Estudo piloto de avaliação de um teste rápido imunocromatográfico para o diagnóstico de sífilis gestacional / Pilot evaluation of a rapid immunochromatographic test for the diagnosis of gestational syphilis

A sífilis gestacional é um problema global de saúde pública e é uma das mais comuns causas de efeitos adversos durante a gravidez devido à ausência ou inadequação do tratamento. Estabelecer um diagnóstico de sífilis durante o pré-natal, evita a transmissão de Treponema pallidum para a criança. Objetivo: o objetivo deste estudo foi avaliar o desempenho de OL Syphilis (OrangeLife, Brasil), um teste imunocromatográfico rápido, para o diagnóstico de sífilis gestacional. Métodos: Um total de 185 mulheres grávidas no pré-natal foram avaliadas por sífilis OL. Os resultados foram comparados com os métodos tradicionais: Laboratório de Pesquisa de Doenças Venéreas e Reaginas de Plasma Rápido (VDRL e RPR) como ensaios de seleção e FTA-ABS como teste confirmatório. Resultados: A prevalência de sífilis nessa população foi de 6,49% (IC 3,40 a 11,06%). A sensibilidade do teste rápido (TR) foi de 91,67% (IC95% 61,52 a 99,79%) e a especificidade foi de 100% (95%IC 97,89 a 100%). O PPV foi 100% (95%CI 71,51 a 100%) e o VPL foi de 99,43 (95%CI 96,84 a 100%). O acordo medido pelo coeficiente Kappa foi de 0,954 (IC95% 0,863 a 1,000). Conclusão: O teste OL Syphilis poderia ser usado no rastreio de mulheres grávidas, fornecendo diagnóstico rápido, aumentando a probabilidade de ter a doença diagnosticada e oportuna, evitando as consequências devastadoras da sífilis congênita.

Gestational syphilis is a global public health problem and one of the most common causes of adverse effects during pregnancy due to absence or inadequacy of treatment. Establishing a diagnosis of syphilis during prenatal care prevents the transmission of Treponema pallidum to the child. Objective: The objective of this study was to evaluate the performance of OL Syphilis (OrangeLife, Brazil), a rapid immunochromatographic test for gestational syphilis diagnosis. Methods: A total of 185 pregnant women in prenatal care were evaluated by OL Syphilis. The results were compared by traditional methods: Venereal Disease Research Laboratory and Rapid Plasma Reagin (VDRL and RPR) for screening and fluorescent treponemal antibody absorption test (FTA-Abs) for confirmation. Results: The prevalence of syphilis in this population was 6.49% (95%CI 3.40 to 11.06%). Rapid Test (RT) sensitivity was 91.67% (95%CI 61.52 to 99.79%) and specificity was 100% (95%CI 97.89 to 100%). Positive predictive value was 100% (95%CI 71.51 to 100%) and Negative predictive value was 99.43% (95%CI 96.84 to 100%). The agreement measured by Kappa coefficient was 0.954 (95%CI 0.863 to 1.000). Conclusion: The OL Syphilis test could be used for screening pregnant women, thus providing rapid diagnosis, increasing the probability of diagnosis and timely treatment, and preventing the devastating consequences of congenital syphilis.

Comparison of Automated Treponemal and Nontreponemal Test Algorithms as First-Line Syphilis Screening Assays

BACKGROUND: Automated Mediace Treponema pallidum latex agglutination (TPLA) and Mediace rapid plasma reagin (RPR) assays are used by many laboratories for syphilis diagnosis. This study compared the results of the traditional syphilis screening algorithm and a reverse algorithm using automated Mediace RPR or Mediace TPLA as first-line screening assays in subjects undergoing a health checkup. METHODS: Samples from 24,681 persons were included in this study. We routinely performed Mediace RPR and Mediace TPLA simultaneously. Results were analyzed according to both the traditional algorithm and reverse algorithm. Samples with discordant results on the reverse algorithm (e.g., positive Mediace TPLA, negative Mediace RPR) were tested with Treponema pallidum particle agglutination (TPPA). RESULTS: Among the 24,681 samples, 30 (0.1%) were found positive by traditional screening, and 190 (0.8%) by reverse screening. The identified syphilis rate and overall false-positive rate according to the traditional algorithm were lower than those according to the reverse algorithm (0.07% and 0.05% vs. 0.64% and 0.13%, respectively). A total of 173 discordant samples were tested with TPPA by using the reverse algorithm, of which 140 (80.9%) were TPPA positive. CONCLUSIONS: Despite the increased false-positive results in populations with a low prevalence of syphilis, the reverse algorithm detected 140 samples with treponemal antibody that went undetected by the traditional algorithm. The reverse algorithm using Mediace TPLA as a screening test is more sensitive for the detection of syphilis.

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.

Importancia de las pruebas específicas e inespecíficas para el diagnóstico de sífilis en donantes de sangre / Importance of specific and unspecific tests to diagnosis syphilis in blood donors

Con la finalidad de mejorar el diagnóstico de laboratorio de sífilis como enfermedad infecto contagiosa en donantes de sangre, se realizó el presente estudio cuyo objetivo es determinar las pruebas serológicas específicas: Inmunoanálisis Enzimático (ELISA), Inmunocromatografía (IC) e inespecíficas: Laboratorio de investigación de enfermedades venéreas (VDRL) y Reaginas séricas no calentadas (USR) más confiable para el descarte de sífilis en donantes de sangre del Hospital Dr. Adolfo Pons de Maracaibo, estado Zulia. Se analizaron 481 sueros de donantes de sangre aparentemente sanos, de ambos sexos en edades comprendidas entre 18 y 60 años. Del total de muestras analizadas por ELISA 10 resultaron positivas (2,07 por ciento) y 8 (1,66 por ciento) por IC. El VDRL captó 4 (0,82 por ciento) sueros con reactividad y USR sólo 2 sueros (0,41 por ciento). Se concluye que la prueba de ELISA conjuntamente con el VDRL son las herramientas más seguras y fidedignos para el descarte de sífilis en donantes de sangre, dado que proporcionan en paralelo resultados confiables, fidedigno que garantice la calidad de la misma al ser transfundida

In order to improve the laboratory diagnosis of syphilis as an infectious and contagious disease in blood donors, we performed this study to determine the reliability of the specific: Enzyme Immunoassay (Elisa) and Immune-chromatography (IC) tests, the unspecific: Venereal Disease Research Laboratory (VDRL) test and the Unheated serum regain (USR) Serologic tests to rule out syphilis from blood donors of the Dr Adolfo Pons Hospital in Maracaibo, Zulia state. We analyzed 481 sera from apparently healthy blood donors, male and female, 18 to 60 years of ages. From the samples analyzed by Elisa 10 were positive (2.07 percent) and 8 (1.66 percent) by IC. VDRL detected 4 (0.82 percent) reactive sera and USR just 2 (0.421 percent). We concluded that Elisa with VDRL are the safest and more reliable tests to rule out syphilis from blood donors, since they gave in parallel reliable results to assure the quality of blood to be transfused

Incidence of seroresistance of syphilis and its relevant factors / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the incidence of seroresistance of syphilis and analyze its relevant factors.</p><p><b>METHODS</b>The clinical data of 131 patients with syphilis were retrospectively analyzed. The incidence of seroresistance was investigated and the correlation between seroresistance and factors including age, gender, original titer, disease course, and medications were analyzed.</p><p><b>RESULTS</b>The incidence of seroresistance was not significantly different among patients with different ages and genders, but was significantly different among patients with different disease courses, antibody titers, and medications. Patients with a baseline serum rapid plasma reagin (RPR) titer of greater than 1: 8, a latent course, or a macrolide therapy history had higher incidences of seroresistance (i. e., 61%, 45.6%, and 72.7% respectively) than those who had a lower RPR titer, a primary course, or a benzathine penicillin therapy history.</p><p><b>CONCLUSION</b>Syphilis patients with a high baseline RPR titer, a latent course, and a macrolides therapy are prone to be seroresistant.</p>

Analysis of Positive Results in Mediace Rapid Plasma Reagin and Treponema pallidum Latex Agglutination as the Automated Syphilis Test / 대한진단검사의학회지

BACKGROUND: We compared the results of automated and quantitative methods for the diagnosis of syphilis, Mediace Rapid Plasma Reagin (RPR) and Mediace Treponema pallidum Latex Agglutination (TPLA) (Sekisui Chemical Co., Ltd, Japan) with those of conventional methods. METHODS: Sera from 3,896 persons who had health checkups between December 2005 and November 2006 were included in the evaluation of positive rates and biological false positives (BFP) for Mediace RPR and TPLA. In addition, 134 patients' sera positive for automated Mediace RPR or TPLA were tested for VDRL and TPHA. Discrepancies between TPLA and TPHA results were confirmed by the RecomBlot Treponemal IgG/IgM (Mikrogen GmbH, Germany). Automated Mediace RPR and TPLA were performed using the Hitachi 7600 chemistry autoanalyzer (Hitachi, Japan). Samples with positive Mediace RPR and negative TPLA results were defined as BFP. RESULTS: Positive rate of automated Mediace RPR was 0.23% (9/3,896). BFP of the Mediace RPR was 0.18%. Positive rate of automated TPLA was 1.62% (37/2,284). Among the 134 patients' sera, 33 (24.6%) showed a discrepancy between conventional VDRL and automated Mediace RPR results: Among 31 Mediace RPR(+)/VDRL(-) sera, 13 were positive and 18 were negative for TPLA. The remaining 2 sera of discrepancy with Mediace RPR(-)/VDRL(+) were all positive for TPLA. There were seven sera that showed a discrepancy between automated TPLA and TPHA results: Two sera with Mediace RPR(+)/TPLA(-)/TPHA(+) showed negative recomBlot Treponemal IgG/IgM results, and among five sera with TPLA(+)/TPHA(-), three demonstrated IgG or IgM by recomBlot Treponemal IgG/IgM. CONCLUSIONS: The results of comparison data demonstrated that automated TPLA results had a high concordance with recomBlot Treponemal IgG/IgM results. Moreover, there are additional advantages of automated methods such as quantitative detection, low infection risk, and no influence by human handling.

Antenatal screening for syphilis at a tertiary care hospital in Riyadh

Routine serologic screening for syphilis is recommended for all pregnant women in Saudi Arabia. This study examined the results of routine antenatal syphilis screening at a tertiary care hospital in Riyadh. Patients and The results of rapid plasma reagin [RPR] tests were compiled for in 3270 pregnant women tested between October 2002 and March 2003 at King Khalid University Hospital. Any RPR reactivity observed in neat or diluted serum was considered positive and confirmed by a Treponema pallidum hemagglutination [TPHA] test.Syphilis screening constituted 87% of RPR tests requested for all reasons during the study period. The majority of women [73%] were screened between 15 to 22 weeks of gestation. Of the 3270 women tested only one was found to have syphilis, a prevalence rate of 0.03%. The prevalence of syphilis is extremely low in the antenatal care population at King Khalid University Hospital in Riyadh. This calls for a nation-wide survey to assess the need for continuation of antenatal syphilis screening with regards to its potential benefits and cost effectiveness in the Kingdom of Saudi Arabia

Prevalencia de anticuerpos virales y reaginas luéticas en donadores de sangre de un hospital / Prevalence of viral antibodies and serology for syphilis in blood donors from a hospital

Objetivo. Establecer la prevalencia de anticuerpos virales y reaginas luéticas en una población de donadores voluntarios. Sitio. Un hospital general de tercer nivel del ISSSTE en la ciudad de Morelia, estado de Michoacán. Desde 1986 es obligatorio en los bancos de sangre de México, investigar en todos los donadores la presencia de anticuerpos contra el virus de la inmunodeficiencia humana (anti-VIH), antígeno de superficie del virus de la hepatitis B (Ags VHB) y reaginas luéticas (RPR); y desde 1993, es también obligatorio determinar anticuerpos contra el virus de la hepatitis C (anti-VHC). Material y métodos. En siete años (01/01/90 a 31/12/96) se obtuvieron 10,077 muestras de donadores voluntarios sanos para la determinación de anti-VIH, AgsVHB y RPR. De 01/07/92 a 31/12/96 se colectaron 7,256 muestras para investigación de anti-VHC. Resultados. Fueron positivos 19 donadores para anti-VIH (0.18 por ciento), 34 para AgsVHB (0.33 por ciento), 12 para RPR (0.11 por ciento) y 22 para anti-VHC (0.30 por ciento). Estas tasas son similares a las de otros bancos de sangre mexicanos

Inmunoglobulina E (IgE) en sangre del cordón umbilical de recién nacidos con antecedentes de atopia familiar / Imnumeglobulin E (IgE) in umbilical cord blood of newborn with family atopy antecedent

Se determinaron los valores de IgE en sangre del cordón en un grupo de recién nacidos con antecedentes atópicos familiares y un grupo control y sin antecedentes familiares de atopia. Los niveles de IgE en sangre del cordón, mayores de 0,7 UI/ml son considerados como índice predictivo de alergia, especialmente cuando existen antecedentes familiares de alergia y/o el individuo es sometido a sobrecarga de alergenos. Se estudiaron 80 recién nacidos, 40 del grupo experimental y 40 del grupo control, determinándose en ambos grupos concentraciones de IgE (UI/ml, edad gestacional entre 37 y 42 semanas, sexo, peso entre 2500 y más de 3000 gms, y atopia familiar más frecuente relacionada con los niveles de IgE) a concentración de IgE en sangre del cordón, en ambos grupos, fue mayor de 0,7 UI/ml. En relación a las variables edad gestional, peso, y sexo, los valores de IgE no presentaron diferencias significativas. Con respecto a los antecedentes de atopia familiar y los niveles de IgE, la muestra se distribuyó de la siguiente manera, asma con 23 casos (95,83 por ciento), rinitis alérgica con 21 (95,45 por ciento), dermatitis atópica, 4 casos (100 por ciento) y para la urticaria 2 casos (100 por ciento), del total de pacientes en este grupo de atopia familiar 3,85 por ciento presentó cifras de IgE inferiores a 0.7 UI/ml

Atopic Cataract Associated with Atopic Dermatitis

Atopic dermatitis is one of the commoner dermatoses of children, adolescents and young aduIt. Atopic persons manifest (1) a high degree of allergic hypersensitivity with the developmmt of atopic reagins in the blood. (2) an exaggerated reaction to various forms of physical and ernotional stress. (3) a favorable symptomatic response to steroidal therapy. (4) an exaggerated reaction to infection with the virus of vaccinia and herpes simplex and (5) an abnormal physiologic response in the skin and the superficial vascular network to physical agents and the acetylcholine. The relation of atopic dermatitis (neurodermatitis disseminata) to various manifestations of ocular disease has been well documented: in the ophthalmologic literature. Cataract formation, re tinal detachment and keratoconjunctivitis have been noted most often. and keratoconus and atopic uveitis are apparently uncommon. Frequency of occurrence of atopic cataract and keratoconjunctivitis was evaluated clinically in 117 patients suppering from atopic dermatitis who were visited to out-patient clinic of dermatology of Eul-Ji Geaeral Hospital during the years 1980 to 1981. A distinctive form of ocular cataract, as a significant complication of atopic dermatitis in the years of adolescence and young adult life, was found in 7 of 117 patients with atopic dermatitis.