Leptospirose: Características da enfermidade em humanos e principais técnicas de diagnóstico laboratorial / Leptospirosis: Characteristics of the human disease and main laboratory diagnostic techniques

A leptospirose é a zoonose de maior distribuição geográfica, com estimativa de cerca de 60.000 mortes por ano. A doença é causada por bactérias do gênero Leptospira, que possui mais de 300 diferentes sorovares e 64 espécies já identificadas, sendo o ambiente a principal fonte de contaminação. A doença em humanos apresenta manifestações clínicas variadas e caráter bifásico, devendo ser confirmada por meio do diagnóstico laboratorial. O objetivo deste trabalho foi reunir conceitos atualizados sobre a leptospirose humana e as principais técnicas de diagnóstico laboratorial empregadas. A MAT é considerada o padrão-ouro para o diagnóstico da leptospirose, mas devido à baixa sensibilidade na fase inicial da doença é necessário o emprego de técnicas mais sensíveis neste período. Baseado em diversos estudos, as metodologias de PCR, ELISA-IgM e teste rápido apresentaram sensibilidade satisfatória nos primeiros dias após o início dos sintomas. Na segunda semana, a MAT apresentou 100% de sensibilidade, mantendo sua alta especificidade em ambas as fases. No geral, os testes sorológicos de ELISA-IgM e teste rápido apresentaram resultados satisfatórios como métodos de diagnóstico precoce, principalmente tratando-se de locais com pouca infraestrutura, diferente dos laboratórios de referência onde é possível empregar as técnicas de PCR e MAT.

Leptospirosis is the most widespread zoonosis, which has a balance of almost 60,000 deaths per year. Bacteria of Leptospira genus, which has more than 300 different serovars and 64 species already identified, cause the disease, being the environment the main source of contamination. The human disease presents a large set of clinical manifestations, showing biphasic presentation, the reason why leptospirosis must be confirmed by laboratory diagnosis. This study aimed to group recent concepts concerning human leptospirosis and the main diagnosis techniques employed at the laboratory. MAT is considered the gold standard for leptospirosis diagnosis, but has low sensitivity on the onset of disease, leading to the use of techniques with higher sensitivity on this period. Based on several studies, PCR, ELISA-IgM and rapid test presented satisfactory sensitivity on the onset of symptoms. In the second week, MAT showed 100% of sensitivity, maintaining its high specificity in both phases. In general, the ELISA-IgM and rapid serological tests showed satisfactory results as methods for early diagnosis, especially in the case of places with poor infrastructure, different from the reference laboratories where it is possible to use the PCR and MAT techniques.

Diagnosis of Brachyspira pilosicoli, Brachyspira hyodysenteriae and Brachyspira intermedia in hens and laying hens in the western region of Paraná through bacterial isolation and identification in qPCR / Diagnóstico de Brachyspira pilosicoli, Brachyspira hyodysenteriae e Brachyspira intermedia em aves de postura e matrizes de corte na região oeste do Paraná através do isolamento bacteriano e identificação na qPCR

Bacteria of the genus Brachyspira can cause enteric diseases in poultry causing a decrease in productivity. The occurrence of this disease in chickens has already been verified in countries such as Australia, Italy, and the United States, but in Brazil, until now, epidemiological studies about Brachyspira sp. frequency were only carried out on pig farms. The objective of this study was to evaluate the presence of bacteria of the genus Brachyspira sp. through isolation and confirmation of the species Brachyspira pilosicoli, Brachyspira hyodysenteriae and Brachyspira intermedia using the qPCR technique. Samples from 110 hens aged from 35 to 82 weeks were collected, 40 were from commercial egg farms and 70 were from laying hens matrices. For the first evaluation, bacterial isolation was performed from the feces. Positive samples were submitted to qPCR to identify the three species proposed. Cecum fragments of the birds were collected and fixed in formaldehyde for histological evaluation and counting of goblet cells. Of the 110 samples, 48 characteristic isolates of Brachyspira (43.6%) were obtained and of these in qPCR 13 identified as B. hyodysenteriae (11.8%) and 5 all from the same farm as Brachyspira intermedia (4.5%), 2 samples were positive for both agents (1.8%) and 28 were not characterized by qPCR (25.5%). None histopathological lesions were observed in the chicken cecum and no significant statistical difference was noticed in the count of goblet cells of the positive hens. It can be evidenced by the occurrence of Brachyspira sp. in laying farms and hens in Brazil, with special relevance to Brachyspira intermedia that can be potentially pathogenic for these animals.(AU)

Bactérias do gênero Brachyspira podem ocasionar enfermidades entéricas em aves acarretando a queda de produtividade. A ocorrência desta enfermidade em galinhas já foi verificada em países como a Austrália, Itália e Estados Unidos, porém no Brasil, até o momento, trabalhos epidemiológicos sobre a frequencia de Brachyspira sp. só foram realizados em granjas de suínos. O objetivo deste estudo foi avaliar a presença de bactérias do gênero Brachyspira sp. através do isolamento e confirmação das espécies Brachyspira pilosicoli, Brachyspira hyodysenteriae e Brachyspira intermedia utilizando a técnica de qPCR. Foram coletadas amostras de 110 aves com idade entre 35 e 82 semanas, sendo 40 de granjas de postura comercial e 70 de granjas de matrizes de corte. Para avaliação primeiramente procedeu-se o isolamento bacteriano a partir das fezes. As amostras positivas foram submetidas a qPCR para identificação das três espécies propostas. Fragmentos de ceco das aves foram coletados e fixados em formol para avaliação histológica e contagem de células caliciformes. Das 110 amostras foram obtidos 48 isolamentos característicos de Brachyspira (43,6%) e destes na qPCR 13 identificadas como B. hyodysenteriae (11,8%) e 5 sendo todas da mesma granja (4,5%) como B. intermedia, 2 amostras foram positivas para ambos os agentes (1,8%) e 28 não foram caracterizadas através da qPCR (25,5%). Não foram observadas alterações histopatológicas no ceco e diferença estatística significativa na contagem de células caliciformes das aves positivas. Conclui-se que a Brachyspira sp. é frequente em granjas de poedeiras e matrizes de corte no Brasil, com especial relevância para a B. intermedia que possui potência patogênico para estas aves.(AU)

Diagnóstico de sífilis: al derecho y al revés / diagnosis of syphilis: rigth and wrong

La sífilis es una infección crónica de transmisión sexual, causada por la espiroqueta Treponema pallidum. A pesar de existir un tratamiento eficaz, continúa siendo un importante problema de salud pública. La Organización Mundial de la Salud (OMS) ha estimado que más de 6 millones de personas se infectan cada año en el mun-do (1), y los Centros para el Con-trol y la Prevención de Enferme-dades (CDC) de Estados Unidos reportaron con preocupación, en el 2017, una incidencia de sífilis primaria y secundaria de 9,5 casos por cada 100 000 habitantes, lo que equivale a un incremento del 72,7 % en comparación con el 2013 (2). En Colombia, se estima una preva-lencia de sífilis venérea sustan-cialmente mayor, del 1,25 % (3)

Syphilis is a chronic sexually transmitted infection, caused by the spirochete Treponema pallidum. Despite effective treatment, it remains a major public health problem. The World Health Organization (WHO) has estimated that more than 6 million people infected each year in the world (1), and the Centers for Disease Control and Prevention (CDC) in the United States reported with concern, in 2017, an incidence of primary and secondary syphilis of 9.5 cases per 100,000 inhabitants, equivalent to an increase of 72.7% compared to 2013 (2). In Colombia, a prevalence of substantially greater venereal syphilis is estimated at 1.25% (3

Evaluation of fecal microbiomes associated with obesity in captive cynomolgus monkeys (Macaca fascicularis)

Microorganisms play important roles in obesity; however, the role of the gut microbiomes in obesity is controversial because of the inconsistent findings. This study investigated the gut microbiome communities in obese and lean groups of captive healthy cynomolgus monkeys reared under strict identical environmental conditions, including their diet. No significant differences in the relative abundance of Firmicutes, Bacteroidetes and Prevotella were observed between the obese and lean groups, but a significant difference in Spirochetes (p < 0.05) was noted. Microbial diversity and richness were similar, but highly variable results in microbial composition, diversity, and richness were observed in individuals, irrespective of their state of obesity. Distinct clustering between the groups was not observed by principal coordinate analysis using an unweighted pair group method. Higher sharedness values (95.81% ± 2.28% at the genus level, and 79.54% ± 5.88% at the species level) were identified among individual monkeys. This paper reports the association between the gut microbiome and obesity in captive non-human primate models reared under controlled environments. The relative proportion of Firmicutes and Bacteroidetes as well as the microbial diversity known to affect obesity were similar in the obese and lean groups of monkeys reared under identical conditions. Therefore, obesity-associated microbial changes reported previously appear to be associated directly with environmental factors, particularly diet, rather than obesity.

Fluorescent membrane markers elucidate the association of Borrelia burgdorferi with tick cell lines

This study aimed to describe the association of Borrelia burgdorferi s.s. with ixodid tick cell lines by flow cytometry and fluorescence and confocal microscopy. Spirochetes were stained with a fluorescent membrane marker (PKH67 or PKH26), inoculated into 8 different tick cell lines and incubated at 30°C for 24 h. PKH efficiently stained B. burgdorferi without affecting bacterial viability or motility. Among the tick cell lines tested, the Rhipicephalus appendiculatus cell line RA243 achieved the highest percentage of association/internalization, with both high (90%) and low (10%) concentrations of BSK-H medium in tick cell culture medium. Treatment with cytochalasin D dramatically reduced the average percentage of cells with internalized spirochetes, which passed through a dramatic morphological change during their internalization by the host cell as observed in time-lapse photography. Almost all of the fluorescent bacteria were seen to be inside the tick cells. PKH labeling of borreliae proved to be a reliable and valuable tool to analyze the association of spirochetes with host cells by flow cytometry, confocal and fluorescence microscopy.

Neurosyphilis Presenting with Non-Convulsive Status Epilepticus

Neurosyphilis is an infectious disease of the central nervous system caused by Treponema pallidum spirochete. There are several case reports on atypical manifestations of neurosyphilis, involving progressive cognitive dysfunction and seizures similar to those in herpes encephalitis. Seizures are common in patients with neurosyphilis, but they are usually associated with a positive Jarisch-Herxheimer reaction and status epilepticus is atypical as an initial manifestation of neurosyphilis. Here, we report on neurosyphilis patient whose initial symptom was nonconversive status epilepticus.

Anti-leptospiral agglutinins in marmosets (Saguinus oedipus and Saguinus leucopus) from illegal trade / Aglutininas anti-leptospira en monos tití (Saguinus oedipus y Saguinus leucopus) de comercio ilegal

Objective. Determine the infection status with pathogenic Leptospira of one Saguinus oedipus and nine Saguinus leucopus at the Cali Zoo that had been confiscated in Colombia from illegal trade. Materials and methods. A full physical examination, blood work, urinalysis were conducted in all individuals during the reception health check-up, in addition to running the microagglutination test with a pool of 19 serovars, with a starting dilution of 1:50. Results. A high positive titer (≥1:3200) to Leptospira alexanderi serovar manhao in an asymptomatic S. oedipus was detected. All S. leucopus tested negative or less than 1:50. Conclusions. Captive locations have been documented to artificially enhance opportunities to come into contact with contaminated bodily fluids from peridomestic rodents. However, infectious diseases acquired during the illegal transport of wildlife to major metropolitan centers are rarely considered a wildlife conservation or public health threat. Infection with zoonotic pathogens should also be considered an additional threat to endangered wild primates involved in illegal trade, which could hamper reintroduction efforts or other population management procedures for primate species with restricted and fragmented distributions.

Objetivo. Determinar el estado de infección con Leptospira patógena en un Saguinus oedipus y nueve Saguinus leucopus en el Zoológico de Cali tras haber sido decomisados de tráfico ilegal en Colombia. Materiales y métodos. Se procedió a realizar un examen físico, cuadro hemático y bioquímica, urianálisis, y adicionalmente se realizó la prueba de microaglutinación con un pool de 19 serovares, en una dilución inicial de 1:50. Resultados. Se detectó una respuesta elevada en títulos (≥1:3200) a Leptospira alexanderi serovar manhao en un S. oedipus. Todos los S. leucopus resultaron negativos o con títulos menores de 1:50. Conclusiones. Se ha documentado que el cautiverio puede incrementar artificialmente las oportunidades para que los animales en encierros entren en contacto con fluidos corporales contaminados de roedores peridomésticos. Sin embargo, las enfermedades infecciosas adquiridas durante el transporte ilegal de la fauna silvestre a los principales centros metropolitanos son rara vez consideradas amenazas a la conservación de la fauna o para la salud pública. La infección con patógenos zoonóticos se debería también considerar como un riesgo adicional para primates en peligro de extinción involucrados en tráfico ilegal, lo que podría afectar esfuerzos de reintroducción u otras medidas de manejo de poblaciones de primates con distribuciones fragmentadas y restringidas.

Two cases of an atypical presentation of necrotizing stomatitis

PURPOSE: The purpose of this report was to describe the clinical and microbiological characteristics of two rare cases of necrotizing stomatitis, and the outcomes of a non-invasive treatment protocol applied in both cases. METHODS: We report two cases of necrotizing stomatitis in a rare location in the hard palate of a 40-year-old woman and a 28-year-old man. Neither had a relevant medical history and both presented with highly painful ulceration in the palate and gingival margin that was accompanied by suppuration and necrosis. 3% hydrogen peroxide was applied to the lesions using sterile swabs, and antibiotic and anti-inflammatory treatment was prescribed to both patients in addition to two daily oral rinses of 0.2% chlorhexidine. RESULTS: In both cases, radiological examination ruled out bone involvement, and exfoliative cytology revealed a large inflammatory component and the presence of forms compatible with fusobacteria and spirochetes. There was a rapid response to treatment and a major improvement was observed after 48 hours, with almost complete resolution of the ulcerated lesions and detachment of necrotic areas with partial decapitation of gingival papillae. CONCLUSIONS: Necrotizing periodontal lesions can hinder periodontal probing and the mechanical removal of plaque in some cases due to the extreme pain suffered by the patients. We present a non-invasive treatment approach that can manage these situations effectively.

Insight into the Pathogenesis of Lyme Disease

Lyme disease is the most common vector-borne disease in the United States and Europe, caused by a tick-borne spirochete, Borrelia burgdorferi. Life cycle alternation between arthropod and mammals enhanced B. burgdorferi to adapt to two diverse niches. Although B. burgdorferi infection in these reservoir hosts appears asymptomatic, infection in human can typically cause inflammation in the skin, nervous system, musculoskeletal system and heart. In this review, we discuss the basic molecular characteristics and cell biology of B. burgdorferi and provide an overview of spirochete-induced activation of innate and adaptive immunity, resulting in particular immunopathology. Advancing understanding of the immune evasion mechanisms of B. burgdorferi provides important implications for ongoing research and clinical practice of Lyme disease.

Meningovascular and Spinal form of Neurosyphilis Presenting as Multiple Cranial Nerve Palsy, Cerebral Infarction and Meningomyelitis in a Human Immunodeficiency Virus Negative-Patient: MR Imaging Features

Neurosyphilis is a rare infection of the brain and spinal cord caused by a spirochete named Treponema pallidum. We describe the magnetic resonance imaging of a 53-year-old man with syphilis who manifested as both meningovascular, and spinal meningomyelitic types, which involved the optic, trigeminal, facial and vestibulocochlear nerves, both middle and left posterior cerebral arteries, thoracic spinal cord and meninges of the lumbar spine. This case report suggests that neurosyphilis should be considered as a possible diagnosis in patients showing complex brain and spinal imaging features. These features include enhancing meningeal lesions with multiple cranial nerve involvement, stenoses in large to medium size cerebral arteries, and intramedullary and meningeal lesions of spine.

Osteomielitis hematógena aguda: mito o realidad / Acute hematogenous osteomyelitis: myth or reality

Antecedentes: Las infecciones óseas y de las articulaciones se conocen desde tiempos remotos, pero fue hasta principios del siglo pasado que se hizo avances en el diagnóstico y tratamiento para disminuir morbilidad y mortalidad. Basados en que todavía son poco conocidos algunos aspectos básicos de la osteomielitis hematógena aguda, se realizó revisión de la fisiopatología,método diagnóstico, tratamiento y complicaciones, con el objeto de proveer datos consensuados que faciliten diagnóstico y tratamiento oportuno, para evitar complicaciones y secuelas.Fuentes: se consultó bibliografía sobre el tema publicados en base de datos Medline, PubMed y biblioteca Cochrane. Desarrollo: La entidad conocida como osteomielitis hematógena aguda, aunque bien definida en la actualidad, todavía ocasiona complicaciones y secuelas en cerca del 6% de los niños afectados. La exploración física y la anamnesis son la piedra angular en el diagnóstico, sobre todo en los países como Honduras donde no siempre se tiene a la disposición, estudios de radiología y laboratorio. El tratamiento tiene como base el uso de antibióticos de acuerdo a hemocultivo cuando son positivos o bien del aspirado o drenaje del material vertido fuera de la metáfisis; sin embargo, el abordaje quirúrgico para drenaje del pus más la descompresión mediante ventana ósea o perforaciones de la metáfisis ósea comprometida generalmente es la regla más que la excepción. Conclusión: Las infecciones óseas y de las articulaciones en los niños no son tan frecuentes, sin embargo, debido a que son entidades con características únicas y poco conocidas en el ámbito médico, en muchas ocasiones pasan desapercibidas, ocasionando un resultado funcional y estético desfavorable para el paciente...

[Effect of climatic factors on canine Lime borreliosis in Iranian Caspian sea littoral provinces]

Lyme borreliosis is a worldwide zoonotic disease caused by spirochetes of the Borrelia burgdorferi sensu lato complex. There are no reports on this subject in dogs from Iran. Determining the serologic prevalence level of produced antibodies against Borrelia burgdorferi sensu lato complex in three Caspian littoral provinces of Iran and studying the effect of climatic risk factors on it are the first aims of this study. During the period from July to September 2009 a seroepidemiological study was conducted on 273 dogs in three Caspian provinces of Guilan, Mazandaran and Golestan, Iran's known habitats of tick [Ixodes ricinus]. In order to study the correlation between infection distribution and climatic factors by geographic information system [GIS], geographic position of seronegative and seropositive dogs was overlaid on climatic maps of Guilan, Mazandaran and Golestan provinces. Multivariate regression model and correlation matrix analyses were used for statistical analysis. From 273 serum samples in the whole studied area, 22 [8.1%] showed antibodies against B. burgdorferi sensu lato complex. The seroprevalence of B. burgdorferi sensu lato in provinces of Guilan, Mazandaran and Golestan were 0.0% [0.91], 2.2% [2.91] and 22% [20.91], respectively. Mean annual temperature had positive and significant correlation with B. burgdorferi sensu lato complex seroprevalence in sampled dogs of the three north provinces [p<0.05]. Regarding the seroprevalence of Lyme borreliosis in dogs of three Caspian provinces of Iran, more attention must be paid to this disease, especially in Golestan province. This is the first study on the role of climatic factors in canine Lyme borreliosis in Iran

Antibacterial Activity of Hydrogen-rich Water Against Oral Bacteria

There are estimated to be about 700 species of bacteria in the oral cavity. Based on epidemiological investigations, some of these strains have been proposed as the pathogens responsible for oral diseases such as dental caries, gingivitis and periodontitis. Since electrolyzed hydrogen-rich water has been shown to have beneficial effects on human immunity, its use has increased. In our study, the antibacterial activity of hydrogen-rich water for oralagainst bacteria associated with oral disease was evaluated. The bacterial strains Streptococcus mutans, Fusobacterium nucleatum, Porphyromonas gingivalis and Tannerella forsythia were cultured in specific growth medium. S. mutans, F. nucleatum and P. gingivalis were soaked to thein both hydrogen water and tap water for 30 sec and then inoculated onto mitis-salivarius agar and brain heart infusion agar including supplemented withvitamin K and hemin, respectively. The numbers of bacterial colonies were then measured after cultivation for 48 hours. In the case of T. forsythia, which does not grow well on agar plates, inoculations into modified new oral spirochete (NOS) broth were performed and growth curve analysis was undertaken every day with a spectrophotometer. Hydrogen water showed antibacterial activity against all four bacterial strains in comparison with tap-water. We conclude from this that hydrogen water may have a positive impact on oral hygiene by helping to remove cariogenic bacteria and periodontopathogens.

Neurogenic Bladder in Lyme Disease / 대한배뇨장애요실금학회지

Lyme disease is a multi-systemic, tick-borne infectious disease caused by a spirochete, Borrelia burgdorferi. Various urologic symptoms are associated with Lyme disease, which can be primary or late manifestations of the disease. Although voiding dysfunction is a rarely reported symptom in patients with Lyme disease, it is one of the most disabling complications of Lyme disease. Korea is not an endemic area of Lyme disease, thus, fewer cases have been reported. Herein, we report a case of a 32-year-old man with rapidly progressive bilateral ptosis, dysphagia, spastic paraparesis, and voiding difficulty in whom Lyme disease was diagnosed through serologic tests for antibodies and Western blot testing. A urodynamic study demonstrated detrusor areflexia and bulbocavernosus reflex tests showed delayed latency, indicating demyelination at S2-S4 levels. He received a 4-week course of intravenous ceftriaxone (2 g/day). The patient has recovered from the bilateral ptosis and spastic paraparesis but still suffers from neurogenic bladder.

Microbial profile of asymptomatic and symptomatic teeth with primary endodontic infections by pyrosequencing / 대한치과보존학회지

OBJECTIVES: The purpose of this in vivo study was to investigate the microbial diversity in symptomatic and asymptomatic canals with primary endodontic infections by using GS FLX Titanium pyrosequencing. MATERIALS AND METHODS: Sequencing was performed on 6 teeth (symptomatic, n = 3; asymptomatic, n = 3) with primary endodontic infections. Amplicons from hypervariable region of the small-subunit ribosomal RNA gene were generated by polymerized chain reaction (PCR), and sequenced by means of the GS FLX Titanium pyrosequencing. RESULTS: On average, 10,639 and 45,455 16S rRNA sequences for asymptomatic and symptomatic teeth were obtained, respectively. Based on Ribosomal Database Project Classifier analysis, pyrosequencing identified the 141 bacterial genera in 13 phyla. The vast majority of sequences belonged to one of the seven phyla: Actinobacteria, Bacteroidetes, Firmicutes, Fusobacteria, Proteobacteria, Spirochetes, and Synergistetes. In genus level, Pyramidobacter, Streptococcus, and Leptotrichia constituted about 50% of microbial profile in asymptomatic teeth, whereas Neisseria, Propionibacterium, and Tessaracoccus were frequently found in symptomatic teeth (69%). Grouping the sequences in operational taxonomic units (3%) yielded 450 and 1,997 species level phylotypes in asymptomatic and symptomatic teeth, respectively. The total bacteria counts were significantly higher in symptomatic teeth than that of asymptomatic teeth (p < 0.05). CONCLUSIONS: GS FLX Titanium pyrosequencing could reveal a previously unidentified high bacterial diversity in primary endodontic infections.

Identificação do agente etiológico da Doença de Lyme-símile brasileira (Síndrome Baggio-Yoshinari) / Identification of the causative agent of Brazilian Lyme diseaselike illness (Baggio-Yoshinari Syndrome)

A Doença de Lyme-símile brasileira ou Síndrome Baggio-Yoshinari (SBY) é uma zoonose emergente, transmitida por carrapatos e até o momento, de descrição restrita ao território brasileiro. O agente etiológico da SBY era desconhecido até o presente trabalho. O objetivo principal do estudo foi identificar a etiologia da SBY. Foi selecionado 2 grupos de pacientes: grupo A (n=68) composto por pacientes com suspeita diagnóstica de SBY, a maioria na fase latente da doença; grupo B (n=10), composto por pacientes com diagnóstico de SBY, que apresentaram obrigatoriamente eritema migratório e que encontravam-se sintomáticos no momento da coleta. Foi utilizado também um grupo controle composto por indivíduos saudáveis e com epidemiologia negativa (n=50). Amostras de sangue foram coletadas para a realização de sorologias, culturas, análises microscópicas (óptica e eletrônica) e reação de cadeia da polimerase (PCR) para diferentes micro-organismos (Mycoplasma spp, Chlamydia spp e Borrelia spp). Além disso, foi realizado um estudo preliminar, através da PCR para Borrelia spp em 47 amostras de carrapatos oriundos de áreas de risco do Espírito Santo (sendo 17 Rhipicephalus microplus e 30 Rhipicephalus sanguineus), e amostras de sangue total de 27 bovinos e 26 equinos, animais estes oriundos da Universidade Federal Rural do Rio de Janeiro. Os resultados mostraram que a SBY não se trata de uma zoonose causada por um conjunto de micro-organismos como pensado inicialmente e sim pela Borrelia burgdorferi sensu lato. Descoberta essa que foi possível empregando-se novos primers amplificadores do principal gene envolvido na síntese do gancho flagelar da Borrelia, chamado flgE...

Brazilian Lyme disease-like illness (BLDL) or Baggio-Yoshinari Syndrome (BYS) is an emerging zoonosis, transmitted by ticks and so far, restricted to the description of the Brazilian territory. The causative agent of BYS was unknown until now. The main objective of this study was to identify the etiology of BYS. We have selected two groups of patients: group A (n = 68) consisting of patients suspected of BYS, mostly in the latent stage of disease; group B (n = 10), composed of patients diagnosed with BYS, who had compulsorily erythema migrans and that were symptomatic at the time of blood collection. We also used a control group composed of healthy individuals with negative epidemiology (n = 50). Blood samples were collected, in which we performed serology, cultures, microscopic analysis (optical and electron) and polymerase chain reaction (PCR) for different microorganisms (Mycoplasma spp, Chlamydia spp and Borrelia spp). In addition, a preliminary study was conducted by PCR for Borrelia spp in 47 samples of ticks from risk areas at Espirito Santo State (being 17 Rhipicephalus microplus and 30 Rhipicephalus sanguineus), 27 cattle and 26 horses, being these animals from the Universidade Federal Rural do Rio de Janeiro. The results showed that BYS is not a zoonosis caused by a set of microorganisms as initially thought, but by Borrelia burgdorferi sensu lato. These findings were possible after employing new primers that are able to amplify portions of the main genes involved in the synthesis of the Borrelia flagellar hook protein, called flgE. We confirmed positivity for the flgE in 6 patients from group B, 2 ticks, a cow, and a horse, which showed 99% homology with the gene of Borrelia burgdorferi flagellar hook protein (flgE) deposited in GenBank (L43849)...

Characterization of Binding of Treponema denticola to Immobilized Fibrinogen using the Fluorescent Fatty Acid Labeling Method

Treponema denticola is a gram-negative anaerobe that can cause periodontal disease. The adhesion of this bacterium to host tissues is considered to be the primary event in the colonization and infection of a host. Fibrinogen is generally found in damaged tissues resulting from periodontitis. The binding ability of T. denticola to fibrinogen may therefore be an important virulence factor in inducing periodontal diseases. It has been reported recently that oral spirochetes can be labeled with fluorescent fatty acids and we speculated that this labeling method could be used in an oral spirochete binding assay. The binding of several different strains of T. denticola to immobilized human fibrinogen was therefore tested using the fluorescent fatty acid labeling method. In the case of immobilized fibrinogen, the T. denticola ATCC 35405 strain showed saturable binding to immobilized fibrinogen. Indeed, all four different T. denticola strains tested in this experiment, T. denticola ATCC 35405, T. denticola ATCC 33520, T. denticola ATCC 35404 and T. denticola OTK showed binding to fibrinogen. The fluorescent fatty acid labeling method thus shows utility in binding assays for T. denticola, different strains of which can generally bind to immobilized fibrinogen.

A Solitary Skull Lesion of Syphilitic Osteomyelitis

We experienced a rare case of solitary syphilitic osteomyelitis of the skull without any other clinical signs or symptoms of syphilis. A 20-year-old man was referred due to intermittent headache and mild tenderness at the right parietal area of the skull with a palpable coin-sized lesion of softened cortical bone. On radiological studies, the lesion was a radiolucent well enhanced mass (17 mm in diameter). The erythrocyte sedimentation rate (52 mm/h) and C-reactive protein (2.24 mg/dL) were elevated on admission. Serum venereal disease research laboratory (VDRL) and Treponema pallidum haemagglutination assay (TPHA) tests were positive. There were no clinical signs or symptoms of syphilis. After treatment with benzathine penicillin, we removed the lesion and performed cranioplasty. The pathologic finding of the skull lesion was fibrous proliferation with lymphoplasmocytic infiltration forming an osteolytic lesion. In addition, a spirochete was identified using the Warthin-starry stain. The polymerase chain reaction study showed a positive band for Treponema pallidum. Solitary osteomyelitis of the skull can be the initial presenting pathological lesion of syphilis.

A Case of Secondary Syphilis with Jarisch-Herxheimer Reaction Presenting as Hypersensitivity Pneumonit

Jarisch-Herxheimer reaction (JHR) is a self-limited, acute febrile hypersensitivity reaction that occurs after antibiotic therapy against spirochetes disease. When occurring in the text of syphilis therapy, the JHR begins typically 1-2 hour after the administration of penicillin and is characterized by fever, chills, myalgias, and exacerbation of skin lesions. Rarely, severe JHR can occur in the form of endocarditis, fulminant hepatitis, and hypersensitivity pneumonitis. Recently, we experienced an interesting case of JHR complicated by the hypersensitivity pneumonitis after treating secondary syphilis. Proper differential diagnosis is required to differentiate this reaction from drug-induced hypersensitivity reaction.