Serological response to syphilis treatment in HIV-positive and HIV-negative patients attending sexually transmitted diseases clinics.

BACKGROUND: HIV-positive patients treated for syphilis may be at increased risk for serological failure. OBJECTIVE: To compare follow-up serologies and serological responses to treatment between HIV-positive and HIV-negative patients attending two sexually transmitted disease (STD) clinics. STUDY DESIGN: Existing records were reviewed from HIV-positive patients who were diagnosed and treated for syphilis at the public STD clinics in Baltimore, Maryland, USA, between 1992 and 2000. Results of their serological follow-up were compared with those of HIV-negative clinic patients at the time of syphilis treatment. Failure was defined as lack of a fourfold drop in rapid plasma reagin (RPR) titre by 400 days after treatment or a fourfold increased titre between 30 and 400 days. RESULTS: Of the 450 HIV-positive patients with syphilis, 288 (64%) did not have documented follow-up serologies and 129 (28.5%) met the inclusion criteria; 168 (17%) of 1000 known HIV-negative patients were similarly eligible. There were 22 failures in the HIV-positive group and 5 in the HIV-negative group (p<0.001). The median times to successful serological responses in both groups were 278 (95% confidence interval (CI) 209 to 350) and 126 (95% CI 108 to 157) days, respectively (p<0.001). A multivariate Cox's proportional hazards model showed an increased risk of serological failure among the HIV-positive patients (hazards ratio 6.0, 95% CI 1.5 to 23.9; p = 0.01). CONCLUSION: HIV-positive patients treated for syphilis may be at higher risk of serological failure. Despite recommendations for more frequent serological follow-up, most patients did not have documentation of serological response after standard treatment for syphilis.

Adverse radiographic contrast media reactions.

There are many unanswered questions about the mechanisms and prevention of adverse reactions to RCM. Serious reactions will likely occur less often in your experience if you observe these precautions: 1. Consider that every patient is a candiate for an adverse reaction when you request the contrast study. 2. Be particularly cautious in performing the study in those with previous reactions to RMC, those who are strongly atopic, and those in whom intravenous cholangiography is planned. Look for alternative diagnostic approaches in treating these individuals. 3. If there is any likelihood of increased reactivity, inform the patient, carry out a study with intravenous infusion in place and appropriate physician observation during and after the study, consider prestudy treatment with antihistamines and/or steroids, and be prepared to institute emergency measures should the need arise.

Detection of syphilitic hearing loss.

Syphilis can cause sensorineural hearing loss that is potentially treatable. To determine the incidence of positive serological findings in patients with sensorineural hearing loss, the rapid plasma reagin card test (RPRCT) and the FTA-ABS test were performed in a study group composed of patients with sensorineural hearing loss of obscure origin. Of the 306 patients with sensorineural hearing loss, 20 (6.5%) demonstrated a positive FTA-ABS as compared with two of 100 (2%) of the control group. Considerable variation was found in the rate of the false-negative and the biological false-positive RPRCT as performed by our hospital and state laboratories when compared with the results of the FTA-ABS test. Syphilis should be considered in any patient with sensorineural hearing loss of obscure origin, despite a negative history for syphilis. The FTA-ABS is the preferred test to exclude hearing loss of syphilitic origin.

Allergy in systemic lupus erythematosus. IgE levels and reaginic phenomenon.

Twenty-seven patients with systemic lupus erythematosus (SLE) were investigated for the presence of allergic reactivity, and serum IgE levels were measured by immunoassay. Compared to controls, SLE patients had significant increases of only allergic rhinitis and drug allergy. Despite the usual hyperimmunoglobulinemia in SLE, IgE levels were not elevated (mean: 251 IU). Because recent reports have noted elevated IgE in rheumatoid arthritis, this finding may suggest basic immunologic differences between rheumatoid arthritis and SLE.

Bovine reaginic antibody. I. Rat mast cell degranulation by bovine allergic serum.

A method of utilizing morphological changes in rat mast cells to determine reaginic antibody activity in bovine serum is described. This technique, which has been shown to be useful for the diagnosis of allergies in man, relies on the ability of antigen to degranulate mast cells sensitized with allergic serum. Experiments with radioactively-labelled allergic bovine globulin indicated the specificity of the binding of such proteins to rat mast cells. Cross-reaction between reaginic bovine antibody and human IgE was shown by a binding assay involving the uptake of 125I-labelled anti-human IgE globulin by mast cells incubated with bovine passive cutaneous anaphylaxis positive globulin.

Identification of IgG antibody as a carrier of reaginic activity in asthmatic patients.

In a previous study it was reported that a group of asthmatic patients, in whom cromolyn sodium did not inhibit bronchial immediate allergic reactions, had reaginic antibodies that did not appear to belong to the IgE class. This study was designed to extend these observations, and it was shown that the IgG fractions from these patients' sera, purified by ion exchange chromatography and specific immunosorbents, had skin-sensitizing activity to the antigen studied, while the IgE fractions did not. The skin-sensitizing activity in the IgG fractions was not removed by anti-IgE antiserum and was not inactivated by heating at 56 degrees C or by reduction/alkylation. It is proposed that IgG antibodies may mediate immediate allergic reactions in some asthmatic patients, that these patients can be detected by means of serum total IgE and allergen-specific IgE estimation, and that cromolyn sodium is not an effective inhibitor of bronchial immediate allergic reactions in these patients.