Correlation of Treponemal Chemiluminescent Microparticle Immunoassay Screening Test Signal Strength Values With Reactivity of Confirmatory Testing.

BACKGROUND: Automated chemiluminescent microparticle immunoassays (CMIAs) are the most common first step at high-volume laboratories for syphilis screening. If the initial screening test is reactive, 1 more treponemal test is required, resulting in increased cost. In this multicenter study, we aimed to determine the correlation between the CMIA signal-to-cutoff ratio (S/Co) and the confirmatory tests to reduce unnecessary confirmatory testing. METHODS: Eight hospitals from 5 provinces participated in this study. All laboratories used Architect Syphilis TP CMIA (Abbott Diagnostics, Abbott Park, IL) for initial screening. Treponema pallidum hemagglutination (TPHA), rapid plasma reagin (RPR), and fluorescent treponemal antibody absorption (FTA-ABS) were used as confirmatory tests according to the reverse or European Centre for Disease Prevention and Control algorithms. A receiver operating characteristic analysis was used to determine the optimal S/Co ratio to predict the confirmation results. RESULTS: We evaluated 129,346 serum samples screened by CMIA between January 2018 and December 2020. A total of 2468 samples were reactive; 2247 (91%) of them were confirmed to be positive and 221 (9%) were negative. Of the 2468 reactive specimens, 1747 (70.8%) had an S/Co ratio ≥10.4. When the S/Co ratios were ≥7.2 and ≥10.4, the specificity values were determined to be 95% and 100%, respectively. In a subgroup of 75 CMIA-positive patients, FTA-ABS was performed and 62 were positive. Among these FTA-ABS-positive patients, 24 had an S/Co ratio <10.4, and negative TPHA and RPR. CONCLUSIONS: We propose a potentially cost-effective reverse screening algorithm with a treponemal CMIA S/Co ratio ≥10.4, obviating the need for secondary treponemal testing in about 71% of the screening-reactive samples. This would substantially reduce the confirmatory testing volume and laboratory expenses. However, in high-risk group patients with CMIA positive results, S/Co ratio <10.4, and negative TPHA and RPR, FTA-ABS may be used for confirmation.

Investigation of syphilis coinfection and performance of the Architect Syphilis Tp ELISA screening test in HIV positive patients

Background/aim: Limited data on syphilis coinfection in human immunodeficiency virus (HIV) positive cases exist in Turkey. Our aim is to investigate syphilis coinfection and to evaluate the compatibility of the screening Architect Syphilis Tp ELISA with the fluorescent treponemal antibody absorption (FTA-abs) confirmation test in HIV positive cases. Materials and methods: Totally 519 HIV positive patients were included in the study. Enzyme linked fluorescent assay (ELFA) was used as a screening test and positive samples were confirmed by line immunassay (LIA). In order to discriminate acute HIV infection and false ELISA positivity, HIV-1 RNA PCR was performed in ELFA positive and LIA negative samples. Architect Syphilis TP ELISA was used for the detection of total antibodies against Treponema pallidum in HIV positive patients. Positive results were confirmed by the FTA-abs test. Results: Out of 519 HIV-1 positive patients, IgG and IgM positivity, and only IgG positivity was detected as 1.9% and 11.4% in all the samples, respectively. A total of 79 (15.2%) sera were positive with Architect Syphilis Tp ELISA test and 69 (13.3%) were positive with FTA-abs test. Statistically significant, almost perfect agreement was found between Architect Syphilis Tp ELISA and FTA-abs tests (kappa = 0.921 and P < 0.001). Conclusion: Implementation of syphilis and HIV screening tests together among risk groups is considered to be appropriate.

The importance of serum biglycan levels as a fibrosis marker in patients with chronic hepatitis B.

BACKGROUND: Liver biopsy is recommended in the majority of patients with chronic viral hepatitis for fibrosis evaluation. Because of the potential risks of liver biopsy, many studies related to non-invasive biomarkers of hepatic fibrosis have been performed. We aimed to assess the diagnostic value of serum biglycan as a non-invasive fibrosis marker in chronic hepatitis B patients. METHODS: This study included 120 patients with biopsy-proven hepatitis B patients and 60 healthy controls. Fibrosis stage and necroinflammatory activity were assessed in liver biopsy specimens. Biglycan level was measured using an ELISA assay. RESULTS: Serum biglycan levels of chronic hepatitis B patients were found to be significantly higher than those of healthy controls (337.3±363.0 pg/mL vs 189.1±61.9 pg/mL, respectively, P<.001). There was a statistically significant positive correlation between serum biglycan level and fibrosis stage (P=.004; r=.213). Besides, a statistically significant positive correlation was found between serum biglycan level and necroinflammatory activity (P<.001; r=.271). The AUROC of BGN levels was 0.702 for fibrosis stage, differentiating patients from healthy controls with statistical significance (P<.001). The AUROC of BGN levels was 0.632 for necroinflammatory activity score, differentiating patients from healthy controls with statistical significance (P=.004). CONCLUSIONS: Serum biglycan might be used as a non-invasive marker of liver fibrosis. Further studies are needed to evaluate the usefulness of this marker.

Community Norms and Human Rights: Supervising Haitian Colleagues on Interpersonal Psychotherapy (IPT) With a Depressed and Abused Pregnant Woman.

After the 2010 Haiti earthquake, Zanmi Lasante, a local health care organization, implemented a collaborative stepped-care model to address depression in community and primary care settings in rural Haiti. Specialized community health workers, the ajans santé, collaborate with local psychologists and primary care doctors to offer home-based evaluation, support, and follow-up. The services include brief interpersonal psychotherapy (IPT) and/or medication to persons who met locally defined criteria for depression. A cross-national (Haiti-United States) expert mental health team has been overseeing the program. The present IPT supervision case of a severely depressed, physically abused, and pregnant young woman illustrates the U.S.-based supervisor's internal struggle to reconcile awareness of and respect for local norms while maintaining a human rights-based framework. It also highlights the critical role of community health workers in addressing the mental health treatment gap in regions plagued by extreme poverty and adversity.

[Serological evaluation of Bordetella pertussis infection in adults with prolonged cough]. / Uzamis öksürügü olan eriskinlerde Bordetella pertussis enfeksiyonunun serolojik olarak degerlendirilmesi.

Pertussis is a vaccine-preventable disease that is transmitted from infected to susceptible individuals by respiratory route. Bordetella pertussis infection may occur at any age as neither vaccine nor natural infection induced immunity lasts life-long. This study was planned to demonstrate the serological evidence of infection among adults, to raise awareness among clinicians and to provide data for the development of strategies to protect vulnerable infants. A total of 538 patients (345 female, 193 male) ages between 18-87 years who had a complain of prolonged cough for more than two weeks were included in the study. Anti-pertussis toxin (PT) IgG and anti-filamentous hemagglutinin (FH) IgG levels from single serum samples were measured by an in-house ELISA test which was standardized and shown to be efficient previously. Anti-PT IgG antibody levels of ≥ 100 EU/ml were considered as acute/recent infection with B.pertussis. In our study, 9.7% (52/538) of the patients had high levels of anti-PT IgG (≥ 100 EU/ml) and among those patients 43 (43/52; 82.7%) also had high (≥ 100 EU/ml) anti-FHA IgG levels. There were no statistically significant differences in terms of age, gender, education level, DPT (diphtheria-pertussis-tetanus) vaccination history, smoking history or average daily cigarette consumption (p> 0.05) between the cases with high antibody levels (n= 52). When the symptoms and the presence of cases with high antibody levels were evaluated, it was detected that no one parameter was significantly different from others, except that 24.1% of the cases with inspiratory whooping had high anti-PT levels. There was also no statistically significant difference between high anti-PT levels ≥ 100 EU/ml and the patients with risk factors [smoking (21/200; 10.5%), presence of disease that cause chronic cough and/or drug usage (19/171; %11.1), and whole factors which cause chronic cough (32/306; %10.5)] and without risk factors (p= 0.581; p= 0.357; p= 0.249, respectively). The distribution of anti-PT IgG geometric mean titer (GMT) according to the age groups, was as follows; 32.41 in 18-30 years; 36.28 in 31-50 years; 36.82 in 51-70 years and 31.15 in ≥ 71 years. Our results indicated that B.pertussis infections are also present among adult population with a frequency not to be underestimated (9.7%) and the results also emphasized that since typical whooping cough symptoms may not be seen in adults, pertussis infection should be considered as a differential diagnosis in adults with prolonged cough, even if there are some other underlying factors of cough. The data obtained from this study was also considered to be helpful in the development of adult vaccination policies for the protection of infants who have not completed the vaccination schedule yet.

Pertussis serosurveillance study in Izmir, Turkey.

Pertussis is a life-threatening, vaccine-preventable infection. Adults who can be asymptomatic may infect infants. The aim of this study is to determine the IgG antibody levels against pertussis toxin (PT) and filamentous hemagglutinin from 6 months to ≥60 years in Izmir, Turkey. A cluster sample design developed by Expanded Programme on Immunization of the World Health Organization was carried out for the selection of the study population, which consisted of 399 healthy subjects. In-house ELISA was studied in Turkish Public Health Institution. Antibody levels of <10 EU/ml, ≥10 EU/ml and ≥100 EU/ml were accepted as non-immune, immune and possible acute/recent infection, respectively. Anti-PT antibody levels were 8.5% <10 EU/ml, 68.2% 10-100 EU/ml and 23.3% ≥100 EU/ml; the latter was correlated with possible acute/recent infection. Results showed that pertussis is endemic, particularly among adolescents and adults, which is a threat for infants who have not completed their primary immunization.

Diagnostic potential of serum direct markers and non-invasive fibrosis models in patients with chronic hepatitis B.

AIM: Liver biopsy is recommended in the majority of patients with chronic viral hepatitis for fibrosis evaluation. Because of the disadvantages of liver biopsy, many studies related to non-invasive biomarkers and scores have been performed. In this study, we aimed to assess the diagnostic value of serum direct markers and non-invasive fibrosis models to predict liver fibrosis in the treatment-naive chronic hepatitis B (CHB) patients and to compare their diagnostic performance. METHODS: This study included 58 patients with a diagnosis of CHB virus infection and 30 healthy controls. Hyaluronic acid, tissue inhibitor of matrix metalloproteinase 1 and amino-terminal propeptide of type III procollagen were measured by enzyme-linked immunosorbent assay; and the Original European Liver Fibrosis panel, the Enhanced Liver Fibrosis (ELF) panel, PP score, aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 indexes were calculated using the formulas taken from previous publications. Fibrosis stage was determined using Ishak's scoring system. RESULTS: The fibrosis stages identified upon liver biopsy was F0 in 12 patients (20.7%), F1-2 in 36 (62.1%) and F3-5 in 10 (17.2%). The diagnostic value of all the non-invasive indices was low to detect mild fibrosis. We demonstrated that the diagnostic accuracy of HA is the best for predicting fibrosis of F3 or more (area under the receiver-operator curve, 0.902). In our study, the results from a combination of tests showed that ELF and APRI had the highest diagnostic value sensitivity of 90%, specificity of 100%, positive predictive value of 100% and negative predictive value of 96.4% for detection of fibrosis of F3 or more. CONCLUSION: In CHB patients, combination of ELF and APRI has a better diagnostic value in predicting fibrosis of F3 or more.

[Detection of Bordetella pertussis infection by culture, real-time polymerase chain reaction and serologic tests among children with prolonged cough]. / Uzamis Öksürügü Olan Çocuklarda Kültür, Gerçek Zamanli Polimeraz Zincir Reaksiyonu ve Seroloji ile Bordetella pertussis Enfeksiyonunun Arastirilmasi

Pertussis is a respiratory infection caused by Bordetella pertussis. It attacks all age groups. It has significantly higher mortality and morbidity among newborns and children. Adolescents and adults with symptomatic but unrecognized pertussis are often the source of the infection for pediatric cases. Therefore, it is suggested to perform laboratory diagnostic tests for B.pertussis infection in children and adolescents with prolonged cough of more than two weeks. In this study, it was aimed to identify B.pertussis infection by culture, real-time polymerase chain reaction (Rt-PCR) and serological methods among children with prolonged cough. Nasopharyngeal swab samples were obtained from 51 children (19 female, 32 male; age between 2 months-14 years; median age: 7.0), who attended the outpatient clinic of Ege University Medical Faculty Department of Pediatrics, Izmir, Turkey with prolonged cough (≥ 14 days) during December 2009-August 2010. While pertussis vaccination had been completed in 48 (94%) of the cases, three cases had not been vaccinated. Previous antibiotic treatment was reported for 38 (75%) of the cases. Cultivation was done by using 7% horse blood and charcoal containing Bordetella Agar (Becton Dickinson, Germany) and Rt-PCR targeting IS481 sequence (Roche Applied Science, Germany) was used to detect B.pertussis. In addition, in house ELISA was performed to detect titers of anti-pertussis toxin (anti-PT) IgG and anti-filamentous hemagglutinin (anti-FHA) IgG antibodies in paired sera collected in 2-4 week intervals. Fourfold titer increase of antibodies or anti-PT IgG levels of at least 100 EU/ml in one serum were evaluated as serological confirmation of B.pertussis infection. In our study, B.pertussis was isolated from one nasopharyngeal swab samples culture among the 51 patients, and IS481 Rt-PCR yielded positive results for B.pertussis in 6 (11.8%) samples. Nine (17.6%) patients were diagnosed as B.pertussis infection by serological tests. Totally 12 patients were evaluated as positive using at least one method. Among them only one had positive results with three of the tests used and two were positive with IS481 Rt-PCR assay and serologic tests. Three patients were found positive with only IS481 Rt-PCR and six were identified only with serologic diagnosis. In this study, 23.5% (12/51) of children with persistant cough were evaluated as having B.pertussis infection. The age range of these cases (5 female, 7 male) was 2 months-11 years and one case had not been vaccinated at all while four cases had not completed the vaccination schedule. It was concluded that since B.pertussis can be detected as the etiologic agent of persistant cough in a significant number of children by culture, PCR and serologic tests, diagnostic tests must be applied to evaluate B.pertussis infection. However, standardized serological methods and PCR protocols are needed for accurate and reliable diagnosis.

[Seroprevalence of Borrelia burgdorferi and tick-borne encephalitis virus in a rural area of Samsun, Turkey]. / Samsun Kirsalinda Borrelia burgdorferi ve Kene Ensefaliti Virusu Seroprevalansinin Arastirilmasi

Lyme disease or lyme borreliosis is a zoonosis caused by Borrelia burgdorferi transmitted by ticks, especially Ixodes species. Lyme borreliosis is a multi-systemic disease that invades the skin, musculoskeletal, cardiovascular and central nervous systems. Tick-borne encephalitis (TBE) is an important arboviral infection caused by tick-borne encephalitis virus (TBEV). The central nervous system is affected and the disease most often manifests as meningitis, encephalitis or meningoencephalitis. Previous studies have shown that B.burgdorferi and TBEV can be transmitted by the same tick species (Ixodes ricinus). Although the geographic location and climate is similar to some south-eastern European countries where lyme borreliosis and TBE have been reported, the incidence and prevalence of these diseases in Turkey still remain unclear. The aim of this study was to determine the seroprevelance of B.burgdorferi and TBEV in healthy population in Tekkeköy (41° 8-13' North; 36° 24-31' East), a district of Samsun province, Turkey with evidence of tick-borne disease and to explore the possible correlations of life styles of healthy individuals and prevelance. The cross-sectional study population included 419 people selected using a random proportional sampling method. All participants were asked at interview to complete a questionnaire and peripheral blood samples were collected. From the blood samples, B.burgdorferi IgG and IgM antibodies were evaluated using commercial ELISA (Euroimmun, Germany) and confirmed with Western blot (WB, Euroimmun, Germany). ELISA method was also used to asses IgM and IgG antibodies against TBEV, and neutralization test was used for confirmation. Of the 419 samples, 17 (4%) were positive for B.burgdorferi IgG by ELISA, however 14 (14/419; 3.3%) of them were confirmed by WB. B.burgdorferi seropositivity was higher among people living in rural areas, at an altitude of ≥ 400 meters and in locations ecologically suitable for wild boar and rabbits; seropositivity was also seen to be higher among dog owners (p= 0.001, p= 0.001, p= 0.001, p= 0.001, p= 0.018, respectively). For TBEV, two samples yielded IgG positive, and one IgM positive results by ELISA, however none of them were confirmed by neutralization assay. Nevertheless, one of those three TBEV ELISA positive samples, was found positive for West Nile virus specific antibodies with neutralization test. The results of this study emphasized the presence of tick-borne diseases in that specific region, and in this regard the need for public health interventions has been demonstrated.

Investigation of immunity against Bordetella pertussis in pregnant women and an overview of the vaccination schedule in Turkey.

BACKGROUND: Pertussis caused by Bordetella pertussis, is a disease leading to significant morbidity and mortality in neonates and infants. Direct protection of the infant may be achieved by maternal and neonatal vaccination. Despite primary vaccination, infants under six months pose the greatest risk of infection with pertussis. Maternal immunization provides a high level of infant protection from birth until immunity is achieved by active vaccination. There is no routine Tdap vaccination recommendation for pregnant women in Turkey. This study was carried out to determine pertussis antibody levels in pregnant women and provide data for improving vaccine planning. METHODS: The study was carried out with 133 pregnant women in Turkey. Antibody titers to pertussis toxin (anti-PT) and filamentous hemagglutinin (anti-FHA) were measured by the commercially available ELISA. RESULTS: Among 133 participants, 93 (69.9%) were found to be immune according to anti-PT IgG antibody levels. According to anti-FHA IgG antibody levels, 123 (92.5%) participants were considered to be immune. A positive correlation was observed between PT and FHA and the findings were statistically significant (P < 0.001, r = 0.343). In the study group, the ages of the participants varied between 17 and 44 years. The mean age of those who were immune was 27.3±5.6, the mean age of non-immune patients was 29.1±6.2 and the difference was not statistically significant (P= 0.14). CONCLUSIONS: Our results reveal that approximately one-third of pregnant women were not immune to pertussis, reflecting many young infants to be vulnerable to pertussis infection until the onset of primary vaccinations, although childhood pertussis vaccination coverage has been high for a long time. We conclude that Tdap vaccine recommendation for pregnant women regardless of previous immunization history may be beneficial for the protection of infants in their first six months.

Pertussis antibody levels in infants and their mothers receiving combined tetanus-diphtheria toxoid and acellular pertussis vaccine during pregnancy in Turkey.

OBJECTIVE: Pertussis is an important cause of morbidity and mortality in infants under two months of age and these high risk babies are dependent on maternally derived antibodies until completion of their first immunization series. This study aimed to evaluate the vaccine response of late preterm and term newborns as well as their mothers who underwent combined tetanus-diphtheria toxoid and acellular pertussis (Tdap) vaccination during pregnancy. STUDY DESIGN: A total of 70 pregnant women were administered Tdap vaccine (Boostrix®, GSK) between 27 and 33 gestational weeks of pregnancy. The IgG antibodies against pertussis toxin (PT) and filamentous hemagglutinin (FHA) in maternal blood before vaccination and in both maternal and umbilical cord blood after vaccination were evaluated using the in-house ELISA method. The geometric mean concentrations (GMC) and placental transfer ratios of antibodies were measured. RESULTS: Participants' with a mean age of 29.59 ± 4.70 years received Tdap vaccine at an average 28.6 ± 1.31 gestational weeks. Average pre and post vaccination levels of anti-PT IgG GMCs and anti-FHA IgG GMCs were 8.01 IU/ml vs 39.48 IU/ml (p = 0.001) and 122.24 IU/ml vs 183.97 IU/ml (p < 0.001), respectively. The anti-PT and anti-FHA IgG GMCs of cord blood after vaccination was 25.15 IU/ml and 118.77 IU/ml, respectively (p < 0.001 and p = 0.064). Placental transfer ratios of anti-PT ve anti-FHA IgG antibodies were detected as 0.65 and 0.62, respectively. CONCLUSION: Immunization of pregnant women with Tdap at the third trimester results in high maternal and infant antibody levels. Maternal immunization during each pregnancy seems to be the best strategy in revealing the highest maternal and infant antibodies and in narrowing the gap between birth and immune system maturation in infants. Pregnant women in our country should also get the Tdap vaccine during pregnancy especially in the early third trimester.

Performance evaluation of nine different syphilis serological tests in comparison with the FTA-abs test.

BACKGROUND: Serological methods have great importance for the detection of Treponema pallidum antibodies in syphilis diagnosis. The goal of the present study is to evaluate various commercially available screening assays in comparison with the FTA-abs test. METHODS: A total of 363 serum samples were enrolled in the study. Following routine testing including RPR and TPHA tests, each sample was tested by treponemal immunoassays (Chorus Syphilis Screen Recombinant, Architect Syphilis TP, Syphilis Virclia Monotest, Siemens Advia Centaur Syphilis, Euroimmun Treponema pallidum Screen ELISA, Vircell Syphilis ELISA IgG + IgM, SD Bioline Syphilis). The result obtained from each test was compared with the confirmatory FTA-abs test. Kappa (κ) coefficients were used to compare the concordance of the tests. RESULTS: When the various tests were evaluated in comparison with the FTA-abs test, the sensitivity, specificity and percent agreement of each test were as follows: Architect Syphilis TP, 92.3%, 94.5%, 92.8%; Chorus Syphilis Screen Recombinant, 87.9%, 91.2%, 88.7%; Syphilis Virclia Monotest, 80.5%, 97.8%, 84.9%; Siemens Advia Centaur Syphilis, 87.5%, 89%, 87.9%; Euroimmun Treponema pallidum Screen ELISA, 87.5%, 85.7%, 87.1%; Vircell Syphilis ELISA IgG + IgM, 73.2%, 62.6%, 70.5%; TPHA, 89%, 63.7%, 82.6%; SD Bioline Syphilis, 58.1%, 94.5%, 67.2%; RPR test, 57.7%, 57.1%, 57.6%. CONCLUSION: The results of the present study show that Treponema pallidum specific immunoassays with a performance similar or better than TPHA test generally performed well with the confirmatory FTA-abs test and may be an alternative for screening total antibodies in syphilis infection.

Epidemiological Study of Tetanus Seropositivity Levels in Different Age Groups in Ankara Province, Turkey, 2017.

The aim of this study was to determine the seropositivity levels of tetanus vaccine by age group in Ankara province, identify possible factors that affect immune status, and develop public health recommendations, especially for those 50 years and older. This cross-sectional epidemiological study covered individuals aged 3 years and older who are registered in the Family Medicine Information System. We received blood samples from 992 individuals and included 968 surveys in the analysis. Protective tetanus antibody levels were 80.5% in the 3-5 years age group, 92.0% in the 6-12 years age group, 94.3% in the 13-20 years age group, 95.2% in the 21-39 years age group, 84.4% in the 40-49 years age group, and 57.3% in the 50 years and older age group. Tetanus seropositivity decreased with age. Awareness of the importance of tetanus vaccine boosters for adults should be increased by providing training, ensuring booster vaccination against tetanus at 10-year intervals, and if necessary, considering mandatory tetanus vaccination for those 50 years and older.

Evaluation of Plasma Urokinase-Type Plasminogen Activator Receptor (UPAR) in Patients With Chronic Hepatitis B, C and Non-Alcoholic Fatty Liver Disease (NAFLD) as Serological Fibrosis Marker.

BACKGROUND/AIMS: Progressive hepatic fibrosis is the main predictor of outcome and prognosis in chronic liver diseases. The importance of the coagulation cascade has been defined in liver fibrosis; however, the role of the fibrinolytic pathway has not been clear yet. We aimed to evaluate the association between the plasma levels of soluble urokinase Plasminogen Activator Receptor (uPAR) and the severity of liver fibrosis in chronic hepatitis B, C and Non-Alcoholic Fatty Liver Disease (NAFLD). METHODS: 96 chronic hepatitis B, 22 chronic hepatitis C and 11 NAFLD patients together with 47 healthy controls were enrolled in the study. uPAR plasma levels were detected by Enzyme-Linked Immunosorbent Assay (ELISA) method. RESULTS: The plasma levels of uPAR in patients with chronic hepatitis B and C significantly exceeded those of healthy controls (P < 0.001) while mean uPAR levels in patients with NAFLD were not different from healthy controls. Mean uPAR levels in chronic viral hepatitis patients with F1-F3 fibrosis and F4-F6 fibrosis were higher than those of control group (P < 0.001). Mean uPAR level in patients with F4-F6 fibrosis was significantly higher than that of patients with F1-F3 fibrosis (P < 0.001). CONCLUSION: This is the first study that investigated uPAR as a fibrosis marker in NAFLD and chronic hepatitis B patients. It is suggested that plasma levels of uPAR are closely related to the fibrosis stage in chronic hepatitis B and C and that uPAR might be a noninvasive marker of liver fibrosis.

Serological Diagnosis of Syphilis: Preliminary Study Searching for an Algorhitm in Turkey.

Different algorithms have been proposed to increase the diagnostic capacity of syphilis. We analyzed three common algorithms for detecting suspected syphilis cases in low prevelance Turkish population. The study included a total of 340 clinical serum samples from adults throughout Turkey, who had syphilis as a clinical preliminary diagnosis and were positive on at least one of the following tests: Rapid Plasma Reagin (RPR), Treponema pallidum Haemagglutination test (TPHA) and FTA-abs Ig. In adittion to percent agreement, kappa coefficients were calculated to compare the conformity between the three algorithms. Both the reverse and the ECDC algorithms had higher diagnostic efficacy than the conventional algorithm. The sensitivity/specificity/ accuracy of conventional, reverse and ECDC algorithms were 51.3%/86.1%/55%; 80.9%/86.1%/81.4% and 80.9%/100%/82.9% respectively. The interrater reliability was moderate for conventional-reverse algorithm (73.53%; к=0.484; 95%CI=0.41-0.56; p=0.001) and conventional-ECDC algorithm (72.06%; к=0.454; 95% CI= 0.37-0.54; p=0.001), and near perfect for reverse-ECDC algorithm (98.53%; к=0.963; 95% CI=0.93-0.99; p=0.0001). Our data support the use of ECDC algorithm in serological diagnosis of syphilis. It may increase the diagnostic capacity if treponemal tests are used for screening, and then positive results are confirmed with a different and second treponemal test.

Evaluation of Symptomatic Patients with Resistant Discharge.

The aim of this study was to detect the presence of Chlamydia trachomatis, Neisseria (N.) gonorrhoeae, Mycoplasma (M.) hominis, M. genitalium, Ureaplasma (U.) urealyticum, and Trichomonas (T.) vaginalis in patients with resistant discharge. The study also evaluated the concordance of the diagnostic tests. Samples from 156 patients were tested by direct microscopy and culture for T. vaginalis and Mycoplasma IES for M. hominis and U. urealyticum. Multiplex Polymerase Chain Reaction (PCR) was used to determine the presence of six agents. Statistical analyses were performed using the SPSS program. Out of 156 patients, 38 had positive result for the agents tested. Of these 38 patients, 28 (73.7%) had single agent positivity and 10 (26.3%) had multiple agent positivity. The detection rate of U. urealyticum, M. hominis, N. gonorrhoeae, C. trachomatis, T. vaginalis, M. genitalium specifically was 10.3%, 9.6%, 6.4%, 3.2%, 2.6%, 0.6% respectively. N. gonorrhoeae and U. urealyticum were the most common in male patients, while M. hominis and U. urealyticum were mostly found in female patients. Different methods used for detecting T. vaginalis were compared to find that interrater reliability was perfect for culture-direct microscopy (κ:0.85; P<0.001) and also for culture-PCR (κ:0.89; P<0.001). The interrater reliability was moderate (κ:0.53; P<0.001) for PCR-Mycoplasma IES test for M. hominis and fair (κ:0.21; P<0.007) for U. urealyticum. U. urealyticum and M. hominis were among the most commonly found sexually transmitted infections (STI) agents in patients with resistant discharge. Multiple agent positivity was high and should be kept in mind in every STI case.

Correlation between IL-17A/F, IL-23, IL-35 and IL-12/-23 (p40) levels in peripheral blood lymphocyte cultures and disease activity in Behcet's patients.

Behcet's disease is a chronic multisystemic disease with remissions and relapses. Several studies have shown that immune mechanisms play an important role in the development of the disease. In order to assess the association of disease activity with IL-17A/F, IL-23, IL-12/23 (p40) and IL-35 expression, we aimed to investigate production of these cytokines in peripheral blood mononuclear cells (PBMCs) from Behcet's patients and normal controls. Furthermore, we included Systemic Lupus Erythematosus (SLE) as disease control to evaluate the specificity of our data for immunopathogenesis of BD. Totally 15 active, 15 inactive Behcet's patients, 12 active and 12 inactive SLE patients and 12 healthy volunteers were enrolled in the study. Peripheral blood mononuclear cells were separated, lymphocyte cultures were performed and IL-17A/F, IL-12/23 p(40), IL-23, IL-35 cytokine levels were measured by ELISA in culture supernatants in the presence or absence of phytohemagglutinin (PHA) on time-dependent manner. IL-17 A/F levels increased parallel to IL-23 levels in Behcet's and SLE patients. Compared to healthy controls, IL-17 A/F levels were higher in active Behcet's and SLE patients; on the contrary, levels of IL-35 were lower. IL-17A/F, IL-12/23 (p40) and IL-23 levels were detectable most frequently in active Behcet's patients followed by active SLE patients. Our results indicate that IL-17 A/F, IL-23 and IL-12/23 (p40) may play role in the immunopathogenesis of BD so as Th17 and Th1 cell responses. Since IL-35 levels were lower in active Behcet's patients compared to inactive patients and healthy controls, there may be a plasticity between Th17 and Treg cells according to the state of disease activity.

Comparison of in-house biotin-avidin tetanus IgG enzyme-linked-immunosorbent assay (ELISA) with gold standard in vivo mouse neutralization test for the detection of low level antibodies.

BACKGROUND: Detection of anti-tetanus antibody levels is necessary for both determination of the immune status of individuals and also for planning preventive measures. ELISA is the preferred test among in vitro tests however it can be affected by the cross reacting antibodies. A previously developed in-house ELISA test was found not reliable for the antibody levels ≤1.0IU/ml. A new method was developed to detect low antibody levels correctly. The aim of the present study was to compare the results of the newly developed in-house biotin-avidin tetanus IgG ELISA test with the in vivo mouse neutralization test, for the antibody levels ≤1.0IU/ml. METHODS: A total of 54 serum samples with the antibody levels of three different levels, =0.01IU/ml, 0.01-0.1IU/ml, 0.1-1IU/ml, which were detected by in vivo mouse neutralization test were studied by the newly developed in-house biotin-avidin tetanus IgG ELISA test. Test was validated by using five different concentrations (0.01IU/ml, 0.06IU/ml, 0.2IU/ml, 0.5IU/ml, 1.0IU/ml). RESULTS: A statistically significant correlation (r2=0.9967 p=0,001) between in vivo mouse neutralization test and in-house biotin-avidin tetanus IgG ELISA test, was observed. For the tested concentrations intra-assay, inter-assay, accuracy, sensitivity, specificity and coefficients of variations were determined as ≤15%. CONCLUSION: In-house biotin-avidin tetanus IgG ELISA test can be an alternative method to in vivo mouse neutralization method for the detection of levels ≤1.0IU/ml. By using in-house biotin-avidin tetanus IgG ELISA test, individuals with non protective levels, will be reliably detected.

Nonsuicidal Self-Injury Is Predictive of Suicide Attempts Among Individuals with Mood Disorders.

Nonsuicidal self-injury (NSSI) prior to age 18 was evaluated as a risk factor for adulthood suicide attempt (SA). Archival data from 222 mood-disordered participants were analyzed using multivariate Cox proportional hazards analysis. Participants with a youth SA were excluded. The hazards of SA among adult participants with a history of youth NSSI were twice than those of mood-disordered participants without youth NSSI (hazard ratio = 2.00, 95% confidence interval = 1.16-3.44, p = .01). Moreover, participants who had both youth and adult NSSI attempted suicide significantly earlier than participants who began NSSI as an adult. Youth NSSI is associated with persistent, elevated SA risk in adulthood.

Serum Cytokine Profiles in Infants with Atopic Dermatitis.

Atopic dermatitis (AD) in infancy is believed to have distinct features as compared to AD in other age groups, and little is known about cytokine production in infants with AD. We aimed to measure the serum cytokine levels of infants with atopic dermatitis and evaluate the association of new anti-inflammatory cytokines with the disease. Eighty-one infant patients with AD and 52 healthy controls were involved in this study. The serum levels of major pro- and anti-inflammatory cytokines of the T-helper (Th) subtypes, as well as more recently defined interleukins (IL-27, IL-35, and IL-37), were measured using the ELISA method. The serum levels of IL-35, IL-5, and interferon (IFN)-γ were found to be significantly higher, while the levels of transforming growth factor (TGF)-ß1 and IL-13 were found to be significantly lower in patients with AD as compared to controls. There was no statistically significant correlation between serum cytokine levels and objective SCORAD index or total immunoglobulin (Ig) E levels. We did not observe prominent serum Th2 polarization in atopic infants. The immunopathogenesis of atopy onset at an early age may be more complicated than that at older ages.