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.

Detecção de sífilis por ensaios de ELISA e VDRL em doadores de sangue do Hemonúcleo de Guarapuava, Estado do Paraná / Syphilis detection using ELISA and VDRL tests on blood donors at the blood center of Guarapuava, State of Paraná

O objetivo desse estudo foi avaliar a soroprevalência de sífilis em 5.752 doadores de sangue atendidos no Hemonúcleo de Guarapuava-PR, em 2006. As taxas de positividade foram de 2,1 por cento pelo teste de ensaio imunoenzimático e 0,2 por cento pelo Veneral Disease Research Laboratory, mostrando baixa prevalência de sífilis nos indivíduos que procuraram este banco de sangue.

The aim of this study was to evaluate the syphilis seroprevalence among 5,752 blood donors who were attended at the blood center of Guarapuava, State of Paraná, in 2006. The seropositivity rates were 2.1 percent for enzyme Linked Immuno Sorbent Assay and 0.2 percent for Veneral Disease Research Laboratory, thus showing low prevalence of syphilis among the individuals who came to this blood bank.

Prevalência da co-infecção HIV-sífilis em um hospital universitário da cidade do Rio de Janeiro no ano de 2005 / Prevalence of HIV-syphilis coinfection in a university hospital in the city of Rio de Janeiro in 2005

Estudo de prevalência da co-infecção HIV-sífilis realizado com 830 pacientes em acompanhamento ambulatorial para HIV/aids entre janeiro e maio de 2005 no Hospital na cidade do Rio de Janeiro. Os participantes realizaram exames de VDRL (veneral disease research laboratory), contagens de células CD4+/CD8+ e de carga viral e responderam perguntas sobre características sócio-demográficas e história prévia de sífilis. A prevalência da sífilis foi de 2,7 por cento (22), a relação entre homens e mulheres co-infectados foi de 4:1, aproximadamente. Homossexuais masculinos foram os mais acometidos e não encontramos associação entre co-infecção e idade, escolaridade e parâmetros laboratoriais testados. Do total de casos com sífilis, 73 por cento (16) relataram tratamento prévio; destes, 14 (88 por cento) pacientes foram re-infectados, enquanto 2 (12 por cento) pacientes realizaram tratamento inapropriado. A presença de co-infecção HIV-sífilis em pacientes em acompanhamento rotineiro alerta-nos para necessidade de aconselhá-los a adotar práticas sexuais seguras durante os seus atendimentos ambulatoriais.

This was a study on the prevalence of HIV-syphilis coinfection among 830 HIV/AIDS patients who were being followed up as outpatients at a hospital in Rio de Janeiro between January and May 2005. The participants underwent laboratory tests at the venereal disease research laboratory (VDRL) consisting of CD4+/CD8+ cell counts and viral load tests. They answered questions about their sociodemographic characteristics and past medical history of syphilis. The prevalence of syphilis was 2.7 percent (22 patients) and the ratio between men and women with coinfection was approximately 4:1. Homosexual men were the category most affected. We did not find any association between coinfection and age, schooling and the laboratory parameters tested. Out of the total number of patients with syphilis, 73 percent (16) reported previous treatment; of these, 14 (88 percent) were reinfected, while two (12 percent) underwent inappropriate treatment. The presence of HIV-syphilis coinfection among patients undergoing routine follow-up signals the need to advise them to adopt safe sex practices, during their outpatient visits.

Single photon emission computed tomography of technetium-99m tetrofosmin myocardial perfusion imaging in patients with systemic lupus erythematosus

Was to evaluate the utility of single-photon emission computed tomography [SPECT] of technetium-99m tetrofosmin [Tc-99m TF] myocardial perfusion imaging to detect myocardial involvement in patients with systemic lupus erythematosus [SLE] and its relation to presence or absence of cardiolipin antibodies [aCL]. Three groups of subjects-group 1: 33 SLE female patients with non-specific cardiac symptoms and signs, group 2: 28 female SLE patients without any cardiac symptoms and signs, and group 3: 24 female healthy controls-were evaluated by comparing rest and dipyridamole-stress Tc-99m TF myocardial perfusion SPECT. Cardiolipin antibodies had been assessed in all cases. Tc-99m TF myocardial perfusion SPECT revealed perfusion defects in 82% and 43% of the cases in groups 1 and 2, respectively. However, no cases in group 3 demonstrated myocardial perfusion defects. Multivariate analysis revealed a positive correlation between age and the number of CAD risk factors [r[2]=0.482]. Also, lower HDL, higher incidence of smoking, higher body mass index and postmenopausal status are an important determinant factors for presence of CAD in SLE patients. However, there is statistically higher prevalence of reversible perfusion defects [RDs] in group 2 with [+] aCL [31%] compared to [-] aCL [13.3%] in the same group. Also, RDs were statistically higher in [-] aCL of group 1 [61.1%] compared to [-] aCL in group 2. Tc-99m TF myocardial perfusion SPECT is a useful noninvasive imaging modality to detect cardiac involvement in SLE patients with or without cardiac symptoms and signs. Lower HDL cholesterol level, age and postmenopausal status in addition to higher body mass index were the variables associated with myocardial perfusion abnormalities in our patients

Prevalence of HIV and VDRL seropositivity in blood donors of Delhi.

Blood transfusion has been the transmission mechanism in 15 per cent of total patients infected with human immunodeficiency virus (HIV). A few reports are available regarding the trend of HIV seropositivity in northern India. Prevalence of VDRL (venereal disease research laboratory) reactivity varies from 0.8-15 per cent in blood donors. We present data on the prevalence and trends of infection with HIV 1 and 2 and VDRL reactivity in blood donors in Delhi. Between 2000-2002, a total of 76089 (voluntary and replacement) donors were screened. Majority (82.4%) were replacement donors. Seropositivity for HIV and VDRL was seen in 0.54 and 2.6 per cent of donors respectively. The percentage of seropositivity for HIV and VDRL was significantly higher in replacement donors (P<0.001). It is suggested that extensive donor selection and a voluntary donor service would reduce the number of infectious donors significantly. Non-renumerated repeat voluntary donor services are urgently required to lower the prevalence of transmissible infections. While the need to change to a voluntary donor service and devising effective donor screening cannot be over emphasized, there is also a need to mandate HIV antigen detection in India.

Infectious markers in blood donors of East Delhi: prevalence and trends.

All blood donors Voluntary and Replacement who have donated blood in the centre or in the voluntary blood donation camps, were analyzed for the prevalence of infectious markers over a period of 3 years from 1997 to 1999. A total of 52500 blood units were collected and screened for hepatitis B surface antigen (HBsAg), antibodies to HIV I and II and VDRL reactivity. Seropositivity was 471 (0.8%) for HIV I and II, 963 (1.8%) for HbsAg, 1449 (2.76%) for VDRL and 64 (0.5%) for anti HCV. Voluntary donors were comparatively safe. The seropositivity for HIV showed increasing trend between 1997 to 1999.

Biological false reactive VDRL tests: when to re-test?

Syphilis serology is a basic screening test for the workers who want to go abroad. Many countries reject migrant workers who have reactive syphilis serology. Biological false reactives warrant repeated syphilis serology. We prospectively studied 30 patients (25 males and 5 females) who had biological false reactive VDRL tests (VDRL reactive, confirmatory TPHA negative). Affirmative tests for syphilis serology for all cases were performed every two weeks. On follow-up, the expected range (95% CI) for seroconversion was between 9.25 and 10.49 weeks. Most cases (25 cases) completely returned to the VDRL non-reactive stage within 10 weeks; three cases completely returned within 6 weeks; 2 cases completely returned within 14 weeks. It is recommended that repeat syphilis serology be conducted 10 weeks after an initial biological false reactive VDRL test.

Beta2-glycoprotein I dependent anticardiolipin antibodies and lupus anticoagulant in patients with recurrent pregnancy loss.

AIM: The present study was aimed to define the incidence of antiphospholipid antibodies of different types lupus anticoagulant (LAC), venereal disease research laboratory test (VDRL) and Beta2-glycoprotein I dependent anticardiolipin antibodies Beta2 I aCL) in our cohort of population experiencing recurrent pregnancy loss (RPL) from Andhra Pradesh, South India. SETTING AND DESIGN: A referral case-control study at a tertiary centre over a period of 5 years. PARTICIPANTS: 150 couples experiencing 3 or more recurrent pregnancy losses with similar number of matched controls. MATERIAL AND METHODS: LAC activity was measured by the activated partial thromboplastin time (aPTT) according to the method of Proctor and Rapaport with relevant modifications. VDRL analysis was performed by the kit method supplied by Ranbaxy Diagnostics Limited and Beta2 Glycoprotein I dependent anticardiolipin antibodies were estimated by ELISA kit (ORGen Tech, GmbH, Germany) with human Beta2 Glycoprotein I as co-factor. STATISTICAL ANALYSIS: Statistical analysis was performed using Student's t test. RESULTS: LAC activity was found positive in 11 women (10.28%). The mean +/- SE Beta2 I aCL concentration in the study group was 14.53 (micro/ml) +/- 1.79 (range 0 to 90.4 micro/ml) which was higher than the control group with a mean +/- SE of 7.26 (micro/ml) +/- 0.40 (range 0 to 18 u/ml). The binding of the antibodies to the antigen was observed in 40.24% (n=33) of the cases compared to 6.09% (n=5) in controls. VDRL test was positive in 7(2.34%) individuals (3 couples and 1 male partner) and none among controls. CONCLUSIONS: The present study indicates the importance of antiphospholipid antibodies in women experiencing RPL and suggests the usefulness of screening for these antibodies as a mandatory routine for instituting efficient therapeutic regimens for a successful outcome of pregnancy.

Audit of management of pregnant women with positive VDRL tests.

BACKGROUND: Syphilis is a preventable cause of foetal loss and congenital disease. Although the VDRL test is an integral part of routine antenatal care in India, little is known about the disease burden in pregnancy in India. Therefore, we carried out a study to determine the prevalence of VDRL positivity and syphilis among pregnant women in Vellore and to audit the management and outcome of VDRL-positive pregnancies. METHODS: A retrospective review of case records. RESULTS: Only 0.98% of pregnant women were positive by the VDRL test. However, foetal loss occurred in 16 (32%) of the 50 seropositive women; 15 of these did not receive antenatal care. Seventeen of the 34 seropositive multiparous women had had previous foetal losses. Only 16 women had received penicillin. CONCLUSION: Although the seroprevalence of syphilis in pregnancy is low, it is an unrecognized cause of foetal loss in Vellore. An audit of the testing and management of VDRL positivity in pregnancy provides valuable information on the quality of antenatal care in an area.

Síndrome antifosfolípido / Antiphospholipid syndrome

El síndrome antifosfolípido es un cuadro clínico caracterizado principalmente por una tríada constituida por trombosis venosa profunda a repetición, abortos frecuentes y trombocitopenia, asociado a la presencia de anticoagulante lúpico y anticuerpos anticardiolipinas circulantes. Puede o no asociarse a mesenquimopatías y su tratamiento está constituido por los anticoagulantes y los corticoides. En este artículo de puesta al día se ha tratado de entregar una visión global muy resumida de una patología que recién está entrando al campo de la clínica y que aún no adquiere toda la importancia que merece. En su conocimiento falta aún mucho camino que recorrer y numerosos aspectos por investigar. Sin embargo, es importante que el clínico tenga presente esta posibilidad diagnóstica tanto en sus formas secundarias como primarias

Anticardiolipin antibodies in children under chronic hemodialysis efficacy

IgG and IgM anticardiolipin antibodies [aCL] concentrations were determined in serum samples of 48 children with ESRD on hemodialysis using ELISA technique in an attempt to analyze their possible role in the occurrence of thrombosis of the vascular access. 10 normal healthy children were studied as a control group. The positivity of both IgG-aCL and IgM-aCL isotypes were high in hemodialysis patients. The mean values of GPL units was 25.7 +/- 10 and 9.4 +/- 3.1 for MPL units. Children with positive levels of aCL had significantly more prior thrombosis of vascular access. A strong negative correlation between platelet count and positive aCL titers was found. Negative correlation was also appeared between platelet count and occurrence of fistula thrombosis. Elevated positive levels of aCL are common in children with ESRD on hemodialysis and should be interpreted as markers of risk for fistula thrombosis, and may be useful in prediction of subsequent vascular occlusive events

Study of anticardiolipin antibodies and anticardiolipin syndrome in rheumatoid arthritis

This study was carried out on two groups of subjects. The control group consisted of 10 apparently healthy subjects with a mean age +/- S.E. 22.5 +/- 1.22 years. The second group consisted of 20 rheumatoid patients with a mean age +/- S. E. of 38.4 +/- 1.38 years. All subjects were free from any disease affecting anticardiolipin antibodies level and also they were already diagnosed as rheumatoid arthritis clinically and serologically. This study revealed a significant increase in the levels of anticardiolipin antibodies in the studied rheumatoid patients when compared with the control group [P <0.001, P <0.05] as regarding IgG and IgM respectively. Also, showed a significant decrease of platelets count in rheumatoid group when compared with the control [P < 0.05]. There was a significant increase in the anticardiolipin antibodies level in the married female rheumatoid cases with recurrent fetal loss compared with those without recurrent fetal loss [P <0.05]. The mean levels of anticardiolipin antibodies in rheumatoid patients were significantly lower after regular plasmapheresis [P < 0.05, P <0.01]. It can be concluded that anticardiolipin antibodies level may be considered a good denominator of recurrent fetal loss and thrombotic episodes in rheumatoid arthritis also regular plasmapheresis recommended as one of the main lines of management of such rheumatoid patients