Syphilis in the AIDS era: Diagnostic dilemma and therapeutic challenge

Scythes, John; Jones, Colman

doi:10.1556/amicr.60.2013.2.2

Cited by 6 publications

(6 citation statements)

References 89 publications

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“…PCR, a crucial technique in molecular diagnosis, has been suggested to be a useful supplement in diagnosing early‐stage syphilis, particularly in those with evident erythema . Some researchers postulated that PCR would increase the rate of detection of syphilis in patients whose symptoms were generally masked by acquired immune deficiency syndrome (AIDS). We now provide a summary of the research status of some PCR method.…”

Section: Introductionmentioning

confidence: 99%

PCR detection for syphilis diagnosis: Status and prospects

Zhou

Zhang

et al. 2019

Clinical Laboratory Analysis

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Syphilis, a re‐emerging public health problem worldwide caused by Treponema pallidum subsp pallidum (T. pallidum), usually induces systemic and chronic inflammation in hosts who do not receive timely therapy after exposing to high‐risk factors such as leprous sexual contact. Before the treatment, rapid and accurate detection of syphilis is essential. However, the existing detection methods, which focus on the treponemal or non‐treponemal antibody test, both have inherent limitations. For instance, both of them cannot distinguish the stage and severity of syphilis. Non‐treponemal test such as RPR, which is generally deemed to be used for assessing treatment response, is influenced by biological false positives. Therefore, it is imperative to seek out a new and effective diagnostic test. With recent advancements in molecular biology and whole‐genome sequencing, the molecular diagnosis has increased in popularity, especially the use of polymerase chain reaction (PCR). Here, we firstly present a mini‐review on the research of PCR detection methods used for syphilis diagnosis over the past decade, and we then compare these methodologies to assess their potential and the challenges faced. This information can provide a fresh perspective to help researchers address the current challenges.

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Section: Introductionmentioning

confidence: 99%

PCR detection for syphilis diagnosis: Status and prospects

Zhou

Zhang

et al. 2019

Clinical Laboratory Analysis

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“…False-negative results can be the consequence of the prozone phenomenon, which occurs in 1-2% of patients, especially in pregnant women and in HIV patients with low CD4 cell counts and high treponemal load. 1,4,[8][9][10][11] The direct method of diagnosis is through microscopic examination of T. pallidum ssp. pallidum in a clinical specimen.…”

Section: Discussionmentioning

confidence: 99%

Treponema pallidum ssp. pallidum identification by real-time PCR targetting the polA gene in paraffin-embedded samples positive by immunohistochemistry

et al. 2017

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Syphilis is a systemic and sexually transmitted infection caused by Treponema pallidum ssp. pallidum. This spirochete causes different clinical and subclinical stages depending on the duration of infection and immune status of the host. Several tests have been developed for diagnosis, and are classified into direct and indirect methods. The first one includes dark field microscopy, direct fluorescent antibody test in fluids or tissue, and molecular biology techniques. In the indirect method (serologic), the routine tests are used, and are divided in two categories: non-treponemal and treponemal ones. The objective of this work was to identify T. pallidum ssp. pallidum in paraffin-embedded skin biopsies positive by immunohistochemistry, using conventional polymerase chain reaction (PCR) and quantitative real time PCR (qPCR). We included a sample of 17 paraffin-embedded biopsies. DNA was extracted and processed by conventional PCR and real-time PCR with a TaqMan® probe to identify the polA gene. Using PCR, 11 tested positive (64.7%) and 6 (35.3%) were negative. With qPCR and TaqMan® probe, 100% of samples tested positive. The minimum number of spirochetes detected in each sample was 2. With this work, we can conclude that qPCR is a fast and very accurate method for diagnosis of syphilis in tissue specimens.

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“…Two to eight weeks later there is a new phase that is the secondary (or disseminated) stage of syphilis. Tertiary syphilis, characterised by chronic inflammation and progressive gumma, may develop years after the initial contact 1 2…”

Section: Discussionmentioning

confidence: 99%

Fever, thoracic pain, skin lesions and Hampton hump

Torres

Acar

Brito

et al. 2014

Thorax

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A 56-year-old white woman who had previously been healthy had been admitted to hospital 6 months previously for 2 months due to fever for 1 week associated with an onset of pain in her left hemithorax. She was initially treated for community-acquired pneumonia with a respiratory quinolone and continued to experience pain, which was worse during expiration. She lost 8 kg over the period of her admittance and developed plaque and papules. A chest X-ray showed opacity with fairly precise limits in the lower third of the left hemithorax similar to a Hampton hump, which consists of a shallow wedge-shaped opacity in the periphery of the lung with its base against the pleural surface, associated with diaphragmatic clamping ( figure 1A-C).The laboratory findings included leukopenia with a discrete presence of monocytosis. D-dimer was within the normal value. Lower limb venous Doppler showed no venous thrombosis and the transthoracic echocardiogram was negative for vegetative lesions. Induced sputum was negative for tuberculosis and the tuberculin test was not reactive. Spirometry showed indices within normal limits. Serological markers for hepatitis B and C and anti-HIV 1 and 2 were negative. A skin biopsy was performed and suggested a framework associated with a lymphomatoid drug eruption.A left pulmonary biopsy was performed and intense lymphocytic inflammatory infiltrate-forming follicles associated with alveolar epithelial hyperplasia and severe flaking occupying the alveoli were identified. Immunohistochemistry showed a heterogeneous population of lymphocytes that was not compatible with lymphoma. The patient was also tested for syphilis.The patient was discharged and continued to be followed in the dermatology outpatient clinic where prednisone was started at a dose of 40 mg/ day for 5 days titrated to 10 mg/day; no improvement was seen. The patient was referred to the pulmonology clinic, where a new review of skin and lung biopsies and new serology for infectious and rheumatic diseases was requested. A Venereal Disease Research Laboratory (VDRL) test was positive (1:256) and fluorescent treponemal antibody absorption test (FTA-Abs) reagent was present. A skin biopsy showed atrophy of the epidermis and infiltration of lymphocytes and plasma cells in the dermis ( figure 2A). These findings were interpreted as a framework of lymphomatoid drug eruption.A pulmonary biopsy of the left lower lobe identified intense inflammatory infiltration of lymphocytes and plasma cells forming follicles associated with alveolar epithelial hyperplasia and severe flaking occupying the alveoli. These inflammatory cells also appeared around vessels, forming a cuff. A nodule with characteristics of a typical gumma was present (figure 2B,C). These findings suggested pulmonary syphilis. Fontana-Tribondeau staining did not reveal any spirochaetes, and a diagnosis of lymphoma was excluded by immunohistochemical testing. Immunostaining for

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Syphilis in the AIDS era: Diagnostic dilemma and therapeutic challenge

Cited by 6 publications

References 89 publications

PCR detection for syphilis diagnosis: Status and prospects

PCR detection for syphilis diagnosis: Status and prospects

Treponema pallidum ssp. pallidum identification by real-time PCR targetting the polA gene in paraffin-embedded samples positive by immunohistochemistry

Fever, thoracic pain, skin lesions and Hampton hump

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