Pseudoretinitis pigmentosa due to syphilis: a case report and literature review / Pseudorretinose pigmentária por sífilis: relato de caso e revisão de literatura

ABSTRACT Syphilis is a sexually transmitted infection caused by the spirochete Treponema pallidum. Ocular involvement can occur at any time, and it may affect 10% of patients in the secondary stage, and from 2% to 5% in the tertiary stage. Uveitis is the most common presentation of ocular syphilis, affecting 0.4% to 8% of patients with systemic disease. Chorioretinitis is the most common posterior alteration. We present the case of a 53-year-old male patient, presenting with bilateral low visual acuity and nyctalopia for 3 years. His physical examination revealed decreased pupillary reflex, anterior vitreous cells, physiologic papillae, arteriolar attenuation, reduced foveal reflex, diffuse retinal pigment epithelium atrophy, peripapillary and perivascular punctate pigment accumulation and peripheral chorioretinitis. Full-field electroretinogram was extinct in both eyes. Treponemal syphilis test was positive. Previously diagnosed as retinitis pigmentosa, evolved to blindness, despite proper treatment. Our case shows syphilis as a significant cause of blindness. Atypical presentations of retinitis pigmentosa must warn ophthalmologists to etiologies of pseudoretinitis pigmentosa, such as syphilis.

RESUMO A sífilis é uma infecção sexualmente transmissível causada pela espiroqueta Treponema pallidum. A sífilis ocular pode ocorrer em qualquer estágio da doença, chegando a 10% na forma secundária e a 2% a 5% em sua forma terciária. A uveíte é a manifestação ocular mais comum, ocorrendo em 0,4% a 8% dos pacientes com a doença sistêmica. A coriorretinite é a manifestação mais comum do segmento posterior. Apresentamos o caso de um paciente do sexo masculino, 53 anos, com queixa de baixa acuidade visual e nictalopia há ٣ anos. Seu exame físico revelou lentificação dos reflexos pupilares, celularidade no vítreo anterior, papilas fisiológicas, atenuação arteriolar, redução do reflexo foveal, atrofia difusa do epitélio pigmentar da retina, acúmulo punctato de pigmento em regiões peripapilar e perivascular e coriorretinite periférica. Eletrorretinograma de campo total extinto em ambos os olhos. O teste treponêmico foi positivo. Foi previamente diagnosticado como portador de retinose pigmentar, evoluindo com cegueira, a despeito do tratamento correto instituído. Esse caso mostra a sífilis como importante causadora de cegueira. Casos atípicos de retinose pigmentar devem alertar o oftalmologista para causas de pseudorretinose pigmentar, como a sífilis.

Prevalencia de marcadores serológicos en donantes de sangre de Boyacá, Colombia, 2014-2015 / Prevalence of serological markers in blood donors in Boyaca, Colombia, 2014-2015

Introducción: La infección que se ocasiona por la transfusión sanguínea se produce por una transmisión directa de un agente infeccioso desde una unidad de sangre al receptor susceptible. Esto constituyen una complicación de gran importancia en relación con la morbilidad y mortalidad de los receptores de sangre y un problema de salud pública. Objetivo: Determinar la prevalencia de marcadores serológicos en donantes de sangre del departamento Boyacá y su relación con variables sociodemográficas. Métodos: Estudio descriptivo transversal, realizado en 32 957 donantes del departamento de Boyacá. La fuente de información fue secundaria. Se determinó la seroprevalencia de marcadores de infección y se compararon según sexo, grupo etario y tipo de donante a través de análisis de frecuencias: Chi cuadrado y Fisher. Resultados: La prevalencia de marcadores serológicos fue 1,15 por ciento en la tamización y 0,24 por ciento con las pruebas confirmatorias. El marcador más prevalente fue sífilis con 0,20 por ciento, seguido el virus de la inmunodeficiencia humana 0,02 por ciento, virus de la hepatitis B 0,01 por ciento y virus de la hepatitis C 0,003 por ciento. La prevalencia del VIH y la prevalencia global de infección presentaron asociación estadísticamente significativa con el sexo y con el grupo etario respectivamente. Conclusiones: La identificación de la prevalencia de marcadores serológicos y las variables sociodemográficas permiten establecer un perfil epidemiológico en donantes de sangre del departamento de Boyacá(AU)

Introduction: The infection that is caused by blood transfusion is produced by a direct transmission of an infectious agent from a unit of blood to the sensitive recipient. This represents a complication of great importance in relation to morbidity and mortality of blood recipients and also a public health problem. Objective: To determine the prevalence of serological markers in blood donors of Boyacá department and its relationship to socio-demographic variables. Methods: A cross-sectional descriptive study was conducted in 32 957 donors of Boyacá department. The source of information was secondary. It was determined the seroprevalence of infection´s markers and those were compared according to sex, age group and type of donor through analysis of frequencies: Chi-square and Fisher. Results: The prevalence of serological markers was 1.15 percent in screening and 0.24 percent with the confirmatory tests. The most prevalent marker was syphilis with 0.20 percent, followed by HIV with 0.02 percent, hepatitis B with 0.01 percent and Hepatitis C virus with 0.003 percent. The prevalence of HIV and the infection´s overall prevalence presented statistically significant association with sex and with the age group respectively. Conclusions: The identification of the serological markers prevalence and socio-demographic variables allow setting an epidemiological profile in blood donors of Boyacá department(AU)

Implementación del algoritmo reverso para el cribado de sífilis en un laboratorio clínico / Implementation of the reverse screening syphilis algorithm in a clinical laboratory

Resumen Introducción: La sífilis sigue siendo un problema de salud pública en todo el mundo; la precisión de las pruebas de diagnóstico es fundamental para el éxito de su control. Actualmente, hay dos enfoques para el diagnóstico serológico de la sífilis: el algoritmo tradicional y el algoritmo reverso. Objetivo: Analizar las ventajas y desventajas en la implementación del cribado para sífilis con el algoritmo reverso en un laboratorio clínico de pacientes ambulatorios. Materiales y Métodos: Se realizó un estudio de corte transversal analizando 246 sueros reactivos en el cribado sobre un total de 14.700 solicitudes de serología para sífilis. Se utilizaron los ensayos ARCHITECT SyphilisTP, V.D.R.L. y FTA-Abs. Resultados: De los 246 sueros reactivos por ARCHITECT Syphilis TP, 129 fueron reactivos y 117 no reactivos con V.D.R.L., éstos últimos resultaron 97 reactivos y 20 no reactivos por FTA-Abs, sugiriendo falsos positivos (0,13%). Se detectaron dos casos de infección primaria, no detectados con V.D.R.L y un caso de infección primaria en una gestante con un valor alto S/CO y V.D.R.L. de 1 dils. Conclusiones: Entre las ventajas de utilizar el algoritmo reverso se encontró mayor sensibilidad en la detección de sífilis primaria; automatización, trazabilidad, interpretación objetiva y resultados concluyentes.

Background: Syphilis remains a public health concern worldwide, the accuracy of diagnostic tests is critical for its successful control. Currently, there are two approaches to the diagnosis of syphilis using serological tests: the traditional algorithm and the reverse algorithm. Aim: The goal of this study was to analyse the advantages and disadvantages in the implementation of the syphilis reverse-screening algorithm in an outpatient clinical laboratory. Methods: An observational cross-sectional study was carried out analyzing 246 reactive sera from a total of 14700 requests for syphilis serology. Chemiluminescent assay ARCHITECT Syphilis TP, V.D.R.L. and FTA-Abs were performed. Results: Among 246 reactive sera by ARCHITECT Syphilis TP, 129 were reactive and 117 were non-reactive by V.D.R.L. the last mentioned resulted in 97 reactive and 20 non-reactive by FTA-Abs, suggesting false positives (0.13%). Two patients with primary infection were detected, that were not detected by V.D.R.L. and one pregnant woman with primary infection with a high value S/CO and V.D.R.L.:1 dils. Conclusions: Among the advantages of using a reverse algorithm were greater sensitivity in the detection of patients with primary syphilis; automation, complete traceability of the samples; objective interpretation and conclusive results.

A comparison of nontreponemal tests in cerebrospinal fluid for neurosyphilis diagnosis: equivalent detection of specific antibodies / Uma comparação de testes não treponêmicos no líquido cefalorraquidiano para diagnóstico de neurossífilis: detecção equivalente de anticorpos específicos

ABSTRACT Syphilis is a re-emerging sexually-transmitted infection, caused by the spirochete Treponema pallidum, that may penetrate early into the central nervous system. The venereal disease research laboratory test (VDRL) on the cerebrospinal fluid (CSF) is the most widely used for neurosyphilis diagnosis. We evaluated the performance of two other nontreponemal tests (rapid plasma reagin [RPR] and unheated serum reagin [USR] tests) in comparison with the VDRL in CSF. Methods: We analyzed CSF samples from 120 individuals based on VDRL reactivity in the CSF and the clinical picture of neurosyphilis. Results: High inter-rater reliability was found among all three tests, with equivalent sensitivity and specificity. Intraclass correlation coefficient for absolute agreement was 1 for VDRL versus USR, 0.99 for VDRL versus RPR, and 0.99 for RPR versus USR. Conclusions: Rapid plasma reagin and unheated serum reagin tests were identified as excellent alternatives for neurosyphilis diagnosis.

RESUMO A sífilis é uma infecção reemergente sexualmente transmissível pelo espiroqueta Treponema pallidum, que pode penetrar precocemente no sistema nervoso central. O teste venereal disease research laboratory test (VDRL) no líquido cefalorraquidiano (LCR) é o mais amplamente utilizado para diagnóstico de neurossífilis. Avalia-se o desempenho de dois outros testes não treponêmicos (rapid plasma reagin - RPR and unheated serum reagin - USR tests) em comparação ao VDRL no LCR. Métodos: Foram analisadas amostras de LCR de 120 indivíduos com base no quadro clínico compatível com neurossifilis e reatividade no VDRL no LCR. Resultados: Os testes apresentaram elevada concordância. O coeficiente de correlação intraclasse para concordância absoluta foi de 1 para VDRL versus USR, 0,99 para VDRL versus RPR e 0,99 para RPR versus USR. Conclusões: Os testes rapid plasma reagin e unheated serum reagin foram identificados como excelentes alternativas para o diagnóstico de neurossífilis.

Sífilis en el siglo XXI: novedades en el enfrentamiento diagnóstico y terapéutico / Syphilis in the XXI century: novelties in the diagnostic and therapeutic confrontation

La sífilis es una enfermedad de transmisión sexual altamente contagiosa con importantes complicaciones, pero con tratamiento efectivo en etapas tempranas. Actualmente, representa un problema de salud pública. La prevalencia reportada en EEUU desde el año 2008 es de 4,5 casos/100.000 habitantes, con una incidencia 10.6 millones de casos cada año, especialmente en hombres que mantienen relaciones sexuales con hombres (HSH) y pacientes portadores de VIH (PVIH). Los métodos diagnósticos basados en test moleculares aún no han sido validados para el diagnóstico de sífilis, lo que ha permitido establecer tres esquemas serológicos con diferentes rendimientos, según prevalencia poblacional. Desde este punto de vista, el screening reverso pareciera ser útil en población de alto riesgo, y el screening tradicional para la población general.

Syphilis is a sexual transmitted disease highly contagious with important complications that can be prevented with an adequate treatment in early stages. Syphilis has become a public health issue, in the USA its incidence has increased from the 2001, with a rate in the 2008 of 4,5 cases/100000 people, with a greater prevalence in men who have sex with men (HSH) and people infected by HIV (PVIH). Despite molecular detection test are used for the diagnostic of many diseases, in syphilis we still using serologist test. There are three different schemes with different per-formance depending in the prevalence of syphilis in the population. In this setting reverse screening is the most adequate method for high prevalence versus traditional method that is better in general population.

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)

Determinación de sífilis por método serológico en gestantes de la ciudad de Guayaquil / Detection of syphilis by a serological method in pregnant women from Guayaquil City

INTRODUCCIÓN: en Ecuador la sífilis es un problema de salud pública. La sífilis congénita conlleva a la aplicación de medidas para lograr la disminución de la transmisión y la erradicación de la enfermedad. El uso de las técnicas de diagnóstico permite detectarla durante la gestación, garantiza un seguimiento durante el control prenatal de las gestantes, para brindar un tratamiento adecuado en caso necesario. OBJETIVO: determinar la sífilis por método serológico en las gestantes que acuden al Centro de Salud # 3, de la ciudad de Guayaquil. MÉTODOS: se aplicó un estudio de carácter correlacionar y retrospectivo a las 445 gestantes que acudieron al centro, para su control prenatal o por libre demanda, de abril a agosto del 2012. Se identificaron las que resultaron positivas a sífilis, mediante la prueba serológica Venereal Disease Research Labotarory. Se diseñó un cuestionario para evaluar el nivel de conocimiento existente sobre la enfermedad, que se aplicó a 71 mujeres seleccionadas al azar. Además se propuso un programa educativo. RESULTADOS: los resultados se estratificaron según el grupo etario y etapa de gestación. De las 18 gestantes con sífilis (4 %), solo 3 recibieron tratamiento. El mayor porcentaje de casos positivos correspondió al rango entre los 21 y 28 años de edad (61 %) y el 50 % correspondió a mujeres en etapa de gestación entre 21 y 28 semanas. La aplicación del cuestionario demostró un gran desconocimiento sobre el tema, por lo que el programa educativo incluyó 9 tareas vinculadas, directo a la capacitación y divulgación del tema.

INTRODUCTION: syphilis is a public health problem in Ecuador. Congenital syphilis leads to the implementation of actions to achieve the reduction of transmission and finally eradication of disease. The use of diagnostic techniques allows detecting the disease during gestation, thus guaranteeing a follow-up in prenatal management stage and an adequate treatment if necessary. OBJECTIVE: to determine syphilis by a serological method in pregnant women who went to the Health Center #3 in the city of Guayaquil. METHODS: aretrospective correlational study of 445 pregnant women who went to the center for prenatal management or at will in the period of April to August 2012. The syphilis positivity was determined by the serological test Venereal Disease Research Laboratory. A questionnaire was designed to evaluate the level of knowledge on the disease and given to 71 randomly selected women. Additionally, an educational program was suggested. RESULTS: the results were stratified by aged group and pregnancy stage. Of 18 pregnant women with syphilis (4%), just 3 were treated. The highest percentage of positive cases was found in 21-28 age group (61%) and 50% of women were in gestational stage between 21 and 28 weeks. the application of the questionnaire showed a lack of knowledge on the topic, so the educational program included 9 tasks directly related to training in and dissemination of information on this topic.

Prevalence of Syphilis and associated factors in homeless people of Sao Paulo, Brazil, using a Rapid Test / Prevalência de Sífilis e fatores associados a população em situação de rua de São Paulo, Brasil, com utilização de Teste Rápido

Introduction: Homeless people are a vulnerable group to sexually transmitted diseases (STD) with high prevalence of syphilis and hepatitis. Objectives: To estimate the prevalence of syphilis infection and its association with risky behaviors for STDs in a sample of homeless people, and to assess the feasibility of the use of rapid syphilis test (RST) in this population. Methods: Cross-sectional study, in a convenience sample of homeless people assisted in social support services of São Paulo, between 2006 and 2007. A structured questionnaire was applied and RST was performed. In addition, a blood sample for syphilis detection was also collected. The sensitivity and specificity of the RST was estimated using conventional laboratory diagnosis (VDRL + TPHA) as reference. Results: 1,405 volunteers were included in the study. The prevalence rate of syphilis was 7.0%, and was associated with homosexual practices (ORadj 4.9; 95%CI 2.6 - 9.4), prior history of STD (ORadj 2.6; 95%CI 1.7 - 4.0) and with self-referred non-white race (ORadj 1.9; 95%CI 1.1 - 3.4). The sensitivity and specificity of the RST for syphilis were, respectively, 81.4 and 92.1%. Conclusion: The high prevalence of syphilis infection among homeless people shows the need for actions for its control and the utilization of RST that can be considered an efficient strategy due to its sensitivity and specificity. Public Health policymakers must strengthen actions for syphilis control, with screening tests for syphilis and early treatment, decreasing morbidity with the improvement of sexual and reproductive health of the population in general and especially the most vulnerable. .

Introdução: Pessoas em situação de rua constituem um grupo com alta vulnerabilidade às doenças sexualmente transmissíveis (DST), com altas prevalências de sífilis e hepatites. Objetivos: Descrever comportamentos, atitudes e práticas de risco para as DST, estimar a prevalência da sífilis, os fatores associados e avaliar a exequibilidade de uso do Teste Rápido (TR) para sífilis em pessoas em situação de rua. Metodologia: Estudo transversal em uma amostra não probabilística de pessoas em situação de rua assistidas em serviços de apoio social da cidade de São Paulo, entre 2006 e 2007. Foi aplicado questionário estruturado e realizado TR, além de coleta de sangue para detecção de sífilis. Estimou-se a sensibilidade e especificidade do TR utilizando como referência o diagnóstico laboratorial convencional (VDRL + TPHA). Resultados: Entre 1.405 voluntários, observou-se prevalência de sífilis de 7,0% que esteve associada à prática homossexual (ORaj 4,9; IC95% 2,6 - 9,4), ao relato de história de DST (ORaj 2,6; IC95% 1,7 - 4,0) e à raça/cor autorreferida não branca (ORaj 1,9; IC95% 1,1 - 3,4). A sensibilidade e especificidade do TR para sífilis foram, respectivamente, de 81,4 e 92,1%. Conclusão: A alta prevalência de sífilis, em pessoas em situação de rua evidencia a necessidade de ações para o seu controle e o uso do TR, devido sua sensibilidade e especificidade, pode ser levado em consideração como uma estratégia eficaz. Políticas públicas de saúde devem priorizar ações para o controle da sífilis, com estratégias de rastreamento, diagnóstico e tratamento precoces, diminuindo a morbidade e com melhoria da saúde sexual e reprodutiva da população ...

Propuesta y evaluación de un modelo estadístico para el control de la calidad de las serologías VDRL/RPR / Proposal and evaluation of a statistical model for the quality control of veneral disease research laboratories/rapid plasma reagin serologies

Introducción: la finalidad de todo laboratorio de control de la calidad del diagnóstico serológico de sífilis es controlar su correcta realización. Objetivo: evaluar una propuesta de modelo estadístico para tabular los resultados de los laboratorios adscritos al control de la calidad de diagnóstico de serología VDRL (venereal disease research laboratories)/RPR (rapid plasma reagin) para la evaluación y atención diferenciada a estos. Métodos: se elaboró un modelo para la recogida de información de los 21 laboratorios de la red en Villa Clara durante 2006-2010 y se hicieron modificaciones hasta llegar a la versión final. Se definieron las variables sueros enviados, total discordantes, discordantes no reactivas, discordantes reactivas, envío por mes, y evaluación integral. Se establecieron criterios de estimación para cada variable. Se presenta la evaluación del modelo con la información del trimestre enero-marzo de 2011. Resultados: la propuesta permitió detectar que las principales dificultades radican en el no cumplimiento del número de sueros enviados, no se recepcionan muestras mensualmente y además se presentan resultados discordantes. El modelo resulta justo al valorar porque se utilizan criterios cuantitativos generalizados que posibilitan dar una evaluación cualitativa individualizada, y se corresponde con las técnicas evaluativas actuales que se aplican en diferentes esferas del quehacer social. Conclusiones: el modelo estadístico valorado permite la tabulación de datos desde el laboratorio provincial de control de la calidad, a través de las variables propuestas y así evaluar a cada laboratorio

Introduction: the purpose of every quality control laboratory for the serological diagnosis of syphilis is to monitor the accuracy of test performance. Objective: to evaluate the proposal of a statistical model to tabulate the results of the laboratories involved in the quality control of the veneral disease research laboratories-rapid plasma reagin serology for the assessment of and customized attention to them. Methods: a model for the collection of information from the 21 laboratories of Villa Clara's provincial network in the 2006-2010 period was designed and refined until the final version was reached. The defined variables comprised Number of sent sera, Total discordant, Nonreactive Discordant, Reactive Discordant, Shipping by month and Final evaluation were defined. Evaluation criteria were set for each variable. This paper presented the evaluation of the model with information from January to March, 2011. Results: the suggested model allowed the detection of the main difficulties such as the non-compliance with the number of sent sera, non-reception of samples monthly and also current conflicting results. The model is fair when making evaluation, since it uses generalized quantitative criteria that enable individualized qualitative assessment and it is also in line with current evaluative techniques applied in different fields of social endeavor. Conclusions: the statistical model allows provincial quality control laboratory to tabulate data by using the suggested variables and thus evaluate each laboratory in Villa Clara

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.

Evaluación de un Inmunoensayo de partículas en gel para la determinación de anticuerpos contra Treponema pallidum en donantes de sangre / Evaluation of a particle gel immunoassay for determination of antibodies against Trepanoma pallidum in blood donors

El tamizaje de laboratorio para sífilis está usualmente llevado a cabo por serología. No se observó resultados falsos positivos cuando se utilizó ID-PaGIA y se observó una excelente sensibilidad y especificidad de esta prueba treponérnica. Las ventajas del método son el tiempo de reacción de tan solo 20 minutos, la simplicidad del procedimiento con poco equipo de laboratorio, la posibilidad de realizar lecturas automatizadas y la posibilidad de mantener un record de los resultados y con ello la trazabilidad.

Laboratory diagnosis of syphilis is usually accomplished by serology. No false-positive results were found with ID-PaGIA and compared with other treponemal tests ID-PaGIA has excellent sensitivity and specificity. Advantages of the PaGIA are the fast reaction time of only 20 minutes and the simplicity of the procedure with minimal technical equipment.

Prevalencia de sífilis materna y evaluación de una prueba diagnóstica rápida en Cochabamba, Bolivia / Evaluation of a rapid diagnostic test to assess the prevalence of maternal syphilis in Bolivia

Background: Syphilis is still a public health problem in Latin America and the Caribbean. Therefore maternal screening is of great importance for public health. Aim: To estimate the prevalence of maternal syphilis and to evaluate a rapid diagnostic test for thedisease among Bolivian women. Material and methods: A total of 489 women delivering in a Public Hospital in Cochabamba, Bolivia, answered a questionnaire about socioeconomic andreproductive characteristics and access to health care services. Syphilis was diagnosed by using RPR and FTA-ABS tests. The rapid test Determine syphilis TP was evaluated taking as reference FTA-ABS test. Results: Twenty two women (4.5%) were positive both for RPR and FTA-ABS tests and fifty (10.2%) were positive for the rapid diagnostic test and FTA-ABS. Compared with FTA-ABS, the sensitivity and specificity of the rapid test were 98% and 99.8%, respectively. Only 15% of women that had at least one antenatal care visit had a syphilis screening test and 40% of the women in whom the test was performed, did not receive its results. Increasing age, low socioeconomic level and a history of a sexually transmitted disease were independently associated with syphilis infection. Conclusions: The magnitude of syphilis infection among the studied women was still high in Cochabamba. The rapid test showed excellent overall performance for maternal syphilis screening. Few women of all attended in the hospital had a screening syphilis test and half of those screened were not aware of the results. Maternal syphilis affected older women of low socioeconomic level and with a history of a sexually transmitted disease.

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

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

Sífilis secundaria en cavidad oral: Reporte de dos casos / Oral secondary syphilis: Two cases report

La sífilis es una enfermedad infecciosa humana causada por una bacteria: el Treponema pallidum. La enfermedad es transmitida por contacto directo a través de lesiones durante el estadio primario y secundario, por vía transplacentaria intrauterina o a través del canal uterino; puede afectar cualquier órgano de la economía causando un número infinito de presentaciones clínicas. La sífilis secundaria cursa con manifestaciones mucocutáneas características y eventual sintomatología general. La presentación clínica de nuestros dos pacientes es singular ya que solo poseían lesiones en la cavidad oral. La respuesta al tratamiento instaurado fue buena.

Syphilis is a human infectious disease caused by the bacterium Treponema pallidum. The disease is transmitted by direct contact with a lesion during the primary or secondary stages, in utero by the transplacental route, or during delivery as the baby passes through an infected canal. The bacterium may infect any organ, causing an infinite number of clinical presentations. Secondary syphilis is characterized by mucocutaneous lesions, a flulike syndrome, and generalized adenopathy. Hepatosplenomegaly may be present. The oral mucosa is the second most frequent site of luetic lesions; the genital areas are the most frequent. In the oral cavity, the most characteristic lesion is a whitish mucosal patch, normally located on the lips, tongue, or palate, which is extremely contagious. The differential diagnosis of this lesion may include oral squamous carcinoma, leukoplakia, candidosis, lichen planus, and hairy oral leukoplakia. Definitive diagnosis is based on clinical information and completed by laboratory examinations even the biopsy can help us. With the diagnosis of secondary syphilis treatment with penicillin G benzathine must be started. We present two cases of secondary syphilis with oral lesions only; the first one, a man with macule covered with a whitish membrane on palate mucosa and a lateral neck adenopathy. The lesion had been present for three months. The second one, a woman with painful whitish mucosal patch since two weeks ago. No fever or flulike syndrome. Luetic serologic tests were positive in both cases and in the first one the biopsy showed a chronic inflammatory infiltrate. The drug of choice in the treatment of our patients was benzathine penicillin G.

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.

Pesquisa de sífilis congénita al momento del parto: ¿Suero materno o sangre de cordón? / Diagnosis of congenital syphilis at delivery: Maternal serum or cord blood?

La sífilis congénita (SC) es un problema importante en Chile, con una tasa de 0,25/1.000 recién nacidos (RNs) vivos en el año 2004. En el año 2000, el Ministerio de Salud recomendaba como tamizaje al momento del parto una muestra de sangre de cordón. El Centro de Control y Prevención de Enfermedades, (CDC), Atlanta, E.U.A. recomendó, desde 1998, el tamizaje al parto con suero materno ya que respecto del suero del RN, la sangre de cordón y el suero materno tienen respectivamente hasta 5 y 0,5 por ciento> de falsos negativos. Objetivo: Determinar el mejor tamizaje al momento del parto. Métodos: Se estudiaron muestras de suero materno y sangre de cordón de los RNs durante un año. Se realizó RPR y de ser positiva, pruebas treponémicas confirmatorias (imunocromatográfico Determine®, ELISA Captia® IgG e IgM y microhemaglutinación). Todos los pacientes confirmados fueron vistos por el especialista para definir los casos de SC. Resultados: Entre junio de 1999 y agosto del 2000 se estudiaron 2.741 binomios madre-RN; de éstos 37/2.704 (1,3 por ciento) fueron RPR reactivos. Once eran RPR reactivo en la madre y en el RN (Grupo I), 9 eran RPR reactivo en el RN y no reactivo en la madre (Grupo II) y 17 eran RN con RPR no reactivo y reactivo en la madre (Grupo III). En el Grupo I hubo 64 por ciento> (7/11) de verdaderos (+)s y 36 por ciento (4/11) de falsos (+)s del RPR. En el Grupo II, 9/ 9 (100 por cientoo), correspondieron a falsos (+)s del RPR en sangre de cordón y en el Grupo III, 11/17 (67 por ciento>) correspondieron a falsos (+)s del RPR en sangre materna pero hubo 6/17 (35 por ciento>) que correspondían a sífilis durante el embarazo y en tres de ellas no hubo tratamiento intra-embarazo, por lo que fueron catalogadas como SC y los RNs debieron ser tratados. En total hubo 9 RNs que correspondieron a SC (6 del grupo I y 3 del grupo III). Si sólo se hubiese realizado tamizaje en sangre de cordón, 3 RNs con SC no se hubiesen....

Congenital syphilis (CS) is an important health problem in Chile, with a rate of 0.25/1,000 live newborn (NB) during year 2004. In 2000, the Chilean Ministry of Public Health recommended to perform a screening in cord blood at the moment of delivery. Instead, the Centers for Disease Control and Prevention guidelines recommend the screening in maternal serum since cord blood has up to 5 percent of false (-) versus 0.5 percent of maternal serum, both with respect to the NB serum. Objective: Maternal serum and NB cord blood were studied during one year to determine the best screening method at delivery. Methods: RPR was performed and positive results were confirmed by treponemic test (immunochromatographyDetermine®, ELISA Captia®, Ig and IgM, and MHA-Tp). Serologically confirmed patients were evaluated by the specialist to define CS cases. Results: Between June 1999 and August 2000 2,741 binomies were studied; of these, 37 (1.3 percent) were RPR reactive and 2.704 were non-reactive. In 11 of the 37 reactive cases, mother and NB were RPR reactive (Group I), in 9 cases the NB was RPR reactive and the mother was non-reactive (Group II), and the other 17 were NB non-reactive and mother reactive (Group III). In group I, 7/11 (64 percent) were true (+)s and 4/11(36 percent)) false (+)s of RPR. In group II, 9/9 (100 percent) corresponded to false (+)s of RPR in cord blood, and in group III, 11/17 (65 percent) corresponded to false (+)s of RPR in maternal blood but 6/17 (35 percent) were found to be cases of syphilis during pregnancy. Three of them were not treated opportunely and were designed as CS. In total 9 NB corresponded to CS (6 in group I and 3 in group III). If the screening had been performed only in cord blood, three NB with CS would have not been diagnosed. Conclusion: Even when maternal serum has a high rate of false (+)s, it has better sensitivity than cord blood for the diagnosis of CS, thus it is suggested to perform the screening ...

Profile of Anti-Tp47 antibodies in patients with positive serology for syphilis analized by western blot

In Brazil, syphilis is still a great problem of public health. Serological test is essential for syphilis diagnosis and the current trend is the use of recombinant antigen in the treponemal tests, due to its confirmed higher sensibility and specificity. The purpose of the present study was to analyze the profile of anti-Tp47 antibodies in patients with positive serology for syphilis. One hundred positive sera samples were analyzed by Western Blot (WB) technique, using the recombinant antigen (rTp47). Ten of them did not present antibodies against the fraction rTp47, the results were confirmed by WB using native T. pallidum antigen. All ten samples had antibodies against the fractions Tp17 and Tp15 and presented low reactivity in VDRL, negative results or title below than 1:4. Considering that VDRL is used for therapeutic monitoring due to seroreversion of nontreponemal antibodies in response to the treatment, and that some studies reported loss of treponemal antibodies after treatment, we could speculate if these ten samples are cases of serological memory from patients previously treated for syphilis. In addition, although several features state the Tp47 fraction as one of the major antigenic components, based on our results we point out to the importance of including other antigenic proteins such as Tp17 and Tp15 in addition to Tp47 in tests for serological screening of syphilis.