Aplicación del algoritmo inverso para diagnóstico de sífilis gestacional en el Instituto Nacional Materno Perinatal, Perú. 2011-2017 / Application of the reverse algorithm for the diagnosis of gestational syphilis at the National Maternal Perinatal Institute, Peru. 2011-2017

RESUMEN Introducción y objetivos: El propósito es evaluar los resultados de la aplicación del algoritmo inverso para el diagnóstico de sífilis gestacional en el Servicio de Medicina Preventiva del Instituto Nacional Materno Perinatal de Lima, entre 2011 al 2017. Método: Estudio observacional, descriptivo y retrospectivo. Revisión de los resultados de los exámenes del Algoritmo inverso de sífilis gestacional. La Prueba Rápida de Sífilis (PRS) se utilizó como tamizaje, su positividad obligaba a efectuar la RPR, cuya reactividad definía la actividad de la enfermedad cuando era igual o mayor de 8 diluciones, títulos menores obligaban al seguimiento serológico. Resultado: Se tamizaron 46,880 embarazadas, la incidencia de sífilis activa fue de 1.02 por mil tamizadas, la frecuencia de títulos menores alcanzó el 29.33% de las positivas al PRS y la discordancia entre PRS y RPR el 57.87%, el seguimiento serológico fue insuficiente (7.27%), al igual que la evaluación de las parejas y/o contactos sexuales de las gestantes con sífilis activa (4.17%). Conclusión: El algoritmo permite un diagnóstico rápido y la instauración oportuna de la terapia antibiótica, pero su fiabilidad se optimizará con la sistematización de los controles de calidad internos y externos, seguimiento serológico sistemático, planificación de la estrategia que asegure la evaluación serológica y tratamiento de las parejas y/o contactos sexuales, y en los casos de discordancia, el algoritmo debe incluir otra prueba treponémica.

SUMMARY Introduction and objectives: The purpose is to evaluate the results of the application of the inverse algorithm for the diagnosis of gestational syphilis in the Preventive Medicine Service of the National Maternal and Perinatal Institute of Lima, between 2011 and 2017. Method: Observational, descriptive and retrospective study. The results of the diagnostic tests applying the inverse algorithm gestational syphilis were reviewed. The Rapid Syphilis Test (PRS)) was used as a screening, its positivity required to perform the RPR, whose reactivity defined the activity of the disease when it was equal to or greater than 8 dilutions, minor titers required serological follow-up. Result: The incidence of active syphilis was 1.02 per thousand screened, the frequency of minor titres reached 29.33% of those positive for PRS and the discordance between PRS and RPR was 57.87%, serological follow-up was insufficient (7.27%), as well as the evaluation of sexual partners and / or contacts of pregnant women with active syphilis (4.17%). Conclusion: The algorithm allows a rapid diagnosis and the timely establishment of antibiotic therapy, but its reliability will be optimized with the systematization of internal and external quality controls, systematic serological monitoring, strategy planning to ensure the serological evaluation and treatment of couples and / or sexual contacts, and in cases of discordance, the algorithm must include another treponemal test.

Nodular tertiary syphilis in an immunocompetent patient

Abstract: Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. About 25% of patients with untreated primary syphilis will develop late signs that generally occur after three to five years, with involvement of several organs. The authors present an immunocompetent female who developed a tertiary stage syphilis presenting with long-standing nodular plaques.

Frequency of antiphospholipid antibodies in patients with infectious diseases using three different ELISA methods

OBJETIVO: O ensaio de enzyme-linked immunosorbent assay (ELISA) para a pesquisa de anticorpos anticardiolipina (aCL) é o mais importante teste para o diagnóstico da síndrome antifosfolipídica (SAF). Entretanto esse teste também pode ser positivo em algumas doenças infecciosas. Tem sido sugerido que a detecção de anticorpos para uma mistura de fosfolípides ou para b2-glicoproteína I (b2-GP I) teria uma maior especificidade para a SAF que o teste de ELISA-padrão para aCL. O objetivo do presente estudo é comparar a especificidade de três testes para anticorpos antifosfolípides (aFL) em pacientes com doenças infecciosas. MÉTODOS: Anticorpos antifosfolípides foram pesquisados por três técnicas de ELISA, ou seja, o teste-padrão para aCL, o kit de ELISA APhL® e o teste para anti-b2-GP I em pacientes com doenças infecciosas, tais como sífilis (69), leptospirose (33) e Calazar (30). RESULTADOS: A freqüência de positividade de aFL da classe IgG em pacientes com sífilis, leptospirose e Calazar foi de 13/69 (19 por cento), 9/33 (27 por cento) e 2/30 (6 por cento), respectivamente, com o ELISA-padrão para aCL versus 1/69 (1,4 por cento), 0/33 (0 por cento) e 0/30 (0 por cento) com o kit de ELISA APhL®. A positividade do isotipo IgM foi de 10/69 (14 por cento), 4/33 (12 por cento) e 1/30 (3 por cento), respectivamente, com o ELISA-padrão para aCL, e 1/69 (1,4 por cento), 0/33 (0 por cento) e 0/30 (0 por cento) com o kit de ELISA APhL®. Anticorpos da classe IgG contra b2GPI foram detectados em 14/69 casos de sífilis (20 por cento), 6/33 casos de leptospirose (18 por cento) e 16/30 casos de Calazar (53 por cento). Assim, o kit de ELISA APhL® apresentou uma maior especificidade: 97 por cento (95 por cento CI: 92 por cento-99 por cento) comparado com 81 por cento (95 por cento CI: 74 por cento-87 por cento) para o teste de aCL-padrão e 72 por cento (95 por cento CI: 64 por cento-79 por cento) para o teste de anticorpos anti-b2 GPI. CONCLUSÕES: O kit de ELISA APhL® parece ser m...

The Effects of Treponema pallidum on Human Dendritic Cells

Cell mediated immune responses play a prominent role in syphilis, which is caused by Treponema pallidum. The role of dendritic cells (DC) in the syphilitic infection is not well understood in human. In the present study, we studied interaction of T. pallidum with DC, generated from human peripheral blood mononuclear cells with GM-CSF and IL-4. After adding T. pallidum for 16 hours to immature DC at culture day 7, the change of surface antigens on DC was monitored by flow cytometry, the amount of IL-12 in culture supernatant of DC was measured by ELISA and T cell stimulatory capacity of DC was checked in mixed lymphocyte reaction (MLR). We have observed an efficient phagocytosis of T. pallidum by electron microscopy as early as 2 hours after addition of T. pallidum to DC. Interaction of DC with T. pallidum resulted in increased surface expression of CD83 which was proportionally increased according to the number of T. pallidum. Expressions of CD80, CD86 and HLA-DR on DC were slightly increased. The amount of IL-12 in the culture supernatant of DC was increased (1, 099pg/ml) after the addition of T. pallidum. T. pallidum-infected DC also displayed enhanced T cell stimulatory capacity in MLR. As seen from the above, we observed phagocytosis of T. pallidum by DC as early as 2 hours after addition of T. pallidum to DC and found that T. pallidum can stimulate DC maturation which mean that DC modulate an protective immune response during T. pallidum infection.

Serological prevalence of antibodies to human immunodeficiency virus (HIV) and hepatitis B virus (HBV) among healthy Nepalese males--a retrospective study.

A retrospective data analysis for sero-prevalence of antibodies to HIV, HBV and syphilis was carried out during the period 3 notrd September 2003 to 3rd June 2004 in 627 apparently healthy Nepalese males aged 17 to 48 years and association of the diseases with age group and blood group were analyzed. The study showed the prevalence of HIV, HBV and syphilis being 1.6%, 2.7% and 0.6% respectively. Analysis of blood group showed that 97.76% of total male population having Rhesus positive blood. Among them, O "positive" was the most common blood group with 31.9% followed by A "positive", B "positive" and AB "positive" respectively. The analysis of relationship showed a tendency of high affinity of those diseases in the subjects with O "positive" blood group. However, no real association of those infections was found with the blood group (HIV: X2=0.902, P=0.99; HBsAg: X2=1.212, P=0.99; RPR: X2=3.975, P=0.789).

A serosurvey of hepatitis B virus, hepatitis C virus, human T lymphotropic virus type-1 and syphilis in HIV-1-infected patients in Jamaica

The seroprevalences of hepatitis B virus (HBV), hepatitis C virus (HCV), human T lymphotropic virus type-1 (HTLV-1) and syphyilis were determined in 129 HIV-1-infected patients using commercially prepared reagents. The seroprevalences were HCV, 0 (0/129); HBV, 37 (48/129); HTLV-1, 5 (6/129) and syphilis, 20 (26/129). Fifteen per cent (19/129) of the patients had active/chronic HBV infection. The seroprevalence of HBV was statistically significantly higher in HIV-1 infected men (24/49, 50 versus 17/80, 21; p = 0.005), while the seroprevalence of syphilis was statistically significantly increased in HIV-1 infected patients in the over-40 age group (10/31, 32 versus 6/53, 11; p = 0.05). These findings throw the spotlight on HBV infection and syphilis and suggest that these two sexually transmitted infections should be carefully surveyed in patients with HIV/AIDS in Jamaica. It is essential for management protocols in Jamaica to include screening for evidence of these co-infections

Anticuerpos IgM e IgA anti Treponema pallidum en pacientes en distintos estadíos de sífilis / Anti treponema pallidum IgM and IgA antibodies in patients in different stages

Se efectuó la detección de anticuerpos treponémicos IgM e IgA en pacientes con distintos estadíos de sífilis por un método de captura de anticuerpos en fase sólida y posterior revelado por hemaglutinación (SPHA-M y SPHA-A). Se evaluaron con SPHA-M 167 muestras séricas, 63 correspondían a pacientes con sífilis sin tratamiento (12 primarias, 18 secundarias, 23 latentes y 10 reinfecciones) y 104 pacientes que habían recibido tratamiento. En 62/167 de las muestras se evaluaron también los anticuerpos IgA, 30 pertenecían a pacientes sin tratamiento (2 primarias, 12 secundarias, 10 latentes y 6 reinfecciones). Las 32 muestras restantes correspondían a pacientes tratados. En la población de los 63 pacientes no tratados se detectó IgM específica en el 25 por ciento de casos de sífilis primaria, en el 100 por ciento de las secundarias y reinfecciones y en el 78,3 por ciento de latencias, pero sólo se encontró IgM específica en el 4,8 por ciento de sífilis tratada. En 30 pacientes no tratados la IgA específica se detectó en 1 de 2 casos de sífilis primaria, en el 100 por ciento de las secundarias y reinfecciones y en el 60 por ciento de sífilis latentes. En sífilis tratada sólo en el 6,2 por ciento se encontró IgA específica. Los anticuerpos IgA coexistieron en todos los casos estudiados con los IgM. El seguimiento post tratamiento de 7 pacientes mediante SPHA-M y VDRL indicó que entre 1 y 5 meses el SPHA-M se negativizaba, mientras la reactividad de la VDRL persistía aún al año de completado el tratamiento. La presencia de IgM y/o IgA específica evaluada según esta metodología permite caracterizar a la sífilis activa en todos los estadíos, excepto en la sífilis primaria. El seguimiento en base a los resultados de SPHA-M reproduce más fielmente la respuesta terapéutica que el seguimiento convencional con VDRL

Frecuencia de anticuerpos antifosfolipidos en enfermedades autoinmunes y sifilis: correlación con caracteristicas clinicas y de laboratorio

Objetivos: establecer la prevalencia de anticuerpos anticardiolipina (aCL) y de anticoagulante lúpico (LAC) en pacientes con lupus eritematoso sistemico (LES), sindrome antifosfolipido (APS), artritis reumatoidea (AR) y sifilis temprana latente. Correlacionar los niveles de aCL con la presentacion clinica y los hallazgos de laboratorio. Material y metodo: se seleccionaron 100 controles normales y 140 pacientes agrupados asi: grupo 1: sindrome antifosfolipido primario (PAPS): 15; grupo 2, LES:60;grupo 3,AR:35 y grupo 4, sifilis temprana latente:30. Se determinó la presencia de aCL y LAC. Resultados: prevalencia de antifosfolipidos: aCL,100 porciento en el grupo 1; 57 porciento en el 2; 51 porciento en el 3 y 73 porciento en el 4. LAC, 42 porciento en el 1; 24 porciento en el 2; 9 porciento en el 3 y 3 porciento en el 4. Las caracteristicas clinicas mas frecuentemente encontradas en la poblacion son trombosis arterial y venosa, y perdida fetal. En los grupos 1 y 2 se encontro asociación entre aCL (IgG y/o IgA) y LAC, a diferencia de lo observado en los grupos 3 y 4, los cuales no presentan manifestaciones del APS asociadas con aCL o LAC. Conclusion: encontramos prevalencias mas altas de aCL y LAC en pacientes con LES, comparadas con otros estudios. La asociacion de varias clases de aCL fue comun en los pacientes con LES y PAPS. En nuestra población la trombosis arterial y/o venosa fueron caracteristicas clinicas del APS más frecuentemente encontradas y las que presentaron una fuerte asociacion con a PL. No encontramos una relacion entre aCL y perdida fetal o trombocitopenia, ni diferencias estadisticas en las carcteristicas clinicas y de laboratorio entre APS primario y secundario

Anticardiolipin antibodies from syphilis and systemic lupus erythematosus induce leakage in cardiolipin vesicles

Anticardiolipin antibodies from sera of patients with systemic lupus erythematosus or syphilis induced leakage of entrapped carboxyfluorescein (CF) from cardiolipin (CL)/phosphatidylcholine(PC) vesicles prepared by sonication of equimolar mixtures of CL:PC. The sera dilution used here was 1:7500. IgG (5-20 mug/ml) from the same sera, not containing beta2GPI, also produced a concentration-dependent leak. Vesicle leakage was inhibited by salt and was not detected with vesicles prepared exclusively with phosphatidylcholine. The demonstration of antibody-induced vesicle leakage offers a convenient system to investigate the mechanism of antibody-lipid binding as well as a potential diagnostic tool.

Anti-HIV, anti-HCV, syphilis, HBsAg serologic tests among high-risk groups and blood donors in Yogyakarta, Indonesia.

This report showed anti-HIV among high-risk groups and blood donors in Yogyakarta were still negative. The frequency of HBsAg among blood donor was 2% (RPHA), 3% (ELISA) positive. Test for syphilis gave 0.3% positive.

Evaluation of donor self exclusion program.

Donor self exclusion is a low technology procedure to avoid blood donations from the high-risk groups for HIV infection. This strategy has been widely used in western countries to reduce the risk of transfusion associated AIDS. At Ramathibodi Hospital, we conducted a study on donor self exclusion program during March-December 1991. It was found 2.60%-6.55% (mean = 4.59%) of a total of 4,286 units of blood that were from the donors who indicated that their blood may not be safe for transfusion while the rest of them declared that their blood was safe based on sexual behavior during the past 3 months and the history of intravenous drug use. Among 202 units of unsafe blood, there were 1 (0.49%) positive for HIV-Ag, 7 (3.46%) for anti-HIV, 5 (2.48%) for anti-HCV, 10 (4.95%) for HBsAg and 6 (2.97%) for VDRL while there was no HIV-Ag detected in 4,084 units of safe blood but 19 (0.46%) were positive for anti-HIV (p < 0.05), 65 (1.59%) for anti-HCV, 219 (5.36%) for HBsAg and 56 (1.37%) for VDRL. It was clearly demonstrated in this study that confidential self-exclusion or HIV-Ag testing would have eliminated this HIV-Ag reactive unit in the "window period" from transfusion, while the syphilis screening would not have had any value as a surrogate marker. However, self-exclusion programs are likely to prove too non-specific and need more time to educate the donors.(ABSTRACT TRUNCATED AT 250 WORDS)

Seroprevalence of toxoplasma gondii, rubella virus, cytomegalovirus herpes simplex virus (TORCH) and syphilis in Jamaican pregnant women

Seroprevalence of toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex virus infections (TORCH) and syphilis were determined in order to assess the immune/susceptibility status in Jamaican pregnant women in 1986. The positive rates were 57%(T. gondii), 69%(rubella), 97%(CMV), 91%(HSV), and 4.9%(syphilis), respectively. The rate of reactivity for rubella was over 50%in all parishes, the highest being 85%in St. Thomas. The seroprevalence of T. gondii was lowest in Trelawny (37.5%). There were no significant differences in seropositivity of CMV and HSV infections between women from various parishes. The importance of seroprevalence of the TORCH group of agents and syphilis on perinatal morbidity and mortality in Jamaican women is discussed, and appropriate recommendations for prevention and control of congenital infections in Jamaica are suggested.

Antyphospholipid antibodies in syphilis

1. An enzyme-linked immunosorbent assay was used to determine the phospholipid specificity of antibodies in sera from 35 syphilis patients. 2. Based on the cross-reaction obtained aginst a mixture of cardiolipin, phosphatidylcholine and holesterol that is standard for flocculation tests according to the Venereal Disease Research Laboratory (CECON, Säo Paulo, Brazil), all 35 patients tested positive for antibodies of the IgG class whereas 13 (37%) also had IgM antibodies for the same mixture of lipids. IgG antibodies to cardiolipin were demonstrated in 2 patients (6%) and IgM antibodies in 5 (15%). Significant levels of IgG anti-phosphatidylcholine were detected in 3 patients (9%) and IgM antibodies in 4(11%). IgG anti-phosphatidylethanolamine antibodies were found in 1 patient (3%) and IgM antibodies in 3(9%). Antibody binding to cardiolipin plus cholesterol or cardiolipin plus phosphatidycholine was as effective as when the standard mixture of all 3 lipids was used. 3. A comparison with serum from systemic lupus erythematosus patients and inhibition studies using liposomes o cardiolipin or the mixture of 3 lipids suggests that there are at least 3 groups of anticardiolipin antibodies

A simple method to quantitate circulating immune complexes in different diseases.

Immune Complexes are involved in the Pathogenesis of many diseases of varied aetiology such as autoimmune disorders, protozoal diseases, bacterial and viral infections. Quantitation of immune Complexes in these diseases can be used for diagnosis and to ascertain the prognosis. The simple method of precipitation by polyethylene glycol and quantitation by single Radial Immunodiffusion has been used in leprosy, syphilis, bacterial endocarditis and systemic lupus erythematosus (SLE). This method found significantly higher levels of circulating immune complexes (CICs) in erythema nodosum leprosum, culture positive bacterial endocarditis and SLE where CICs are known to play an important role in the pathogenesis.