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1.
BMC Infect Dis ; 20(1): 455, 2020 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-32600260

RESUMEN

BACKGROUND: Men who have sex with men (MSM) bear a high burden of syphilis infection. Expanding syphilis testing to improve timely diagnosis and treatment is critical to improve syphilis control. However, syphilis testing rates remain low among MSM, particularly in low- and middle-income countries. We describe the protocol for a randomised controlled trial (RCT) to assess whether provision of syphilis self-testing services can increase the uptake of syphilis testing among MSM in China. METHODS: Four hundred forty-four high-risk MSM will be recruited online and randomized in a 1:1:1 ratio to (1) standard syphilis self-testing arm; (2) a self-testing arm program enhanced with crowdsourcing and a lottery-based incentive, and (3) a standard of care (control). Self-testing services include a free syphilis self-test kit through the mail at monthly intervals. Participants in the lottery incentive arm will additionally receive health promotion materials generated from an open crowdsourcing contest and be given a lottery draw with a 10% chance to win 100 RMB (approximately 15 US Dollars) upon confirmed completion of syphilis testing. Syphilis self-test kits have step-by-step instructions and an instructional video. This is a non-blinded, open-label, parallel RCT. Participants in each arm will be followed-up at three and 6 months through WeChat (a social media app like Facebook messenger). Confirmation of syphilis self-test use will be determined by requiring participants to submit a photo of the used test kit to study staff via secure data messaging. Both self-testing and facility-based testing will be ascertained by sending a secure photographic image of the completed kit through an existing digital platform. The primary outcome is the proportion of participants who tested for syphilis in the past 3 months. DISCUSSION: Findings from this study will provide much needed insight on the impact of syphilis self-testing on promoting routine syphilis screening among MSM. The findings will also contribute to our understanding of the safety, effectiveness and acceptability of syphilis self-testing. These findings will have important implications for self-testing policy, both in China and internationally. TRIAL REGISTRATION: ChiCTR1900022409 (10 April, 2019).


Asunto(s)
Pruebas Diagnósticas de Rutina/métodos , Promoción de la Salud/métodos , Homosexualidad Masculina , Inmunoensayo/métodos , Tamizaje Masivo/métodos , Minorías Sexuales y de Género , Serodiagnóstico de la Sífilis/métodos , Sífilis/diagnóstico , Treponema pallidum/inmunología , Serodiagnóstico del SIDA/métodos , China , Colaboración de las Masas/métodos , Pruebas Diagnósticas de Rutina/efectos adversos , Estudios de Seguimiento , Infecciones por VIH/diagnóstico , Infecciones por VIH/virología , VIH-1/inmunología , VIH-2/inmunología , Humanos , Masculino , Tamizaje Masivo/efectos adversos , Motivación , Medios de Comunicación Sociales , Sífilis/microbiología , Serodiagnóstico de la Sífilis/efectos adversos
2.
BMC Infect Dis ; 20(1): 405, 2020 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-32522244

RESUMEN

BACKGROUND: Syphilis is a sexually and vertically transmitted infection caused by the bacteria Treponema pallidum for which there are few proven alternatives to penicillin for treatment. For pregnant women infected with syphilis, penicillin is the only WHO-recommended treatment that will treat the mother and cross the placenta to treat the unborn infant and prevent congenital syphilis. Recent shortages, national level stockouts as well as other barriers to penicillin use call for the urgent identification of alternative therapies to treat pregnant women infected with syphilis. METHODS: This prospective, randomized, non-comparative trial will enroll non-pregnant women aged 18 years and older with active syphilis, defined as a positive rapid treponemal and a positive non-treponemal RPR test with titer ≥1:16. Women will be a, domized in a 2:1 ratio to receive the oral third generation cephalosporin cefixime at a dose of 400 mg two times per day for 10 days (n = 140) or benzathine penicillin G 2.4 million units intramuscularly based on the stage of syphilis infection (n = 70). RPR titers will be collected at enrolment, and at three, six, and nine months following treatment. Participants experiencing a 4-fold (2 titer) decline by 6 months will be considered as having an adequate or curative treatment response. DISCUSSION: Demonstration of efficacy of cefixime in the treatment of active syphilis in this Phase 2 trial among non-pregnant women will inform a proposed randomized controlled trial to evaluate cefixime as an alternative treatment for pregnant women with active syphilis to evaluate prevention of congenital syphilis. TRIAL REGISTRATION: Trial identifier: www.Clinicaltrials.gov, NCT03752112. Registration Date: November 22, 2018.


Asunto(s)
Antibacterianos/uso terapéutico , Cefixima/uso terapéutico , Sífilis/tratamiento farmacológico , Brasil/epidemiología , Protocolos de Ensayos Clínicos como Asunto , Ensayos Clínicos Fase II como Asunto , Femenino , Humanos , Penicilina G Benzatina/uso terapéutico , Distribución Aleatoria , Sífilis/microbiología , Sífilis/prevención & control , Resultado del Tratamiento , Treponema pallidum/efectos de los fármacos , Treponema pallidum/aislamiento & purificación
3.
PLoS One ; 15(4): e0230926, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32236138

RESUMEN

Treponema pallidum subsp. endemicum (TEN) is the causative agent of endemic syphilis (bejel). Until now, only a single TEN strain, Bosnia A, has been completely sequenced. The only other laboratory TEN strain available, Iraq B, was isolated in Iraq in 1951 by researchers from the US Centers for Disease Control and Prevention. In this study, the complete genome of the Iraq B strain was amplified as overlapping PCR products and sequenced using the pooled segment genome sequencing method and Illumina sequencing. Total average genome sequencing coverage reached 3469×, with a total genome size of 1,137,653 bp. Compared to the genome sequence of Bosnia A, a set of 37 single nucleotide differences, 4 indels, 2 differences in the number of tandem repetitions, and 18 differences in the length of homopolymeric regions were found in the Iraq B genome. Moreover, the tprF and tprG genes that were previously found deleted in the genome of the TEN Bosnia A strain (spanning 2.3 kb in length) were present in a subpopulation of TEN Iraq B and Bosnia A microbes, and their sequence was highly similar to those found in T. p. subsp. pertenue strains, which cause the disease yaws. The genome sequence of TEN Iraq B revealed close genetic relatedness between both available bejel-causing laboratory strains (i.e., Iraq B and Bosnia A) and also genetic variability within the bejel treponemes comparable to that found within yaws- or syphilis-causing strains. In addition, genetic relatedness to TPE strains was demonstrated by the sequence of the tprF and tprG genes found in subpopulations of both TEN Iraq B and Bosnia A. The loss of the tprF and tprG genes in most TEN microbes suggest that TEN genomes have been evolving via the loss of genomic regions, a phenomenon previously found among the treponemes causing both syphilis and rabbit syphilis.


Asunto(s)
Proteínas de la Membrana Bacteriana Externa/genética , Treponema pallidum/genética , Treponema/genética , Infecciones por Treponema/microbiología , Bosnia y Herzegovina , Genes Bacterianos , Genoma Bacteriano , Filogenia , Sífilis/microbiología , Secuenciación Completa del Genoma , Buba/microbiología
4.
Doc Ophthalmol ; 141(2): 187-193, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32248327

RESUMEN

PURPOSE: We present our findings in two cases of retinal dysfunction caused by syphilitic outer retinopathy. CASE 1: A 59-year-old man visited our clinic complaining of blurred vision in his left eye. Optical coherence tomography (OCT) demonstrated an absence of the ellipsoid zone (EZ) in the left eye. A round yellowish-white lesion was observed in the posterior pole of the left fundus. Fundus autofluorescence (FAF) showed hyperfluorescent areas in the posterior pole of both fundi although no specific ophthalmoscopic findings were seen in the right eye. The amplitudes of the LA 3.0 1 Hz and LA 3.0 30 Hz ERG responses were reduced with better preservation of the rod responses. Based on a strong positivity to the rapid plasma reagin (RPR) assay and the Treponema pallidum hemagglutination (TPHA) test, he was diagnosed with syphilitic outer retinopathy and treated with systemic antibiotics. The treatment resulted in a restoration of the retinal structures and cone function. CASE 2: A 47-year-old man was referred to our clinic complaining of reduced vision in both eyes. Although the ocular fundus appeared normal, FAF showed a diffuse hyperfluorescent area in the posterior pole and multiple hyperfluorescent spots. Indocyanine green angiography showed multiple confluent areas of hypofluorescence. OCT demonstrated irregular EZs in both eyes. The amplitudes of the LA 3.0 1 Hz and LA 3.0 30 Hz ERG responses were slightly reduced with prolonged implicit times. These findings are comparable to the findings in patients with multiple evanescent white dot syndrome. However, the strong positivity to the RPR and TPHA tests led us to diagnose the patient with outer retinopathy caused by syphilis. Systemic administration of antibiotics resulted in the restoration of the retinal structures and retinal function. CONCLUSIONS: Syphilitic outer retinopathy affected the retinal structures and function that can be restored by antibiotic treatments.


Asunto(s)
Infecciones Bacterianas del Ojo/diagnóstico , Retina/fisiopatología , Enfermedades de la Retina/diagnóstico , Sífilis/diagnóstico , Ampicilina/uso terapéutico , Antibacterianos/uso terapéutico , Electrorretinografía , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/fisiopatología , Angiografía con Fluoresceína , Pruebas de Hemaglutinación , Humanos , Masculino , Persona de Mediana Edad , Oftalmoscopía , Enfermedades de la Retina/tratamiento farmacológico , Enfermedades de la Retina/microbiología , Enfermedades de la Retina/fisiopatología , Sífilis/tratamiento farmacológico , Sífilis/microbiología , Sífilis/fisiopatología , Tomografía de Coherencia Óptica/métodos
5.
BMC Infect Dis ; 20(1): 273, 2020 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-32264923

RESUMEN

BACKGROUND: Syphilis has been associated with an increase in HIV RNA and a temporary decline in CD4 T cell counts in people living with HIV who are not receiving antiretroviral treatment (ART), and may be associated with a transient HIV RNA rebound in those who are receiving ART. Our case is the first to highlight the risk of a multidrug-resistant HIV viral rebound during the course of early syphilis even if antiretroviral drug concentrations are within the therapeutic range. CASE PRESENTATION: This 50-year-old HIV-1-positive male patient with concomitant early syphilis presented with an HIV RNA rebound (8908 copies/mL) during a scheduled visit to our clinic. He was receiving a stable ART regimen consisting of darunavir/cobicistat plus dolutegravir, and had a 15-year history of viral suppression. Good short-term drug adherence could be inferred as liquid chromatography tandem mass spectrometry showed that his trough antiretroviral drug concentrations were within the therapeutic range: darunavir 2353 ng/mL (minimum effective concentration > 500 ng/mL) and dolutegravir 986 ng/mL (minimum effective concentration > 100 ng/mL). A plasma RNA genotype resistance test revealed wild-type virus in the integrase region and protease region (PR), but extensive resistance in the reverse transcriptase (RT) region (M41L, E44D, D67N, K70R, M184V, L210W and T215Y). Phylogenetic analysis of next-generation sequences (used to investigate the presence of minor viral variants), the PR and RT sequences from plasma HIV RNA and pro-viral DNA extracted from peripheral blood mononuclear cells during the viral rebound, and a Sanger sequence obtained during a previous virological failure suggested clonal viral expression because the previous PR resistance mutations had been lost or had not been archived in pro-viral DNA. CONCLUSIONS: This case shows that early syphilis may cause an HIV RNA rebound in patients under stable virological control with the potential of transmitting an extensively drug-resistant virus.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Darunavir/uso terapéutico , Farmacorresistencia Viral Múltiple/genética , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , VIH-1/genética , Compuestos Heterocíclicos con 3 Anillos/uso terapéutico , Sífilis/complicaciones , Coinfección , Infecciones por VIH/virología , Humanos , Leucocitos Mononucleares/virología , Masculino , Persona de Mediana Edad , Oxazinas , Filogenia , Piperazinas , Piridonas , ARN Viral/sangre , Minorías Sexuales y de Género , Sífilis/microbiología , Treponema pallidum , Carga Viral/efectos de los fármacos
6.
PLoS Negl Trop Dis ; 14(4): e0007921, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32251462

RESUMEN

Developing a vaccine against Treponema pallidum subspecies pallidum, the causative agent of syphilis, remains a public health priority. Syphilis vaccine design efforts have been complicated by lack of an in vitro T. pallidum culture system, prolific antigenic variation in outer membrane protein TprK, and lack of functional annotation for nearly half of the genes. Understanding the genetic basis of T. pallidum reinfection can provide insights into variation among strains that escape cross-protective immunity. Here, we present comparative genomic sequencing and deep, full-length tprK profiling of two T. pallidum isolates from blood from the same patient that were collected six years apart. Notably, this patient was diagnosed with syphilis four times, with two of these episodes meeting the definition of neurosyphilis, during this interval. Outside of the highly variable tprK gene, we identified 14 coding changes in 13 genes. Nine of these genes putatively localized to the periplasmic or outer membrane spaces, consistent with a potential role in serological immunoevasion. Using a newly developed full-length tprK deep sequencing protocol, we profiled the diversity of this gene that far outpaces the rest of the genome. Intriguingly, we found that the reinfecting isolate demonstrated less diversity across each tprK variable region compared to the isolate from the first infection. Notably, the two isolates did not share any full-length TprK sequences. Our results are consistent with an immunodominant-evasion model in which the diversity of TprK explains the ability of T. pallidum to successfully reinfect individuals, even when they have been infected with the organism multiple times.


Asunto(s)
Proteínas de la Membrana Bacteriana Externa/genética , Variación Genética , Sífilis/microbiología , Treponema/clasificación , Treponema/aislamiento & purificación , Adulto , Genómica , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Masculino , Recurrencia , Treponema/genética
7.
PLoS One ; 15(3): e0230288, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32160272

RESUMEN

BACKGROUND: Treponema pallidum subspecies pallidum (TPA) and subsp. endemicum (TEN) are the causative agents of syphilis and bejel, respectively. TEN shows similar clinical manifestations and is morphologically and serologically indistinguishable from TPA. Recently, bejel was found outside of its assumed endemic areas. Using molecular typing we aimed to discover bejel and characterize circulating TPA types among syphilis cases with Surinamese, Antillean and Dutch ethnicity in Amsterdam. METHODS: DNA was extracted from 137 ulcer swabs, which tested positive in the in-house diagnostic PCR targeting the polA gene. Samples were collected between 2006 and 2018 from Surinamese, Antillean and Dutch patients attending the Amsterdam STI clinic. Multilocus sequence typing was performed by partial sequence analysis of the tp0136, tp0548 and tp0705 genes. In addition, the 23S rRNA loci were analyzed for A2058G and A2059G macrolide resistance mutations. RESULTS: We found 17 distinct allelic profiles in 103/137 (75%) fully typed samples, which were all TPA and none TEN. Of the strains, 82.5% were SS14-like and 17.5% Nichols-like. The prevalence of Nichols-like strains found in this study is relatively high compared to nearby countries. The most prevalent types were 1.3.1 (42%) and 1.1.1 (19%), in concordance with similar TPA typing studies. The majority of the TPA types found were unique per country. New allelic types (7) and profiles (10) were found. The successfully sequenced 23S rRNA loci from 123/137 (90%) samples showed the presence of 79% A2058G and 2% A2059G mutations. CONCLUSIONS: No TEN was found in the samples from different ethnicities residing in Amsterdam, the Netherlands, so no misdiagnoses occurred. Bejel has thus not (yet) spread as a sexually transmitted disease in the Netherlands. The strain diversity found in this study reflects the local male STI clinic population which is a diverse, mixed group.


Asunto(s)
Genes Bacterianos , Sífilis/microbiología , Treponema pallidum/genética , Adulto , Alelos , Código de Barras del ADN Taxonómico , Grupos Étnicos/estadística & datos numéricos , Humanos , Países Bajos , Antillas Holandesas , Suriname , Sífilis/epidemiología , Sífilis/etnología , Treponema pallidum/clasificación , Treponema pallidum/patogenicidad
8.
BMC Infect Dis ; 20(1): 165, 2020 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-32087699

RESUMEN

BACKGROUND: Treponema pallidum (T. pallidum) infection evokes significant immune responses, resulting in tissue damage. The immune mechanism underlying T. pallidum infection is still unclear, although microRNAs (miRNAs) have been shown to influence immune cell function and, consequently, the generation of antibody responses during other microbe infections. However, these mechanisms are unknown for T. pallidum. METHODS: In this study, we performed a comprehensive analysis of differentially expressed miRNAs in healthy individuals, untreated patients with syphilis, patients in the serofast state, and serologically cured patients. miRNAs were profiled from the peripheral blood of patients obtained at the time of serological diagnosis. Then, both the target sequence analysis of these different miRNAs and pathway analysis were performed to identify important immune and cell signaling pathways. Quantitative reverse transcription-polymerase chain reaction (RT-PCR) was performed for microRNA analysis. RESULTS: A total of 74 differentially regulated miRNAs were identified. Following RT-qPCR confirmation, three miRNAs (hsa-miR-195-5p, hsa-miR-223-3p, hsa-miR-589-3p) showed significant differences in the serofast and serologically cured states (P < 0.05). One miRNA (hsa-miR-195-5p) showed significant differences between untreated patients and healthy individuals. CONCLUSIONS: This is the first study of miRNA expression differences in peripheral blood mononuclear cells (PBMCs) in different stages of T. pallium infection. Our study suggests that the combination of three miRNAs has great potential to serve as a non-invasive biomarker of T. pallium infections, which will facilitate better diagnosis and treatment of T. pallium infections.


Asunto(s)
Leucocitos Mononucleares/metabolismo , MicroARNs/genética , Sífilis/sangre , Transcriptoma/genética , Treponema pallidum/inmunología , Biomarcadores , Perfilación de la Expresión Génica , Humanos , MicroARNs/inmunología , Pronóstico , Reacción en Cadena en Tiempo Real de la Polimerasa , Pruebas Serológicas , Sífilis/diagnóstico , Sífilis/microbiología , Treponema pallidum/aislamiento & purificación
9.
Vet Rec ; 186(14): 450, 2020 04 18.
Artículo en Inglés | MEDLINE | ID: mdl-32066637

RESUMEN

BACKGROUND: Non-healing bovine foot lesions, including non-healing white line disease, non-healing sole ulcer and toe necrosis, are an increasingly important cause of chronic lameness that are poorly responsive to treatment. Recent studies have demonstrated a high-level association between these non-healing lesions and the Treponema phylogroups implicated in bovine digital dermatitis (BDD). However, a polymicrobial aetiology involving other gram-stain-negative anaerobes is suspected. METHODS: A PCR-based bacteriological survey of uncomplicated BDD lesions (n=10) and non-healing bovine foot lesions (n=10) targeting Fusobacterium necrophorum, Porphyromonas endodontalis, Dichelobacter nodosus and Treponema pallidum/T. paraluiscuniculi was performed. RESULTS: P. endodontalis DNA was detected in 80.0% of the non-healing lesion biopsies (p=<0.001) but was entirely absent from uncomplicated BDD lesion biopsies. When compared to the BDD lesions, F. necrophorum was detected at a higher frequency in the non-healing lesions (33.3% vs 70.0%, respectively), whereas D. nodosus was detected at a lower frequency (55.5% vs 20.0%, respectively). Conversely, T. pallidum/T. paraluiscuniculi DNA was not detected in either lesion type. CONCLUSION: The data from this pilot study suggest that P. endodontalis and F. necrophorum should be further investigated as potential aetiological agents of non-healing bovine foot lesions. A failure to detect syphilis treponemes in either lesion type is reassuring given the potential public health implications such an infection would present.


Asunto(s)
Enfermedades de los Bovinos/microbiología , Dermatitis Digital/microbiología , Infecciones por Fusobacterium/veterinaria , Sífilis/veterinaria , Infecciones por Treponema/veterinaria , Animales , Bovinos , ADN Bacteriano/aislamiento & purificación , Femenino , Infecciones por Fusobacterium/microbiología , Fusobacterium necrophorum/genética , Fusobacterium necrophorum/aislamiento & purificación , Proyectos Piloto , Reacción en Cadena de la Polimerasa/veterinaria , Porphyromonas endodontalis/genética , Porphyromonas endodontalis/aislamiento & purificación , Sífilis/microbiología , Treponema pallidum/genética , Treponema pallidum/aislamiento & purificación , Infecciones por Treponema/microbiología , Reino Unido
10.
PLoS One ; 15(1): e0227769, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31929602

RESUMEN

Clinical isolates of Treponema pallidum subspecies pallidum (T. pallidum) would facilitate study of prevalent strains. We describe the first successful rabbit propagation of T. pallidum from cryopreserved ulcer specimens. Fresh ulcer exudates were collected and cryopreserved with consent from syphilis-diagnosed patients (N = 8). Each of eight age-matched adult male rabbits were later inoculated with a thawed specimen, with two rabbits receiving 1.3 ml intratesticularly (IT), and six receiving 0.6 ml intravenously (IV) and IT. Monitoring of serology, blood PCR and orchitis showed that T. pallidum grew in 2/8 rabbits that were inoculated IV and IT with either a penile primary lesion specimen (CDC-SF003) or a perianal secondary lesion specimen (CDC-SF007). Rabbit CDC-SF003 was seroreactive by T. pallidum Particle Agglutination (TP-PA) and Rapid Plasma Reagin (RPR) testing, PCR+, and showed orchitis by week 6. Euthanasia was performed in week 7, with treponemal growth in the testes confirmed and quantified by qPCR and darkfield microscopy (DF). Serial passage of the extract in a second age-matched rabbit also yielded treponemes. Similarly, rabbit CDC-SF007 showed negligible orchitis, but was seroreactive and PCR+ by week 4 and euthanized in week 6 to yield T. pallidum, which was further propagated by second passage. Using the 4-component molecular typing system for syphilis, 3 propagated strains (CDC-SF003, CDC-SF007, CDC-SF008) were typed as 14d9f, 14d9g, and 14d10c, respectively. All 3 isolates including strain CDC-SF011, which was not successfully propagated, had the A2058G mutation associated with azithromycin resistance. Our results show that immediate cryopreservation of syphilitic ulcer exudate can maintain T. pallidum viability for rabbit propagation.


Asunto(s)
Sífilis/microbiología , Sífilis/patología , Treponema pallidum/aislamiento & purificación , Animales , Criopreservación , Modelos Animales de Enfermedad , Humanos , Masculino , Tipificación Molecular , Conejos , Sífilis/diagnóstico , Treponema pallidum/genética , Treponema pallidum/fisiología
11.
BMC Genomics ; 21(1): 33, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31924165

RESUMEN

BACKGROUND: Spirochetal organisms of the Treponema genus are responsible for causing Treponematoses. Pathogenic treponemes is a Gram-negative, motile, spirochete pathogen that causes syphilis in human. Treponema pallidum subsp. endemicum (TEN) causes endemic syphilis (bejel); T. pallidum subsp. pallidum (TPA) causes venereal syphilis; T. pallidum subsp. pertenue (TPE) causes yaws; and T. pallidum subsp. Ccarateum causes pinta. Out of these four high morbidity diseases, venereal syphilis is mediated by sexual contact; the other three diseases are transmitted by close personal contact. The global distribution of syphilis is alarming and there is an increasing need of proper treatment and preventive measures. Unfortunately, effective measures are limited. RESULTS: Here, the genome sequences of 53 T. pallidum strains isolated from different parts of the world and a diverse range of hosts were comparatively analysed using pan-genomic strategy. Phylogenomic, pan-genomic, core genomic and singleton analysis disclosed the close connection among all strains of the pathogen T. pallidum, its clonal behaviour and showed increases in the sizes of the pan-genome. Based on the genome plasticity analysis of the subsets containing the subspecies T pallidum subsp. pallidum, T. pallidum subsp. endemicum and T. pallidum subsp. pertenue, we found differences in the presence/absence of pathogenicity islands (PAIs) and genomic islands (GIs) on subsp.-based study. CONCLUSIONS: In summary, we identified four pathogenicity islands (PAIs), eight genomic islands (GIs) in subsp. pallidum, whereas subsp. endemicum has three PAIs and seven GIs and subsp. pertenue harbours three PAIs and eight GIs. Concerning the presence of genes in PAIs and GIs, we found some genes related to lipid and amino acid biosynthesis that were only present in the subsp. of T. pallidum, compared to T. pallidum subsp. endemicum and T. pallidum subsp. pertenue.


Asunto(s)
Sífilis/microbiología , Treponema pallidum/genética , Genoma Bacteriano/genética , Islas Genómicas/genética , Humanos , Filogenia , Treponema pallidum/clasificación
12.
Sex Transm Infect ; 96(3): 223-226, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-31383781

RESUMEN

OBJECTIVES: The prevalence of syphilis, caused by the spirochete Treponema pallidum subsp. pallidum (TPA), remains high despite the availability of effective antibiotics. In the Netherlands, most syphilis cases are found among men who have sex with men (MSM). We studied the distribution of TPA strain types by molecular characterisation and related this to available characteristics. In addition, resistance to macrolides was assessed. METHODS: TPA DNA was extracted from 136 genital ulcer swab or skin lesions samples deriving from 135 patients diagnosed with syphilis in 2016 and 2017 at the Public Health Service in Amsterdam, the Netherlands. Molecular typing was done according to the enhanced CDC method (E-CDC), in which three genetic regions of the arp, tpr and tp0548 genes are analysed by gel electrophoresis of the arp and tpr regions and by sequence analysis for the tp0548 region. Part of the 23S rDNA locus was sequenced to determine the presence of macrolide resistance-associated mutations. RESULTS: Full E-CDC strain types could be determined for 99/136 (73%) DNA samples, which tested positive in a diagnostic PCR targeting the polA gene. Types differed within one patient of whom two samples were available. No association was found between the demographic and clinical characteristics and the TPA types. The most prevalent type was 14d/g, found in 23 of the 99 (23%) fully typed samples. Part of the 23S rDNA locus was successfully sequenced for 93/136 (68%) samples and 83 (88%) contained the A2058G mutation. No A2059G mutation was found. CONCLUSIONS: A broad strain distribution was found. Few subtypes were clonally expanded, and most other subtypes were rare. Detection of the most prevalent strain type, 14d/g, is in concordance with other TPA typing studies. The high prevalence of genetic macrolide resistance indicates that azithromycin is not an alternative treatment option.


Asunto(s)
Variación Genética , Genotipo , Sífilis/microbiología , Treponema pallidum/clasificación , Treponema pallidum/genética , Adulto , Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Femenino , Genes Bacterianos , Humanos , Macrólidos/farmacología , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Tipificación Molecular , Países Bajos/epidemiología , Prevalencia , Sífilis/epidemiología , Treponema pallidum/aislamiento & purificación
14.
BMJ Open ; 9(11): e024393, 2019 11 02.
Artículo en Inglés | MEDLINE | ID: mdl-31678932

RESUMEN

OBJECTIVE: This study investigated the association between syphilis seroprevalence and age among blood donors, and described the distribution of serological titres among syphilis-infected donors, aiming to confirm the syphilis epidemic characteristics and to promote effective interventions for older adults. METHODS: Data were obtained from the Shenzhen Programme for Syphilis Prevention and Control in 2014-2017. Blood samples were screened using the ELISAs, and confirmed using the Treponema pallidum particle agglutination assay (TPPA) and toluidine red unheated serum test (TRUST). RESULTS: Among 394 792 blood donors, 733 tested TPPA and TRUST positive (active infection), and 728 tested only TPPA positive (historical infection). The overall prevalence of syphilis seropositivity was 370.1 per 100 000 (95% CI 351.1 to 389.0 per 100 000); the prevalence of active infection was 185.7 per 100 000 (95% CI 172.2 to 199.1 per 100 000). People aged ≥45 years displayed a prevalence of 621.8 per 100 000 in syphilis seropositivity and 280.5 per 100 000 in active infection, which were 3.8 times and 2.4 times higher than that for people aged <25 years, respectively. The prevalence of syphilis seropositivity (χ2 trend=311.9, p trend<0.001) and active infection (χ2 trend=72.1, p trend<0.001) increased significantly with age. After stratification by gender and year of donation, the increasing trend of prevalence with age remained (p trend<0.05), except for the prevalence of active infection in males and females in 2014. About 16.3% of donors with active infection and aged ≥45 years had a TRUST titre of ≥1∶8, lower than that of patients aged <25 years (51.3%) and 25-34 years (34.1%). CONCLUSIONS: The findings confirm the high prevalence of syphilis among older adults, and suggest the need to increase awareness among healthcare providers and deliver more targeted prevention interventions for older adults to promote early testing.


Asunto(s)
Anticuerpos Antibacterianos/análisis , Donantes de Sangre , Tamizaje Masivo/métodos , Estudios Seroepidemiológicos , Sífilis/epidemiología , Treponema pallidum/inmunología , Adulto , Factores de Edad , China/epidemiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Sífilis/inmunología , Sífilis/microbiología
15.
Medicina (B Aires) ; 79(5): 415-418, 2019.
Artículo en Español | MEDLINE | ID: mdl-31671396

RESUMEN

We present the case of a 62-year-old woman who consulted for fever (38°), stabbing thoracic pain (on one side), and pruritic skin lesions. She underwent peripheral blood tests, chest X-rays and CT. Her symptoms were interpreted as severe communityacquired pneumonia. After a treatment with antibiotics, her skin lesions persisted, and other symptoms were only partially relieved. A skin biopsy was performed, which revealed Treponema pallidum. Such finding was confirmed through positive serum VDRL and FTA-ABS tests. The patient received 4 doses of benzathine penicillin G with favorable evolution of skin lesions and improvement of radiological images.


Asunto(s)
Enfermedades Pulmonares/microbiología , Sífilis/complicaciones , Biopsia , Dermatitis/microbiología , Dermatitis/patología , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/patología , Persona de Mediana Edad , Radiografía Torácica , Sífilis/microbiología , Tomografía Computarizada por Rayos X , Treponema pallidum/aislamiento & purificación
16.
Medicine (Baltimore) ; 98(44): e17744, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689826

RESUMEN

Congenital syphilis (CS) can cause serious impact on the fetus. However, congenital syphilis presenting as sepsis is a critical condition but hardly identified by the clinic for the first time. In this study, we aimed to identify the benefit of earlier and accurate diagnosis for the infants who suffer congenital syphilis presenting as sepsis.A retrospective study was performed with patients diagnosed of congenital syphilis presenting as sepsis who were the inpatients in the West China Second Hospital between 2011 and 2018. The control group was collected in the neonatal sepsis patients whose blood culture are positive.Fifty-eight patients were included in the study. In the congenital syphilis group, one patient died and 12 (41.3%) patients get worse to MODS (multiple organ dysfunction syndrome). Symptoms, signs, and lab examinations are found to be significantly different (P < .05) between two groups as below, including rash, palmoplantar desquamation, abdominal distension, splenomegaly, hepatomegaly, etc. And, at the aspect of Hb, PLT, WBC, CRP, ALT, AST, these differences occurred in the different groups. It is obvious that the prognosis of children with syphilis is worse. According to a comparison between the different outcomes in the CS, the worse outcome subgroup of patients is significantly younger and have more severely impaired liver function.Because of the high mortality of these infants, pediatricians should improve awareness of CS. Syphilis screening is recommended for pregnant women.


Asunto(s)
Sepsis Neonatal/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Sepsis/diagnóstico , Sífilis Congénita/diagnóstico , Sífilis/diagnóstico , Estudios de Casos y Controles , China , Diagnóstico Diferencial , Diagnóstico Precoz , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/microbiología , Insuficiencia Multiorgánica/mortalidad , Sepsis Neonatal/microbiología , Sepsis Neonatal/mortalidad , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Complicaciones Infecciosas del Embarazo/mortalidad , Estudios Retrospectivos , Sepsis/microbiología , Sepsis/mortalidad , Sífilis/microbiología , Sífilis/mortalidad , Serodiagnóstico de la Sífilis , Sífilis Congénita/mortalidad
17.
Turk J Ophthalmol ; 49(5): 297-299, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31650814

RESUMEN

We report a patient with unilateral syphilitic intermediate uveitis without dermatological, neurological, or any systemic involvement. He presented to our clinic with complaints of eye floaters and worsening visual acuity in the left eye. He had intermediate uveitis and cystoid macular edema in that eye and both venereal disease research laboratory and microhemagglutination assay for Treponema pallidum serological tests were confirmatory for syphilis. Ocular manifestations of syphilis have variable presentations, and it should be considered when diagnosing unexplained ocular inflammatory diseases, even if the patient's recent history and systemic evaluation are not compatible.


Asunto(s)
Infecciones Bacterianas del Ojo/etiología , Sífilis/complicaciones , Uveítis Intermedia/etiología , Agudeza Visual , Anticuerpos Antibacterianos/análisis , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Humanos , Mácula Lútea/patología , Masculino , Sífilis/diagnóstico , Sífilis/microbiología , Tomografía de Coherencia Óptica , Treponema pallidum/inmunología , Uveítis Intermedia/diagnóstico , Uveítis Intermedia/microbiología , Adulto Joven
18.
Sex Health ; 16(6): 598-599, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31665617

RESUMEN

Men who have sex with men (MSM) with symptomatic secondary syphilis present with characteristic symptoms of rash, fever and lymphadenopathy; due to delays in microbiology results and some patients failing to return for treatment, empirical treatment is sometimes offered. We reviewed all patients presenting with secondary syphilis diagnosed on the basis of clinical symptoms and signs and reviewed treatment. Of the 36 patients, 16 MSM (44%; 95% confidence interval (CI) 27.8-60.2%) were treated empirically, whereas treatment was delayed for 20 (56%; 95% CI 39.8-72.2%) waiting for microbiology results. Treatment delays were longer for HIV-negative than HIV-positive MSM (10 vs 5 days respectively; P = 0.01); the cumulative treatment delay was 143 days. Concerns over antimicrobial resistance and overuse of antimicrobials should drive the use of point-of-care testing for syphlis.


Asunto(s)
Antibacterianos/uso terapéutico , Sífilis/tratamiento farmacológico , Adulto , Coinfección/diagnóstico , Coinfección/tratamiento farmacológico , Coinfección/microbiología , Coinfección/virología , Infecciones por VIH/complicaciones , Homosexualidad Masculina , Humanos , Masculino , Persona de Mediana Edad , Sífilis/diagnóstico , Sífilis/microbiología , Factores de Tiempo
19.
Future Microbiol ; 14: 1099-1108, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31512516

RESUMEN

Aim: To describe the molecular types of Treponema pallidum and the proportion of macrolide and tetracycline resistance mutations in Barcelona. Materials & methods: Molecular type was determined using the Enhanced-CDC Typing system and antibiotic resistance was determined by sequencing the 23S and 16S rRNA genes. Results: A total of 183 patients were enrolled and 213 specimens (99 ulcers, 114 bloods) were collected. Sixty-two (70.5%) of 88 ulcers and 0 (0%) of bloods T. pallidum-DNA containing samples were fully typed. Up to 21 different strain types were identified (14d/g in 27.4%; 14f/g in 14.5%). Macrolide resistance mutations were present in 95% and tetracycline in 0%. Conclusion: Several different strains co-exist in Barcelona with a high proportion of macrolide resistance and absence of tetracycline resistance.


Asunto(s)
Farmacorresistencia Bacteriana , Macrólidos/farmacología , Tipificación Molecular , Sífilis/epidemiología , Tetraciclina/farmacología , Treponema pallidum/clasificación , Treponema pallidum/efectos de los fármacos , Antibacterianos/farmacología , ADN Bacteriano/genética , ADN Ribosómico/genética , Humanos , Mutación , Prevalencia , Estudios Prospectivos , ARN Ribosómico 16S/genética , ARN Ribosómico 23S/genética , Análisis de Secuencia de ADN , España/epidemiología , Sífilis/microbiología , Treponema pallidum/genética , Treponema pallidum/aislamiento & purificación
20.
Am J Dermatopathol ; 41(12): 924-926, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31389806

RESUMEN

The Treponema pallidum antibody immunohistochemical (IHC) stain has improved our ability to detect the organism histologically. We present a case of a man with genital condyloma acuminatum with a positive T. pallidum IHC stain but negative T. pallidum serologies and no syphilitic symptoms. It has been shown that the T. pallidum antibody IHC can cross-react, staining other spirochetes, including Borrelia burgdorferi and the Brachyspira family of intestinal spirochetes. Because of the proximity of our patient's lesions to the anus, and the persistently negative T. pallidum serologies, we believe nontreponemal spirochetes colonized the condyloma, giving a false-positive T. pallidum IHC. This cross-reactivity is a potential diagnostic pitfall and is important for the dermatopathologist to recognize, thereby avoiding false diagnosis of syphilis.


Asunto(s)
Anticuerpos/inmunología , Condiloma Acuminado/diagnóstico , Enfermedades de los Genitales Masculinos/diagnóstico , Inmunohistoquímica , Sífilis/diagnóstico , Treponema pallidum/inmunología , Adulto , Especificidad de Anticuerpos , Biopsia , Condiloma Acuminado/inmunología , Condiloma Acuminado/microbiología , Reacciones Falso Positivas , Enfermedades de los Genitales Masculinos/inmunología , Enfermedades de los Genitales Masculinos/microbiología , Humanos , Masculino , Valor Predictivo de las Pruebas , Sífilis/inmunología , Sífilis/microbiología , Serodiagnóstico de la Sífilis
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