Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.638
Filtrar
1.
BMJ Case Rep ; 13(12)2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33370929

RESUMEN

Syphilitic proctitis is a rare presentation of sexually transmitted infection that poses a diagnostic challenge as it mimics rectal cancer clinically, radiologically and endoscopically. We report a case of a 66-year-old male patient with a background of HIV infection presenting with obstructive bowel symptoms and initial diagnosis of rectal cancer on CT. Sigmoidoscopy and histopathology were non-diagnostic. A diagnosis of secondary syphilis was suspected after obtaining sexual history and diagnostic serology, avoiding planned surgical intervention.


Asunto(s)
Infecciones por VIH , Obstrucción Intestinal , Penicilinas/administración & dosificación , Proctitis/diagnóstico , Neoplasias del Recto/diagnóstico , Recto , Treponema pallidum , Anciano , Antibacterianos/administración & dosificación , Diagnóstico Diferencial , Infecciones por VIH/complicaciones , Infecciones por VIH/terapia , Humanos , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Masculino , Proctitis/etiología , Proctitis/fisiopatología , Proctitis/terapia , Recto/diagnóstico por imagen , Recto/microbiología , Recto/patología , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/terapia , Sigmoidoscopía/métodos , Sífilis/complicaciones , Sífilis/diagnóstico , Sífilis/terapia , Tomografía Computarizada por Rayos X/métodos , Treponema pallidum/inmunología , Treponema pallidum/aislamiento & purificación
2.
PLoS Pathog ; 16(9): e1008871, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32936831

RESUMEN

Deconvolution of syphilis pathogenesis and selection of candidate syphilis vaccinogens requires detailed knowledge of the molecular architecture of the Treponema pallidum outer membrane (OM). The T. pallidum OM contains a low density of integral OM proteins, while the spirochete's many lipoprotein immunogens are periplasmic. TP0751, a lipoprotein with a lipocalin fold, is reportedly a surface-exposed protease/adhesin and protective antigen. The rapid expansion of calycin/lipocalin structures in the RCSB PDB database prompted a comprehensive reassessment of TP0751. Small angle X-ray scattering analysis of full-length protein revealed a bipartite topology consisting of an N-terminal, intrinsically disordered region (IDR) and the previously characterized C-terminal lipocalin domain. A DALI server query using the lipocalin domain yielded 97 hits, 52 belonging to the calycin superfamily, including 15 bacterial lipocalins, but no Gram-negative surface proteins. Surprisingly, Tpp17 (TP0435) was identified as a structural ortholog of TP0751. In silico docking predicted that TP0751 can bind diverse ligands along the rim of its eight-stranded ß-barrel; high affinity binding of one predicted ligand, heme, to the lipocalin domain was demonstrated. qRT-PCR and immunoblotting revealed very low expression of TP0751 compared to other T. pallidum lipoproteins. Immunoblot analysis of immune rabbit serum failed to detect TP0751 antibodies, while only one of five patients with secondary syphilis mounted a discernible TP0751-specific antibody response. In opsonophagocytosis assays, neither TP0751 nor Tpp17 antibodies promoted uptake of T. pallidum by rabbit peritoneal macrophages. Rabbits immunized with intact, full-length TP0751 showed no protection against local or disseminated infection following intradermal challenge with T. pallidum. Our data argue that, like other lipoprotein lipocalins in dual-membrane bacteria, TP0751 is periplasmic and binds small molecules, and we propose that its IDR facilitates ligand binding by and offloading from the lipocalin domain. The inability of TP0751 to elicit opsonic or protective antibodies is consistent with a subsurface location.


Asunto(s)
Proteínas Bacterianas/inmunología , Vacunas Bacterianas/inmunología , Inmunización , Lipoproteínas/inmunología , Sífilis/inmunología , Treponema pallidum/inmunología , Animales , Proteínas Bacterianas/genética , Vacunas Bacterianas/genética , Humanos , Lipoproteínas/genética , Dominios Proteicos , Pliegue de Proteína , Conejos , Sífilis/genética , Sífilis/patología , Sífilis/prevención & control , Treponema pallidum/genética , Treponema pallidum/patogenicidad
3.
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
4.
BMC Infect Dis ; 20(1): 392, 2020 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-32493291

RESUMEN

BACKGROUND: The first yaws eradication campaign reduced the prevalence of yaws by 95%. In recent years, however, yaws has reemerged and is currently subject to a second, ongoing eradication campaign. Yet, the epidemiological status of Tanzania and 75 other countries with a known history of human yaws is currently unknown. Contrary to the situation in humans in Tanzania, recent infection of nonhuman primates (NHPs) with the yaws bacterium Treponema pallidum subsp. pertenue (TPE) have been reported. In this study, we consider a One Health approach to investigate yaws and describe skin ulcers and corresponding T. pallidum serology results among children living in the Tarangire-Manyara ecosystem, an area with increasing wildlife-human interaction in northern Tanzania. METHODS: To investigate human yaws in Tanzania, we conducted a cross-sectional study to screen and interview skin-ulcerated children aged 6 to 15 years, who live in close proximity to two national parks with high numbers of naturally TPE-infected monkeys. Serum samples from children with skin ulcers were tested for antibodies against the bacterium using a treponemal (Treponema pallidum Particle Agglutination assay) and a non-treponemal (Rapid Plasma Reagin) test. RESULTS: A total of 186 children aged between 6 and 15 years (boys: 10.7 ± 2.1 (mean ± SD), N = 132; girls: 10.9 ± 2.0 (mean ± SD), N = 54) were enrolled. Seven children were sampled at health care facilities and 179 at primary schools. 38 children (20.4%) reported active participation in bushmeat hunting and consumption and 26 (13.9%) reported at least one physical contact with a NHP. None of the lesions seen were pathognomonic for yaws. Two children tested positive for treponemal antibodies (1.2%) in the treponemal test, but remained negative in the non-treponemal test. CONCLUSIONS: We found no serological evidence of yaws among children in the Tarangire-Manyara ecosystem. Nevertheless, the close genetic relationship of human and NHPs infecting TPE strains should lead to contact prevention with infected NHPs. Further research investigations are warranted to study the causes and possible prevention measures of spontaneous chronic ulcers among children in rural Tanzania and to certify that the country is free from human yaws.


Asunto(s)
Anticuerpos Antibacterianos/sangre , Úlcera Cutánea/patología , Treponema pallidum/inmunología , Buba/patología , Adolescente , Animales , Niño , Estudios Transversales , Ecosistema , Femenino , Haplorrinos , Humanos , Masculino , Prevalencia , Enfermedades de los Primates/microbiología , Enfermedades de los Primates/patología , Úlcera Cutánea/sangre , Úlcera Cutánea/microbiología , Encuestas y Cuestionarios , Tanzanía/epidemiología , Treponema pallidum/aislamiento & purificación , Buba/epidemiología , Buba/microbiología
5.
BMC Infect Dis ; 20(1): 444, 2020 Jun 23.
Artículo en Inglés | MEDLINE | ID: mdl-32576149

RESUMEN

BACKGROUND: The syphilis epidemic continues to cause substantial morbidity and mortality worldwide, particularly in low- and middle-income countries, despite several recent disease control initiatives. Though our understanding of the pathogenesis of this disease and the biology of the syphilis agent, Treponema pallidum subsp. pallidum has improved over the last two decades, further research is necessary to improve clinical diagnosis and disease management protocols. Additionally, such research efforts could contribute to the identification of possible targets for the development of an effective vaccine to stem syphilis spread. METHODS: This study will recruit two cohorts of participants with active syphilis infection, one with de novo infection, one with repeat infection. Whole blood specimens will be collected from each study participant at baseline, 4, 12, 24, 36, and 48 weeks, to track specific markers of their immunological response, as well as to compare humoral reactivity to Treponema pallidum antigens between the two groups. Additionally, we will use serum specimens to look for unique cytokine patterns in participants with early syphilis. Oral and blood samples, as well as samples from any syphilitic lesions present, will also be collected to sequence any Treponema pallidum DNA found. DISCUSSION: By furthering our understanding of syphilis pathogenesis and human host immune response to Treponema pallidum, we will provide important data that will help in development of new point-of-care tests that could better identify active infection, leading to improved syphilis diagnosis and management. Findings could also contribute to vaccine development efforts.


Asunto(s)
Vacunas Bacterianas/uso terapéutico , Sífilis/epidemiología , Sífilis/prevención & control , Treponema pallidum/inmunología , Vacunación , Antígenos Bacterianos/inmunología , Secuencia de Bases , Estudios de Cohortes , Citocinas/análisis , ADN Bacteriano/genética , Estudios de Seguimiento , Humanos , Tipificación Molecular , Perú/epidemiología , Sífilis/sangre , Sífilis/inmunología , Treponema pallidum/genética
6.
PLoS One ; 15(6): e0234043, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32555593

RESUMEN

Syphilis serodiagnosis is challenging because distinct clinical forms of the infection may influence serological performance and discordant results between tests make clinical decisions difficult. Several recombinant Treponema pallidum-proteins have already been tested for syphilis diagnosis and they are critical to achieve high accuracy in serological testing. Our aim was to assess the varied from performance of T. pallidum-recombinant proteins TmpA, TpN17 and TpN47 for syphilis serodiagnosis. The proteins were evaluated using sera of 338 T. pallidum-negative, 173 T. pallidum-positive individuals and 209 sera from individuals infected with unrelated diseases. The diagnostic potential was validated by analysis of ROC curves. In the liquid microarray analyses, the ROC curve varied from 99.0% for TmpA and TpN17 to 100% for TpN47. The sensitivity score yielded values of up to 90% for TpN17, 100% for TpN47 and 80.0% for TmpA. The lowest and highest specificity values were presented by TpN47 (91.9%) and TmpA antigens (100%), respectively. TpN47 showed the highest accuracy score (95.5%) among all the recombinant proteins assayed. For the ELISA, the ROC curve was 97.2%, 91.8% and 81.6% for TpN17, TmpA and TpN47, respectively. TpN17 and TmpA yielded a sensitivity of 69.9%, while TpN47 obtained a value of 53.8%. Specificity was almost 100% for all three proteins. No cross-reaction was observed for TpN17 in the serum samples from non-bacterial infections. Regarding leptospirosis-positive samples, cross-reactivity score was varied from 8.6 to 34.6%. This is most probably due to conservation of the epitopes in these proteins across bacteria. The use of recombinant proteins in immunoassays for syphilis diagnosis was showed provide greater reliability to results of the treponemal assays. Despite the low sensitivity, the proteins showed high diagnostic capacity due to the AUC values found. However, an improvement in sensitivity could be achieved when antigenic mixtures are evaluated.


Asunto(s)
Proteínas Bacterianas/inmunología , Proteínas Recombinantes/inmunología , Pruebas Serológicas , Sífilis/diagnóstico , Treponema pallidum/inmunología , Reacciones Cruzadas , Sífilis/inmunología
7.
BMC Public Health ; 20(1): 517, 2020 Apr 17.
Artículo en Inglés | MEDLINE | ID: mdl-32303204

RESUMEN

BACKGROUND: Neglected tropical diseases (NTDs) comprise 20 communicable diseases that are prevalent in rural poor and remote communities with less access to the health system. For effective and efficient control, the WHO recommends that affected countries implement integrated control interventions that take into account the different co-endemic NTDs in the same community. However, implementing these integrated interventions involving several diseases with different etiologies, requiring different control approaches and driven by different vertical programs, remains a challenge. We report here the results and lessons learned from a pilot test of this integrated approach based on integrated screening of skin diseases in three co-endemic health districts of Côte d'Ivoire, a West African country endemic for Buruli ulcer, leprosy and yaw. METHOD: This cross-sectional study took place from April 2016 to March 2017 in 3 districts of Côte d'Ivoire co-endemic for BU, leprosy and yaws. The study was carried out in 6 stages: identification of potentially co-endemic communities; stakeholder training; social mobilization; mobile medical consultations; case detection and management; and a review meeting. RESULTS: We included in the study all patients with skin signs and symptoms at the screening stage who voluntarily accepted screening. In total, 2310 persons screened had skin lesions at the screening stage. Among them, 07 cases were diagnosed with Buruli ulcer. There were 30 leprosy cases and 15 yaws detected. Other types of ulcerations and skin conditions have been identified and represent the majority of cases detected. We learned from this pilot experience that integration can be successfully implemented in co-endemic communities in Côte d'Ivoire. Health workers are motivated and available to implement integrated interventions instead of interventions focused on a single disease. However, it is essential to provide capacity building, a minimum of drugs and consumables for the care of the patients identified, as well as follow-up of identified patients, including those with other skin conditions. CONCLUSIONS: The results of this study show that the integration of activities can be successfully implemented in co-endemic communities under the condition of staff capacity building and minimal care of identified patients.


Asunto(s)
Úlcera de Buruli/epidemiología , Lepra/epidemiología , Tamizaje Masivo/métodos , Mycobacterium leprae , Mycobacterium ulcerans , Enfermedades Desatendidas/epidemiología , Treponema pallidum/inmunología , Buba/epidemiología , Adolescente , Adulto , Anciano , Úlcera de Buruli/diagnóstico , Úlcera de Buruli/microbiología , Niño , Costa de Marfil/epidemiología , Estudios Transversales , Enfermedades Endémicas , Femenino , Humanos , Lepra/diagnóstico , Lepra/microbiología , Masculino , Persona de Mediana Edad , Enfermedades Desatendidas/diagnóstico , Enfermedades Desatendidas/microbiología , Proyectos Piloto , Prevalencia , Población Rural , Buba/diagnóstico , Buba/microbiología , Adulto Joven
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.
BMC Infect Dis ; 20(1): 129, 2020 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-32046662

RESUMEN

BACKGROUND: Syphilis is a sexually transmitted infection (STI) transmitted from person to person mainly by sexual intercourse or through vertical transmission during pregnancy. Female sex workers (FSWs) are exposed especially to syphilis infection, and besides all the efforts to control the spread of STIs, syphilis prevalence is still rising, mainly occurring in low-income countries. This study aimed to investigate the syphilis prevalence, demographic characteristics and sexual habits among FSWs in the Amazon region of Brazil. METHODS: A cross-sectional study was carried out including 184 FSWs from 3 countryside cities of the state of Pará, Amazon region of Brazil. A venereal disease research laboratory test and an indirect immunoenzyme assay to test antibodies against Treponema pallidum were used for screening syphilis infection, while sexual habits and demographic data information were collected through a semi-structured questionnaire. Data was analyzed comparing groups with/without syphilis. Poisson regression models were used to estimate the reasons of prevalence (RP). RESULTS: The overall prevalence of syphilis was 14.1% (95% CI = 9.8-17.8). FSWs had between 15 and 56 years of age, most were unmarried (65.7%), had attended less than 8 years of formal education (64.1%), had between 10 and 20 partners per week (64.1%), and reported no previous history of STIs (76.1%) and regular use of condom (52.7%). Low level of education attending up to the primary school (RP adjusted = 3.8; 95% CI = 1.4-9.2) and high frequency of anal sex during the past year (RP adjusted = 9.3; 95% CI = 3.5-28.7) were associated with a higher prevalence of syphilis. CONCLUSIONS: A high prevalence of syphilis among FSWs in the Brazilian Amazon region was identified, showing that syphilis is more likely to be transmitted in FSW working in low-income areas, which is attributed to the low level of education. Anal intercourse was found as a risk factor associated with syphilis. Health programs focused on risk populations appear as a rational way to control syphilis spread, which is a rising problem in Brazil and in other several countries.


Asunto(s)
Trabajadores Sexuales/estadística & datos numéricos , Sífilis/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Ciudades/estadística & datos numéricos , Condones/estadística & datos numéricos , Estudios Transversales , Escolaridad , Femenino , Humanos , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Conducta Sexual/estadística & datos numéricos , Parejas Sexuales , Sífilis/diagnóstico , Serodiagnóstico de la Sífilis , Treponema pallidum/inmunología , Adulto Joven
11.
Am J Perinatol ; 37(1): 112-118, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31905408

RESUMEN

OBJECTIVE: We evaluate diagnostic accuracy of the ARCHITECT chemiluminescent immunoassay (CIA) screening test in pregnancy, and evaluate pregnancy outcomes among screen-positive women. STUDY DESIGN: Samples from routine prenatal rapid plasma reagin (RPR) tests were collected between June 22 and August 18, 2017 and frozen. Samples were batch-tested with the Abbott ARCHITECT syphilis TP immunoassay (CIA, index test). We calculated sensitivity, specificity, predictive value, and false positivity. We compared pregnancy and neonatal outcomes among screen-positive women. RESULTS: Of 1,602 specimens, 35 (2.2%) were RPR + ; of those, 24 (69%) were CIA +/Treponema pallidum particle agglutination assay (TPPA)+ and 11 (31%) were CIA-/TPPA-. Of 1,567 RPR- specimens, 14 (0.9%) were CIA + ; of those, 13 (93%) were TPPA + , and one (7%) had a false positive CIA test. Sensitivity of the CIA (95% CI) was 100% (90.5-100%), specificity 99.9% (99.6-100%), positive predictive value 97.4% (86.2-99.9%), and false positive rate 0.06% (0.002-0.4%) for current or past syphilis. Among 37 CIA +/TPPA+ women, seven (19%) had RPR-negative status (Group 1), 11 (30%) had previously treated syphilis (Group 2), and 19 (51%) had active infection (Group 3). One stillbirth occurred in a woman with early, active syphilis identified at delivery; no adverse perinatal outcomes occurred among women in Groups 1 or 2. CONCLUSION: The ARCHITECT syphilis TP immunoassay accurately diagnoses current or past syphilis in pregnancy. Clinical history and staging remain essential using a reverse algorithm.


Asunto(s)
Algoritmos , Inmunoensayo/métodos , Complicaciones Infecciosas del Embarazo/diagnóstico , Sífilis/diagnóstico , Treponema pallidum/aislamiento & purificación , Adulto , Femenino , Prueba de Absorción de Anticuerpos Fluorescentes de Treponema , Humanos , Luminiscencia , Embarazo , Resultado del Embarazo , Serodiagnóstico de la Sífilis , Treponema pallidum/inmunología
12.
Am J Perinatol ; 37(7): 671-678, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-31910464

RESUMEN

OBJECTIVE: This study aimed to evaluate the association of ARCHITECT chemiluminescent immunoassay (CIA) signal strength (signal-to-cutoff [S/CO] ratio), with maternal syphilis stage, rapid plasma reagin (RPR) reactivity, and congenital syphilis. STUDY DESIGN: A prospective observational study of reverse syphilis screening was conducted. Pregnant women were screened with CIA. Reactive CIA was reflexed to RPR; particle agglutination test (Treponema pallidum particle agglutination [TPPA]) was performed for CIA+/RPR- results. Clinical staging with history and physical was performed, and disease stage was determined. Prior treatment was confirmed. We compared S/CO ratio and neonatal outcomes among the following groups: Group 1: CIA+/RPR+/TPPA+ or CIA+/RPR-/TPPA+ with active syphilis; Group 2: CIA+/RPR-/TPPA+ or CIA+/serofast RPR/TPPA+, previously treated; Group 3: CIA+/RPR-/TPPA+, no history of treatment or active disease; Group 4: CIA+/RPR-/TPPA-, false-positive CIA. RESULTS: A total of 144 women delivered with reactive CIA: 38 (26%) in Group 1, 69 (48%) in Group 2, 20 (14%) in Group 3, and 17 (12%) in Group 4. Mean (±standard deviation) S/CO ratio was 18.3 ± 5.4, 12.1 ± 5.3, 9.1 ± 4.6, and 1.9 ± 0.8, respectively (p < 0.001). Neonates with overt congenital syphilis occurred exclusively in Group 1. CONCLUSION: Women with active syphilis based on treatment history, clinical staging, and laboratory indices have higher CIA S/CO ratio and are more likely to deliver neonates with overt evidence of congenital syphilis.


Asunto(s)
Inmunoensayo , Complicaciones Infecciosas del Embarazo/diagnóstico , Sífilis Congénita , Sífilis/diagnóstico , Treponema pallidum/inmunología , Adulto , Algoritmos , Anticuerpos Antibacterianos/sangre , Femenino , Humanos , Inmunoensayo/métodos , Recién Nacido , Mediciones Luminiscentes , Masculino , Tamizaje Masivo/métodos , Embarazo , Complicaciones Infecciosas del Embarazo/sangre , Estudios Prospectivos , Sífilis/sangre , Serodiagnóstico de la Sífilis
13.
Transfusion ; 60(2): 334-342, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31909495

RESUMEN

BACKGROUND: Chinese blood donors with unconfirmed serological and/or molecular screening results are deferred permanently. This study investigated the implementation and performance of a follow-up program aiming to improve the notification and management of deferred donors in Dalian, China. STUDY DESIGN AND METHODS: From January 2013 to February 2018, 411,216 donations were tested for HBsAg, anti-HCV, anti-HIV/HIV antigen, and antibodies to Treponema pallidum. HBV, HCV, and HIV nucleic acid testing (NAT) was performed in mini-pools of six or in individual donations (IDs). Reactive donations were evaluated further with alternative serological assays and ID-NAT re-testing. A follow-up procedure was developed to evaluate a subset of deferred donors that were either potential NAT yield cases, serology non-reactive and NAT non-repeated reactive (NRR), or serology NRR irrespective of NAT result. RESULTS: Serological and molecular routine, plus supplemental testing, identified HBV, HCV, HIV, and TP in 503 (0.12%), 392 (0.09%), 156 (0.04%), and 2041 (0.49%) donations, respectively. Overall, 683 of 4156 (16.4%) eligible donors and 205 donors deferred prior 2013 participated in the program. They included 664 serology NRR and 224 NAT yield cases, and 58.8% repeat donors. All markers combined, follow-up documented false reactivity, primary acute infections, and OBI in 61.9% (550/888), 3.3% (29/888), and 12.8% (114/888) of these donors, respectively. Isolated anti-HBc or anti-HBs reactivity was observed in 22% of cases. CONCLUSION: Follow-up testing refined infection status in 78.0% (693/888) of deferred donors with unconfirmed screening results. This high false-positive rate encouraged to reevaluate the current screening strategies and to consider donor reentry.


Asunto(s)
Donantes de Sangre/estadística & datos numéricos , Hepatitis B/epidemiología , Tamizaje Masivo/métodos , China/epidemiología , Femenino , VIH/inmunología , VIH/patogenicidad , Antígenos de Superficie de la Hepatitis B/inmunología , Antígenos de Superficie de la Hepatitis B/metabolismo , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/inmunología , Virus de la Hepatitis B/patogenicidad , Hepatitis C/epidemiología , Humanos , Masculino , ARN Viral/genética , Treponema pallidum/inmunología , Treponema pallidum/patogenicidad
14.
J Clin Lab Anal ; 34(1): e23033, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31617243

RESUMEN

BACKGROUND AND OBJECTIVES: To prevent Treponema Pallidum (TP) transmission from blood transfusion, enzyme-linked immunosorbent assay (EIA) for anti-TP has been widely used in routine blood donation screening in China for many years. The aim of this study was to evaluate the performance of the Abbott CMIA assay for detection of anti-TP in Chinese blood donors. MATERIALS AND METHODS: A total of 2420 plasma samples, already routinely screened for anti-TP by two different EIAs, from four blood Centers were tested for anti-TP by Abbott CMIA. Subsequently, all samples with positive results by one or both EIAs and/or by Abbott CMIA were subjected to confirmatory testing (CT) using recombinant immunoblot assay (RIBA) or Treponema Pallidum particle agglutination assay (TPPA). TP infection was defined by a RIBA or TPPA positive. RESULTS: Compared with two EIAs strategy, Abbott CMIA showed a relatively best sensitivity as 98.80% (95% CI: 97.44%-100.16%) and a relatively best specificity as 99.58% (95% CI: 99.30%-99.85%), yielding the best consistency (99.49%) between anti-TP CT results with the highest κ value of .98. CONCLUSION: This is the first study to evaluate the performance of the Abbott CMIA assays for detection of syphilis in Chinese blood donors. Our results suggested that CMIA performed better than both EIAs, and implementation of CMIA replacing two different EIA reagents might help to further reduce the risk of transfusion-transmitted TP infection, decrease unnecessary blood waste and loss of blood donors.


Asunto(s)
Grupo de Ascendencia Continental Asiática , Donantes de Sangre , Inmunoensayo/métodos , Mediciones Luminiscentes/métodos , Serodiagnóstico de la Sífilis/métodos , Sífilis/sangre , Sífilis/diagnóstico , Humanos , Tamizaje Masivo , Treponema pallidum/inmunología
16.
Rev Chilena Infectol ; 36(4): 525-530, 2019 Aug.
Artículo en Español | MEDLINE | ID: mdl-31859779

RESUMEN

BACKGROUND: Syphilis remains a public health concern worldwide, the accuracy of diagnostic tests is critical for its successful control. Currently, there are two approaches to the diagnosis of syphilis using serological tests: the traditional algorithm and the reverse algorithm. AIM: The goal of this study was to analyse the advantages and disadvantages in the implementation of the syphilis reverse-screening algorithm in an outpatient clinical laboratory. METHODS: An observational cross-sectional study was carried out analyzing 246 reactive sera from a total of 14700 requests for syphilis serology. Chemiluminescent assay ARCHITECT Syphilis TP, V.D.R.L. and FTA-Abs were performed. RESULTS: Among 246 reactive sera by ARCHITECT Syphilis TP, 129 were reactive and 117 were non-reactive by V.D.R.L. the last mentioned resulted in 97 reactive and 20 non-reactive by FTA-Abs, suggesting false positives (0.13%). Two patients with primary infection were detected, that were not detected by V.D.R.L. and one pregnant woman with primary infection with a high value S/CO and V.D.R.L.:1 dils. CONCLUSIONS: Among the advantages of using a reverse algorithm were greater sensitivity in the detection of patients with primary syphilis; automation, complete traceability of the samples; objective interpretation and conclusive results.


Asunto(s)
Tamizaje Masivo/métodos , Serodiagnóstico de la Sífilis/métodos , Sífilis/diagnóstico , Treponema pallidum/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Estudios Transversales , Femenino , Humanos , Mediciones Luminiscentes , Masculino , Persona de Mediana Edad , Embarazo , Sensibilidad y Especificidad , Treponema pallidum/inmunología , Adulto Joven
17.
BMC Infect Dis ; 19(1): 1064, 2019 Dec 19.
Artículo en Inglés | MEDLINE | ID: mdl-31856758

RESUMEN

BACKGROUND: HIV, HBV and HCV remain a global public health concern especially in Africa. Prevalence of these infections is changing and identification of risk factors associated with each infection in Mali is needed to improve medical care. METHODS: We conducted a cross-sectional study of all individuals donating blood (n = 8207) in 2018 to the blood bank at university hospital in Bamako, Mali, to assess prevalence and risks factors associated with HIV, HBV, HCV and syphilis infections. RESULTS: HIV-seroprevalence was 2.16% and significantly increased with age, being married and decreasing education level. In multivariate analysis, after adjustements with age, marital status and geographical setting, only education level was associated with HIV-infection (OR, 1.54 [95% CI, 1.15-2.07], p = 0.016). HBsAg prevalence was 14.78% and significantly increased with to be male gender. In multivariate analysis, adjusting for age, marital status and type of blood donation, education level (OR, 1.17 [95%CI, 1.05-1.31], p = 0.02) and male gender (OR, 1.37 [95%CI, 1.14-1.65], p = 0.005) were associated with HBV-infection. HCV-prevalence was 2.32% and significantly increased with living outside Bamako. In multivariate analysis, adjusting for gender, age and education level, living outside Bamako was associated with HCV-infection (OR, 1.83 [95% CI, 1.41-2.35], p < 0.001). Syphilis seroprevalence was very low (0.04%) with only 3 individuals infected. Contrary to a prior study, blood donation type was not, after adjustments, an independent risk factor for each infection. CONCLUSIONS: Overall, HIV and HBV infection was higher in individuals with a lower level of education, HBV infection was higher in men, and HCV infection was higher in people living outside of Bamako. Compared to studies performed in 1999, 2002 and 2007 in the same population, we found that HIV and HCV prevalence have decreased in the last two decades whereas HBV prevalence has remained stable. Our finding will help guide infection prevention and treatment programs in Mali.


Asunto(s)
Donantes de Sangre , Infecciones por VIH/epidemiología , Seroprevalencia de VIH/tendencias , VIH/inmunología , Hepacivirus/inmunología , Virus de la Hepatitis B/inmunología , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Sífilis/epidemiología , Treponema pallidum/inmunología , Adolescente , Adulto , Coinfección , Estudios Transversales , Femenino , Hospitales Universitarios , Humanos , Masculino , Malí , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Adulto Joven
18.
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
20.
Emerg Infect Dis ; 25(11): 2147-2149, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31625860

RESUMEN

Human yaws has historically been endemic to Kenya, but current epidemiologic data are lacking. We report seroprevalence for Treponema pallidum antibodies in olive baboons (Papio anubis) and vervet monkeys (Chlorocebus pygerythrus) in Laikipia County, Kenya. Our results suggest endemicity of the yaws bacterium in monkeys, posing a possible zoonotic threat to humans.


Asunto(s)
Anticuerpos Antibacterianos/inmunología , Enfermedades de los Monos/epidemiología , Enfermedades de los Monos/microbiología , Estudios Seroepidemiológicos , Treponema pallidum , Buba/veterinaria , Animales , Kenia/epidemiología , Prevalencia , Primates , Vigilancia en Salud Pública , Treponema pallidum/inmunología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA