High prevalence of syphilis-HIV co-infection at four hospitals of the city of Buenos Aires, Argentina.

A cross-sectional anonymous study of 261 STD (sexually transmitted diseases) outpatients and 288 outpatients from other hospital departments was conducted at four major city hospitals in Buenos Aires. High prevalence of human immunodeficiency virus (HIV) (14.5%) and syphilis (30.2%) was noted. Fifty-two persons were diagnosed with both HIV and syphilis. Of the 87 HIV cases observed, 52 (59.7%) were co-infected with syphilis. Stratified analysis by gender showed that the prevalence of HIV, syphilis and HIV/syphilis co-infection was significantly (p < 0.001) higher in men than women (HIV: 20.1% vs. 4.6%; syphilis: 39.3% vs. 17.4%; co-infection: 13.6% vs. 1.7%). Integrated HIV/STD intervention programs and more effective surveillance are required in Argentina.

[Syphilis and pregnancy. Prenatal control, seroprevalence and false biological positives]. / Sifilis y embarazo. Control prenatal, seroprevalencia y falsos biológicos positivos.

Syphilis may be transmitted vertically, especially if the mother is in an early stage with a high bloodstream treponema concentration, although it may also be transmitted to a lesser degree in late latency, when non-treponemic serology may become negative spontaneously with persistence of treponemic serology. The prenatal control for syphilis is routinely carried out by means of a non-treponemic reaction such as VDRL or rapid plasma reagin (RPR) which, when positive, should be confirmed by treponemic techniques such as fluorescent treponemal antibody absorption (FTA-abs) and/or hemagglutination (MHA-Tp). Prevalence of syphilis should be defined on the basis of positive treponemic reactions. To define the seroprevalence and the validity of these control guidelines, 1,056 pregnant women attending the Hospital de Clínicas for their initial control were evaluated by means of serological treponemic and non-treponemic methods. Serological results disclosed 4 distinct groups. Group 1 (n = 17 or 1.61%) presented both types of reactive tests, while Group II (n = 22 or 2.08%) only presented reactive treponemic tests, and both groups were seroreactive for syphilis. Group III (n = 7 or 0.66%) only showed reactive non-treponemic tests, which were considered biological false-positive (BFP) reactions. Five of them were reactive for antiphospholipid antibodies. Group IV (n = 1,010 or 95.65%) fell to present serological evidence of syphilis. To conclude: 1) global seroprevalence in this population was 3.69%; 2) since 2.08% of pregnant seroreactive mothers had not been detected by routine screening, it would be advisable to perform simultaneous treponemic and non-treponemic techniques for prenatal control. 3) This methodology should identify the BFP tests in the same screening.

Sifilis y embarazo. Control prenatal, seroprevalencia y falsos biológicos positivos. / [Syphilis and pregnancy. Prenatal control, seroprevalence and false biological positives]

Syphilis may be transmitted vertically, especially if the mother is in an early stage with a high bloodstream treponema concentration, although it may also be transmitted to a lesser degree in late latency, when non-treponemic serology may become negative spontaneously with persistence of treponemic serology. The prenatal control for syphilis is routinely carried out by means of a non-treponemic reaction such as VDRL or rapid plasma reagin (RPR) which, when positive, should be confirmed by treponemic techniques such as fluorescent treponemal antibody absorption (FTA-abs) and/or hemagglutination (MHA-Tp). Prevalence of syphilis should be defined on the basis of positive treponemic reactions. To define the seroprevalence and the validity of these control guidelines, 1,056 pregnant women attending the Hospital de Clínicas for their initial control were evaluated by means of serological treponemic and non-treponemic methods. Serological results disclosed 4 distinct groups. Group 1 (n = 17 or 1.61

) presented both types of reactive tests, while Group II (n = 22 or 2.08

) only presented reactive treponemic tests, and both groups were seroreactive for syphilis. Group III (n = 7 or 0.66

) only showed reactive non-treponemic tests, which were considered biological false-positive (BFP) reactions. Five of them were reactive for antiphospholipid antibodies. Group IV (n = 1,010 or 95.65

) fell to present serological evidence of syphilis. To conclude: 1) global seroprevalence in this population was 3.69

; 2) since 2.08

of pregnant seroreactive mothers had not been detected by routine screening, it would be advisable to perform simultaneous treponemic and non-treponemic techniques for prenatal control. 3) This methodology should identify the BFP tests in the same screening.

Detection of human Toxoplasma-specific immunoglobulins A, M, and G with a recombinant Toxoplasma gondii rop2 protein.

The Toxoplasma gondii rhoptry protein Rop2 was expressed in Escherichia coli as a fusion protein containing 44 kDa of the 55-kDa mature Rop2, supplied with six histidyl residues at the N-terminal end (Rop2196-561). Humoral response during Toxoplasma infection of humans was analyzed by immunoglobulin G (IgG), IgA, and IgM enzyme-linked immunosorbent assay with Rop2196-561 as the antigen substrate. The analyzed sera were divided according to T. gondii-specific serological tests (IgG, IgA, or IgM indirect immunofluorescence and IgA or IgM immunosorbent agglutination assay) as group A (IgG+ IgA- IgM-; n = 35), group B (IgG+ IgA+ IgM+; n = 21), group C (IgG+ IgA+ IgM-; n = 5), and group D (IgG+ IgA- IgM+; n = 16). Twenty-six T. gondii-seronegative sera from individuals with other infections were also included (group E). Anti-Rop2 IgG antibodies were detected in 82.8% of group A sera and in 97.6% of the sera with acute-phase marker immunoglobulins (groups B, C, and D). The percentage of IgA antibody reactivity against Rop2196-561 was 17.1% in group A, 50% in group D, and 80.8% in groups B and C. The percentage of IgM antibody reactivity was 0% in groups A and C and 62% in groups B and D. Sera from group E failed to show IgA, IgM, or IgG antibody reactivity. Since T. gondii Rop2 elicits a strong humoral response from an early stage of infection, it is suggested that recombinant Rop2196-561 would be suitable for use in diagnostic systems, in combination with other T. gondii antigens, to detect specific IgG, IgA, and IgM antibodies.

Diagnosis of toxoplasmosis by joint detection of immunoglobulin A and immunoglobulin M.

An indirect immunofluorescence test with total anti-human immunoglobulin conjugate (IgG,A,M-IIF) can be used for joint detection of immunoglobulin A (IgA) and IgM antibodies, provided serum IgG is previously absorbed with anti-human IgG. To determine the validity of the IgG,A,M-IIF assay with absorbed sera, the results obtained were compared with those obtained by methods routinely used for the detection of acute-phase markers, IgA and IgM IIF and enzyme immunoassay. Accordingly, 114 serum samples were selected from patients showing titers of > or = 1:1,024 by IgG,A,M-IIF. (i) In 90 of the samples, neither IgA nor IgM was detected by any of the methods employed; (ii) the remaining 24 samples showed IgA and/or IgM. In all cases, the IgG,A,M-IIF assay with absorbed sera was positive. These comparative data support the use of IgG,A,M-IIF, performed with absorbed and unabsorbed sera simultaneously, for determining the presence of specific IgG, IgA, and IgM by employing a single technique (IIF), one conjugate (anti-IgG,A,M), and only one sample (with and without previous absorption), thus providing a useful initial tool for the diagnosis of toxoplasmosis.

[The impact of HIV infection on the incidence of syphilis and gonorrhea at a university hospital (1985-1994)]. / El impacto del HIV sobre la incidencia de sífilis y gonorrea en un Hospital Universitario (1985-1994).

Syphilis and gonorrhea are two sexually transmitted diseases (STD) which still persist in spite of the existence of effective treatment. In this paper the incidence of these two diseases was evaluated between 1985-1994, a decade during which the problem of HIV infection arose. Every patient who attended the STD Program at the Hospital and was suspected of having syphilis and/or gonorrhea was clinically evaluated and was subjected to the following tests: a) search for Neisseria gonorrhoeae (Ng) and penicinilase producers (PPNG) identification, b) search for Treponema pallidum (Tp) by darkfield microscopy, c) serological studies for syphilis. From 1985 to 1991 the average of positive cases for Ng was 14.8% while from 1992 to 1994 it was 4.0% (p < 0.0001) showing a dramatic decrease between 1991 and 1992. PPNG increased from 8.7% in 1985 to 44.6% in 1988 and then slowly decreased down to 26.9% in 1994. From 1985 to 1990 the average of positive darkfield examinations was 20.7% while from 1991 to 1994 it was 12.2% (p < 0.0001). Between 1985 to 1988 syphilis serological studies showed 45.7% positive cases dropping to 34.3% between 1989 and 1994 (p < 0.0001). HIV infection appearance had a wide repercussion throughout the world generating behavioral and sexual habit changes which have probably helped to prevent these two STD. Gonorrhea incidence was also influenced by the appearance of new effective treatments, even against PPNG, such as fluorated quinolones and third generation cephalosporines. The population studied belongs to the most crowded area in Argentina, so that these observations should not be extrapolated to the rest of the country.

Oxidative stress in blood of HIV infected patients.

The oxidative stress in human erythrocytes was studied in asymptomatic and symptomatic patients infected by the human immunodeficiency virus (HIV), and patients with the acquired immunodeficiency syndrome (AIDS). tert-Butyl hydroperoxide initiated chemiluminescence, superoxide dismutase and catalase activities, and total glutathione were evaluated in the erythrocytes and the total antioxidant capacity in the plasma of control, patients infected with HIV that have not yet developed acquired immunodeficiency syndrome, and patients in the later stage of AIDS. tert-Butyl hydroperoxide initiated chemiluminescence was increased by 33% in asymptomatic (stage A1) and symptomatic patients (stage B2) infected with HIV and 82% for patients with AIDS (stage B3) (P < 0.05). While catalase activity did not show any difference between patients and controls, other indices showed differences that, in some cases, reached statistical significance. Superoxide dismutase activity was increased by 24% in stages A1 and B2 of HIV infection and 65% in patients in stage B3 (P < 0.05). Glutathione was decreased by 20% in stages A1 and B2, and by 32% in stage B3 patients (P < 0.05). Total plasma antioxidant capacity was increased in 30 and 57% for the asymptomatic and AIDS patients groups, respectively (P < 0.05). The data indicate that erythrocyte's oxidative stress is associated with the progressive development of HIV disease. Parameters indicating oxidative stress could be an interesting form to screen the evolution of these patients and their response to anti-oxidant therapies.

[Incidence of Chagas infection in pregnant women and newborn infants in a non-endemic area]. / Incidencia de la infección chagásica en embarazadas y en recién nacidos en área no endémica.

The aim of this report was to determine Chagas infection incidence in pregnant women and congenital infection of their children in a hospital of a non-endemic area. From January 1990 to February 1991 we studied: a) 729 pregnant women with the serologic techniques of indirect hemagglutination and indirect immunofluorescence; b) 38 newborns from the 62 babies of seroreactive mothers with the parasitologic microhematocrit method to diagnose the infection. The serological tests were used as an index of the transplacental passage and for the eventual post-treatment control. We found 8.5% of women with Chagas disease, most of whom were born in an endemic area and did not know that they were infected (Table 1). We detected parasitemia in two newborns which represent 5.3% of congenital infection. Both babies were born in good conditions: at term, with normal weight and asymptomatic (Table 2). They were treated with nifurtimox and they showed a good response; the microhematocrit technique became negative a month later. At the end of the treatment the children were in perfect conditions showing an important decrease in the specific antibodies titer (Fig. 1). One of the cases was studied longer than the sixth month of life, maintaining negative serology. Our results in pregnant women are not different from those previously published in Buenos Aires; this points out the need to keep fighting the vector so as to lessen the existing reservoirs. We found a greater incidence of congenital Chagas disease with the microhematocrit technique than that previously published in Buenos Aires with other methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidencia de la infección chagásica en embarazadas y en recién nacidos en área no endémica. / [Incidence of Chagas infection in pregnant women and newborn infants in a non-endemic area]

The aim of this report was to determine Chagas infection incidence in pregnant women and congenital infection of their children in a hospital of a non-endemic area. From January 1990 to February 1991 we studied: a) 729 pregnant women with the serologic techniques of indirect hemagglutination and indirect immunofluorescence; b) 38 newborns from the 62 babies of seroreactive mothers with the parasitologic microhematocrit method to diagnose the infection. The serological tests were used as an index of the transplacental passage and for the eventual post-treatment control. We found 8.5

of women with Chagas disease, most of whom were born in an endemic area and did not know that they were infected (Table 1). We detected parasitemia in two newborns which represent 5.3

of congenital infection. Both babies were born in good conditions: at term, with normal weight and asymptomatic (Table 2). They were treated with nifurtimox and they showed a good response; the microhematocrit technique became negative a month later. At the end of the treatment the children were in perfect conditions showing an important decrease in the specific antibodies titer (Fig. 1). One of the cases was studied longer than the sixth month of life, maintaining negative serology. Our results in pregnant women are not different from those previously published in Buenos Aires; this points out the need to keep fighting the vector so as to lessen the existing reservoirs. We found a greater incidence of congenital Chagas disease with the microhematocrit technique than that previously published in Buenos Aires with other methods.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute gonorrhea. Treatment schedules. Evaluation]. / Gonococia aguda. Esquemas de tratamiento. Evaluación.

It has become gradually more difficult to achieve therapeutic efficacy in the treatment of gonorrhea without the help of bacteriologic examinations that include the identification of resistant strains. We present information that evaluates the incidence of beta-lactamase producing strains and discuss the efficacy of the prescribed treatments.