ABSTRACT
A sífilis é uma doença infecciosa sistêmica, de evolução crônica e causada pelo Treponema pallidum, um espiroqueta de transmissão sexuale vertical, que pode produzir, respectivamente, as formas adquirida e congênita da doença. No Brasil, segundo o Ministério da Saúde (MS), embora a subnotificação de casos de sífilis seja alta, alguns dados disponíveis indicam a elevada magnitude deste problema infeccioso. Objetivo: comparar a coletadas amostras de sangue no papel de filtro (PF) e no plasma (padrão-ouro) na triagem pré-natal, utilizando anticorpos antitreponêmicos totais (IgG + IgM) no procedimento imunoquímico ELISA, registrado pelo Imunoscreen, da firma MBiolog. Métodos: foram estudadas 1.142 grávidas de quatro municípiosdo Estado de Rio de Janeiro: Itaboraí (N = 131), Itaguaí (N = 597), Niterói (N = 377) e São João de Meriti (N = 37) a partir do mês de novembro de 2008 até fevereiro de 2009. As grávidas foram submetidas a punção venosa e digital para a rotina da triagem pré-natal, sendo a última aplicada em PF. Foram calculados os limites de especificidade, sensibilidade e valores preditivos positivo e negativo para o estudo. Resultados: os resultados da sorologia parasífilis nas amostras do município de Itaboraí apresentaram ELISA positivo em 4,58%, os municípios de Itaguaí, Niterói e São João de Meriti mostraram positividade em 3,18%, 2,65% e 0%, respectivamente. Os procedimentos realizados tiveram uma sensibilidade e especificidade de 100% e os critérios preditivos positivos e negativos para todas as grávidas, estudados nas 1.142 amostras, foram de 100%. Conclusão: os resultados da sorologia para sífilis no sangue seco coletado em PF foram semelhantes aos da coleta por punção venosa, validando esta técnica.
Syphilis is a systemic disease of chronic evolution and caused by Treponema pallidum, a spirochete of sexual and vertical transmission,which can produce, respectively, the form of acquired and congenital disease. In Brazil, according to the Ministry of Health (MoH), although the underreporting of cases of congenital syphilis is high, some available data indicate the high magnitude of this problem that especially affects the weakness of pregnant women. Congenital syphilis causes great social impact, which results in deterioration of quality of life on a important stratum of the population,and indirect costs to the economy of the country, which, added to the direct costs resulting from hospitalizations and procedures for the treatment of its complications, increasing the total costs of care of public health. Objective: to compare the collection of blood samples on filter paper (FP) and plasma(gold standard) in prenatal screening, using anti-treponema total (IgG + IgM) in ELISA immunochemical. Methods: we studied 1,142 pregnant of the following cities: Itaboraí (N = 131), Itaguaí (N = 597), Niterói (N = 377) and St. João de Meriti (N = 37). Blood samples were collected from the finger and venipuncture of pregnant women in stations of collection of these counties, calculating elapsed time from sample collection to delivery of the report to thecouncil. We calculated the limits of sensitivity, specificity, positive predictive value and negative for the study. Results: Itaboraí showed positive ELISA in4.58%, in Itaguai, Niterói and St. João de Meriti showed, respectively, 3.18%, 2.65% and 0%. The procedures performed had a sensitivity and specificity of 100%, and the positive and negative predictive criteria for all pregnant women studied in 1,142 samples were 100%. All positive cases were reported to the Municipality within 10 days of sample collection. Conclusion: we conclude that the implementation of collection of dried blood on filter paper in pregnantwomen screening, was similar to that collected by venipuncture, validating this technology.
Subject(s)
Humans , Female , Pregnancy , Serology , Syphilis/diagnosis , Sexually Transmitted Diseases , Enzyme-Linked Immunosorbent Assay , Infectious Disease Transmission, Vertical , Maternal Serum Screening TestsABSTRACT
Introducción: la alternativa para la colecta de las muestras de sangre en el papel de filtro (PF) muestra cada día mayor interés en los investigadores yasistentes de salud que buscan mejorar los programas de pesquisaje masivo de la población. Muchos autores desde la apertura esta posibilidad en el siglo pasado iniciaron sus proyectos con la conservación de la muestra de sangre seca para estudios masivos neonatales. . Objetivo: valorar la calidad del papel de filtro (Hahnemuehle, 2992) para la colecta de muestras de sangre para el tamisaje de sífilis, como alternativa en la conservación de sangre seca en los laboratorios que usan esta alternativa y estrategia en los estudios de terreno. Métodos: fue realizadoun diseño para el estudio comparativo de calidad entre el PF Schleicher & Schuell 903 que sirvió como patrón de oro y el PF Hahnemuehle 2992, para a coleta e almacenamiento de muestras de sangre para el estudio de anticuerpos totales (IgM e IgG) contra el Treponema pallidum con una técnica ELISA tipo Sándwich. Se compararon 140 señales de absorbancia del mismo número de muestras de mujeres embarazadas, previo consentimiento escrito, para registrar su semejanza estadísticamente según los procedimientos estadísticos del Test de Fisher y Student (Test T) con un valor de seguridad de P > 0,05. Resultados: se encontró correspondencia entre los valores de especificidad, sensibilidad y valor predictivo positivo entre el procedimiento usando con los dos PF en el universo estudiado, así como los valores de T = 0,344331 para el análisis de comparación de medias entre la absorbancia obtenida con los dos PF para de P < 0,001. Conclusión: se concluye que la comparación del PF Hahnemuehle 2992 con el Schleicher & Schuell 903 para el estudio de muestras de sangre seca para la detección de anticuerpos totales del Treponema pallidum por ensayo ELISA es significativamente semejante y cuentan con la misma calidad.
Introduction: the filter paper (dried blood spot DBS) as an alternative of blood sample collection shows an increased interest of scientific investigators and health assistants that search to improve massive research programs of the population. Since the opening of this possibility in the last century, many authors started their projects using dried blood spots for massive neonatal studies. Objective: to assess the filter paper quality (Hahnemuehle, 2992) for collecting blood samples for sifilis screening as an alternative to the conservation of dry blood in the laboratory using this alternative strategyand in camp studies. Methods: a design for a comparative study of quality between Schleicher and Schuell 903 paper used as golden standard- andHahnemuehle 2992 paper was realized, for the collection and storage of dried blood for the totals antibodies (IgM and IgG) against the Treponema pallidum study, using ELISA assay (sandwich type). A hundred and forty (140) signals of absorbance of the same number of pregnant samples, with previous written consent, to register their similarity, using statistic procedures of the Test of Fisher and Student (test T) with a security value of P > 0,05. It was also compared the absorbance values of the positive cases (according a settled cut off for each plate) and sensitivity,specificity and predictive value criteria were calculatedon a total of 604 pregnant of the study. Results: it was detected correspondence of sensitivity, specificity and positive predictive values, in the procedures using the two types of fi lter papers, as well as the value of T = 0,344331 for the analysis of the average comparison between the obtained absorbance with the two types to P < 0,001. Conclusion: it was concluded that Hahnemuehle 2992 fi lter paper compared with Schleicher and Schuell 903 shows signifi cantly similar and have the same quality for the detection of totals antibodies Treponema pallidum of using ELISA test.