Integrated Cell Culture-PCR Detection of Enteroviruses and Reoviruses in Water Sources in Gyeonggi-do

The integrated cell culture-PCR (ICC-PCR) method has been suggested as an improved method for detection of viruses in water environments. We tested 57 source waters including finished water samples in Gyeonggi-do for enteric viral contamination using total culturable virus assay (TCVA) using BGMK cells and ICC-PCR. Nineteen of the 57 source water samples (33.3%) exhibited the cytopathic effect (CPE) on BGMK cells and no finished water did exhibited CPE. Nineteen samples (33.3%) of the 57 were positive for reoviruses. For the enteroviruses, only 3 samples (5.3%) of the 57 samples showed positive results. By using ICC-PCR method, 202 flasks from source water samples were positive for enteroviruses and reoviruses. Three samples from source water were positive for both viruses. However, any flasks tested was not co-infected with two types of viruses. While the enteric viral frequencies in TCVA and ICC-PCR were similar, the viral frequency for reoviruses at first passage in two type of method was higher in ICC-PCR (94.7%) than TCVA (56.9%).

Receptors for Treponema pallidum Attachment to the Surface and Matrix Proteins of Cultured Human Dermal Microvascular Endothelial Cells

Pathogenicity of Treponema pallidum may depend upon the binding of Treponema pallidum to matrix proteins, especially to fibronectin. Infectious organism or cell to matrix interactions are mediated by a family of adhesion molecule receptors known as integrins. Once in the host, the pathogenic Treponema pallidumdum adheres to the vascular endothelium and readily penetrates surrounding tissues. Fibronectin plays an important role in the mediation of the attachment of Treponema pallidum to host cells, including endothelial cells. We found that the binding of Treponema pallidum to human dermal microvascular endothelial cells and to a glass surface coated with fibronectin is inhibited by the presence of arginine-glycine- aspartic acid (RGD), and analysis of the surface receptor revealed an antigenic similarity to an integrin molecule, namely alpha5. This ability to adhere to host endothelium and fibronectin is quite unique to T. pallidum among the treponemes, and may be a key pathogenic factor.

Virulent Treponema pallidum 47 kDa antigen regulates the expression of cell adhesion molecules and binding of T-lymphocytes to cultured human dermal microvascular endothelial cells

Perivasculitis and endothelial cell abnormalities are prominent histopathologic features of syphilis. Various cutaneous lesions are the main clinical features of syphilis. We examined whether Treponema pallidum 47 kDa antigen regulates the expression of cell adhesion molecules on human dermal microvascular endothelial cells (HDMEC) and the regulation of T-lymphocytes binding to HDMEC. Using immunofluorescence flow cytometry and enzyme-linked immunosorbent assay (ELISA), we demonstrated that T. pallidum upregulated the expression of adhesion molecules, including intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and E-selectin. The 47 kDa antigen of T. pallidum also activated endothelium as measured by the upregulation of the expression of adhesion molecules on HDMEC, and it also promoted an increased adherence of T-lymphocytes to HDMEC. The expressions of ICAM-1 and VCAM-1 on HDMEC and the adherence of T-lymphocytes to HDMEC were inhibited by treatment with anti-TNF-alpha antibody or anti-IL-1alpha antibody. These results show that T. pallidum or T. pallidum-specific 47 kDa antigen are capable of stimulating HDMEC to increase the expression of ICAM-1, VCAM-1 and E-selectin and thereby, promote the adherence of T-lymphocytes. The whole process may play an important role in the immunopathogenesis of syphilis and it is likely that TNF-alpha and IL-1alpha are involved.

A Case of Type V Hyperlipoproteinemia and Xanthoma Eruptivum Associated with Diabetes Mellitus / 대한피부과학회지

We report a case of type V hyperlipoproteinemia and xanthoma eruptivum associated with diabetes mellitus in a 12-year-old female. She had diffuse erythematous yellowish papules on the extremities and trunk with itching. The laboratory findings showed increased serum blood glucose, cholesterol and triglyceride, increasing pre- and chylomicron bands on electrophoresis of lipoprotein. The biopsy specimen of an erythematous yellowish colored papule on the trunk showed characteristic findings of xanthoma.

A Case of Lipoma with Membranous Fat Necrosis / 대한피부과학회지

Membranous fat necrosis is a variant of fat necrosis characterized by the presence of membranocystic foci which is lined by eosinophilic, homogeneous and crenulated membrane that has pseudopapillary projections. Membranous fat necrosis may be idiopathic or has been associated with many local and systemic diseases. The pathogenesis of membranous fat necrosis is uncertain but trauma may be suspected in our case. We describe a case of lipoma with membranous fat necrosis.

Follow-up Study on Cell-mediated Immune Responses In Syphilitic Patients after in vitro Stimulation with the 47 kDa Antigen of Treponema pallidum / 대한면역학회지

Present study was aimed to investigate the immunological activities of the 47 kDa protein antigen from Treponema pallidum and conducted on 12 patients with syphilis (early, late, spontaneously healed, congenital and treated patients) followed by therapy. Peripheral blood mononuclear cells (PBMC) were obtained three times from each patient, on admission before the initiation of therapy, 1 and 6 months later. Eleven (96.7%) of the patients prior to therapy, showed depressed lymphoproliferative responses to the 47 kDa antigen (stimulation index <4) by 3H-thymidine incorporation assay. However, these T cell responses were seemed to be transient because most of the patients (63.6%) exhibited significantly higher lymphoproliferation after therapy. Before therapy, PBMC from spontaneously healed syphilis patients resulted in significantly increased gene expression of IFN- and proinflarnmatory cytokines, such as TNFa, IL-1B and IL-6, in response to the 47 kDa. Patients with late latent and late congenital syphilis exhibited lower IFN-r and proinflammatory cytokine mRNA expression than spontaneously healed syphilis group did. After therapy, IFN-r and proinflammatory cytokine mRNA expressions were gradually reduced in these groups. On the other hand, IFN- and proinflammatory cytokine gene expressions were considerably depressed in early syphilis patients, but these patients went on to express prominent IFN-r and proinflamrnatory cytokine mRNA with treatment. These data suggest that the pattern of cellular immune response in response to the 47 kDa antigen may be involved in the evaluation of the clinical course and outcome of syphilis followed by therapy.

Histopaghologic Finding and Modulation of Expression of The Cell Surface Molecules in The Primary Syphilitic Sedions of a Rabbit Infected with Treponema pallidum / 대한피부과학회지

BACKGROUND: When T. pallidum invades through skin and mucous membrane, there may be some changes in the expression of cell surface molecules and cell adhesion molecules on the keratinocytes and vascular endothelial cells. OBJECTIVES: The purpose of this study was to investigate histologic changes and changes in the expression of cell surface molecules and cell adhesion molecules on the keratinocytes and vascular endothelial cells according to the time course of primary syphilic lesion. METHODS: We obtained primary syphilitic lesions by inoculation of T. pallidum into the back skin of the rabbit. Biopsies of the syphilitic lesions were performed according to the stages. and H&E and immunohistochemical stains for cell surface molecules were done. RESULTS: 1. Out of the 39 injected sites(103 T. pallidum were inoculated into the back skin of the rabbit), 24(61.5%) primary syphilitic lesion could be found. The duration for the developement of papules, ulcers, and softenings is an average 15 days, 27 days, and 47 days respectively. 2. H & E findings :Acanthosis, spongiosis, and exocytosis in the epidermis were observed in the papule of the primary syphilitic lesion. Infiltration of inflammatory cells, including many lymphocytes, a few histiocytes and plasma cells was also observed. Some cases showed endothelial cell swelling of vessels. Compared to papules, the number of lymphocytes in the ulcer reduced but the number of histiocytes increased. Softened lesion showed infiltrating cells, consisted of lymphocytes and histiocytes, and fibrosis. 3. Immunohistochemical findings :Keratinocytes of the lower epidermis, upper portion of hair follicles, vessel, and infiltrating inflammatory cells in papules and ulcers showed expression of the MHC class II molecule. Most of the infiltrating cells in all cases of papules showed CD5 expression. Keratinocytes, inflammatory cells, and vascular endothelial cells showed positive reaction to ICAM-1 stain in papules and ulcers. VCAM-1 showed the positive reaction to the vascular endothelial cells in the papules and ulcers. In softened lesions, the intensity of the positive reaction to MHC class II, ICAM-1 and VCAM-1 was weakened. CONCLUSION: The skin of the rabbit which was invaded by T. pallidum increased the expression of the cell surface molecules and cell adhesion molecules of MHC class I, MHC class II, ICAM-1, and VCAM-1. We believe that these expressions of cell surface molecules and cell adhesion molecules by T. pallidum, inflammatory cells, activated keratinocytes, and vascular endothelial cells play important roles in the host defence mechanism and the T. pallidum infection.

Cell-mediated Immune Responses in Syphilitic Patients after In vitro Stimulation with the 47 kDa Antigen of Treponema pallidum / 대한면역학회지

Present study was aimed to investigate the immunological activities of the 47 kDa glycoprotein antigen from Treponema pallidum and conducted on 24 patients with syphilis, (early, late, spontaneously healed, congenital and treated patients) and on 17 normal healthy controls. Two opposite lymphoproliferative manifestations to the 47 kDa antigen were observed in syphilis patients by H-thymidine incorporation assay. Ten responders (stimulation index [Sl] >4) showed a 3-fold-higher proliferation than the nonresponders, and four of those responders were spontaneously healed patients. Furthermore, analysis by flow cytometry indicated a preferential expansion of CD4' T lymphocytes by the 47 kDa antigen in the spontaneously healed syphilis patients. Stimulation of PBMCs of spontaneously healed syphilis patients with the 47 kDa antigen for greater than 72 hrs resulted in piogressive augmentation of IFN-r, IL-2Ra and IL-2 mRNA measured by RT-PCR, but considerably reduced IL-4 and IL-10 mRNA expression. However, patients with late latent syphilis exhibited more increased IL-4 and IL-10 mRNA expressions in response to the 47 kDa antigen than spontaneously healed syphilis group. In contrast to other groups, when cultured with the 47 kDa antigen very low IFN-#y, IL-2Ra and IL-2 mRNA expressions were shown in early syphilis group. These data suggest that the Th1-predominant cellular responses induced by the 47 kDa antigen may be involved in the clinical outcome of syphilis and provide the immunologic basis for further functional studies regarding the role of the 47 kDa in the immunopathogenesis of syphilis.

Isolation and Characterization of Keratinases from Different Kinds of Dermatophytes / 대한의진균학회지

BACKGROUND: Several groups of workers have isolated and purified the keratinolytic proteinases from some species of dermatophytoses. But it is not efficient to compare the interspecies of dermatophytosis because the separation and purification are done by different conditions. OBJECTIVE: To compare the characteristics and difference of the keratinases which are isolated and purified from Trichophyton rubrum, Trichophyton mentagrophytes and Microsporum canis in the same conditions. METHODS: Proteinases elaborated from T. rubrum, T. mentagrophytes and M. canis were purified by precipitation using ammonium sulfate and by SMART. SDS-polyacrylamide gel electrophoresis was carried out, and the effect of various inhibitors was investigated. A variety of substrates for KPase were tested. RESULTS: 1. The keratinases were isolated and purified 17.3, 22.0, 17.6-fold from T. rubrum, T. mentagrophytes and M. canis. 2. Each molecular weight of the keratinolytic proteinases isolated and purified from T. rubrum, T. mentagrophytes and M. canis was 53 kDa, 65 kDa, 77 kDa. 3. Phenylmethylsulfonylfluoride inhibited the keratinase activity in T. rubrum, T. mentagrophytes and M. canis 4. The keratinases from T. rubrum, T. mentagrophytes and M. canis digested much more human stratum corneum and human nail than human scalp hair, but keratinase from M. canis digested much more human scalp hair than human stratum corneum and human nail. CONCLUSION: The results show keratinases from T. rubrum, T. mentagrophytes and M. canis were different each other, but they may be a kind of serine proteinase. The keratinases from T. rubrum, T. mentagrophytes and M. canis may play an important role in tinea pedis and tinea unguis by affecting the human stratum corneum and human nail, and the keratinase from M. canis may play an important role in tinea capitis by affecting the human hair.

Recent Trends of Syphilis Prevalence in the Normal Population in Korea - 1995 / 대한피부과학회지

BACKGROUND: The VDRL is used as a screening test for syphilis worldwide. In addition, reactive rates of the VDRL test are used to estimate the incidence of syphilis. The prevalence of syphilis reported in Korea varies according to the study population, district and time. Reports on prevalence of syphilis indicate that reactive rates of the serologic test for syphilis showed an increasing tendency in the 1960s and has steadily decreased in the 1990s. We have already reported VDRL positive rates periodically since the late 1970s in similar areas with similar population groups and methods in order to standardize the results for accurate analysis of the prevalence of syphilis in Korea. OBJECTIVE: This study was performed utilizing the VDRL test in order to find out if the decreasing trend of syphilis prevalence is still continuing. METHODS: The ser ologic tests for syphilis were carried out on 13,426 apparently normal adults aged twenty-years-old or over(8,250 blood donors in the Seoul area, 2,461 physical examinees examined at Severance Hospital, Yonsei University and 2,715 pregnant women at delivery at Severance Hospital, Yonsei University ) from January to December 1995. We hve performed the VDRL quantitative test in VDRL-reactive persons among blood donors and pregnant women. RESULTS: The reactive rate of the serum VDRL test was 0.2% in 13,426 healthy adults(blood donors.0.2%, physical examinees:0,2%, pregnant women:0.3%). There was a statistically decreasing tendency compared to 0.4% in 1990(p<0.001). The VDRL quantitative test resulted in levels below the 1:2 titer in 92% of the VDRL-reactive physical exarninees and pregnant women. CONCLUSION: From the comparison of VDRL reactive rates for syphilis in an apparently normal Korean population obtained by the present author group since 1977, i.e., 2.5% in 1977, 1.1% in 1981, 0.6% in 1986, 0.4% in 1990 and 0.2% in 1995, it is clear that the prevalence of syphilis has been rapidly decreasing since the mid 1970s in Korea.

The Effect of TCA Chemical Peel on Acne Scars / 대한피부과학회지

BACKGROUND: Trichloroacetic acid(TCA) chemical peel has been used for variable skin lesions. However, the effect of TCA chemical peel on acne scars has not been studied. OBJECTIVE: The object of this study is to evaluate the effect of TCA chemical peel on atrop hic acne scars. METHOD: Twenty three patients with atrophic acne scars, who were treated with TCA chemical peel were included. The patieits were interviewed for evaluation of the therapeutic efficacy of TCA chemical peel regarding the number of treatment and satisfaction rates. RESULTS: Those who received treatment for more than 6 times with good or excellent results were 13 out of 15 patients, whereas, those who received treatment for 4 times with good or excellent results were 4 out of 7 patients Thus, chemical peel on acne scars showed that the more often the treatment was carried out, the better the therapeutic effect. There was no significant complication. CONCLUSION: TCA chemical peel is safe and effective for the treatment of atrophic acne scars.

Two Cases of Fungal Granuloma Caused by Trichophyton mentagrophytes / 대한의진균학회지

Dermatophytes have been demonstrated infrequently in the dermis, subcutis, lymph nodes, bones and other tissues. A few cases of deep granulomatous cutaneous infections due to dermatophytes have been reported, but Trichophyton mentagrophytes are extremely rare. We report two cases of T. mentagrophytes infection showing unusual granulomatous manifestations. A 63-year-old woman presented with multiple erythematous patches and nodules on both arms and lower extremities for 3 months. The second patient was a 69-year-old man who had erythematous annular plaques on the dorsum of the left hand for 4 months. Histopathologic examinations of the skin lesions of both patients showed chronic granulomatous inflammation with fungal elements. The biopsy specimens yielded T. mentagrophytes on culture. The skin lesions were cured after administration of itraconazole.

Expression of Surface Antigens in HaCaT Cells by Virulent Treponema Pallidum / 대한피부과학회지

BACKGROUND: In primary syphilis, Treponema pallidum invades skin and mucosa through the epidermis, enters blood vessels and circulates in the blood. Afterwards, T. pallidum migrates out of the blood vessels to the pidermis in secondary syphilis to induce diverse skin findings. Therefore, the epidermis seems to be one of the main targets in syphilis. Most of the epidermal cells are keratinocytes and it can be presumed that T. pallidum infection elicits defence mechanisms at keratinocyte level resulting in changes of the keratinocyte surface molecule expression. OBJECTIVE: We have examined by ELISA whether virulent T. pallidum and its 47-kDa antigen could change the expressions of E cadherin, MHC-I, and ICAM-1 on the surface of HaCaT, a transformed human kerainocyte cell line. METHODS: The 96 well plates of 4 x 10(4) HaCaT cells/well were cultured for 1-2 days at 37 degrees C, and cultured for 16 hours at 37 degrees C including 3x 10(5) T. pallidum per well or its 47-kDa antigen. Then the changes of E-cadherin, MHC-I and, ICAM-I were observed by ELISA. Media alone was used for negative control and TNF-alpha of 10U/well was used for positive control. RESULTS: On culturing with T. pallidum, the expression of E-cadherin and MHC-I increased significantly compared with the negative control. That of ICAM-1 showed increased findings compared to the negative control, but it was not significant. On culturing with its 47-kDa antigen, the expression of E-cadioerin and MHC-I increased significantly compared with negative control ICAM-1 expression was increased compared to the negative control, but it was not significant. CONCLUSION: The increase in E-cadherin and MHC-I expressions in HaCaT cells cultured with T. pallidum may be related to the defence mechanisms of the host cells.

A Case of Dermatofibrosarcoma Protuberans Treated with Mohs Micrographic Surgery and Purse - String Suture Repair / 대한피부과학회지

Dermatofibrosarcoma protuberans is an uncommon, locally aggressive fibroblastic tumor, characterized by infrequent metastasis and a marked tendency of local recurrence after excision. Histologically, it shows large uniformed spindle shaped cells arranged in a cartwheel or storiform pattern. We report a case of dermatoribrosarcoma protuberans on the lower abdomen of a man aged of thirty, treated with Mohs micrographic surgery and purse-string suture repair.

Detection of Treponema pallidum by polymerase chain reaction in the cerebrospinal fluid of syphilis patients

To find out if polymerase chain reaction could be used as a diagnostic tool for detecting neurosyphilis, we have applied the PCR for the detection of Treponema pallidum DNA in the cerebrospinal fluid (CSF) of syphilis patients. The results of the PCR of the CSF in 26 patients with at various stages of illness were compared with the results of other conventional tests used in the WHO criteria. T. pallidum was detected in the CSF of patients at all stages of syphilis, which indicates that they invade the central nervous system from the early stages of infection. However, the presence of T. pallidum in the CSF was not correlated with the results of other tests used in the WHO criteria, and its significance in the diagnosis of neurosyphilis should further be evaluated.

Conjugal Syphilis

BACKGROUND: The infection rate of syphilis in married couples has been reported by a few investigators during the 1940s. However, studies on recent trends of that particular aspect of syphilis in married couples have not yet been done. OBJECTIVE: We therefore studied the infectivity of T. pallidum and recent trends of conjugal syphilis by observing the spouses of patients with untreated syphilis. METHODS: Couples married for more than 1 year who visited Yonsei Medical Center from 1983 to 1990 for syphilis were entered into this study. We observed the infection rate among spouses of 224 index patients (defined as, between husband and wife, the one who was the first to be diagnosed to have syphilis) who were not treated for syphilis. Syphilis was diagnosed on the basis of physical examination, history of extramarital sexual contacts, and the results of VDRL, TPHA, FTA-ABS, and 19S(IgM)-FTA tests. RESULTS: Fifty-six wives(48%) of 117 male index patients and 50 husbands (47%) of 107 female index patients had been infected at the time of examination. Among the 224 couples, 106(47%) were both infected and in 118(53%), only either husbands(27%) or wives(26%) were infected. Two spouses(50%) of the 4 first incident patients with primary syphilis, 9(53%) of 17 with secondary syphilis and 23(72%) of 32 with early latent syphilis were infected at the time of examination. CONCLUSION: From our results showing the low infection rates among married couples, even in early syphilis when the infectivity is high, it can be deduced that T. pallidum has only a low infectivity.

Abnormal Imposition of hands as a Possible Cause of Syphilis / 대한피부과학회지

Syphilis is a communicahble disease caused by the motile microaerophilic spirochete Treponema pallidum, which is only a netural pathogen for human. Prevalence of syphilis and other sexually transmitted diseases has traditioially fluctuated with changes in sccia, conditions and sexual behavior. Although sexual contact is the main route of transmission, T. pallidum may also be infected through direct contact with syphilitic lesions, blood transfusion, ingestion of menstrual blood or vaginal secretions, or trsnsplacental transemission. Fomites as the means of transfer is only hypothetical and account for very few, if any, infection. Prosectors, blood handlers and laboratory technicians are at risk for accidental inoculation with infected materials. In extremely unusual circumstances, infection by means of contact with a skin lesion and human bite have been reported. We report two cases of eyphilis following the abnormal imposition of hands, which caused unnecessary erosive trauma with fingernails,

Eetection of treponema pallidum by polymerase chain reaction / 대한피부과학회지

BACKGROUND: Definite criteria for the diagnosis and treatment evaluation for different clinical stags of syphilis are not yet present dute to the inability to dultivate Treponema pallidum in vitro. However, as the staining methods and the serological tests currently used have their limitations, a more definite method for its confirmation is needed. Polymerase chain reaction (PCR), due to its high sensitivity and specificity, is currently being applied to the detection of T. pallidum. OBJECTIVE: We have used PCR for the detection of T. pallidum DNA in various clinical specimens in orber to evaluate its potenital as a diagnostic tool. METHOD: Clinical specimens were collected from patients with different stages of syphilis who visited ithe Deparment of Dermatology of Yonsei medical Center for 1 year beginning from May, 1991. Sera from 63 patients, cerebrospinal fluids from 24 patients, amniotic fluids from 3 patients, and 21 tissues from 19 patients were subjected to PCR and the results were analyzed to evaluate its usefulness as a diagnostic and treatment evaluation tool. A portion of the T. pallidum-specific chromosomal DNA, tpp47, which encodes the 47 kDa surface protein, was used as the template DNA to amplify the 658 bp DNA fragment, and the following results were obtained. PCR using primers 47-1 and 47-2 were applied to amplify 658 bp DNA fragments from the T. pallidum-specific tpp47 gene encoding 47 kDa surface protein. RESULT: 1. To evaluate the sensitivity of the PCR, T. pallida and their chromosomal DNA were diluted. The diluents contataining a single organism and 1 fg of the chromosomal DNA showed positive reactions by the amplification. 2. Specificity of the PCR was determined by using T. pallidum, 4 species beloging to genus Treponema, and 9 species of nonpathogenic or pathogenic organisms. A positive reaction was obtained only when T. pallidum chromosomal DNA was used. 3. PCR was positive in 5 of 9 (55%) sera in primary syphilis, 22 of 26(84%) in secondary syphilis, 3 to 15(20%) in early latent syphilis, 1 of 19 (11%0 in late latent syphilis, 2 of 2 (100%) in neurosyphlis, and 0 of 2 (0%) in congenital syphilis. The differences in the positive rates were statistically significant (P<0.01) in all stages except neurosyphilis and congenital syphilis, as their numbers were too smalll to deduce any significant meaning. Despite their high VDRL titers, the positive rate in early latent syphilis was relatively low when compared to the rate in secondary syphilis. 4. Follw-up PCR of sera in some patients showed positive results 9 months after treatment. However, some with negative PCR before treatment showed positive results after treatment. 5. PCR was positive in 1 of 1 (50%) cerebrospinal fluid in primary syphilis, 3 of 14 (21%) in secondary syphilis, 2 of 7 (29%) in early latent syphilis, and 1 of 1(100%) in neurosyphlis. The differences in the positive rates showed no statistical significance in relation to the clinical stages. Cerebrospinal fluid VDRL test, white blood cell count, and protein content showed no correlation to the PCR results in early syphilis patients. 6. Amniotic fluid showed a positive PCR result only in a pregnant woman whose serum showed a high VDRL titer and a positive PCR. 7. PCR positive rates were 90% in frozed tissues and 50% in paraffin embedded tissues. CONCLUSION: From the results, it is suggested that PCR is not suitable for treatment evaluation but is useful for the detection of T. pallidum in sera of secondary syphilis patients and syphilitic lesions, and for the confirmation of the diagnosis the diagnosis in these cases.

Recent Trends of Syphilis Prevalence in Normal Population in Korea-1990

From January to December of 1990, we have evaluated VDRL reactivity among 17,142 apparently normal Korean adults which consisted of 9,151 blood donors in Seoul area, 2,682 pregnant woman delivered at Severance Hospital, Yonsei University and 5,309 physical examinees. The VDRL-positive rates were 0.3% in the blood donors, 0.1% in the pregnant women and 0.8% in the physical examinees but the rates were higher in the age group of 50 years or older. The VDRL titers were below 1:2 in 94% of the VDRL-positive pregnant women and physical examinees. From the comparison of the results obtained by the present author group since 1977, i.e., 2.5 % in 1977, 1.1 % in 1981, 0.6 % in 1986 and 0.4 % in 1990, it is evident that the prevalence of syphilis in Korea is continually decreasing.

Noduloulcerative syphilis / 대한피부과학회지

A 26-year-old female presented herself to our clinic due to noduloulcerative lesions of one month duration on her face and trunk with accompaning headache and mild fever. In family history, her husband was reported to have a history of chaner. On physical examinat.ion, rice sized eythematous papules and bean sized nodules with central ulceration were seen on the face and trunk. VDRL was 1:31 positive. A skin biopsy iif a noduloulcerative lesion showed ulceration, vascular dilatation with fibrinoid changes and perivascular inflarnmatory cellu infilt.rations, especially plasma cells. Immunoperoxidase stain showed T. pallidum at the epidermis and papillary dermis. The diagnsis was made asecondary syphilis with unusual clinical presentation as noduloucerative skin lesions. The skin lesions completely disappeared one month after treatment with injection of benzathine pelnicillin G 2.4 million unit intramuscularly weekly for three times.