Ocular Syphilis: A Case Report.

Neurosyphilis refers to the involvement of the central nervous system by Treponema pallidum. Ocular syphilis can present with a range of manifestations, uveitis being the most common, and it can occur at any stage of acquired syphilis. There are multiple tests available for the diagnosis of syphilis. Moreover, the treatment of syphilis depends upon the stage of the disease. For years, the management of syphilitic uveitis was controversial among physicians, with several reviews debating whether ocular syphilis is a subtype of neurosyphilis. Recent recommendations state that ocular syphilis should be treated similarly to neurosyphilis, even with a normal liquor examination. Herein, we describe a case of a 57-year-old male patient who was diagnosed with ocular syphilis.

A case report of severe bleeding due to lupus anticoagulant hypoprothrombinemia syndrome.

Association of acquired factor II deficiency and lupus anticoagulant is a rare disease that can be related to sudden, severe or fatal haemorrhage. We present a 74-years-old woman with history of myelodysplastic syndrome, admitted to the Emergency Department due to spontaneous mucocutaneous bleeding. Coagulation assays revealed prolonged prothrombin time and activated partial thromboplastin time with evidence of an immediate acting inhibitor. Antithrombotic therapy usage, drug ingestion, disseminated intravascular coagulation, liver dysfunction and sepsis were excluded. Patient was admitted for close monitoring and etiological evaluation. A comprehensive bleeding diathesis workup was performed showing factor II levels severely decreased and transient positive lupus anticoagulant. Immunosuppression with methylprednisolone lasted for 3 days, followed by prednisolone. After 20 days she was discharged and follow-up was scheduled. Early diagnosis of lupus anticoagulant hypoprothrombinemia syndrome is critical, as it may result in fatal complications if not treated appropriately. There is no consensus regarding the best treatment, most being based on immunosuppression.

Prevalence of Parvovirus B19 and Hepatitis A virus in Portuguese blood donors.

INTRODUCTION: In recent years, concern about the safety of blood in regard to the transmission of blood-borne viruses has been decreased. Safety has been achieved with a combination of different strategies, such as careful selection of donors, screening for relevant virological markers and viral inactivation/removal methods. More recently, the implementation of the nucleic acid amplification technologies for the detection of HIV-1, HCV and HBV, has increased safety by reducing the "window period" of the infections. Other viruses, such as Parvovirus B19 (PB19) and Hepatitis A virus (HAV), can cause problems for blood safety. These infections could provoke serious complications in some risk groups, such as pregnant women, patients with hematological problems, children and patients with immunodeficiencies. MATERIALS AND METHODS: An observational study was performed to determine the prevalence of PB19 and HAV in Portuguese blood donors. We gathered, during four months, 5025 plasma donations and made them into 505 pools with no more than 10 donations each. The nucleic acids were isolated using MagNA Pure LC (Roche, Mannheim, Germany). A "Real Time PCR" (LightCycler, Roche) was used to perform the nucleic acid amplification and detection, using kits from the manufacturer. RESULTS: We found a prevalence of 0.12% for PB19 and 0% for HAV. Viraemia levels found in the positive donations range from 7.1x10(4) to 2.1x10(12)IU/ml. DISCUSSION: This study demonstrates the possibility of performing these tests in routine blood banks. We found a similar prevalence of PB19 when compared with other European and USA countries. In the case of HAV, we predict a maximum risk of 0.06% for a donor to be infected. It is necessary to perform other studies, including cost/benefit analysis to evaluate the risks and profits of implementing these methodologies in Transfusion Medicine.

Evaluation of NucliSens-AmpliScreen methodology to detect subtypes G of HIV-1 and 4c/4d of HCV in the screening of blood donors.

BACKGROUND AND OBJECTIVES: Albeit, the NucliSens Extractor combined with the Ampliscreen was validated for application in NAT minipool screening, a study to evaluate the reliability of the procedure in relation to subtypes G of human immunodeficiency virus (HIV)-1 RNA and 4c/4d of hepatitis C virus (HCV) RNA should be performed, due to their genetic differences and the high frequency in our country. STUDY DESIGN: Samples from patients infected with subtypes G of HIV-1 RNA and 4c/4d of HCV RNA were diluted with negative plasma and tested eight times for each concentration. For nucleic acid extraction we used an automated silica-based extraction method (NucliSens Extractor) and for amplification and detection the AmpliScreen HIV-1 version 1.5 and AmpliScreen HCV version 2.0 (Roche Diagnostic Systems) were applied. RESULTS: The sensitivity for HIV-1 RNA genotype G using the NucliSens-AmpliScreen method-95% detection limit (95% CI) of 25 (18-50) copies per ml-is comparable with those described for genotypes B and E and to that obtained by the Multiprep procedure. In the case of HCV, the sensitivity of the method was also similar, when we compared the detection limits obtained for genotype 4c/4d-95% detection limit (95% CI) of 34 (24-71) IU/ml-with the genotype 1 published. CONCLUSIONS: The data presented here suggest that these infections will not be missed because of genetic variation, as the platform exhibited similar limits of detection for the subtypes evaluated, meeting the sensitivity requirements set by the regulatory bodies.

Detection of HIV-1 subtype G using Cobas Ampliscreen test.

A nucleic acid amplification test for detection of HIV-1 RNA was designed for screening pools of human plasma. This test achieves a similar level of sensitivity for group M subtypes, but few samples of subtype G and none of its CRFs had been tested, which are the most relevant in Portugal. We found that the test is effective in detecting HIV-1 subtypes and has an analytical sensitivity similar to B subtype.