Neonatal cholestasis secondary to congenital syphilis

@#We report two infants with neonatal cholestasis and hepatosplenomegaly secondary to congenital syphilis. The onset of jaundice of the first infant was at six weeks of life and the second case on the 28th hour of life with associated neurologic and bone involvement. The diagnosis was suspected based on a maternal history of untreated syphilis, clinical findings, and a reactive rapid plasma reagin. Early recognition and treatment can lead to clinical improvement but prevention by mandatory testing and treatment of maternal syphilis is a more effective strategy

Seroprevalence of syphilis among pregnant females attending antenatal clinic at a tertiary care hospital in North India

Background: Syphilis is a sexually transmitted disease caused by bacteria named Treponema palladium, subsp. pallidum. Nearly 1.36 million pregnant women are known to be affected by syphilis in the developing countries. When left untreated syphilis during pregnancy can result in adverse fetal outcomes such as spontaneous abortion and stillbirth. Objective of the study was to evaluate the seroprevalence of syphilis among pregnant females attending Antenatal Clinic (ANC).Methods: A hospital based cross-sectional study was done over a period of six months from January to June 2019. A total of 132 pregnant females were included in the study who attended Antenatal Clinic for routine checkup whose blood samples were sent to Microbiology Laboratory for screening for syphilis by Rapid Plasma Reagin (RPR) test.Results: Out of 132 samples of pregnant females screened for syphilis, none of the sample was found reactive for syphilis by RPR test. Maximum patients (57.6%) belonged to age group 20-25 years followed by (27.3%) of 26-30 years. 30.3% patients belonged to urban areas and 69.7% patients belonged to rural areas. Majority of patients (80.3%) belonged to first trimester, followed by (18.9%) patients to second trimester and (0.8%) patients to third trimester. 78.8% patients were from lower socio-economic class followed by 12.9% patients from middle class and 8.3% patients from upper class.Conclusions: Although zero percent syphilis prevalence was observed in this study, it is recommended that free screening for syphilis should be offered to all pregnant females visiting Antenatal Clinic.

Intravitreal sustained-release dexamethasone implant for the treatment of persistent cystoid macular edema in ocular syphilis

With a resurgence of syphilis with human immunodeficiency virus (HIV) infection in last few years, various ocular manifestations of syphilis have been described in literature. This case report described an HIV-positive patient on anti-retroviral therapy who was diagnosed and treated for posterior uveitis secondary to ocular syphilis in the recent past presented to our clinic with cystoid macular edema (CME). CME, which did not respond to periocular corticosteroid, resolved with intravitreal sustained release dexamethasone implant. There was a recurrence CME 9 months later and repeat injection of intravitreal implant showed complete resolution. A long-term follow-up did not reveal reactivation of the infection with intravitreal corticosteroid. Intravitreal sustained release dexamethasone implant can be an effective treatment for refractory CME in patients with regressed syphilitic uveitis.

Comparative Performance of the Reverse Algorithm Using Architect Syphilis TP Versus the Traditional Algorithm Using Rapid Plasma Reagin in Florida's Public Health Testing Population

In Florida, where syphilis is a reportable disease, the number of primary and secondary (P&S) syphilis cases has increased from 3,266 in 2008–2010 to 5,340 in 2013–2015, a 63% increase. The objective of this study was to compare the performance and sensitivity of the syphilis reverse algorithm with the traditional algorithm for detecting P&S (infectious) syphilis cases. Clinical specimens from individuals who self-referred for syphilis testing at public health clinics were processed using the traditional algorithm (non-treponemal rapid plasma reagin (RPR) test followed by a confirmatory treponemal (EIA) test) and then further tested with the Architect Syphilis TP (ASTP) immunoassay (Abbott Diagnostics, Chicago, IL, USA) or by RPR confirmation, if needed (reverse algorithm). Of 1,079 specimens, 59 were positive for syphilis. The sensitivity of the reverse algorithm was 98.3% (58/59) and of the traditional algorithm was 72.9% (43/59). Based on clinical evidence, of the 16 traditional algorithm-negative but reverse algorithm-positive cases, 68.8% (11/16) were classified as missed P&S infections (treatment naïve) and 31.2% (5/16) were classified as missed past syphilis (latent or infections with documented linkage to care). The reverse algorithm enables the detection of additional P&S syphilis cases missed by our current traditional algorithm.

Comparison of RPR′s performance in syphilis screening between pregnant women and non-pregnant women / 国际检验医学杂志

Objective To study comparatively the performance of rapid plasma reagin (RPR) test in syphilis detection among pregnant women and non-pregnant women to provide reference for detecting syphilis in pregnant women.Methods The women aged 20-40 years old were selected and divided into the pregnant group and the non-pregnant group.RPR and treponema pallidum particle assay(TPPA) were simultaneously adopted to conduct the syphilis detection.The positive cases were judged by the TPPA detection results combined with the contact history,clinical symptoms and treatment situation.The results were compared with those by RPR for determining the false negative and false positive in RPR.The false negative rate and false positive rate of RPR detection results were analyzed in the two groups.Results Among 117 pregnant women,15 cases were false negative in RPR and 9 cases were false positive in RPR;among 755 non-pregnant women,there were 44 cases of false negative RPR results and 8 cases of false positive RPR results.The false negative rates in the pregnant group and non-pregnant group were 25.0% and 8.8% respectively,the difference was statistically significant(χ2=14.739,P<0.05);the false positive rates in the pregnant group and non-pregnant group were 15.7% and 3.1% respectively,the difference was statistically significant (χ2=14.722,P<0.05).Conclusion There are many factors affecting RPR for detection syphilis,pregnant women are the specific group,so higher false positive rate and false negative rate exist than non-pregnant women,the detection results should be comprehensively judged by combining with clinical symptoms and disease history,if necessary,combining with other syphilis detection method for avoiding missed diagnosis and misdiagnosis.

Analysis of peripheral blood lymphocyte subsets and its correlation with the rapid plasma reagin titers in serofast syphilis patients / 中华传染病杂志

Objective To investigate the reason of persisting positive rapid plasma reagin (RPR) in serofast syphilis patients, and to provide reference for clinical treatment and prognosis.Methods A total of 33 serofast patients and 23 healthy controls were enrolled in this study.The percentages and absolute counts of CD3+, CD4+, CD8+ T lymphocytes and natural killer (NK) cells were detected by flow cytometry.The comparison of two groups was analyzed by independent sample t test, and the correlation between change of lymphocyte subgroups and RPR titer in serofast syphilis patients was analyzed by bivariate linear correlation method.Results Compared with healthy controls, the percentages of CD3+, CD8+ T lymphocytes in serofast syphilis group were both increased significantly (75.75±5.76)% vs (68.37±5.80)%, (t=4.69, P<0.01);(27.34±7.02)% vs (24.33±1.95)%, (t=2.34, P=0.025), while both the percentage and absolute count of NK cells were significantly decreased (7.32±4.48)% vs (14.87±6.26)%, (t=5.269, P<0.01);(136.2±83.4)/μL vs (298.8±166.9)/μL, (t=4.311, P<0.01).RPR titer of the patients was negatively correlated with both percentage and absolute count of CD4+ T lymphocytes (r=-0.476 and-0.515, respectively, both P<0.01), and it was positively correlated of CD8+ lymphocytes (r=0.588 and 0.305, P<0.01 and P=0.804).Conclusion The imbalance of immune response of lymphocyte subsets observed in serofast syphilis may explain the RPR titers change.

Evaluation of AutoLab Rapid Plasma Reagin and AutoLab Treponema pallidum Latex Agglutination for Syphilis Infection Testing / 임상검사와정도관리

BACKGROUND: Automated assays have recently been developed for efficient serological testing of syphilis infection. Here, we evaluate the performance of new automated serological assays for syphilis infection. METHODS: The precision, linearity, and detection limit of the automated kits AutoLab rapid plasma reagin (RPR) (IVD-RPR) and AutoLab (Treponema pallidum Latex Agglutination) TPLA (IVD-TPLA) (IVDLab Co., Korea) were evaluated using an immunoturbidimetric method. In addition, the results of these tests were compared with those obtained using the HiSens Auto RPR LTIA (HBi-RPR) and HiSens Auto TP LTIA (HBi-TPLA) tests (HBi Co., Korea) with 122 serum samples. RESULTS: Both the IVD-RPR and IVD-TPLA kits showed acceptable precision for the positive controls (IVDLab Co., Korea). The within-run and total precision of IVD-RPR were better than those of HBi-RPR at cut-off levels (CV, 7.0% to 7.4% for IVD-RPR; CV, 33.3% to 40.0% for HBi-RPR). The IVD-RPR and IVD-TPLA kits demonstrated acceptable linearity and limits of detection. The agreement rate between IVD-RPR and HBi-RPR was 83.60% (102/122). Nineteen samples were IVD-RPR negative but HBi-RPR positive; 12 of these were from patients with a history of syphilis. The agreement rate between IVD-TPLA and HBi-TPLA was 96.72% (118/122). All discrepant results were IVD-TPLA positive and HBi-TPLA negative. CONCLUSIONS: IVD-RPR and IVD-TPLA exhibited acceptable precision, linearity, and limits of detection for the diagnosis of syphilis infection. IVD-RPR was suitable for monitoring syphilis infections with good precision that was near cut-off levels. IVD-TPLA was useful for detecting primary syphilis infection.

Screening of syphilis using rapid plasma reagin test in apparently healthy population in Madhya Pradesh: a 6 years study.

To analyze the prevalence of syphilis in apparently healthy population in Madhya Pradesh during last 6 years. Methods: Serum samples were collected from Departments of Obstetrics and Gynecology, Skin and Venereal diseases, Medicine, Surgery, etc., of the period of 6 years. All the serum samples were screened for syphilis by rapid plasma reagin (RPR) test using standard methods. Results: Out of 21,742 samples, 133 (0.62%) serum samples were found to be positive. The highest seroprevalence was observed in the group aged 25-31 years (0.89%) and lowest in 18-24 years (0.31%). Conclusion: RPR testing in this populations group plays a special value in the diagnosis, treatment and prevention of syphilis.

Clinical application and evaluation of 4 kinds of siphilis serological detection method / 国际检验医学杂志

Objective To compare the value of four kinds of commonly used serological detection method for detecting Trepone-ma Pallidum,i.e.,Treponema Pallidum enzyme-linked immunosorbent assay(TP-ELISA),Treponema pallidum particle agglutina-tion test(TPPA),Treponema Pallidum rapid plasma reagin test(RPR)and Treponema Pallidum antibody detection(TP-AD,emul-sion method).Methods 5 870 specimens from outpatients and inpatients were screened by TP-ELISA.121 cases of detected posi-tive specimen were simultaneously detected by TP-AD,TPPA and RPR.Then the detection results were performed the comparative analysis.Results Among 5 870 specimens,121 cases were positive by ELISA,the detection rate was 2.06%.Among 121 positive cases,119 cases were positive by TPPA,the conformity degree was 98.34%,49 cases were positive by RPR,the conformity degree was 40.41%,113 cases were positive by TP-AD,the conformity degree was 93.38%.With the TPPA results as the standard,there was no statistically significant difference between TPPA and TP-AD(P >0.05),but there was statistically significant difference be-tween TPPA and RPR(P <0.01).Conclusion The four kinds of method have their applicability.ELISA d has good specificity and high sensitivity,and is simple to operate and suitable for the physical examination of large amount of pregnant women,parturients and normal people.TPPA has good specificity and high accuracy,is suitable for definite diagnosis.RPR is suitable for the monito-ring and the curative effect observation in the patients with the active stage of siphilis.Compared with ELISA,TP-AD has slightly less sensitivity,but good specificity and can be used for screening without specific instrument.

Delayed diagnosis of ocular syphilis that manifested as retinal vasculitis and acute posterior multifocal placoid epitheliopathy.

A 55‑year‑old female presented with bilateral progressive retinal vasculitis. She was on systemic and intravitreal steroids on the basis of uveitis work‑up result (negative result including rapid plasma reagin), but her visual acuity continued to deteriorate to light perception only. Ocular examination showed retinal vasculitis, multiple yellow placoid lesions and severe macula edema in both eyes. Repeated work‑up revealed positivity of fluorescent treponemal antibody‑absorption in serum and subsequently in cerebrospinal fluid. Ocular syphilis was diagnosed. And intravenous penicillin G resulted in rapid resolution of vasculitis and macular edema. To avoid delay in the diagnosis of ocular syphilis, high index of suspicion and repeating serological tests (including both treponemal and non‑treponemal tests) are warranted.

Comparison of Quantitative Results among Two Automated Rapid Plasma Reagin (RPR) Assays and a Manual RPR Test / 대한진단검사의학회지

BACKGROUND: We compared two automated Rapid Plasma Reagin (RPR) assay kits with a manual RPR assay kit to evaluate the possibility of using the two automated RPR assays as an alternative to the manual RPR assay for a quantitative monitoring. METHODS: One hundred eighty-five samples were analyzed, including 16 sera from patients with primary, secondary, and latent syphilis. Measured RPR unit (R.U.) values of two automated RPR assay kits, Mediace RPR (Sekisui Chemical Co., Ltd, Japan) and HBi Auto RPR (HBI Co., Ltd, Korea), were compared with the RPR titers of Macro-Vue RPR card test (Becton Dickinson BD Microbiology systems, USA). As a confirmatory test, Anti-Treponema pallidum EUROLINE WB (IgG) and Anti-Treponema pallidum EUROLINE WB (IgM) (Euroimmun, Germany) were used. RESULTS: There was a prozone effect with Mediace RPR at RPR titer (card test) of 1:16, but not with HBi Auto RPR. The R.U. values of the two automated RPR assays did not show proportional increase to the RPR titer. Agreement between manual RPR and two automated RPR assay kits, Mediace RPR assay and HBi Auto RPR assay, were 83.8% and 83.2%, respectively. CONCLUSIONS: The two automated RPR assay kits could not be used as an alternative to manual RPR test for quantitative analysis of RPR titer. As Mediace RPR shows a prozone effect at relatively low RPR titer, caution is needed in the interpretation of the measured values.