Impacto da exposição à sífilis materna no sistema auditivo de recém-nascidos / Impact of exposure to maternal syphilis on the newborn's auditory system

RESUMO Objetivo Avaliar os achados audiológicos de recém-nascidos expostos à sífilis materna, tratada adequadamente na gestação. Métodos Estudo de coorte única não concorrente, realizado em um hospital público. Fizeram parte da amostra recém-nascidos filhos de mães que apresentaram sorologia positiva para sífilis e que realizaram o tratamento adequado durante a gestação, compondo o grupo estudo, e recém-nascidos sem indicadores de risco para deficiência auditiva, grupo comparação. Resultados Participaram do estudo 90 recém-nascidos, sendo 41 do grupo estudo e 49 do grupo comparação. No exame de emissões otoacústicas por estímulo transiente, todos apresentaram presença de resposta bilateralmente e, na comparação das amplitudes de respostas nas bandas de frequências de 3,0 kHz, 3,5 kHz e 4,0 kHz observou-se menor amplitude de resposta no grupo exposto, com diferença estatisticamente significativa para a frequência de 4 kHz à direita. Na análise das respostas do exame de potencial evocado auditivo de tronco encefálico, não se observou assimetria de resposta entre as orelhas que sugerisse alteração retrococlear e nem diferenças nos valores das latências absolutas ou intervalos interpicos, entre os grupos. Conclusão As respostas eletroacústicas foram discretamente inferiores nos recém-nascidos exposto à sífilis materna, enquanto que as respostas eletrofisiológicas foram semelhantes às encontradas na população de baixo risco para deficiência auditiva.

ABSTRACT Purpose To evaluate the audiological findings of newborns exposed to maternal syphilis, properly treated during pregnancy. Methods This was a single, non-concurrent cohort study conducted in a public hospital. The sample included newborns whose mothers had positive syphilis serology and who underwent adequate treatment during pregnancy, composing the study group, and newborns without risk indicators for hearing loss, as a comparison group. Results Ninety newborns participated in the study, 41 were the study group and 49 were the comparison group. In the transient evoked otoacoustic emissions test, all newborns showed a bilateral response, and when comparing the amplitudes of responses in the 3.0 kHz, 3.5 kHz and 4.0 kHz frequency bands, a smaller amplitude of response in the studied group with a statistically significant difference for the frequency of 4 kHz on the right was observed. An analysis of the response of the brainstem auditory evoked potential test showed no asymmetry of response between the ears that suggest a retrocochlear alteration, nor difference in the values of absolute latencies or interpeak intervals between groups. Conclusion The electroacoustic responses were slightly lower in newborns exposed to maternal syphilis, whereas their electrophysiological responses were similar to those found in the population at low risk for hearing loss.

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)

Neurosífilis, evaluación de pruebas inmunológicas para su diagnóstico / Immunological test evaluation for neurosyphilis diagnosis

Con el objetivo de correlacionar las pruebas VDRL (Venereal Disease Research Laboratory) y USR (unheated serum reagin) para diagnóstico de neurosífilis, se evaluaron los resultados en 106 líquidos cefalorraquídeos. De 106 líquidos cefalorraquídeos procesados con VDRL y USR, 7,54% fue reactivo por los dos métodos, 90,57% no reactivo por ambos métodos y 1,89% discordante. VDRL y USR clasifican de la misma manera, p no significativa (prueba de Mac Nemar). Si bien la VDRL en líquido cefalorraquídeo es la prueba serológica estándar para neurosífilis, la USR podría ser usada para su diagnóstico, ya que no existe diferencia estadísticamente significativa con la VDRL, es más económica, más práctica y más accesible en el mercado.

The results of 106 cerebrospinal fluids have been evaluated with the aim of correlating the VDRL (Venereal Disease Research Laboratory) and USR (unheated serum reagin) tests for neurosyphilis diagnosis. From 106 cerebrospinal fluids processed with VDRL and USR, 7.54% was reactive by the two methods, 90.57% was nonreactive by both methods and 1.89% was discordant. Mac Nemars test determined that VDRL and USR classified in the same way (not significative p). Although the VDRL in cerebrospinal fluids is the standard serologic test for neurosyphilis, the USR could be used as well for its diagnosis, since it is not significatively different from the statistical point of view with the VDRL; it is less expensive, more practical and more easily available in the market.

Unilateral papillitis and exudative retinal detachment: an unusual manifestation of ocular syphilis

The common and typical posterior segment manifestations of ocular syphilis are choroiditis, retinitis and retinal vasculitis but since syphilis has a tendency to masquerade any uveitis entity it should be ruled out in all cases of posterior uveitis. We describe an uncommon case of unilateral papillitis and exudative retinal detachment where syphilis was initially a remote possibility. Systemic steroids seemed to make the clinical situation worse. Then a single positive serological test for syphilis [TPABS] suggested ocular syphilis. Complete resolution was obtained with an anti-syphilis antibiotic regimen