ABSTRACT
Objective To investigate the incidence of prozone phenomenon of rapid plasma reagin (RPR) test in syphilis serolog-ic testing and its correlation with the intensity of chemiluminescent microparticle immunoassay (CMIA) results.Methods A total of 101493 patients in our hospital from January 2014 to December 2015 were performed syphilis serologic testing by CMIA ,RPR and treponema pallidum particle agglutination (TPPA).The incidence rate of prozone phenomenon in RPR testing was evaluated.Its in-fluencing factors were investigated by using the Logistic regression.Results Among 101493 serum samples ,2180 cases were posi-tive by CMIA and 767 cases were positive by RPR ,the incidence rate of prozone phenomenon was 3.3% (26/767)in RPR.The Lo-gistic regression results indicated that the incidence of prozone phenomenon was significantly correlated with CMIA S /CO values and RPR titer ,but had no correlation with sex ,age and seasonality.Conclusion Although the incidence of prozone phenomenon is low in syphilis serologic testing ,but it is enough important.The patients with higher S/CO value in CMIA test have a higher inci-dence rate of RPR prozone phenomenon.
ABSTRACT
Rupioid syphilid is a type of pustular syphilis which accounts for <2% of cases of secondary syphilis. In pustular syphilis, pustules undergo central necrosis giving rise to "limpet-like" crusts resembling an "oyster shell." When the clinical findings are atypical, a diagnosis is made based on serologic testing. The prozone phenomenon occurs in <1% of patients with primary or secondary syphilis. This is a false negative reaction that occurs when very high antibodies in the serum prevent the formation of the antibody-antigen lattice needed to visualize a flocculation reaction. We report a case of rupioid syphilid in a pregnant woman accompanied by the prozone phenomenon. An accurate diagnosis was delayed because of atypical clinical findings and false-negative serologic results.
Subject(s)
Female , Humans , Antibodies , False Negative Reactions , Flocculation , Necrosis , Pregnant Women , Serologic Tests , Syphilis , Syphilis, CutaneousABSTRACT
La sífilis es una infección de transmisión sexual que debe ser considerada en el diagnóstico diferencial de lesiones cutáneas en pacientes con infección por el virus de inmunodeficiencia humana (VIH). Se presenta el caso de un paciente positivo para VIH con una placa eritematosa que simuló ser un linfoma cutáneo, una infección por micobacterias, una histoplasmosis o una esporotricosis. El diagnóstico de sífilis secundaria se retardó debido al fenómeno de prozona. Los hallazgos clínicos e histopatológicos hicieron el diagnóstico de sífilis secundaria atípica.
Syphilis is a sexually transmitted disease that should be considered in the differential diagnosis of cutaneous lesions in HIV patients. We report the case of a patient who presented to the dermatology clinic with an erythematous plaque, appearing to be a cutaneous lymphoma, mycobacteria infection, histoplasmosis or esporotricosis. The real diagnosisof secondary syphilis was delayed because of a prozone phenomenon. The clinical findings, epidemiology and histologic findings establish the diagnosis of atypical secondary syphilis.
Subject(s)
Syphilis , Case ReportsABSTRACT
Introdução: as incidências de sífilis no adulto e sífilis congênita são elevadas no Brasil, sendo decisivas no aumento do coeficiente de mortalidade infantil. Objetivo: relatar um caso de sífilis recente, em gestante de segundo trimestre, com efeito prozona em sorologia, identificado durante o atendimento na Maternidade da Santa Casa de Misericórdia de Vitória, ES. Métodos: relato de caso atendido, em outubro de 2007, na Maternidade da Santa Casa de Misericórdia de Vitória, Espírito Santo. Resultados: a paciente apresentava sifílides papulosas em genitália externa, exantema macular em abdome e dorso, e febre não-aferida. O VDRL foi negativo com soro puro. Após a diluição, foi reativa até 1/128, caracterizando, assim, efeito prozona. O teste treponêmico FTA-Abs foi positivo e os exames anti-HCV, HBsAg e anti-HIV foram não-reatores. Conclusão: o profissional de saúde deve estar capacitado para o diagnóstico clínico da sífilis e estar atento para a possibilidade da ocorrência de efeito prozona em pacientes com sifílides papulosas. A diluição sorológica é sempre recomendada para o correto diagnóstico laboratorial da sífilis. A instituição de tratamento adequadoo mais precocemente possível em gestante com sífilis, bem como no parceiro sexual também deve ser observada.
Introduction: the incidence of adult syphilis and the congenital syphilis are raised in Brazil, being some of the causes to increase infantile death rate.Objective: this study aims at relating a recent syphilis case, in a second trimester pregnant woman, with serum prozone phenomenon, identified duringattendance in the Maternidade da Santa Casa de Misericórdia de Vitória, Espírito Santo. Methods: case report related during attendance in October of 2007, at Maternitdade da Santa Casa de Misericórdia de Vitória, Espírito Santo State. Results: the patient presented papulosa sifilides in her external genital area and macular exanthema in the abdominal and back regions, with no gauged fever. The VDRL was negative with pure serum. After dilution it was reagent till up to 1/128 characterizing, thus, prozone phenomenon. The FTA-Abs treponemic test was positive and the anti-HCV, HBsAg and the anti-HIV were no reagent. Conclusion: the health professional must be capable for clinical diagnosis of syphilis and be attentive to the possibility of prozone phenomenon occurrence in patients with papulosa sifílides. Serum dilution is always recommended for the correct syphilis laboratorial diagnosis and to institute adjusted treatment in pregnant woman with syphilis, as well as for the sexual partner, as early as possible.