Laboratory diagnosis and interpretation of tests for syphilis.

1995 ◽  
Vol 8 (1) ◽  
pp. 1-21 ◽  
Author(s):  
S A Larsen ◽  
B M Steiner ◽  
A H Rudolph
Keyword(s):  
Congenital Syphilis ◽  
Direct Detection ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Clinical Signs ◽  
Laboratory Diagnosis ◽  
Dark Field ◽  
Alternative Methods ◽  
Detection Methods ◽  
Enzyme Linked Immunosorbent Assay

The lack of a method for demonstrating the presence of Treponema pallidum by growth necessitates the use of alternative methods. Traditionally, these methods are divided into direct detection methods (animal inoculation, dark-field microscopy, etc.) and serologic tests for the presence of patient antibody against T. pallidum. Serologic methods are further divided into two classes. One class, the nontreponemal tests, detects antibodies to lipoidal antigens present in either the host or T. pallidum; examples are the Venereal Disease Research Laboratory and rapid plasma reagin and tests. Reactivity in these tests generally indicates host tissue damage that may not be specific for syphilis. Because these tests are easy and inexpensive to perform, they are commonly used for screening, and with proper clinical signs they are suggestive of syphilis. The other class of test, the treponemal tests, uses specific treponemal antigens. Confirmation of infection requires a reactive treponemal test. Examples of the treponemal tests are the microhemagglutination assay for antibodies to T. pallidum and the fluorescent treponemal antibody absorption test. These tests are more expensive and complicated to perform than the nontreponemal tests. On the horizon are a number of direct antigen, enzyme-linked immunosorbent assay, and PCR techniques. Several of these techniques have shown promise in clinical trials for the diagnosis of congenital syphilis and neurosyphilis that are presently difficult to diagnose.

Congenital Syphilis in Honiara, Solomon Islands

2020 ◽  
Vol 66 (6) ◽  
pp. 583-588
Author(s):  
Maxson Lifigao ◽  
Titus Nasi ◽  
Carol Titiulu ◽  
Steven Lumasa ◽  
Trevor Duke
Keyword(s):  
Congenital Syphilis ◽  
Solomon Islands ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Clinical Signs ◽  
Syphilis Infection ◽  
Middle Income ◽  
Middle Income Countries ◽  
Neurodevelopmental Problems

Abstract Introduction Congenital syphilis remains a significant cause of newborn mortality and long-term neurodevelopmental problems in some low- and middle-income countries. This study was done in Honiara, Solomon Islands to determine the incidence of babies born to mothers with a positive venereal disease research laboratory (VDRL) test and a positive Treponema pallidum haemagglutination assay (TPHA); to determine the VDRL status of newborns and features of congenital syphilis; and to estimate the proportion of stillbirths associated with syphilis. Methodology All neonates born to VDRL-positive mothers, including stillbirths were included between April and July 2019. Neonates were examined, investigated and treated. Results Among 1534 consecutive births, 1469 were live births and 65 (4.2%) were stillbirths. One hundred and forty-three neonates were born to VDRL-positive mothers: 130 (90.1%) were live infants and 13 (8.9%) stillbirths. Of the 130 VDRL-exposed live-born infants, 72 (55%) had reactive VDRL and a positive TPHA and 7 (9.7%) had clinical signs of congenital syphilis. Five of the infants with clinical signs of syphilis infection had a 4-fold higher VDRL titre than their mother. Four infants of VDRL-positive mothers died during admission, all of whom had clinical signs of syphilis. Ninety percent of affected infants were born to mothers who were not treated or only partially treated during pregnancy. Conclusions In this study, 1:210 live-born babies had clinical and serological evidence of congenital syphilis, and evidence of Treponema infection was found disproportionately in stillbirths. In a setting where Treponema infections are common, an empirical approach to prevention may be needed.

scholarly journals Molecular and Direct Detection Tests for Treponema pallidum Subspecies pallidum: A Review of the Literature, 1964–2017

2020 ◽  
Vol 71 (Supplement_1) ◽  
pp. S4-S12 ◽  
Author(s):  
Elitza S Theel ◽  
Samantha S Katz ◽  
Allan Pillay
Keyword(s):  
Direct Detection ◽  
Treponema Pallidum ◽  
Dark Field ◽  
Performance Characteristics ◽  
Nucleic Acid Amplification ◽  
Detection Methods ◽  
Cochrane Library ◽  
Silver Stain ◽  
Detection Techniques ◽  
Ovid Medline

Abstract Direct detection methods for Treponema pallidum include dark-field microscopy (DFM), direct fluorescence antibody (DFA) testing, immunohistochemistry (IHC), and nucleic acid amplification tests (NAATs). Here, we reviewed the relevant syphilis diagnostic literature to address 2 main questions with respect to T. pallidum direct detection techniques: “What are the performance characteristics for each direct detection test for T. pallidum and what are the optimal specimen types for each test?” and “What options are available for T. pallidum molecular epidemiology?” To answer these questions, we searched 5 electronic databases (OVID Medline, OVID Embase, CINAHL, Cochrane Library, and Scopus) from 1964 to 2017 using relevant search terms and identified 1928 articles, of which 37 met our inclusion criteria. DFM and DFA sensitivities ranged from 73% to 100% in cases of primary syphilis; and while sensitivity using silver stain histopathology for T. pallidum was generally low (0%–41%), higher performance characteristics were observed for T. pallidum–specific IHC (49–92%). Different genes have been targeted by T. pallidum–specific NAATs, with the majority of studies indicating that sensitivity is primarily dependent on the type of collected biological sample, with highest sensitivity observed in primary lesion exudate (75–95%). Given the rising incidence of syphilis, the development of direct, Food and Drug Administration–cleared T. pallidum NAATs should be considered an immediate priority.

scholarly journals Molecular detection of Treponema pallidum sp. pallidum in blood samples of VDRL-seroreactive women with lethal pregnancy outcomes: a retrospective observational study in northern Brazil

2011 ◽  
Vol 44 (4) ◽  
pp. 451-456 ◽  
Author(s):  
Charliana Aragão Damasceno Casal ◽  
Mayra Oliveira da Silva ◽  
Igor Brasil Costa ◽  
Eliete da Cunha Araújo ◽  
Tereza Cristina de Oliveira Corvelo
Keyword(s):  
Pregnancy Outcomes ◽  
Congenital Syphilis ◽  
Treponema Pallidum ◽  
Laboratory Diagnosis ◽  
Control Measures ◽  
Prenatal Period ◽  
Serum Samples ◽  
Significant Difference ◽  
Northern Brazil ◽  
Maternal Syphilis

INTRODUCTION: Although control measures of maternal and congenital syphilis are available in Brazil, difficulties exist within the healthcare network in providing a laboratory diagnosis of the infection during the prenatal period. The objective of this study was to confirm the presence of Treponema pallidum by PCR in women with positive VDRL serology and lethal pregnancy outcomes, i.e., abortion, stillbirth and neonatal death. METHODS: A retrospective study was conducted on VDRLseroreactive women with lethal pregnancy outcomes admitted to the Fundação Santa Casa de Misericórdia do Pará (FSCM-PA) between January and July 2004. Serum samples and DNA from whole blood were obtained at the time of screening by the VDRL test. These samples were analyzed by IgG ELISA, IgM FTA-Abs and simple PCR (polA). RESULTS: During the study period, 0.7% (36/4,912) of women with lethal pregnancy outcomes presented a positive VDRL test. The polAgene was amplified in 72.7% (24/33) of these women, with 55.6% (20/36) and 94.4% (34/36) presenting IgM and IgG antibodies against T. pallidum, respectively. Comparison of these results showed a significant difference, with agreement between the PCR and IgM FTA-Abs results, suggesting that maternal syphilis was an active infection. No basic cause of death of the conceptus was reported in 97.2% (35/36) of cases. Among women who were submitted to the VDRL test during the prenatal period, only four of the nine seroreactive patients underwent treatment. CONCLUSIONS: The high frequency of syphilis in the group studied indicates the fragility of the service of infection diagnosis, treatment and monitoring, compromising epidemiological control.

scholarly journals Canine ehrlichiosis: clinical, hematological, serological and molecular aspects

2008 ◽  
Vol 38 (3) ◽  
pp. 766-770 ◽  
Author(s):  
Andréa Cristina Higa Nakaghi ◽  
Rosangela Zacarias Machado ◽  
Mirela Tinucci Costa ◽  
Marcos Rogério André ◽  
Cristiane Divan Baldani
Keyword(s):  
Direct Detection ◽  
Clinical Signs ◽  
Chronic Phase ◽  
Antibody Test ◽  
Acute Stage ◽  
Detection Methods ◽  
Serological Tests ◽  
Humoral Immune ◽  
Canine Ehrlichiosis ◽  
Dot Elisa

The aim of the present study was to compare the direct detection methods of Ehrlichia canis (blood smears and nested PCR), serological tests (Dot-ELISA and Immunofluorescent Antibody Test - IFAT), and demonstrate the most suitable test for the diagnosis of different stages of infection. Blood samples and clinical data were collected from 30 dogs examined at the Veterinary Teaching Hospital, UNESP, Jaboticabal, SP, Brazil. The clinical signs most frequently observed were apathy, anorexia, pale mucous membrane, fever, lymphadenopathy, splenomegaly, hemorrhages and uveitis. Evaluating the humoral immune response, 63.3% of the sera were IFAT positive, while 70% were Dot-ELISA positive. By nestedPCR 53.3% of the samples were positive. Comparing these techniques it was concluded that serology and nPCR are the most suitable tests to confirm the diagnosis of canine ehrlichiosis, however it should be always treated as a complementary data to clinical and hematological evaluation. Serology has an important role in the subclinical and in the chronic phase, nPCR is recommended in the acute stage, and, especially, to identify the ehrlichia specie.

scholarly journals Canadian Public Health Laboratory Network Laboratory Guidelines for the Use of Direct Tests to Detect Syphilis in Canada

2015 ◽  
Vol 26 (supplement a) ◽  
pp. 13A-17A ◽  
Author(s):  
Raymond SW Tsang ◽  
Muhammad Morshed ◽  
Max A Chernesky ◽  
Gayatri C Jayaraman ◽  
Kamran Kadkhoda
Keyword(s):  
Ethical Issues ◽  
Direct Detection ◽  
Histopathological Examination ◽  
Fluorescent Antibody ◽  
Treponema Pallidum ◽  
Antibody Test ◽  
Turnaround Time ◽  
Dark Field ◽  
Specimen Collection ◽  
Infectivity Test

Treponema pallidumsubsp.pallidumand/or its nucleic acid can be detected by various methods such as microscopy, rabbit infectivity test or polymerase chain reaction (PCR) tests. The rabbit infectivity test forT. pallidum, although very sensitive, has been discontinued from most laboratories due to ethical issues related to the need for animal inoculation with liveT. pallidum, the technically demanding procedure and long turnaround time for results, thus making it impractical for routine diagnostic use. Dark-field and phase-contrast microscopy are still useful at clinic- or hospital-based laboratories for near-bedside detection ofT. pallidumin genital, skin or mucous lesions although their availability is decreasing. The lack of reliable and specific anti-T. pallidumantibodies and its inferior sensitivity to PCR may explain why the direct fluorescent antibody test forT. pallidumis not widely available for clinical use. Immunohistochemical staining forT. pallidumalso depends on the availability of specific antibodies, and the method is only applicable for histopathological examination of biopsy and autopsy specimens necessitating an invasive specimen collection approach. With recent advances in molecular diagnostics, PCR is considered to be the most reliable, versatile and practical for laboratories to implement. In addition to being an objective and sensitive test for direct detection ofTreponema pallidumsubsp. pallidumDNA in skin and mucous membrane lesions, the resulting PCR amplicons from selected gene targets can be further characterized for antimicrobial (macrolide) susceptibility testing, strain typing and identification ofT. pallidumsubspecies.

scholarly journals Laboratory Examination of Syphilis

2021 ◽  
Vol 5 (3) ◽  
pp. 722-741
Author(s):  
M. Izazi Hari Purwoko ◽  
Mutia Devi ◽  
Suroso Adi Nugroho ◽  
Fitriani Fitriani ◽  
Raden Pamudji ◽  
...  
Keyword(s):  
Venereal Disease ◽  
Transmitted Disease ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Rapid Test ◽  
Dark Field ◽  
Morphological Observation ◽  
Serologic Test ◽  
Sexually Transmitted ◽  
Antibody Absorption

Syphilis, is sexually transmitted disease caused by spirochete Treponema pallidum subsp.pallidum. It have many diverse clinical manifestations that occur in distinct stages. Early diagnosis and management are the main things to prevent transmission and complication. Direct test or morphological observation is the definitive diagnosis of syphilis. This can be done through animal inoculation test, dark field microscopy, direct fluorescence antibody (DFA), and nucleid acid amplification test (NAAT). While the indirect test is a nontreponemal serologic test consist of Wasserman test, venereal disease research laboratory (VDRL), toluidine red unheated serum test (TRUST), unheated serum reagin (USR), rapid plasma reagin (RPR) and treponemal serologic test, such as T. pallidum passive particle agglutination (TPPA), T. pallidum haemagglutination assay (TPHA), fluorescent treponemal antibody absorption (FTA-Abs), enzyme immunoassay (EIA) and rapid test. The algorithm of serologic test can be divided into traditional or reverse.

scholarly journals LABORATORY DIAGNOSIS AND CLINICAL SIGNS OF CANINE VISCERAL LEISHMANIASIS IN DOGS EXAMINED AT THE CENTER FOR ZOONOSIS CONTROL IN CAMPO GRANDE – MS, BRAZIL

2012 ◽  
Vol 17 (4) ◽  
Author(s):  
Rodrigo Casquero Cunha ◽  
Renato Andreotti ◽  
Elaine Silva ◽  
Elisângela Pereira ◽  
Tayra Sato ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Urban Areas ◽  
Clinical Symptoms ◽  
Fluorescent Antibody ◽  
Clinical Signs ◽  
Primary Source ◽  
Laboratory Diagnosis ◽  
Leishmania Species ◽  
Enzyme Linked Immunosorbent Assay ◽  
Mato Grosso

Visceral leishmaniasis is a type of zoonosis caused by several Leishmania species endemic to tropical, subtropical, and Mediterranean climate regions. Dogs are the primary source of infection in urban areas and can be symptomatic or asymptomatic. This study focused on the observation of clinical signs of leishmaniasis in dogs in Campo Grande, Mato Grosso do Sul, Brazil. Samples from affected animals were analyzed using indirect fluorescent antibody (IFA) tests, an enzyme-linked immunosorbent assay (ELISA), and polymerase chain reaction (PCR) assays to determine the optimal diagnostic tool for use on animals that present clinical symptoms. A predominance of clinical symptoms affecting the integumentary system was observed, and splenomegaly and hepatomegaly were the most important pathological signs. Among the diagnostic tests, the greatest agreement was seen between ELISA and IFA, followed by ELISA and PCR, and finally IFA and PCR. PCR diagnostic results showed the greatest extent of correlation with clinical signs, followed by ELISA and then IFA. When choosing a diagnostic method, veterinarians should consider the clinical signs and health status of the patient.

scholarly journals Congenital Syphilis Coinfection in a Preterm Infant with Early Onset Sepsis due to Enterobacter cloacae

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Sakviseth Bin ◽  
Sethikar Im
Keyword(s):  
Early Onset ◽  
Clinical Symptoms ◽  
Congenital Syphilis ◽  
Treponema Pallidum ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Enterobacter Cloacae ◽  
Benzyl Penicillin ◽  
Fourfold Increase ◽  
Early Onset Sepsis

Introduction. Syphilis is a tropical disease, caused by a spirochete Treponema pallidum, which can be transmitted transplacentally from untreated mothers to the fetus during any stages of pregnancy. Clinical manifestations of early congenital syphilis are variable and nonspecific. The diagnosis is based on the serology status of the mother, newborn clinical symptoms, and comparative serology titer between mother and newborn. Case Presentation. A late preterm female infant, appropriate for gestational age, was treated for severe early onset sepsis due to Enterobacter cloacae since day 2 of life. The coinfection with Treponema pallidum was suspected and confirmed at day 4 with clinical signs and a fourfold increase of rapid plasma reagin (RPR) compared to mother’s serology. Combined with meropenem and amikacin, Benzyl-Penicillin was used for 10 days, thereby resulting in a significant clinical and laboratory improvement. The girl was discharged at day 18 and brought for regular follow-ups for both growth milestone and syphilis serology. RPR decreased fourfold at the age of 1 month. Conclusion. Syphilis should not be overlooked. The vertical transmission is preventable by an on-time treatment of the infected mother, triggered by a proper antenatal screening at the right time. Congenital syphilis should be ruled out in any challenging neonatal sepsis. The diagnosis tools and treatments are easily accessible and inexpensive in our economical settings.

scholarly journals Laboratory Examination of Syphilis

2021 ◽  
Vol 5 (8) ◽  
pp. 726-745
Author(s):  
M. Izazi Hari Purwoko ◽  
Mutia Devi ◽  
Suroso Adi Nugroho ◽  
Fitriani Fitriani ◽  
Raden Pamudji ◽  
...  
Keyword(s):  
Venereal Disease ◽  
Transmitted Disease ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Rapid Test ◽  
Dark Field ◽  
Morphological Observation ◽  
Serologic Test ◽  
Sexually Transmitted ◽  
Antibody Absorption

Syphilis, is sexually transmitted disease caused by spirochete Treponema pallidum subsp.pallidum. It have many diverse clinical manifestations that occur in distinct stages. Early diagnosis and management are the main things to prevent transmission and complication. Direct test or morphological observation is the definitive diagnosis of syphilis. This can be done through animal inoculation test, dark field microscopy, direct fluorescence antibody (DFA), and nucleid acid amplification test (NAAT). While the indirect test is a nontreponemal serologic test consist of Wasserman test, venereal disease research laboratory (VDRL), toluidine red unheated serum test (TRUST), unheated serum reagin (USR), rapid plasma reagin (RPR) and treponemal serologic test, such as T. pallidum passive particle agglutination (TPPA), T. pallidum haemagglutination assay (TPHA), fluorescent treponemal antibody absorption (FTA-Abs), enzyme immunoassay (EIA) and rapid test. The algorithm of serologic test can be divided into traditional or reverse.

scholarly journals Evaluation the efficiency of Trichomonas vaginalis depending on clinical sings , direct examination ,culturing and serological test

2011 ◽  
Vol 8 (1) ◽  
pp. 392-399
Author(s):  
Baghdad Science Journal
Keyword(s):  
Trichomonas Vaginalis ◽  
Clinical Symptoms ◽  
Culture Media ◽  
Serological Test ◽  
Clinical Signs ◽  
Direct Methods ◽  
Laboratory Diagnosis ◽  
Enzyme Linked Immunosorbent Assay ◽  
Indirect Haemagglutination ◽  
Number Of Patients

The adequacy of diagnostic tests, together with trichomoniasis associated clinical symptoms, were investigated in females suffering vaginitis, and they were referred to the Gynecology Department, Al-Yarmouk Teaching Hospital during the period December 2004 – June 2005. The total number of patients was 250 cases (age range: 18 - 52 years), and each patient was examined using a sterile speculum to obtain vaginal swabs for examination. The diagnosis with T. vaginalis was done in many methods. The direct methods included wet and stained (Leishman's stain) examinations and cultivation in different culture media (Kupferberg Trichomonas Broth Base;, Trichomonas Agar Base; TAB and Trichomonas Modified CPLM), while the indirect methods were serological detections of anti-trichomonas antibodies in the sera of patients by using of indirect haemagglutination test (IHAT) and enzyme linked immunosorbent assay (ELISA). The results of this profile were as the following: 1. Out of 250 females with abnormal vaginal discharges, 15 patients (6%) were infected with T. vaginalis. 2. The sensitivity of testing methods was different. It was 66.7 and 13.3% for wet and stained examinations, respectively. In culture examinations, the sensitivity was 60, 80 and 100% for Kupferberg, TAB and CPLM media, respectively, while the sensitivity IHAT and ELISA were 40 and 73.3%, respectively. 3. The clinical sings of infection in women were discharge and itching (46.7%), discharge with itching and dysuria (20.0%), discharge only (13.3%), itching only (13.3%) and discharge with dysuria (6.7%). Therefore we can conclude that impossible to the clinical signs in diagnose of Trichomonasis because of the variation and the laboratory diagnosis is necessary especially the cultivation method.

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