#43;&#41; numerosas bact&#233;rias em todos os campos&#59; &#40;2&#43;&#41; numerosas bact&#233;rias em alguns campos&#59; e &#40;1&#43;&#41; raras bact&#233;rias&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As an&#225;lises estat&#237;sticas foram realizadas usando o <span class="elsevierStyleItalic">software</span> SPSS vers&#227;o&#160;20&#46; Raz&#245;es de preval&#234;ncia &#40;RP&#41; e seus respectivos intervalos de confian&#231;a &#40;IC&#41; de 95&#37; foram calculados para medir a associa&#231;&#227;o entre a positividade da IHQ e as vari&#225;veis cl&#237;nico&#8208;histopatol&#243;gicas&#46; Os testes de Qui&#8208;quadrado &#40;&#967;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a>&#41; e exato de Fisher foram usados para determinar a signific&#226;ncia estat&#237;stica&#46; O n&#237;vel de signific&#226;ncia de&#160;0&#44;05 foi definido&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Trinta e oito pacientes &#40;29&#160;homens e 9&#160;mulheres&#41; com idades entre&#160;19&#160;e&#160;66&#160;anos &#40;m&#233;dia&#58;&#160;42&#160;anos&#44; mediana&#58;&#160;39&#160;anos&#41; com s&#237;filis e suas&#160;40&#160;amostras de pele foram inclu&#237;dos no estudo&#46; A sorologia anti&#8208;HIV foi positiva em 22 pacientes&#59; 10 pacientes demonstravam carga viral<span class="elsevierStyleHsp" style=""></span>&#62; 1&#46;000&#160;c&#243;pias&#47;mL&#59; sete pacientes apresentavam contagem de CD4 &#60;<span class="elsevierStyleHsp" style=""></span>200&#160;c&#233;lulas&#47;mm<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a>&#44; e seis pacientes tinham ambos&#46; As les&#245;es de pele eram predominantes nos membros superiores&#160;&#40;32&#47;38&#41;&#46; Vinte e seis pacientes exibiam les&#245;es papulares&#44; e 22&#160;em placas&#46; Outras les&#245;es de pele descritas foram exantemas &#40;10&#47;38&#41;&#44; n&#243;dulos &#40;10&#47;38&#41; e p&#250;stulas ou crostas &#40;8&#47;38&#41;&#46; Vinte e nove amostras &#40;72&#44;5&#37;&#41; vieram de pacientes com s&#237;filis secund&#225;ria&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Os laudos histopatol&#243;gicos de 30&#47;40&#160;&#40;75&#37;&#41; amostras de pacientes com s&#237;filis foram considerados compat&#237;veis com o diagn&#243;stico&#46; Farmacodermia&#44; psor&#237;ase&#44; s&#237;ndrome de Reiter e xantogranuloma foram outros diagn&#243;sticos histopatol&#243;gicos sugeridos&#46; Em cinco laudos&#160;&#40;12&#44;5&#37;&#41;&#44; nenhuma sugest&#227;o de diagn&#243;stico histopatol&#243;gico foi feita&#46; Os padr&#245;es de rea&#231;&#227;o tecidual mais comuns foram dermatite perivascular superficial e profunda e de interface &#40;27&#44;5&#37;&#41;&#44; e o achado mais comum foi hiperplasia endotelial &#40;75&#37;&#41; &#8211; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Vinte e seis amostras de pele formaram o grupo controle e eram de pacientes diagnosticados com outras dermatoses &#40;10 farmacodermias&#44; 10 com psor&#237;ase&#44; quatro de l&#250;pus eritematoso&#44; quatro eczemas&#44; duas de hansen&#237;ase&#44; duas eritrodermias&#44; duas vasculites&#44; uma s&#237;ndrome de Sweet&#44; e uma l&#237;quen plano&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A impregna&#231;&#227;o pelo WS foi negativa ou inconclusiva em todas as amostras&#46; Um fundo com impregna&#231;&#227;o de estruturas inespec&#237;ficas e de melanina nos dendritos dos melan&#243;citos tornou imposs&#237;vel identificar definitivamente as espiroquetas &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">A IHQ foi positiva em&#160;24&#160;das&#160;40&#160;amostras de pele de pacientes com s&#237;filis&#44; e foi negativa em todas&#160;as 36 amostras do controle sem s&#237;filis&#44; produzindo sensibilidade de 60&#37; &#40;95&#37;&#160;IC&#160;44&#44;8&#8208;75&#44;2&#41;&#44; especificidade de 100&#37;&#44; valor preditivo positivo de 100&#37;&#44; valor preditivo negativo de 69&#44;2&#37; &#40;95&#37;&#160;IC&#160;56&#44;7&#8208;81&#44;8&#41;&#46; A acur&#225;cia do teste foi de&#160;78&#44;9&#37; &#40;95&#37;&#160;IC&#160;69&#44;8&#8208;88&#44;1&#41;&#46; Os diagn&#243;sticos histol&#243;gicos propostos nas amostras positivas de IHQ foram s&#237;filis&#160;&#40;17&#47;24&#41;&#59; farmacodermia apenas&#160;&#40;4&#47;24&#41;&#59; farmacodermia e s&#237;filis como hip&#243;tese adicional&#160;&#40;2&#47;24&#41;&#59; s&#237;ndrome de Reiter&#160;&#40;1&#47;24&#41;&#59; e nenhuma sugest&#227;o histopatol&#243;gica foi feita em&#160;duas&#160;amostras&#46; A maioria dos nossos casos apresentava espiroquetas tanto na derme &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>A&#41; quanto na epiderme &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>B&#41;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> demonstra os resultados da IHQ&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Os resultados da revis&#227;o dos dados cl&#237;nicos e dos achados histopatol&#243;gicos e suas correla&#231;&#245;es com a IHQ s&#227;o apresentados nas <a class="elsevierStyleCrossRefs" href="#tbl0010">tabelas 2 e 3</a>&#46; A IHQ foi frequentemente positiva nas amostras de pacientes com s&#237;filis secund&#225;ria &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;441&#41; ou com s&#237;filis terci&#225;ria &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;286&#41;&#44; com sorologia anti&#8208;HIV n&#227;o reagente &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;444&#41; ou em imunossupress&#227;o pelo HIV com CD4&#160;&#60;<span class="elsevierStyleHsp" style=""></span>200&#160;c&#233;lulas&#47;mm<span class="elsevierStyleSup">3</span> e CV<span class="elsevierStyleHsp" style=""></span>&#62;1&#46;000&#160;c&#243;pias&#47;mL &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;133&#41;&#46; Os resultados positivos tamb&#233;m foram mais prevalentes em amostras com dermatite perivascular superficial&#44; profunda e de interface &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;582&#41; ou com plasm&#243;citos abundantes &#43;&#43;&#47;&#43;&#43; &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;547&#41;&#46; Amostras com dermatite perivascular superficial e profunda &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;304&#41; ou plasm&#243;citos &#43;&#47;&#43;&#43; &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;619&#41; apresentaram mais resultados negativos na IHQ&#46; Entretanto&#44; essas associa&#231;&#245;es n&#227;o foram consideradas significantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0070" class="elsevierStylePara elsevierViewall">Uma descri&#231;&#227;o cl&#237;nica e histopatol&#243;gica dos casos de s&#237;filis e estudo de acur&#225;cia diagn&#243;stica da IHQ com anticorpo anti&#8208;<span class="elsevierStyleItalic">T&#46; pallidum</span> foi realizada&#46; Nosso estudo mostrou alta frequ&#234;ncia de s&#237;filis adquirida em homens &#40;76&#44;3&#37;&#41;&#44; assim como reportado pela literatura&#44;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1&#8211;3</span></a> especialmente com relatos entre homens que fazem sexo com homens&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1&#44;13</span></a> S&#237;filis tamb&#233;m foi observada em adolescentes e pacientes mais velhos&#44; grupos comumente considerados sem risco ou com baixo risco para a infec&#231;&#227;o&#46; A fase secund&#225;ria da doen&#231;a foi predominante&#44; provavelmente em decorr&#234;ncia da alta frequ&#234;ncia de bi&#243;psias de pele realizadas nessa fase&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">A dermatite de interface associada &#224; dermatite perivascular superficial e profunda&#160;&#40;27&#44;5&#37;&#41; e &#224; dermatite perivascular superficial e profunda e perianexial&#160;&#40;20&#37;&#41; destacou a mistura de padr&#245;es de rea&#231;&#227;o tecidual j&#225; reportada&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a> Hiperplasia endotelial tamb&#233;m foi frequente&#160;&#40;75&#37;&#41;&#44; como nos estudos anteriores&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">14&#44;15</span></a> Plasm&#243;citos foram raros ou ausentes em sete amostras de pele&#160;&#40;17&#44;5&#37;&#41;&#44; concordando com relatos da literatura de escassez e aus&#234;ncia de plasm&#243;citos em at&#233;&#160;25&#37;&#8208;33&#37; das amostras&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">16&#8211;18</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">As espiroquetas e sua morfologia t&#237;pica foram facilmente visualizadas pelo m&#233;todo imuno&#8208;histoqu&#237;mico&#46; Resultados semelhantes s&#227;o relatados com os mesmos anticorpos&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> ou anticorpos semelhantes&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">6&#44;8</span></a> A IHQ como teste diagn&#243;stico forneceu diagn&#243;stico espec&#237;fico de s&#237;filis em 60&#37; dos casos&#44; n&#250;mero que se aproxima de estudos anteriores &#40;71&#37;&#8208;100&#37; de sensibilidade&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">6&#44;9</span></a> N&#227;o foi poss&#237;vel determinar a positividade pela&#160;t&#233;cnica&#160;de Warthin&#8208;Starry &#40;WS&#41;&#46; Quatresooz e Pi&#233;rard&#44; em 2009&#44; mostraram achados semelhantes com resultados inconclusivos ou negativos com a t&#233;cnica WS devido ao fundo de melanina na epiderme e fibrilas de reticulina na derme&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> Outros autores&#44; entretanto&#44; encontraram taxas de sensibilidade de 9&#37; e 60&#37; em amostras de pele&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">8&#44;10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">As espiroquetas podem predominar na derme<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> ou na epiderme de les&#245;es de pele da s&#237;filis secund&#225;ria&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">7&#44;8</span></a> A maioria dos nossos casos apresentava espiroquetas tanto na derme quanto na epiderme&#44; e a alta carga bacteriana &#40;3&#43;&#41; foi predominante&#46; Esses resultados indicam que os micro&#8208;organismos ainda est&#227;o difusamente disseminados na pele durante a fase secund&#225;ria da doen&#231;a&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Na epiderme&#44; as espiroquetas localizaram&#8208;se principalmente na camada basal ou suprabasal&#44; e em&#160;62&#44;5&#37; das amostras n&#227;o foram observadas na parte mais alta&#44; ao contr&#225;rio dos resultados de Phelps et al&#46;&#44; que raramente observaram espiroquetas nas por&#231;&#245;es mais baixas da epiderme&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> O achado de espiroquetas no epit&#233;lio folicular e ao redor dos anexos em&#160;58&#44;3&#37; das amostras positivas apoiam ainda mais a teoria de epiteliotropismo do micro&#8208;organismo&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">As altera&#231;&#245;es vasculares s&#227;o componentes importantes da resposta inflamat&#243;ria tecidual na s&#237;filis&#46; Hiperplasia endotelial foi achado comum e evidente&#44; e numerosas espiroquetas imunomarcadas foram detectadas nas paredes dos vasos&#46; Martin&#8208;Ezquerra et al&#46; tamb&#233;m encontraram um padr&#227;o vasculotr&#243;pico &#8211; por&#233;m&#44; principalmente nas les&#245;es de s&#237;filis prim&#225;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhuma correla&#231;&#227;o significante entre IHQ e caracter&#237;sticas cl&#237;nicas ou histopatol&#243;gicas foi observada&#46; No entanto&#44; a preval&#234;ncia de resultados positivos pela IHQ foi alta em amostras de pacientes sem coinfec&#231;&#227;o pelo HIV &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;444&#41; e naqueles com imunossupress&#227;o pelo HIV com CD4&#160;&#60;<span class="elsevierStyleHsp" style=""></span>200&#160;c&#233;lulas&#47;mm<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a> e CV<span class="elsevierStyleHsp" style=""></span>&#62; 1&#44;000&#160;c&#243;pias&#47;mL &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;133&#41;&#46; Esses resultados sugerem que a infec&#231;&#227;o pelo HIV por si s&#243; n&#227;o teve impacto principal na detec&#231;&#227;o de espiroquetas&#44; mas o estado de imunossupress&#227;o pode influenciar a dissemina&#231;&#227;o de espiroquetas nas amostras de s&#237;filis&#46; Similar aos nossos achados&#44; pesquisas anteriores reportaram alta carga bacteriana em amostras de pele de pacientes com contagem de CD4 &#60;<span class="elsevierStyleHsp" style=""></span>250&#160;c&#233;lulas<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a> ou em estados de imunossupress&#227;o associados com s&#237;filis maligna precoce&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">As amostras cut&#226;neas de s&#237;filis com dermatite perivascular superficial e profunda e de interface e com plasm&#243;citos vis&#237;veis no infiltrado &#40;&#43;&#43;&#47;&#43;&#43;&#41; mostraram alta preval&#234;ncia de resultados positivos na IHQ em compara&#231;&#227;o com amostras sem esses achados &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;582&#59; RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;547&#44; respectivamente&#41;&#46; Ao contr&#225;rio&#44; amostras com dermatite perivascular superficial e profunda &#40;RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;304&#41; ou poucos plasm&#243;citos &#40;&#43;&#47;&#43;&#43;&#59; RP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;619&#41; sugerem que mesmo com resultados negativos na IHQ&#44; o diagn&#243;stico da s&#237;filis n&#227;o pode ser exclu&#237;do&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">A detec&#231;&#227;o de ant&#237;genos no protocolo de IHQ real&#231;ou espiroquetas de <span class="elsevierStyleItalic">Treponema pallidum</span> e possibilitou diagn&#243;stico indubit&#225;vel de s&#237;filis nas amostras teciduais&#46; A impregna&#231;&#227;o por WS foi considerada ineficiente na detec&#231;&#227;o da bact&#233;ria e n&#227;o ofereceu nenhuma contribui&#231;&#227;o para o diagn&#243;stico espec&#237;fico da doen&#231;a&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Comit&#234;s &#233;ticos</span><p id="par0115" class="elsevierStylePara elsevierViewall">Os comit&#234;s &#233;ticos do Hospital Clementino Fraga Filho &#40;HUCFF&#41; da Universidade Federal do Rio de Janeiro &#40;UFRJ&#41; e do Instituto Nacional de Doen&#231;as Infecciosas Evandro Chagas &#40;INI&#41;&#44; Funda&#231;&#227;o Oswaldo Cruz &#40;Fiocruz&#41;&#44; Brasil&#44; aprovaram o estudo&#46; Os comit&#234;s dispensaram informe de consentimento porque nenhuma informa&#231;&#227;o de identifica&#231;&#227;o pessoal foi inclu&#237;da no conjunto de dados usado para an&#225;lise&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Suporte financeiro</span><p id="par0120" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Contribui&#231;&#227;o dos autores</span><p id="par0125" class="elsevierStylePara elsevierViewall">Mariana Freitas de Assis Pereira Rosa&#58; Concep&#231;&#227;o e o desenho do estudo&#59; levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do artigo ou revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Leonardo Pereira Quintella&#58; Concep&#231;&#227;o e o desenho do estudo&#59; levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do artigo ou revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Luiz Claudio Ferreira&#58; Levantamento dos dados&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Tullia Cuzzi&#58; Concep&#231;&#227;o e o desenho do estudo&#59; levantamento dos dados&#44; ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; reda&#231;&#227;o do artigo ou revis&#227;o cr&#237;tica do conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o final da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflito de interesses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A s&#237;filis&#44; em suas diferentes fases&#44; pode ser diagn&#243;stico dif&#237;cil na &#225;rea cl&#237;nica e histopatol&#243;gica&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a detec&#231;&#227;o e a distribui&#231;&#227;o tecidual de <span class="elsevierStyleItalic">Treponema pallidum</span> nas les&#245;es de pele de s&#237;filis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo cego de acur&#225;cia diagn&#243;stica foi realizado com imuno&#8208;histoqu&#237;mica e impregna&#231;&#227;o por prata de Warthin&#8208;Starry nas amostras de pele de pacientes com s&#237;filis e outras doen&#231;as&#46; Os pacientes foram atendidos em dois hospitais terci&#225;rios entre os anos de&#160;2000&#160;e&#160;2019&#46; Raz&#245;es de preval&#234;ncia &#40;RP&#41; e intervalos de confian&#231;a &#40;IC&#41; de 95&#37; foram calculados para avaliar associa&#231;&#227;o entre positividade da imuno&#8208;histoqu&#237;mica e vari&#225;veis cl&#237;nicas&#8208;histopatol&#243;gicas&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Trinta e oito pacientes com s&#237;filis e suas&#160;40&#160;amostras de bi&#243;psias foram inclu&#237;das para o estudo&#46; Trinta e seis amostras de pele formaram os controles sem s&#237;filis&#46; A t&#233;cnica de Warthin&#8208;Starry foi incapaz de demonstrar de maneira acurada a bact&#233;ria em todas as amostras&#46; A imuno&#8208;histoqu&#237;mica mostrou espiroquetas apenas em amostras de pele de pacientes de s&#237;filis &#40;24&#47;40&#41; com sensibilidade de 60&#37; &#40;95&#37;&#160;IC&#160;44&#44;8&#8208;75&#44;2&#41;&#46; A especificidade foi de 100&#37; e a acur&#225;cia de 78&#44;9&#37; &#40;95&#37;&#160;IC&#160;69&#44;8&#8208;88&#44;1&#41;&#46; A maioria dos nossos casos teve espiroquetas tanto na derme quanto na epiderme&#44; com alta carga bacteriana&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">As correla&#231;&#245;es entre imuno&#8208;histoqu&#237;mica e caracter&#237;sticas cl&#237;nico&#8208;histopatol&#243;gicas foram observadas&#44; mas foram limitadas estatisticamente em decorr&#234;ncia do pequeno tamanho da amostra&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Espiroquetas foram prontamente vistas no protocolo de imuno&#8208;histoqu&#237;mica&#44; o que pode contribuir para o diagn&#243;stico de s&#237;filis em amostras de bi&#243;psias cut&#226;neas&#46; Por outro lado&#44; a t&#233;cnica de Warthin&#8208;Starry mostrou ser de nenhum valor pr&#225;tico&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Como citar este artigo&#58; Rosa MFAP&#44; Quintella LP&#44; Ferreira LC&#44; Cuzzi T&#46; Immunohistochemical detection of <span class="elsevierStyleItalic">Treponema pallidum</span> in skin samples with clinical and histopathological correlations and Warthin&#8208;Starry staining critical analysis&#46; An Bras Dermatol&#46; 2023&#59;98&#58;480&#8211;6&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Trabalho realizado no Hospital Clementino Fraga Filho&#44; Universidade Federal do Rio de Janeiro e Instituto Nacional de Doen&#231;as Infecciosas Evandro Chagas&#44; Funda&#231;&#227;o Oswaldo Cruz&#44; Rio de Janeiro&#44; RJ&#44; Brasil&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Localiza&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epiderme e derme&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;75&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Derme &#40;apenas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;20&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epiderme &#40;apenas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Localiza&#231;&#227;o epid&#233;rmica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;79&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basal e suprabasal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;37&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basal &#40;apenas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;16&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basal&#44; suprabasal e por&#231;&#245;es altas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suprabasal &#40;apenas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basal e por&#231;&#245;es altas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Localiza&#231;&#227;o d&#233;rmica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;95&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extracelular&#44; no infiltrado inflamat&#243;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;87&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parede de vasos d&#233;rmicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;83&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intracelular&#44; no infiltrado inflamat&#243;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;75&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" scope="col">Vari&#225;veis cl&#237;nicas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;filis secund&#225;ria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29 &#40;72&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19 &#40;47&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;694 &#40;0&#44;345&#8208;1&#44;396&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;filis secundo&#8208;terci&#225;ria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">21 &#40;52&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;filis terci&#225;ria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">39 &#40;97&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;60&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;37&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;82&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">10 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;15&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Negativa &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Padr&#245;es de rea&#231;&#245;es teciduais perivasculares superficiais apenas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;82&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;52&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;30&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;485 &#40;0&#44;608&#8208;3&#44;628&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dermatite perivascular superficial</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">39 &#40;97&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;60&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Padr&#245;es de rea&#231;&#245;es teciduais perivasculares superficiais e profundas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dermatite espongi&#243;tica&#44; de interface e nodular</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Melan&#243;fagos</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">7 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Plasm&#243;citos</span> &#43;&#43;&#47;&#43;&#43;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">21 &#40;52&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;619 &#40;0&#44;321&#8208;1&#44;194&#41;&nbsp;\t\t\t\t\t\t\n
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