Comparison of a Treponema pallidum IgM immunoblot with a 19S fluorescent treponemal antibody absorption test for the diagnosis of congenital syphilis

Herremans, M M; Notermans, Daan W.; Mommers, M.; Kortbeek, L. M.

doi:10.1016/j.diagmicrobio.2007.04.021

Cited by 20 publications

(11 citation statements)

References 19 publications

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“…Reactions with 47, 17 and 15.5 kDa were found in most reactive blots, together with a variety of other reactions, including those corresponding to 72, 45, 42, 37, 34.5, 31, 24 and 7 kDa [4,50]. Not all of the infected infants' sera reacted with all these antigens, but the 47-kDa band is one of the major immunogens in neonatal IgM antibody production in CS [4,9,10,51] and is also detected in the blood of foetuses [34]. The 45-and 42-kDa antigens represent either breakdown products of the 47-kDa antigen or other related molecular weight derivates [52].…”

Section: Laboratory Diagnosismentioning

confidence: 95%

A review of diagnostic tests for congenital syphilis in newborns

Herremans

Kortbeek

Notermans

2010

Eur J Clin Microbiol Infect Dis

108

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Congenital syphilis (CS) can occur when a mother is inadequately treated or not treated at all for an active Treponema pallidum infection. Symptoms of CS are often subtle and non-specific, and it is estimated that up to 60% of affected infants are asymptomatic at birth, making the diagnosis dependent on laboratory findings. Despite decades of experience with CS, problems still arise in its diagnosis because laboratory test results for children at risk for CS can be inconclusive and no single diagnostic test can be used to diagnose CS. The development of diagnostic tests such as enzyme immunoassays, immunoblotting and polymerase chain reaction (PCR) has increased the sensitivity and specificity of diagnoses, but the detection of specific IgM is currently the most sensitive serological method, and the presence of specific IgM should be considered as evidence of a congenital T. pallidum infection. Suspected cases can also be confirmed or excluded by serial post-partum tests of antibody kinetics. The authors note strongly that it is considered unethical not to treat a baby at risk of contracting CS, even without a definitive diagnosis. In this review, we describe the various microbiological methods-and their shortcomings-used in the laboratory diagnosis of CS.

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Section: Laboratory Diagnosismentioning

confidence: 95%

A review of diagnostic tests for congenital syphilis in newborns

Herremans

Kortbeek

Notermans

2010

Eur J Clin Microbiol Infect Dis

108

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“…Two alternative data sources were investigated in order to acquire an insight into the number of CS cases in the Netherlands. The RIVM performs IgM serodiagnostics in neonates and young children (<1 year) who are suspected of having CS [10]. In addition, CS-related hospital admissions from LMR were also analysed.…”

Section: Methodsmentioning

confidence: 99%

Antenatal screening for HIV, hepatitis B and syphilis in the Netherlands is effective

et al. 2011

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BackgroundA screening programme for pregnant women has been in place since the 1950s in the Netherlands. In 2004 universal HIV screening according to opting out was implemented. Here, we describe the evaluation of the effectiveness of antenatal screening in the Netherlands for 2006-2008 for HIV, hepatitis B virus (HBV) and syphilis in preventing mother-to-child transmission, by using various data sources.MethodsThe results of antenatal screening (2006-2008) were compared with data from pregnant women and newborns from other data sources.ResultsEach year, around 185,000 pregnant women were screened for HIV, HBV and syphilis. Refusal rates for the screening tests were low, and were highest (0.2%) for HIV. The estimated annual prevalence of HIV among pregnant women was 0.05%.Prior to the introduction of screening, 5-10 children were born with HIV annually After the introduction of screening in 2004, only 4 children were born with HIV (an average of 1 per year). Two of these mothers had become pregnant prior to 2004; the third mother was HIV negative at screening and probably became infected after screening; the fourth mother's background was unknown. Congenital syphilis was diagnosed in fewer than 5 newborns annually and 5 children were infected with HBV. In 3 of these, the mothers were HBeAg positive (a marker for high infectivity). We estimated that 5-10 HIV, 50-75 HBV and 10 syphilis cases in newborns had been prevented annually as a result of screening.ConclusionsThe screening programme was effective in detecting HIV, HBV and syphilis in pregnant women and in preventing transmission to the child. Since the introduction of the HIV screening the number of children born with HIV has fallen dramatically.Previous publication[Translation from: 'Prenatale screening op hiv, hepatitis B en syphilis in Nederland effectief', published in 'The Dutch Journal of Medicine ' (NTVG, in Dutch)]

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“…One assay performed using the IgM capture format and labeled treponemal antigens was more sensitive than the 19S FTA-ABS IgM test (111), but the number of patients included in the study was small. Another study reported an immunoblot assay for IgM which was more sensitive and specific than the 19S FTA-ABS IgM test (114), but it was an in-house assay that required special reagents and expertise. Due to the poor performance of currently available IgM tests for syphilis, including a commercially available immunoglobulin (IgM) test approved for use by the U.S. FDA (Captia Syphilis-M EIA; Trinity BioTech, Bray, Ireland), they are not currently recommended by the CDC (20).…”

Section: Prenatal Syphilis Screening and Congenital Syphilismentioning

confidence: 99%

Recent Trends in the Serologic Diagnosis of Syphilis

Morshed

Singh

2014

Clin. Vaccine Immunol.

167

156

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bComplexities in the diagnosis of syphilis continue to challenge clinicians. While direct tests (e.g., microscopy or PCR) are helpful in early syphilis, the mainstay of diagnosis remains serologic tests. The traditional algorithm using a nontreponemal test (NTT) followed by a treponemal test (TT) remains the standard in many parts of the world. More recently, the ability to automate the TT has led to the increasingly widespread use of reverse algorithms using treponemal enzyme immunoassays (EIAs). Rapid, point-of-care TTs are in widespread use in developing countries because of low cost, ease of use, and reasonable performance. However, none of the current diagnostic algorithms are able to distinguish current from previously treated infections. In addition, the reversal of traditional syphilis algorithms has led to uncertainty in the clinical management of patients. The interpretation of syphilis tests is further complicated by the lack of a reliable gold standard for syphilis diagnostics, and the newer tests can result in false-positive reactions similar to those seen with older tests. Little progress has been made in the area of serologic diagnostics for congenital syphilis, which requires assessment of maternal treatment and serologic response as well as clinical and laboratory investigation of the neonate for appropriate management. The diagnosis of neurosyphilis continues to require the collection of cerebrospinal fluid for a combination of NTT and TT, and, while newer treponemal EIAs look promising, more studies are needed to confirm their utility. This article reviews current tests and discusses current controversies in syphilis diagnosis, with a focus on serologic tests.

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Comparison of a Treponema pallidum IgM immunoblot with a 19S fluorescent treponemal antibody absorption test for the diagnosis of congenital syphilis

Cited by 20 publications

References 19 publications

A review of diagnostic tests for congenital syphilis in newborns

A review of diagnostic tests for congenital syphilis in newborns

Antenatal screening for HIV, hepatitis B and syphilis in the Netherlands is effective

Recent Trends in the Serologic Diagnosis of Syphilis

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