Inmunoanálisis quimioluminiscente de micropartículas (CMIA) en el diagnóstico de sífilis: caracterización y valorización

Introducción: La inmunoquimioluminiscencia de micropartículas (CMIA), no es recomendada en el día de hoy para el tamizaje ni confirmación de sífilis en pacientes, las guías chilenas recomiendan tamizaje con V.D.R.L y confirmación con hemaglutinación. Objetivo: Determinar la especificidad, sensibilidad y correlación diagnóstica de esta técnica respecto a la prueba treponémica de uso habitual. Materiales y Métodos: De 815 muestras obtenidas en un periodo de 6 meses, a todas las cuales se les aplicó las pruebas de VDRL, MHA-TP y CMIA, 484 muestras fueron positivas para MHA-TP. Se determinó el rendimiento, se graficaron las curvas ROC, índice de correlación y punto de corte óptimo. Resultados: La CMIA. demostró una sensibilidad de 100%, especificidad: 94,6%, VPN: 100% y VPP: 96.4% y una eficiencia de 97,8% con respecto al MHA-TP, con un índice de correlación: 0,97 y un punto de corte de 7.665, de modo que toda muestra con una CMIA. sobre este valor no necesitaría de una segunda prueba treponémica para su confirmación. El 7,11% tuvo valores intermedios de CMIA (1.0 a 7.664). Conclusión: La CMIA. es una técnica automatizada altamente sensible y específica, equiparable al MHA-TP. Aplicada como prueba inicial de testeo para sífilis incrementa la certeza diagnóstica y podría permitir el diagnóstico precoz de la enfermedad.

Background: The chemiluminescent microparticle immunoassay (CMIA) is not recommended for screening or confirmation of syphilis in patients, Chilean guidelines recommend screening with VDRL and confirmation with hemagglutination. Aim: To determine the specificity, sensitivity, and diagnostic correlation of this technique compared to the usual treponemal test. Methods: Of the 815 samples obtained over a period of 6 months, all of which were subjected to VDRL, MHATP, and CMIA. testing, 484 samples were positive for MHA-TP. The performance was determined, ROC curves were graphed, correlation index and optimal cutoff point were determined. Results: CMIA showed a sensitivity of 100%, specificity of 94.6%, NPV of 100%, PPV of 96.4%, and an efficiency of 97.8% compared to MHA-TP, with a correlation index of 0.97 and a cutoff point of 7.665, such that any sample with a CMIA. value above this value would not require a second treponemal test for confirmation. 7.11% had intermediate CMIA. values (1.0 to 7.664). Conclusion: CMIA. is a highly sensitive and specific automated technique comparable to MHA-TP. When applied as an initial screening test for syphilis, it increases diagnostic certainty and may allow for early diagnosis of the disease.

Sífilis: las sombras en el diagnóstico. A propósito de un caso clínico

La sífilis es una infección de transmisión sexual, potencialmente grave. La presentación clínica es muy variada, desde manifestaciones cutáneo-mucosas hasta neurológicas. Para el diagnóstico se emplean estudios de laboratorio, treponémicos y no treponémicos, con los que se realizan diferentes algoritmos para disminuir las limitaciones de cada prueba por separado. Se discute el caso de un joven que se presenta con fiebre y lesiones en piel sugestivas de sífilis secundaria, con un test VDRL falso negativo por efecto prozona. Este fenómeno, infrecuente, se debe a la concentración desproporcionadamente alta de anticuerpos. Conocer las herramientas diagnósticas y trabajar en conjunto con el equipo de laboratorio, puede facilitar el acercamiento a la enfermedad y a un tratamiento oportuno disminuyendo así la morbimortalidad de los pacientes.

Syphilis is a potentially serious sexually transmitted infection. The clinical presentation is very varied, from cutaneous-mucosal to neurological manifestations. For the diagnosis, treponemal and non-treponemal laboratory studies are used, with which different algorithms are performed to reduce the limitations of each test separately. We discuss the case of a young man who presented with fever and skin lesions suggestive of secondary syphilis, with a false negative VDRL test due to prozone effect. This rare phenomenon is due to a disproportionately high concentration of antibodies. Knowing the diagnostic tools and working together with the laboratory team can facilitate the approach to the disease and timely treatment, thus reducing the mor bidity and mortality of patients.

A sífilis é uma infecção sexualmente transmissível potencialmente grave. A apresentação clínica é muito variada, desde manifestações cutâneo-mucosas a neurológicas. Para o diagnóstico, são utilizados estudos laboratoriais, treponêmicos e não treponêmicos, com os quais são realizados diferentes algoritmos para reduzir as limitações de cada teste separadamente. Discutimos o caso de um jovem que apresentou febre e lesões cutâneas sugestivas de sífilis secundária, com teste VDRL falso negativo devido ao efeito prozona. Esse fenômeno raro se deve à concentração desproporcionalmente alta de anticorpos. Conhecer as ferramentas diagnósticas e trabalhar em conjunto com a equipe do laboratório pode facilitar a abordagem da doença e o tratamento oportuno, reduzindo assim a morbimortalidade dos pacientes.

Alopecia areata y vitamina D sérica en pacientes iraquíes: un estudio de casos y controles / Alopecia Areata And Serum Vitamin D in Iraqi Patients: a case-control study

Background: Alopecia areata (AA) is a typical hair issue, which may have obliterating mental and social outcomes and is portrayed by the nearness of nonscarring alopecia. Objective: This examination has targets to assess the serum nutrient D levels , with AA; contrast the outcome and clearly sound control; and confirm relationship between AA types and serum nutrient D levels. Patients Also Methods: the examine might have been led clinched alongside Tikrit educating healing facility throughout those time starting with June 2019 of the limit for January 2020. Irrefutably the quantity of subjects associated with the assessment was ninety individuals isolated in two social events; the patients bundle were forty five the people who whimper of AA while the resulting gathering including a forty five age and sex-made solid volunteers were picked as a benchmark gathering. The degree and movement of the alopecia were noted and the patients were meticulously broke down for signs of various ailments. Research center assessments were led to patients and also to those control population, these included serum vitamin D levels were measured as 25-hydroxyvitamin D {25(OH)D} using a chemiluminescence microparticle immunoassay. Blood models were gotten starting with patients and control subjects after totally taught consent was gotten. Results : An essential complexity may have been found for serum 25-OH Vit D levels between patients other than controls. Vitamin D sufficiency were more common in controls than in patients. Serum Vitamin D was deficient in both cases and controls group; but, the deficiency was significantly more throughout AA group (35. 6%) compared to the handle group (11. 1%). Among the list patients gathering, levels associated with nutrient D were totally higher in guys in contrast with females. Conclusions: AA might be related with nutrient D deficiency as mean degrees of nutrient D of patients were seen as fundamentally lower than typical sound controls.

Prevalence of Seropositive VDRL Cases amongst Pregnant Women at the Rivers State University Teaching Hospital, Nigeria: Is Routine Screening for Syphilis Using VDRL Still Relevant?

Background: Untreated maternal syphilis is strongly associated with adverse birth outcomes. The WHO recommends routine serological screening in pregnancy. Some workers have advised a reappraisal of this practice, having demonstrated low seroprevalence in their antenatal population.Objective:To determine the prevalence of seropositive VDRL cases amongst pregnant women at the Rivers State University Teaching Hospital (RSUTH) in order to justify the need and cost-effectiveness for continued routine syphilis screening using VDRL alone.Methodology:A retrospective review of hospital and laboratory records of all pregnant women booked for antenatal care (ANC) at RSUTH in a two-year period, from May 2017 to April 2019, was carried out. Data on patients’ age, parity and educational level, and reactivity of VDRL test at booking were retrieved using structured pro-forma and analyzed using Epi Info Version 7. Test for significance using Chi-square was set at significant level of P<0.05.Results:3560 clinic patients had VDRL screening out of which 63 were positive. The overall prevalence rate in this study was 1.8%. The mean age was 31.5±4.7 years and the mean gestational age at booking was 22.1±6.8 weeks. There was no significant relationship between their age (χ2 = 0.403, p-value=0.940), parity (χ2 = 3.707, p-value=0.0.157), and educational status (χ2 = 1.853, p-value=0.396),and seropositivity. The cost of VDRL test per patient in RSUTH is $3, to detect the 63 cases the sum of $10,680 was spent.Conclusion: The seroprevalence rate of syphilis in this study was low. Initial screening using VDRL alone is neither justified nor cost effective. Selective screening based on risk factors and specific test with TPHA is recommended.

Trend of Seroprevalence of Syphilis in a Tertiary Care Centre

Syphilis is a sexually transmitted disease (STD), caused by Treponema pallidum subsp. pallidum. In this study done in a Tertiary Care Centre, seroprevalence and rising or falling trend of syphilis in different groups among patients was analyzed. Aims: To study trend of seroprevalence of syphilis in a tertiary care centre. Methods: A retrospective study was carried over a period of 3 alternate years from 1st May 2012 to 30th April 2013, 1st May 2014 to 30th April 2015 and 1st May 2016 to 30th April 2017. Seroprevalence of syphilis in different patient groups was analyzed by Venereal Disease Research Laboratory (VDRL) and Treponema Pallidum Hemagglutination Assay (TPHA). A Rising or falling trend of syphilis seroprevalence was also analyzed. Results: Among the 17941 serum samples tested, 504 (2.80%) were found reactive by VDRL test. A total of 1244 were tested by both quantitative VDRL test & TPHA assay. A falling trend of seroprevalence was observed from 1.04% in May 2012-April 2013 to 0.58% in May16-April17. A falling trend was observed in STD clinic attendees from 7.9% in May 2012-April 2013 to 6.12% in May 2016-April 2017. A seroprevalence of 61.72% was observed in males compared to 38.27% in females. Conclusion: A decreasing trend of syphilis was observed over a study period among antenatal women, STD clinic attendees & HIV-seropositive individuals. These findings could be interpreted as indicators of sustained efforts for case detection, treatment and improved programme for prevention & management of STD’s.

Trends of transfusion transmittable infections among voluntary blood donors in a cardiac care hospital, Bengaluru, India

Introduction: Transmission of infectious diseases through donated blood is of concern to blood safety as transfusion forms an integral part of medical and surgical therapy. Blood transfusion carries the risk of transfusion-transmittable infections including HIV, hepatitis–B etc. Screening of voluntary donors who represent healthy population serves as a predictor for these dreadful diseases in healthy population. Materials and Methods: This retrospective study was conducted at the blood bank of Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru. Data were analyzed for a period of 7 years from January 2011 to December 2017. All voluntary donors including replacement donors of our blood bank were screened for Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) and Syphilis infection by using ELISA. Results: The most common infection was Hepatitis B (0.69%) followed by Syphilis (0.34%) and HIV (0.0736%) and least with HCV (0.04%) in our study. Conclusion: This study has shown a decrease in seroprevalence for HIV and increase in seroprevalence for HCV over 7 years study period.

Diagnóstico laboratorial confirmatório da sífilis realizado no Instituto Adolfo Lutz de São José do Rio Preto / Confirmatory laboratory diagnosis of syphilis performed at the Adolfo Lutz Institute in São José do Rio Preto

Introdução: A sífilis é uma doença infecciosa causada pela bactéria Treponema pallidum, transmitida principalmente pelo contato sexual. O Instituto Adolfo Lutz de São José do Rio Preto (IAL-SJRP) tem um importante papel no controle da sífilis, sendo o laboratório de saúde pública referência para 102 municípios do Departamento Regional de Saúde XV. Objetivo(s): Realizar a confirmação da sífilis em amostras recebidas no IAL-SJRP. Casuística e Métodos: Após triagem nas unidades de saúde, as amostras enviadas para confirmação foram: testes rápidos positivos, VDRL reagentes, crianças 0-18 meses e parceiros de pessoas com sífilis. Foram analisadas 781 amostras de soro de setembro/2016 a agosto/2017 conforme fluxograma do Manual Técnico para Diagnóstico da Sífilis do Ministério da Saúde e adotados testes treponêmicos e não treponêmicos. Resultados: Das 781 amostras enviadas pelas unidades, 299 (38,3%) eram teste rápido positivo, 75 (9,6%) VDRL reagente, 243 (31,1%) eram pacientes controles de tratamento, 23 (2,9%) parceiros, 25 (3,2%) amostras de crianças 0-18 meses e 116 (14,9%) vieram sem justificativa. As amostras recebidas com resultados positivos nos testes rápidos, VDRL e controle de tratamento foram confirmadas em 94,3%, 93,3% e 77% respectivamente. Dentre os parceiros 91,3% foram negativas, amostras de crianças de 0-18 meses 92% foram negativas e, amostras sem justificativas 75 (64,7%) foram positivas, 37 (31,9%) negativas e 4 (3,4%) indeterminadas Conclusão: A confirmação do diagnóstico da sífilis ocorreu em 79,39% das amostras analisadas. O IAL-SJRP como laboratório de referência em saúde pública, tem um importante papel no controle da sífilis.

Análisis de técnicas treponémicas y no treponémicas en el tamizaje serológico de sífilis / Analysis of treponemical and non treponemical techniques for syphilis blood bank screening

Introducción: las infecciones producidas por el Treponema pallidum causante de la sífilis han alcanzado gran trascendencia entre las enfermedades infecciosas transmitidas por transfusión (ITT) y un nuevo repunte a nivel mundial. Debido a las diferentes etapas clínicas que presenta la enfermedad, el desempeño de cada prueba de detcción varía y se limita. Así, la elección de una técnica de tamizaje adecuada se convierte en un punto fundamental para garantizar la calidad y seguridad de cada hemocomponente despachado. Objetivo: analizar y evaluar la eficacia de cuatro técnicas de tamizaje serológico. Métodos: se realizó un estudio comparativo transversal con 1 376 muestras seleccionadas al azar a nivel nacional en el mes de diciembre 2015. Se compararon las técnicas de inmunocromatografía (IC), floculación (VDRL), electroquimioluminiscencia (ECLIA) y microelisa. Se analizó la eficacia individual de cada técnica y comparativa con respecto a la gold standard (FTA-ABS) utilizando para ello el coeficiente de correlación Cohen-Kappa (К). Resultados: las cuatro pruebas presentaron un nivel de concordancia del 98,67 por ciento. Del total de resultados discrepantes el 63,16 por ciento fueron generados por VDRL, la cual al mismo tiempo demostró tener el menor rendimiento (k=0,14) y alcanzó los valores más bajos de sensibilidad (s=69 por ciento) y especificidad (e=45 por ciento), lo cual contrastó con la IC que demostró el mayor rendimiento (k=0,863, s=100 por ciento, e=0,8 2 por ciento), seguido de la ECLIA (k=0,801, s=96 por ciento, e=0,82 por ciento) y el microelisa (k=0,711, s=100 por ciento, e=0,64 por ciento). Conclusión: se evidencia la necesidad de utilizar pruebas de nuevas tecnologías en el tamizaje serológico de sífilis y remplazar el uso de VDRL, ya que una correcta selección asegura el descarte de hemocomponentes en el número correcto (evitando grandes pérdidas de sangre y de dinero) y, en especial se asegura la calidad sanitaria de cada hemocomponente(AU)

Introduction: Infections produced by Treponema pallidum, which causes syphilis, have reached an important high level among infectious transmitted by transfusion (ITT). Due to the different clinical stages of the disease, the performance of each test is varied and limited. Thus, the choice of a suitable screening technique becomes a fundamental point in a blood bank, to guarantee the quality and safety of each blood component dispatched. Objective: The aim of this study was to analyze and evaluate the performance of four serological screening techniques. Methods: A cross-sectional study was conducted with 1 376 randomly selected samples nationwide in December 2015. The techniques used were immunochromatography (IC), flocculation (VDRL), electrochemiluminescence (ECLIA) and microelisa, and we compared the performance of each one and with respect to the gold standard (FTA-ABS) by using the Cohen-Kappa correlation coefficient (K). Results: The four tests had a concordance level of 98.67 percent. Of the total discrepant results the 63.16 percent were generated by VDRL, which at the same time showed the worst performance (k=0,14) and reached the lowest values ​​of sensitivity (s=69 percent) and specificity (e=45 percent). That contrasted with IC, which showed the best performance (k=0,883, s=100 percent, e=82 percent), followed by ECLIA (k=0,801, s=96 percent, e=0,82 percent) and microelisa (k=0,711, s=100 percent, e=0.64 percent). Conclusion: There is a necessity to use tests with new technologies in the serological screening of syphilis and to replace the use of VDRL in a blood bank, due to a correct selection, ensures the quality and the disposal of blood components in the correct number avoiding great losses of blood and money(AU)

Prevalência de resultados positivos de VDRL (Venereal Disease Research Laboratory) e análise das variáveis epidemiológicas em pacientes atendidos no serviço de saúde pública / Prevalence of VDRL (Venereal Disease Research Laboratory) positive results and epidemiological variables analysis in patients assessed on a public health service

Syphilis is an infection caused by Treponema pallidum of sexual, blood and vertical transmission. Despite being easy to diagnose and treat, its incidence has been increasing in Brazil in recent years, and it is being considered a public health problem in the country and worldwide. The aim of this study was to describe the prevalence of positive results for VDRL (Venereal Diseases Research Laboratory) in the city of Juiz de Fora / MG between 2014 and 2016, as well its epidemiological characteristics. 25,735 VDRL results were analyzed from the database of the Central Laboratory (LACEN) of the city hall of Juiz de Fora. The results were then related to the variables year, gender, age, pregnant or not and the region of the city where the test was performed. The prevalence of positive results was 5.55%, with the highest number of cases recorded in 2015. Reactive cases were more prevalent in the central region, in men and a higher prevalence was obtained for the age group of 12 to 18 years. Among women, it was observed higher VDRL positivity in non-pregnant women from August 2015 to December 2016. The data obtained in this study indicates an increase in prevalence of syphilis from 2014 to 2015, followed by a reduction in the following year, among the population served by SUS, where young men represent the population at greater risk.

Application comparison of VDRL and TRUST in syphilis laboratory diagnosis / 国际检验医学杂志

Objective To investigate the application of venereal disease research laboratory(VDRL) test and toluidine red unheated serum test(TRUST) in syphilis laboratory diagnosis.Methods Serum,plasma and cerebrospinal fluid (CSF) in syphilis patients and healthy controls were measured by VDRL and TRUST.Results The VDRL detection results in serum and CSF sepcimens were generally higher than the TRUST detection results by 1-2 titers,while in plasma specimen,the VDRL detection results were generally lower than the TRUST detection results by 1-2 titers than TRUST when using plasma specimen.In addition,the VDRL detection in normal control serum and plasma specimens all appeared different degrees of false positive,but in the detection of normal control CSF,the results of TRUST and VDRL were consistent.Conclusion TRUST is more suitable for serum and plasma specimens,and CSF is suitable for the CSF specimen,but not suitable for serum and plasma detection.

Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis / El examen del líquido céfalo raquídeo puede ser útil en el diagnóstico de neurosífilis en pacientes VIH + asintomáticos con sífilis

ABSTRACT Lumbar puncture in neurologically asymptomatic HIV+ patients is still under debate. There are different criteria for detecting neurosyphilis through cerebrospinal fluid (CSF), especially in cases that are negative through the Venereal Disease Research Laboratory (VDRL), regarding cellularity and protein content. However, a diagnosis of neurosyphilis can still exist despite negative VDRL. Treponema pallidum hemagglutination assay (TPHA) titers and application of the TPHA index in albumin and IgG improve the sensitivity, with a high degree of specificity. Thirty-two patients were selected for this study. VDRL was positive in five of them. The number of diagnoses reached 14 when the other techniques were added. It was not determined whether cellularity and increased protein levels were auxiliary tools in the diagnosis. According to our investigation, CSF analysis using the abovementioned techniques may be useful in diagnosing neurosyphilis in these patients.

RESUMO La punción lumbar (PL) en pacientes VIH+ neurológicamente asintomáticos es controversial. Existen diferentes criterios para detectar en el líquido cefalorraquídeo (LCR) neurosífilis (NS): el examen Venereal Disease Research Laboratory (VDRL) en primer lugar, en caso de negatividad: la celularidad y el tenor de proteinas. Sin embargo el diagnóstico de NS puede ser sostenido a pesar de la negatividad de las técnicas mencionadas. La titulación del Treponema pallidum hemagglutination assay (TPHA) y la aplicación del índice de TPHA en Albúmina e Ig G mejoran la sensibilidad asociando elevado grado de especificidad. 32 pacientes fueron seleccionados para este estudio, el VDRL fue positivo en 5. El diagnóstico se elevó a 14 cuando se sumaron el resto de las técnicas. No se evidenció que la celularidad y el aumento de proteínas fueran herramientas auxiliares para el diagnóstico. De acuerdo a nuestro trabajo el estudio del LCR con las técnicas señaladas puede ser de utilidad en el diagnóstico de NS en estos pacientes.

Sífilis congênita em município da Amazônia brasileira / Congenital syphilis in brazilian amazon city

Objetivo: estudar a epidemiologia da sífilis congênita(SC) em mulheres que deram a luz em uma maternidade de refe-rência do Sistema Único de Saúde (SUS) na cidade de Marabá-Pará. Método: estudo retrospectivo, transversal, onde foram estudadas 170 mulheres com sífilis, registradas no Sistema Nacional de Agravos de Notificação (SINAN), no período de 2008 a 2010. Resultados: A prevalência de SC foi de 43,5% (74/170); 82,4% das mães realizaram o pré-na-tal, sendo que 12,2% delas foram diagnosticadas nesse período; 23% eram adolescentes (15 a 19 anos) e 68,9% tinham entre 20 a 34 anos; 8ª série incompleta (41,9%) foi a escolaridade mais prevalente; o VDRL foi reagente em 97,3% das crianças; 4,1% delas receberam tratamento inadequado e 14,9% não foram tratadas; 16,2% dos parceiros das mães dessas crianças não foram tratados. Conclusão: dados como alta prevalência da doença na fase reprodutiva da mulher, baixa escolaridade, crianças não tratadas ou tratadas de modo inadequado e o não tratamento do parceiro demonstram que maiores esforços e investimentos são necessários para o controle da SC.

Objective: to study the epidemiology of congenital syphilis (CS) in women who gave birth in a reference maternity of the Unified Health System (SUS) in the city of Maraba Para. Method: a retrospective, cross-sectional study were stud-ied 170 women with syphilis, registered in the National System for Notifiable Diseases (SINAN), from 2008 to 2010. Results: the prevalence of CS was 43.5% (74/170 ); 82.4% of the mothers had prenatal care, and 12.2% were diagnosed during that period; 23% were adolescents (15-19 years) and 68.9% were between 20-34 years; 8th grade incomplete (41.9%) was the most prevalent schooling; VDRL was positive in 97.3% of children; 4.1% of them received inadequate treatment and 14.9% were not treated; 16.2% of partners of these children?s mothers were not treated. Conclusion: data as high prevalence in the reproductive phase of women, low education, untreated children or improperly treated and the partner?s non-treatment demonstrate that greater efforts and investiments are needed to control the SC.

Seroprevalence of syphilis in patients attending a tertiary care hospital in Southern India

Objective: To report our experience with two tests, anti-cardiolipin antibody test [venereal disease reasearch laboratory (VDRL) test] and specific treponemal test (Treponema pallidum hemagglutination assay), used for screening antenatal, high risk cases and cases from sexually transmitted infection in a tertiary care hospital from January 2006 till December 2008. Methods: A total of 14 639 samples received from various patient groups including antenatal cases, patients attending sexually transmitted disease (STD) clinic, blood donors and HIV positive patients were screened. Results: Among the 14 639 samples collected, 103 were positive by VDRL test. Of these 89 cases were confirmed by quantitative VDRL test and Treponema pallidum hemagglutination assay. The cumulative seroprevalence over two years was found to be 0.61% in this study. The syphilis seroprevalence reduced from 0.88% in 2006 to 0.40% in 2008. Among the various sub-populations studied, patients attending the sexually transmitted infection clinic showed a seroprevalence of 2.62%. The seroprevalence decreased significantly from 4.00% in 2006 to 1.39% in 2008. Conclusions: Our study showed a statistically significant declining rate of syphilis in STD clinics as well as the overall seroprevalence. These findings could be interpreted as indicators of improved programmes for prevention and management of STDs.

Seroprevalence of syphilis in patients attending a tertiary care hospital in Southern India

To report our experience with two tests, anti-cardiolipin antibody test [venereal disease reasearch laboratory (VDRL) test] and specific treponemal test (Treponema pallidum hemagglutination assay), used for screening antenatal, high risk cases and cases from sexually transmitted infection in a tertiary care hospital from January 2006 till December 2008. Methods: A total of 14639 samples received from various patient groups including antenatal cases, patients attending sexually transmitted disease (STD) clinic, blood donors and HIV positive patients were screened. Results: Among the 14639 samples collected, 103 were positive by VDRL test. Of these 89 cases were confirmed by quantitative VDRL test and Treponema pallidum hemagglutination assay. The cumulative seroprevalence over two years was found to be 0.61% in this study. The syphilis seroprevalence reduced from 0.88% in 2006 to 0.40% in 2008. Among the various sub-populations studied, patients attending the sexually transmitted infection clinic showed a seroprevalence of 2.62%. The seroprevalence decreased significantly from 4.00% in 2006 to 1.39% in 2008. Conclusions: Our study showed a statistically significant declining rate of syphilis in STD clinics as well as the overall seroprevalence. These findings could be interpreted as indicators of improved programmes for prevention and management of STDs.

Alterações neonatais de sífilis congênita em um hospital universitário do município de Niterói, Rio de Janeiro / Congenital syphilis neonatal alterations in a university hospital in Niterói-RJ

A prevalência da infecção pelo Treponema pallidum diminuiu sensivelmente com a penicilina, porém se observa tendência mundial no recrudescimento da sífilis, em particular dos casos de sífilis congênita (SC). Objetivos: Descrever as repercussões neonatais da SC nos recém-nascidos (RN) notificados como caso de SC em um hospital público de Niterói, Rio de Janeiro, no período de janeiro de 2005 a junho de 2006; observar o peso ao nascer e a sorologia dos RN com notificação de SC; descrever o tratamento dos casos de SC. Métodos: Amostra constituída de 35 fichas de notificação de SC do Centro de Vigilância Hospitalar do Hospital Universitário Antônio Pedro (HUAP). Utilizaram-se dados da notificação e realizou-se visita domiciliar para coleta de sangue. esultados: A população foi constituída por 29 pacientes nascidos vivos, 4 nascidos mortos e 2 abortamentos. Apenas dois casos (6,9%) evidenciavam alterações ósseas de SC. O teste Veneral Disease Research Laboratory (VDRL) realizado no líquido cefalorraquidiano (LCR) demonstrou-se não reator para todos os pacientes avaliados. O VDRL do soro dos RN no nascimento foi positivo para 23 (79,31%) pacientes. A penicilina G cristalina (PGC) foi administrada em 26 (89,65%) casos, a penicilina G procaína (PGP) em dois (6,9%) e um individuo utilizou PGC e PGP. Conclusão:O óbito fetal e aborto foram o desfecho mais ominoso como repercussão da SC. A alteração dos ossos longos foi pouco encontrada na amostra. O baixo peso ao nascer foi observado em poucos casos. O VDRL do LCR foi não reator em todos os casos. A utilização de diversos esquemas de antibiótico estava em desacordo com o protocolo proposto pelo Ministério da Saúde.

Syphilis is a sexually transmitted disease caused due to bacterium Treponema pallidum.The prevalence of this infection decreased significantly by the use of penicillin, but it is observed that it reappears particularly in cases of congenital syphilis (CS).Objective:to describe the effects of neonatal CS in newborns (NB) in a public hospital in Niterói - RJ, from January 2005 to June 2006 and to observe the birth weight and serology of newborns with CS notification.The purpose of this study is also to describe the CS treatment in each case.Methods:a sample of 35 CS notifications was recorded from the Center for Hospital Surveillance at the Antonio Pedro University Hospital (HUAP), Niterói - RJ, from January 2005 to June 2006. Data from the notifications was used and homevisit was done to collect blood samples.Results:the study population is comprised of 29 live birth patients, four miscarriages and two stillbirths. Only two cases(6.9%) had evidence of CS bone abnormalities. The VDRL test performed in cerebrospinal fluid (CSF) of the cases proved to be non-reactive for all patients.VDRL serum of newborns at birth was positive for 23 (79.31 %) patients. The crystalline penicillin G was administered in 26 (89.65 % cases,) procaine penicillinG in two (6.9%) and for one individual both crystalline penicillin G and procaine penicillin G was used.Conclusion:fetal death and abortion were the mostominous outcome and impact of CS. Long bones alterations were scarcely found in few samples. Low birth weight was observed in a few cases. CSF VDRL was not reactive in all cases. The use of several antibiotic regimens was in disagreement with the proposed protocol issued by the Ministry of Health.

Evaluación de las características funcionales del juego de reactivos VDRL Plus / Evaluation of the functional characteristics of the set of reagents called VDRL Plus

Introducción: la prueba de VDRL (venereal disease research laboratories) es una técnica no treponémica de microfloculación en lámina para la detección cualitativa y semicuantitativa de reaginas plasmáticas. El VDRL Plus es un juego de reactivos que contiene una suspensión antigénica estabilizada (no alcohólica), basada en una mezcla de cardiolipina, colesterol y lecitina en tampón fosfato. Objetivo: determinar un conjunto de parámetros funcionales que caracterizan el desempeño diagnóstico o clínico del juego de reactivo VDRL Plus producido en Centro de Isótopos (CENTIS). Métodos: los parámetros del desempeño diagnóstico evaluados fueron: sensibilidad y especificidad diagnóstica, valores predictivos positivo y negativo, razón de verosimilitud positiva y negativa. Se determinaron además los índices de Youden y de concordancia Kappa. Se emplearon como métodos de referencia TPHA (Treponema pallidum hemagglutination) y RPR (rapid plasma reagin)-carbón producidos en el CENTIS. Se utilizaron muestras de sueros obtenidas en diferentes instituciones de salud de La Habana y el estudio se realizó con dos lotes del producto. Resultados: para los dos lotes evaluados se obtuvieron valores de sensibilidad de 100 porciento y de especificidad diagnóstica de 81 y 84 porciento. Los valores predictivos positivos resultaron de 71 y 75 porciento, y los negativos de 100 porciento. Por su parte, las razones de verosimilitud negativas fueron de 0 porciento y las positivas de 5,3 y 6,3 porciento, para cada lote estudiado. Los índices de Youden obtenidos (0,84 y 0,81) y la concordancia expresada mediante Kappa muestran que existe una adecuada correlación entre los resultados con el método en evaluación y los de referencia. Conclusiones: las características funcionales evaluadas evidencian que el diagnosticador VDRL Plus es apto para el uso previsto y que estas son consistentes entre los lotes estudiados

Introduction: the VDRL test (venereal disease research laboratories) is a no-treponemal slide microaglutination test for the qualitative and semi-quantitative detection of plasma reagins in human serum. The VDRL Plus contains non alcoholic stabilized antigen suspension based in cardiolipin, lecithin and cholesterol in phosphate buffer. Objective: to determine a group of functional parameters in the diagnostic or clinical performance of the VDRL Plus set of reagents produced by the Center of Isotopes (CENTIS). Methods: several parameters, such as, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were evaluated. Likewised, Youden and Kappa indexes were calculated. Two references methods were employed, that is, TPHA (Treponema pallidum hemagglutination) and RPR-Carbon (rapid plasma reagin)-carbon, both from CENTIS. Serum samples were collected from several health centers in Havana city. Two different product batches were evaluated. Results: the sensitivity value for both evaluated batches was 100 percent and the specificity was 81 and 84 percent. The positives predictive values were 71 and 75 percent and negative predictive value was 100 percent. The positive likelihood ration were 5.3 and 6,3 percent respectively and negative likelihood ration was 0 percent for both batches. The Youden indexes obtained (0.84 and 0.81) and Kappa's indexes showed that there was an adequate correlation between the results obtained and the evaluation and reference methods. Conclusions: the evaluated functional characteristics showed that they are consistent among studied batches and that the VDRL Plus assay is suitable for the intended use

Molecular detection of Treponema pallidum sp. pallidum in blood samples of VDRL-seroreactive women with lethal pregnancy outcomes: a retrospective observational study in northern Brazil / Detecção molecular do Treponema pallidum sp. pallidum em amostras de sangue de mulheres sororeativas ao VDRL com resultado letal da gravidez: um estudo observacional retrospectivo no norte do Brasil

INTRODUCTION: Although control measures of maternal and congenital syphilis are available in Brazil, difficulties exist within the healthcare network in providing a laboratory diagnosis of the infection during the prenatal period. The objective of this study was to confirm the presence of Treponema pallidum by PCR in women with positive VDRL serology and lethal pregnancy outcomes, i.e., abortion, stillbirth and neonatal death. METHODS: A retrospective study was conducted on VDRLseroreactive women with lethal pregnancy outcomes admitted to the Fundação Santa Casa de Misericórdia do Pará (FSCM-PA) between January and July 2004. Serum samples and DNA from whole blood were obtained at the time of screening by the VDRL test. These samples were analyzed by IgG ELISA, IgM FTA-Abs and simple PCR (polA). RESULTS: During the study period, 0.7% (36/4,912) of women with lethal pregnancy outcomes presented a positive VDRL test. The polAgene was amplified in 72.7% (24/33) of these women, with 55.6% (20/36) and 94.4% (34/36) presenting IgM and IgG antibodies against T. pallidum, respectively. Comparison of these results showed a significant difference, with agreement between the PCR and IgM FTA-Abs results, suggesting that maternal syphilis was an active infection. No basic cause of death of the conceptus was reported in 97.2% (35/36) of cases. Among women who were submitted to the VDRL test during the prenatal period, only four of the nine seroreactive patients underwent treatment. CONCLUSIONS: The high frequency of syphilis in the group studied indicates the fragility of the service of infection diagnosis, treatment and monitoring, compromising epidemiological control.

INTRODUÇÃO: Apesar das medidas de controle da sífilis materna e congênita estarem disponíveis no Brasil, existem dificuldades da rede em prover o diagnóstico laboratorial da infecção durante o pré-natal. O objetivo deste estudo foi confirmar a presença do Treponema pallidum pela PCR em mulheres com sorologia positiva ao VDRL e com resultado letal da gravidez, isto é, aborto, natimorto e neomorto. MÉTODOS: Estudo retrospectivo realizado em mulheres VDRL-sororeativas com resultado negativo da gravidez, admitidas na Fundação Santa Casa de Misericórdia do Pará FSCM-PA entre janeiro e julho de 2004. As amostras de soro e DNA de sangue total foram obtidas no mesmo período da triagem pelo VDRL. Estas amostras foram analisadas pelo ELISA IgG, FTA-Abs IgM e PCR simples (polA). RESULTADOS: Durante o período de estudo, 0,7% (36/4.912) das mulheres com resultado letal da gravidez apresentaram VDRL positivo. O genepolA foi amplificado em 72,7% (24/33) destas mulheres,com 55,6% (20/36) e 94,4% (34/36) apresentando anticorpos tipo IgG e IgM contra o T. pallidum, respectivamente. A comparação destes resultados mostrou uma diferença estatística significativa, sendo que os resultados da PCR versus FTA-Abs Ig Mmostraram-se concordantes, sugerindo que a sífilis materna era uma infecção ativa. A causa básica de morte dos conceptos não foi relatada em 97,2% (35/36) dos casos. Entre as mulheres que foram submetidas ao VDRL no pré-natal, somente quatro das nove soropositivas receberam tratamento. CONCLUSÕES: A elevada frequência de sífilis no grupo de estudo indica a fragilidade do serviço no diagnóstico, tratamento e monitoramento da infecção, comprometendo o controle epidemiológico.

Recent Trends of Syphilis Prevalence in Normal Population in Korea: A Single Center Study in Seoul / 대한피부과학회지

BACKGROUND: Due to effective medicine and improved socioeconomic status, the prevalence of syphilis has rapidly decreased in South Korea. We have reported the prevalence of syphilis periodically in our center since 1977, using the same geographical areas and similar population groups and methods in order to determine trends. OBJECTIVE: To determine the current prevalence of syphilis in the healthy population of Korea and trends of syphilis prevalence during the last 30 years. METHODS: Venereal Disease Reserch Laboratory (VDRL) tests were administered to 12,453 healthy adults aged 20 or greater (12,013 physical examinees, 440 pregnant women) examined at Severance Hospital between January and December of 2005. We carried out VDRL quantitative tests and FTA-ABS tests in VDRL-reactive persons. The results were compared with that of 6 previous surveys in similar population groups reported by the same authors. Statistical analysis of the data was conducted using the Statistical Analysis System (SAS version 9.1, SAS Institute Inc., Cary, NC, USA). RESULTS: The total number of subjects positive on the VDRL test was 83 of 12,453 (0.7%). A VDRL-positive rate of 0.2% was found among the 440 pregnant women, while the 12,013 physical examinees showed a positive rate of 0.7%. Among all age groups, the VDRL-positive rate exhibited a decreasing trend from 1977 to 2005 (p<0.0001). Although there is a difference between 2000 and 2005, which indicates an increase in prevalence in those surveyed as a whole, the increase is not significant when analyzed by age groups. CONCLUSION: During the last thirty-years, the prevalence of syphilis has decreased. But, in our survey of 2005, we found an increase in prevalence. Further evaluation is necessary to confirm the trend towards an increase and the causes of the increase. Moreover, extensive policies and strategies including prophylaxis, management, education of syphilis are needed.

Seroprevalencia de Sífilis en embarazadas Alto Parana-2008

Background: Congenital syphilis is acquired from an infected mother in utero or through the birth canal. With the diagnosis of the disease and the advent of penicillin, it becomes a significant reduction. Nontreponemal serologic evidence as the VDRL (Venereal Disease Research Laboratory) or RPR (Rapid Plasma Reagin) are easy to determined, economic cost, are useful for diagnosis and essential to monitor response to treatment, which needs to the study is quantitative. The aim of this study was to investigate the incidence of syphilis infection in the pregnant population in 6 cities of Alto Paraná, in 2008. Materials and methods: Study retrospective, descriptive cross-sectional. We reviewed the files of maternal and child services private and public, of 7,380 pregnant women who attended the pre-natal control 2,028 serology for syphilis. Results: Of a total of 7,380 chips analyzed, 5,310 were public institutions, where 17% of pregnant women, presented in the medical record VDRL test. In private institutions, of 2,070 pregnant, 54% of them had registered VDRL test. In Ciudad del Este, (capital of Alto Paraná) pregnant women in public institutions were 2,445, of which, only 36% made 4 or more controls during pregnancy, 0.80% tested positive for VDRL test, 7.20% was negative and 92% did not record data, this scenario is repeated in all major cities of the department and the percentage is even lower in public institutions. Conclusion: The situation of pregnant women in Alto Paraná is alarming because it represents a significant and unnecessary risk to the newborn, because they account for many years with appropriate pharmacological and economic weapons to avoid.

La sífilis congénita se adquiere a partir de una madre infectada in útero o por el canal del parto. Con el diagnóstico de la enfermedad y el advenimiento de la penicilina, se torna una reducción significativa. Existen pruebas serológicas no treponémicas como el VDRL (Venereal Disease Research Laboratory) o RPR (Rapid Plasma Reagin) fáciles de realizar, tienen escaso costo económico, son útiles para el diagnóstico y esenciales para controlar la respuesta al tratamiento, para lo cual se necesita que el estudio sea cuantitativo. El objetivo del trabajo consistió en investigar la incidencia de la infección por sífilis, en la población embarazada, en 6 ciudades del Alto Paraná, durante el año 2008. Materiales y métodos: Se realizó un estudio retrospectivo, descriptivo, de corte transversal. Se revisaron los archivos de Servicios materno-infantil privado y público, de 7.380 embarazadas que concurrieron al control pre-natal, donde se registraba la serología para sífilis. Resultados: De un total de 7.380 fichas analizadas, 5.310 fueron de Instituciones Públicas, en donde el 17% de las embarazadas, presentaban en la historia clínica registro de test de VDRL. En Instituciones privadas, de 2.028 embarazadas, el 54% de ellas tenían registrado test de VDRL. En Ciudad del Este, (capital del Alto Paraná) las embarazadas de Instituciones Públicas, fueron 2.445, de las cuales: solo el 36% realizaron 4 o más controles durante la gestación, el 0,80% dio positivo el test para VDRL, el 7,20% dio negativo, y 92 % no registra datos, este panorama se repite en las grandes ciudades del departamento y el porcentaje es menor en Instituciones públicas. Conclusión:La situación de las embarazadas en el Alto Paraná es alarmante ya que supone un riesgo importante e innecesario para el recién nacido, debido a que se cuenta, hace muchos años con las armas farmacológicas adecuadas y económicas para evitarlas.