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INTRODUCCIÓN: La inmunoquimioluminiscencia de micropartículas (CMIA), no es recomendada en el día de hoy para el tamizaje ni confirmación de sífilis en pacientes, las guías chilenas recomiendan tamizaje con V.D.R.L y confirmación con hemaglutinación. OBJETIVO: Determinar la especificidad, sensibilidad y correlación diagnóstica de esta técnica respecto a la prueba treponémica de uso habitual. MATERIALES Y MÉTODOS: De 815 muestras obtenidas en un periodo de 6 meses, a todas las cuales se les aplicó las pruebas de VDRL, MHA-TP y CMIA, 484 muestras fueron positivas para MHA-TP. Se determinó el rendimiento, se graficaron las curvas ROC, índice de correlación y punto de corte óptimo. RESULTADOS: La CMIA. demostró una sensibilidad de 100%, especificidad: 94,6%, VPN: 100% y VPP: 96.4% y una eficiencia de 97,8% con respecto al MHA-TP, con un índice de correlación: 0,97 y un punto de corte de 7.665, de modo que toda muestra con una CMIA. sobre este valor no necesitaría de una segunda prueba treponémica para su confirmación. El 7,11% tuvo valores intermedios de CMIA (1.0 a 7.664). CONCLUSIÓN: La CMIA. es una técnica automatizada altamente sensible y específica, equiparable al MHA-TP. Aplicada como prueba inicial de testeo para sífilis incrementa la certeza diagnóstica y podría permitir el diagnóstico precoz de la enfermedad.
BACKGROUND: The chemiluminescent microparticle immunoassay (CMIA) is not recommended for screening or confirmation of syphilis in patients, Chilean guidelines recommend screening with VDRL and confirmation with hemagglutination. AIM: To determine the specificity, sensitivity, and diagnostic correlation of this technique compared to the usual treponemal test. METHODS: Of the 815 samples obtained over a period of 6 months, all of which were subjected to VDRL, MHATP, and CMIA. testing, 484 samples were positive for MHA-TP. The performance was determined, ROC curves were graphed, correlation index and optimal cutoff point were determined. RESULTS: CMIA showed a sensitivity of 100%, specificity of 94.6%, NPV of 100%, PPV of 96.4%, and an efficiency of 97.8% compared to MHA-TP, with a correlation index of 0.97 and a cutoff point of 7.665, such that any sample with a CMIA. value above this value would not require a second treponemal test for confirmation. 7.11% had intermediate CMIA. values (1.0 to 7.664). CONCLUSION: CMIA. is a highly sensitive and specific automated technique comparable to MHA-TP. When applied as an initial screening test for syphilis, it increases diagnostic certainty and may allow for early diagnosis of the disease.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Imunoensaio , Sífilis/diagnóstico , Medições Luminescentes/métodos , Algoritmos , Testes de Hemaglutinação , Sorodiagnóstico da Sífilis , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Reações Falso-PositivasRESUMO
La sífilis es una infección de transmisión sexual, potencialmente grave. La presentación clínica es muy variada, desde manifestaciones cutáneo-mucosas hasta neurológicas. Para el diagnóstico se emplean estudios de laboratorio, treponémicos y no treponémicos, con los que se realizan diferentes algoritmos para disminuir las limitaciones de cada prueba por separado. Se discute el caso de un joven que se presenta con fiebre y lesiones en piel sugestivas de sífilis secundaria, con un test VDRL falso negativo por efecto prozona. Este fenómeno, infrecuente, se debe a la concentración desproporcionadamente alta de anticuerpos. Conocer las herramientas diagnósticas y trabajar en conjunto con el equipo de laboratorio, puede facilitar el acercamiento a la enfermedad y a un tratamiento oportuno disminuyendo así la morbimortalidad de los pacientes.
Syphilis is a potentially serious sexually transmitted infection. The clinical presentation is very varied, from cutaneous-mucosal to neurological manifestations. For the diagnosis, treponemal and non-treponemal laboratory studies are used, with which different algorithms are performed to reduce the limitations of each test separately. We discuss the case of a young man who presented with fever and skin lesions suggestive of secondary syphilis, with a false negative VDRL test due to prozone effect. This rare phenomenon is due to a disproportionately high concentration of antibodies. Knowing the diagnostic tools and working together with the laboratory team can facilitate the approach to the disease and timely treatment, thus reducing the mor bidity and mortality of patients.
A sífilis é uma infecção sexualmente transmissível potencialmente grave. A apresentação clínica é muito variada, desde manifestações cutâneo-mucosas a neurológicas. Para o diagnóstico, são utilizados estudos laboratoriais, treponêmicos e não treponêmicos, com os quais são realizados diferentes algoritmos para reduzir as limitações de cada teste separadamente. Discutimos o caso de um jovem que apresentou febre e lesões cutâneas sugestivas de sífilis secundária, com teste VDRL falso negativo devido ao efeito prozona. Esse fenômeno raro se deve à concentração desproporcionalmente alta de anticorpos. Conhecer as ferramentas diagnósticas e trabalhar em conjunto com a equipe do laboratório pode facilitar a abordagem da doença e o tratamento oportuno, reduzindo assim a morbimortalidade dos pacientes.
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Oral secondary syphilis may mimic various infectious, neoplastic, or immune-mediated processes; hence, its diagnosis may represent a challenge. Early diagnosis of syphilis, a disease that has increased in recent decades, is essential for adequate management, particularly in people living with HIV (PLWH). This study aimed to comprehensively characterize oral secondary syphilis in a group of 47 PLWH. A group of PLWH with oral secondary syphilis attending four HIV-referral centers in Mexico City was included (2004-2021). Clinical and laboratory data were retrieved, and an exhaustive oral examination was performed following the established criteria. Demographic, clinicopathological, immunohistochemical, and serological features of the patients were analyzed. Approximately 11% of PLWH with oral secondary syphilis demonstrated negative Venereal Disease Research Laboratory tests. A noticeable feature was the absence of symptoms in 95.7% of cases, despite the clinically evident appearance of the lesions. In contrast to previous results, 18% of ulcerations were detected to be deep, crateriform, and infiltrative, and 22% of the mucous patches were highly keratotic lesions. Most samples (77.3%) showed superficial lymphoplasmacytic infiltrates in the superficial lamina propria, with perivascular and perineural patterns, and immunohistochemistry was positive in 66.7% of the cases. The "great imitator" appears not only clinically but also histopathologically and immunohistochemically, where features may be comparable with those of chronic inflammatory processes, deep infections, or malignant processes. Although not recommended as a routine assay, IHC could be a critical tool, particularly in PLWH with atypical clinical features or with negative and/or dubious serology.
Assuntos
Infecções por HIV , Sífilis , Humanos , Sorodiagnóstico da SífilisRESUMO
BACKGROUND: The diagnosis of neurosyphilis is a challenge, and the criteria for deciding when to perform a lumbar puncture are still controversial, especially in people living with HIV with a late latent syphilis diagnosis. METHODS: Retrospective analysis of demographic, clinical, and laboratory data of people with HIV and documented late latent syphilis or syphilis of unknown duration with a cerebrospinal fluid VDRL test. RESULTS: 122 patients were evaluated, of whom 52 had the diagnosis of neurosyphilis. Patients with and without neurosyphilis presented a similar viral load and lymphocyte CD4+ T-cell count. Neurological symptoms (OR 6.4, 95% CI 2.1-22.4; p < 0.01), serum VDRL titers of 1:32 (p<0.01), 1:64 (p = 0.055), and ≥1:128 (p < 0.001) were associated with neurosyphilis. Furthermore, serum VDRL ≥1:32 were associated with (OR 24.9, 95% CI 5.45-154.9; p < 0.001) or without (OR 6.5, 95% CI 2.0-29.2; p = 0.004) neurological symptoms with neurosyphilis; however, VDRL ≤1:16 with neurological symptoms can be associated with neurosyphilis (OR 7.6, 95% CI 1.03-64.3; p = 0.046). CONCLUSION: Neurological symptoms, particularly headache, were predictors of neurosyphilis in people with HIV irrespective of their viral load and lymphocyte CD4+ T-cell count in late latent syphilis. A serum VDRL ≥1:32 increased the risk of neurosyphilis in patients with or without any symptoms.
Assuntos
Infecções por HIV , Neurossífilis , Sífilis Latente , Sífilis , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Neurossífilis/complicações , Neurossífilis/diagnóstico , Neurossífilis/epidemiologia , Estudos Retrospectivos , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/epidemiologia , Sorodiagnóstico da SífilisRESUMO
BACKGROUND: The increasing incidence of syphilis worldwide has called attention to the risk of transmission by transfusion. AIMS: To determine the prevalence of active syphilis in blood donors and characterise the serological profile of syphilis-positive donors. METHODS: Samples positive for Treponema pallidum using the chemiluminescent microparticle immunoassay (CMIA) during blood donor screening from 2017 to 2018 were tested by the Venereal Disease Research Laboratory (VDRL) non-treponemal test and for anti-T. pallidum IgM by ELISA (Immunoassay Enzyme test for detection of IgM antibodies). The INNO-LIA Syphilis test (Line Immuno Assay solid test for confirmation antibodies to Treponema pallidum) was performed as a confirmatory test on samples that were positive on ELISA-IgM but negative on VDRL. ELISA-IgM (+) samples were also tested for T. pallidum DNA in sera by real-time polymerase chain reaction (PCR). RESULTS: Of 248 542 samples screened, 1679 (0.67%) were positive for syphilis by CMIA. Further analysis was performed on 1144 (68.1%) of these samples. Of those tested, 16% were ELISA IgM(+)/VDRL(+), 16.5% were ELISA IgM(-)/VDRL(+), 4.1% were ELISA IgM(+)/VDRL(-), and 63.4% were ELISA IgM (-)/VDRL(-). The INNO-LIA Syphilis test results were 33 (3%) positive, 2 (0.2%) undetermined and 12 (1%) negative. Of the 230 EIA-IgM(+) samples (20.1%), 5 (2.2%) were PCR positive. The prevalence of active syphilis in 2017 and 2018 was 0.1% and 0.07%, respectively, and overall prevalence of serologic markers for syphilis was highest among male, unmarried, 25-34-year-olds with a high school education and who were first-time donors. CONCLUSION: There is a risk of transfusion-transmitted syphilis in blood banks that exclusively use the VDRL test for donor screening, as is currently the situation in some Brazilian blood centres, as well as in other blood centres around the world.
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Anticorpos Antibacterianos/sangue , Doadores de Sangue , Segurança do Sangue , Seleção do Doador/métodos , Sorodiagnóstico da Sífilis , Sífilis/diagnóstico , Treponema pallidum/imunologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Brasil/epidemiologia , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoensaio , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Prevalência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estudos Soroepidemiológicos , Sífilis/sangue , Sífilis/epidemiologia , Sífilis/transmissão , Sorodiagnóstico da Sífilis/métodos , Adulto JovemRESUMO
Background: Alopecia areata (AA) is a typical hair issue, which may have obliterating mental and social outcomes and is portrayed by the nearness of nonscarring alopecia. Objective: This examination has targets to assess the serum nutrient D levels , with AA; contrast the outcome and clearly sound control; and confirm relationship between AA types and serum nutrient D levels. Patients Also Methods: the examine might have been led clinched alongside Tikrit educating healing facility throughout those time starting with June 2019 of the limit for January 2020. Irrefutably the quantity of subjects associated with the assessment was ninety individuals isolated in two social events; the patients bundle were forty five the people who whimper of AA while the resulting gathering including a forty five age and sex-made solid volunteers were picked as a benchmark gathering. The degree and movement of the alopecia were noted and the patients were meticulously broke down for signs of various ailments. Research center assessments were led to patients and also to those control population, these included serum vitamin D levels were measured as 25-hydroxyvitamin D {25(OH)D} using a chemiluminescence microparticle immunoassay. Blood models were gotten starting with patients and control subjects after totally taught consent was gotten. Results : An essential complexity may have been found for serum 25-OH Vit D levels between patients other than controls. Vitamin D sufficiency were more common in controls than in patients. Serum Vitamin D was deficient in both cases and controls group; but, the deficiency was significantly more throughout AA group (35. 6%) compared to the handle group (11. 1%). Among the list patients gathering, levels associated with nutrient D were totally higher in guys in contrast with females. Conclusions: AA might be related with nutrient D deficiency as mean degrees of nutrient D of patients were seen as fundamentally lower than typical sound controls.
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Humanos , Deficiência de Vitamina D/complicações , Teste de Imobilização do Treponema , Nutrientes/deficiência , Anticorpos Antinucleares/imunologia , Alopecia em Áreas/diagnóstico , Estudos de Casos e ControlesRESUMO
Introdução: A sífilis é uma infecção sexualmente transmissível (IST), causada pela espiroqueta Treponema pallidum e reemergente em nosso país. Pessoas com neurossífilis e que vivem com HIV (Human Immunodeficiency Virus) apresentam maior chance de falência terapêutica e maior tempo para normalização dos exames laboratoriais da sífilis. A neurossífilis pode ser sintomática ou assintomática e o tratamento de escolha é a penicilina G cristalina. Ceftriaxona constitui terapia alternativa, porém existem poucos dados que avaliem essa opção terapêutica. O objetivo do presente estudo foi descrever pessoas vivendo com HIV (PVHIV), diagnosticados com neurossífilis assintomática, que receberam tratamento com ceftriaxona. Metodologia: Estudo observacional, retrospectivo, realizado no Hospital Dia do Instituto de Infectologia Emílio Ribas, no período de janeiro de 2015 a dezembro de 2018. Foram incluídas pessoas que vivem com HIV (PVHIV) com diagnóstico sorológico de sífilis e teste de VDRL (Venereal Disease Research Laboratory) reagente no líquido cefalorraquidiano (LCR), assintomáticas do ponto de vista neurológico e que receberam tratamento com ceftriaxona. Foram avaliadas as características dos pacientes incluídos e a evolução laboratorial após tratamento (títulos de VDRL sérico e liquórico). Assim, os pacientes foram classificados em "respondedores" sorológicos ou liquóricos e "não respondedores" sorológicos ou liquóricos. Resultados: Foram incluídos 61 casos. A mediana de idade foi de 39 anos e 59 (96,7%) pacientes eram do gênero masculino. Trinta (57,7%) de 52 pacientes tinham sífilis precoce no momento do diagnóstico de neurossífilis. As medianas de VDRL sérico e contagem de células T CD4 foram de 1:64 e 629 células/ml, respectivamente. Cinquenta e quatro (88,6%) pacientes apresentaram títulos iniciais de VDRL sérico ≥1/16. Trinta e oito (77,5%) pacientes foram considerados "respondedores" sorológicos; trinta e quatro (79,4%) pacientes foram considerados "respondedores" liquóricos. Nenhum paciente apresentou sintomas neurológicos até à data do último exame de controle da sífilis. Conclusão: No presente estudo, a maioria dos pacientes foram jovens, de gênero masculino, com altos níveis de células T CD4 e VDRL sérico basal ≥1/16. Dentre os pacientes com exame de controle, 86,2% foram considerados "respondedores" sorológicos e/ou liquóricos. Ceftriaxona permite tratamento em regime de Hospital Dia e pode ser considerada como alternativa terapêutica em PVHIV com neurossífilis assintomática.
Assuntos
Humanos , Ceftriaxona , Infecções Sexualmente Transmissíveis , Líquido Cefalorraquidiano , HIV , NeurossífilisRESUMO
Introdução: A sífilis é uma doença infecciosa causada pela bactéria Treponema pallidum, transmitida principalmente pelo contato sexual. O Instituto Adolfo Lutz de São José do Rio Preto (IAL-SJRP) tem um importante papel no controle da sífilis, sendo o laboratório de saúde pública referência para 102 municípios do Departamento Regional de Saúde XV. Objetivo(s): Realizar a confirmação da sífilis em amostras recebidas no IAL-SJRP. Casuística e Métodos: Após triagem nas unidades de saúde, as amostras enviadas para confirmação foram: testes rápidos positivos, VDRL reagentes, crianças 0-18 meses e parceiros de pessoas com sífilis. Foram analisadas 781 amostras de soro de setembro/2016 a agosto/2017 conforme fluxograma do Manual Técnico para Diagnóstico da Sífilis do Ministério da Saúde e adotados testes treponêmicos e não treponêmicos. Resultados: Das 781 amostras enviadas pelas unidades, 299 (38,3%) eram teste rápido positivo, 75 (9,6%) VDRL reagente, 243 (31,1%) eram pacientes controles de tratamento, 23 (2,9%) parceiros, 25 (3,2%) amostras de crianças 0-18 meses e 116 (14,9%) vieram sem justificativa. As amostras recebidas com resultados positivos nos testes rápidos, VDRL e controle de tratamento foram confirmadas em 94,3%, 93,3% e 77% respectivamente. Dentre os parceiros 91,3% foram negativas, amostras de crianças de 0-18 meses 92% foram negativas e, amostras sem justificativas 75 (64,7%) foram positivas, 37 (31,9%) negativas e 4 (3,4%) indeterminadas Conclusão: A confirmação do diagnóstico da sífilis ocorreu em 79,39% das amostras analisadas. O IAL-SJRP como laboratório de referência em saúde pública, tem um importante papel no controle da sífilis.
Assuntos
Sífilis/diagnóstico , Técnicas e Procedimentos Diagnósticos/estatística & dados numéricosRESUMO
Introducción: las infecciones producidas por el Treponema pallidum causante de la sífilis han alcanzado gran trascendencia entre las enfermedades infecciosas transmitidas por transfusión (ITT) y un nuevo repunte a nivel mundial. Debido a las diferentes etapas clínicas que presenta la enfermedad, el desempeño de cada prueba de detcción varía y se limita. Así, la elección de una técnica de tamizaje adecuada se convierte en un punto fundamental para garantizar la calidad y seguridad de cada hemocomponente despachado. Objetivo: analizar y evaluar la eficacia de cuatro técnicas de tamizaje serológico. Métodos: se realizó un estudio comparativo transversal con 1 376 muestras seleccionadas al azar a nivel nacional en el mes de diciembre 2015. Se compararon las técnicas de inmunocromatografía (IC), floculación (VDRL), electroquimioluminiscencia (ECLIA) y microelisa. Se analizó la eficacia individual de cada técnica y comparativa con respecto a la gold standard (FTA-ABS) utilizando para ello el coeficiente de correlación Cohen-Kappa (Ð). Resultados: las cuatro pruebas presentaron un nivel de concordancia del 98,67 por ciento. Del total de resultados discrepantes el 63,16 por ciento fueron generados por VDRL, la cual al mismo tiempo demostró tener el menor rendimiento (k=0,14) y alcanzó los valores más bajos de sensibilidad (s=69 por ciento) y especificidad (e=45 por ciento), lo cual contrastó con la IC que demostró el mayor rendimiento (k=0,863, s=100 por ciento, e=0,8 2 por ciento), seguido de la ECLIA (k=0,801, s=96 por ciento, e=0,82 por ciento) y el microelisa (k=0,711, s=100 por ciento, e=0,64 por ciento). Conclusión: se evidencia la necesidad de utilizar pruebas de nuevas tecnologías en el tamizaje serológico de sífilis y remplazar el uso de VDRL, ya que una correcta selección asegura el descarte de hemocomponentes en el número correcto (evitando grandes pérdidas de sangre y de dinero) y, en especial se asegura la calidad sanitaria de cada hemocomponente(AU)
Introduction: Infections produced by Treponema pallidum, which causes syphilis, have reached an important high level among infectious transmitted by transfusion (ITT). Due to the different clinical stages of the disease, the performance of each test is varied and limited. Thus, the choice of a suitable screening technique becomes a fundamental point in a blood bank, to guarantee the quality and safety of each blood component dispatched. Objective: The aim of this study was to analyze and evaluate the performance of four serological screening techniques. Methods: A cross-sectional study was conducted with 1 376 randomly selected samples nationwide in December 2015. The techniques used were immunochromatography (IC), flocculation (VDRL), electrochemiluminescence (ECLIA) and microelisa, and we compared the performance of each one and with respect to the gold standard (FTA-ABS) by using the Cohen-Kappa correlation coefficient (K). Results: The four tests had a concordance level of 98.67 percent. Of the total discrepant results the 63.16 percent were generated by VDRL, which at the same time showed the worst performance (k=0,14) and reached the lowest values ââof sensitivity (s=69 percent) and specificity (e=45 percent). That contrasted with IC, which showed the best performance (k=0,883, s=100 percent, e=82 percent), followed by ECLIA (k=0,801, s=96 percent, e=0,82 percent) and microelisa (k=0,711, s=100 percent, e=0.64 percent). Conclusion: There is a necessity to use tests with new technologies in the serological screening of syphilis and to replace the use of VDRL in a blood bank, due to a correct selection, ensures the quality and the disposal of blood components in the correct number avoiding great losses of blood and money(AU)
Assuntos
Humanos , Masculino , Feminino , Sorodiagnóstico da Sífilis/métodos , Sífilis/prevenção & controle , Antitreponêmicos/normas , Estudo Comparativo , Estudos Transversais , Cromatografia de Afinidade/métodosRESUMO
Syphilis is an infection caused by Treponema pallidum of sexual, blood and vertical transmission. Despite being easy to diagnose and treat, its incidence has been increasing in Brazil in recent years, and it is being considered a public health problem in the country and worldwide. The aim of this study was to describe the prevalence of positive results for VDRL (Venereal Diseases Research Laboratory) in the city of Juiz de Fora / MG between 2014 and 2016, as well its epidemiological characteristics. 25,735 VDRL results were analyzed from the database of the Central Laboratory (LACEN) of the city hall of Juiz de Fora. The results were then related to the variables year, gender, age, pregnant or not and the region of the city where the test was performed. The prevalence of positive results was 5.55%, with the highest number of cases recorded in 2015. Reactive cases were more prevalent in the central region, in men and a higher prevalence was obtained for the age group of 12 to 18 years. Among women, it was observed higher VDRL positivity in non-pregnant women from August 2015 to December 2016. The data obtained in this study indicates an increase in prevalence of syphilis from 2014 to 2015, followed by a reduction in the following year, among the population served by SUS, where young men represent the population at greater risk.
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Sífilis , Infecções Sexualmente Transmissíveis , Saúde Pública , Prevalência , Técnicas e Procedimentos Diagnósticos , Serviços de SaúdeRESUMO
ABSTRACT Lumbar puncture in neurologically asymptomatic HIV+ patients is still under debate. There are different criteria for detecting neurosyphilis through cerebrospinal fluid (CSF), especially in cases that are negative through the Venereal Disease Research Laboratory (VDRL), regarding cellularity and protein content. However, a diagnosis of neurosyphilis can still exist despite negative VDRL. Treponema pallidum hemagglutination assay (TPHA) titers and application of the TPHA index in albumin and IgG improve the sensitivity, with a high degree of specificity. Thirty-two patients were selected for this study. VDRL was positive in five of them. The number of diagnoses reached 14 when the other techniques were added. It was not determined whether cellularity and increased protein levels were auxiliary tools in the diagnosis. According to our investigation, CSF analysis using the abovementioned techniques may be useful in diagnosing neurosyphilis in these patients.
RESUMO La punción lumbar (PL) en pacientes VIH+ neurológicamente asintomáticos es controversial. Existen diferentes criterios para detectar en el líquido cefalorraquídeo (LCR) neurosífilis (NS): el examen Venereal Disease Research Laboratory (VDRL) en primer lugar, en caso de negatividad: la celularidad y el tenor de proteinas. Sin embargo el diagnóstico de NS puede ser sostenido a pesar de la negatividad de las técnicas mencionadas. La titulación del Treponema pallidum hemagglutination assay (TPHA) y la aplicación del índice de TPHA en Albúmina e Ig G mejoran la sensibilidad asociando elevado grado de especificidad. 32 pacientes fueron seleccionados para este estudio, el VDRL fue positivo en 5. El diagnóstico se elevó a 14 cuando se sumaron el resto de las técnicas. No se evidenció que la celularidad y el aumento de proteínas fueran herramientas auxiliares para el diagnóstico. De acuerdo a nuestro trabajo el estudio del LCR con las técnicas señaladas puede ser de utilidad en el diagnóstico de NS en estos pacientes.
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Humanos , Treponema pallidum/isolamento & purificação , Imunoglobulina G/líquido cefalorraquidiano , Soropositividade para HIV/líquido cefalorraquidiano , Infecções Assintomáticas , Neurossífilis/líquido cefalorraquidiano , Treponema pallidum/imunologia , Estudos Transversais , Sensibilidade e Especificidade , Neurossífilis/diagnósticoRESUMO
There are cases of patients having urticaria that do not respond satisfactorily to antihistamine treatment suggested by guidelines. In order to expand the search for associated factors, research about possible related infections have been performed. This paper describes the case of two patients evaluated in our center for hives resistant to standard treatment in which syphilis was diagnosed, with remission of urticaria when specific antibiotic treatment was established.
Existen pacientes con urticaria que no se controlan satisfactoriamente con el tratamiento antihistamínico sugerido por las guías. Con el objetivo de ampliar la búsqueda de factores asociados, se realizaron investigaciones de infecciones como posibles implicados. Se describe el caso de dos pacientes atendidos en nuestro servicio por urticaria resistente al tratamiento habitual, en los que se diagnosticó sífilis, con remisión de la urticaria al administrar el tratamiento antibiótico específico.
RESUMO
Objetivo: estudar a epidemiologia da sífilis congênita(SC) em mulheres que deram a luz em uma maternidade de refe-rência do Sistema Único de Saúde (SUS) na cidade de Marabá-Pará. Método: estudo retrospectivo, transversal, onde foram estudadas 170 mulheres com sífilis, registradas no Sistema Nacional de Agravos de Notificação (SINAN), no período de 2008 a 2010. Resultados: A prevalência de SC foi de 43,5% (74/170); 82,4% das mães realizaram o pré-na-tal, sendo que 12,2% delas foram diagnosticadas nesse período; 23% eram adolescentes (15 a 19 anos) e 68,9% tinham entre 20 a 34 anos; 8ª série incompleta (41,9%) foi a escolaridade mais prevalente; o VDRL foi reagente em 97,3% das crianças; 4,1% delas receberam tratamento inadequado e 14,9% não foram tratadas; 16,2% dos parceiros das mães dessas crianças não foram tratados. Conclusão: dados como alta prevalência da doença na fase reprodutiva da mulher, baixa escolaridade, crianças não tratadas ou tratadas de modo inadequado e o não tratamento do parceiro demonstram que maiores esforços e investimentos são necessários para o controle da SC.
Objective: to study the epidemiology of congenital syphilis (CS) in women who gave birth in a reference maternity of the Unified Health System (SUS) in the city of Maraba Para. Method: a retrospective, cross-sectional study were stud-ied 170 women with syphilis, registered in the National System for Notifiable Diseases (SINAN), from 2008 to 2010. Results: the prevalence of CS was 43.5% (74/170 ); 82.4% of the mothers had prenatal care, and 12.2% were diagnosed during that period; 23% were adolescents (15-19 years) and 68.9% were between 20-34 years; 8th grade incomplete (41.9%) was the most prevalent schooling; VDRL was positive in 97.3% of children; 4.1% of them received inadequate treatment and 14.9% were not treated; 16.2% of partners of these children?s mothers were not treated. Conclusion: data as high prevalence in the reproductive phase of women, low education, untreated children or improperly treated and the partner?s non-treatment demonstrate that greater efforts and investiments are needed to control the SC.
RESUMO
A prevalência da infecção pelo Treponema pallidum diminuiu sensivelmente com a penicilina, porém se observa tendência mundial no recrudescimento da sífilis, em particular dos casos de sífilis congênita (SC). Objetivos: Descrever as repercussões neonatais da SC nos recém-nascidos (RN) notificados como caso de SC em um hospital público de Niterói, Rio de Janeiro, no período de janeiro de 2005 a junho de 2006; observar o peso ao nascer e a sorologia dos RN com notificação de SC; descrever o tratamento dos casos de SC. Métodos: Amostra constituída de 35 fichas de notificação de SC do Centro de Vigilância Hospitalar do Hospital Universitário Antônio Pedro (HUAP). Utilizaram-se dados da notificação e realizou-se visita domiciliar para coleta de sangue. esultados: A população foi constituída por 29 pacientes nascidos vivos, 4 nascidos mortos e 2 abortamentos. Apenas dois casos (6,9%) evidenciavam alterações ósseas de SC. O teste Veneral Disease Research Laboratory (VDRL) realizado no líquido cefalorraquidiano (LCR) demonstrou-se não reator para todos os pacientes avaliados. O VDRL do soro dos RN no nascimento foi positivo para 23 (79,31%) pacientes. A penicilina G cristalina (PGC) foi administrada em 26 (89,65%) casos, a penicilina G procaína (PGP) em dois (6,9%) e um individuo utilizou PGC e PGP. Conclusão:O óbito fetal e aborto foram o desfecho mais ominoso como repercussão da SC. A alteração dos ossos longos foi pouco encontrada na amostra. O baixo peso ao nascer foi observado em poucos casos. O VDRL do LCR foi não reator em todos os casos. A utilização de diversos esquemas de antibiótico estava em desacordo com o protocolo proposto pelo Ministério da Saúde.
Syphilis is a sexually transmitted disease caused due to bacterium Treponema pallidum.The prevalence of this infection decreased significantly by the use of penicillin, but it is observed that it reappears particularly in cases of congenital syphilis (CS).Objective:to describe the effects of neonatal CS in newborns (NB) in a public hospital in Niterói - RJ, from January 2005 to June 2006 and to observe the birth weight and serology of newborns with CS notification.The purpose of this study is also to describe the CS treatment in each case.Methods:a sample of 35 CS notifications was recorded from the Center for Hospital Surveillance at the Antonio Pedro University Hospital (HUAP), Niterói - RJ, from January 2005 to June 2006. Data from the notifications was used and homevisit was done to collect blood samples.Results:the study population is comprised of 29 live birth patients, four miscarriages and two stillbirths. Only two cases(6.9%) had evidence of CS bone abnormalities. The VDRL test performed in cerebrospinal fluid (CSF) of the cases proved to be non-reactive for all patients.VDRL serum of newborns at birth was positive for 23 (79.31 %) patients. The crystalline penicillin G was administered in 26 (89.65 % cases,) procaine penicillinG in two (6.9%) and for one individual both crystalline penicillin G and procaine penicillin G was used.Conclusion:fetal death and abortion were the mostominous outcome and impact of CS. Long bones alterations were scarcely found in few samples. Low birth weight was observed in a few cases. CSF VDRL was not reactive in all cases. The use of several antibiotic regimens was in disagreement with the proposed protocol issued by the Ministry of Health.
Assuntos
Humanos , Recém-Nascido , Penicilinas , Sífilis Congênita/terapia , Antígenos , Infecções Sexualmente TransmissíveisRESUMO
Introducción: la prueba de VDRL (venereal disease research laboratories) es una técnica no treponémica de microfloculación en lámina para la detección cualitativa y semicuantitativa de reaginas plasmáticas. El VDRL Plus es un juego de reactivos que contiene una suspensión antigénica estabilizada (no alcohólica), basada en una mezcla de cardiolipina, colesterol y lecitina en tampón fosfato. Objetivo: determinar un conjunto de parámetros funcionales que caracterizan el desempeño diagnóstico o clínico del juego de reactivo VDRL Plus producido en Centro de Isótopos (CENTIS). Métodos: los parámetros del desempeño diagnóstico evaluados fueron: sensibilidad y especificidad diagnóstica, valores predictivos positivo y negativo, razón de verosimilitud positiva y negativa. Se determinaron además los índices de Youden y de concordancia Kappa. Se emplearon como métodos de referencia TPHA (Treponema pallidum hemagglutination) y RPR (rapid plasma reagin)-carbón producidos en el CENTIS. Se utilizaron muestras de sueros obtenidas en diferentes instituciones de salud de La Habana y el estudio se realizó con dos lotes del producto. Resultados: para los dos lotes evaluados se obtuvieron valores de sensibilidad de 100 porciento y de especificidad diagnóstica de 81 y 84 porciento. Los valores predictivos positivos resultaron de 71 y 75 porciento, y los negativos de 100 porciento. Por su parte, las razones de verosimilitud negativas fueron de 0 porciento y las positivas de 5,3 y 6,3 porciento, para cada lote estudiado. Los índices de Youden obtenidos (0,84 y 0,81) y la concordancia expresada mediante Kappa muestran que existe una adecuada correlación entre los resultados con el método en evaluación y los de referencia. Conclusiones: las características funcionales evaluadas evidencian que el diagnosticador VDRL Plus es apto para el uso previsto y que estas son consistentes entre los lotes estudiados
Introduction: the VDRL test (venereal disease research laboratories) is a no-treponemal slide microaglutination test for the qualitative and semi-quantitative detection of plasma reagins in human serum. The VDRL Plus contains non alcoholic stabilized antigen suspension based in cardiolipin, lecithin and cholesterol in phosphate buffer. Objective: to determine a group of functional parameters in the diagnostic or clinical performance of the VDRL Plus set of reagents produced by the Center of Isotopes (CENTIS). Methods: several parameters, such as, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were evaluated. Likewised, Youden and Kappa indexes were calculated. Two references methods were employed, that is, TPHA (Treponema pallidum hemagglutination) and RPR-Carbon (rapid plasma reagin)-carbon, both from CENTIS. Serum samples were collected from several health centers in Havana city. Two different product batches were evaluated. Results: the sensitivity value for both evaluated batches was 100 percent and the specificity was 81 and 84 percent. The positives predictive values were 71 and 75 percent and negative predictive value was 100 percent. The positive likelihood ration were 5.3 and 6,3 percent respectively and negative likelihood ration was 0 percent for both batches. The Youden indexes obtained (0.84 and 0.81) and Kappa's indexes showed that there was an adequate correlation between the results obtained and the evaluation and reference methods. Conclusions: the evaluated functional characteristics showed that they are consistent among studied batches and that the VDRL Plus assay is suitable for the intended use
Assuntos
Humanos , Masculino , Feminino , Doenças Bacterianas Sexualmente Transmissíveis/microbiologia , Indicadores e Reagentes/análise , Kit de Reagentes para Diagnóstico/microbiologia , Sensibilidade e Especificidade , Técnicas de Laboratório Clínico/métodosRESUMO
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.
INTRODUÇÃO: Apesar das medidas de controle da sífilis materna e congênita estarem disponíveis no Brasil, existem dificuldades da rede em prover o diagnóstico laboratorial da infecção durante o pré-natal. O objetivo deste estudo foi confirmar a presença do Treponema pallidum pela PCR em mulheres com sorologia positiva ao VDRL e com resultado letal da gravidez, isto é, aborto, natimorto e neomorto. MÉTODOS: Estudo retrospectivo realizado em mulheres VDRL-sororeativas com resultado negativo da gravidez, admitidas na Fundação Santa Casa de Misericórdia do Pará FSCM-PA entre janeiro e julho de 2004. As amostras de soro e DNA de sangue total foram obtidas no mesmo período da triagem pelo VDRL. Estas amostras foram analisadas pelo ELISA IgG, FTA-Abs IgM e PCR simples (polA). RESULTADOS: Durante o período de estudo, 0,7% (36/4.912) das mulheres com resultado letal da gravidez apresentaram VDRL positivo. O genepolA foi amplificado em 72,7% (24/33) destas mulheres,com 55,6% (20/36) e 94,4% (34/36) apresentando anticorpos tipo IgG e IgM contra o T. pallidum, respectivamente. A comparação destes resultados mostrou uma diferença estatística significativa, sendo que os resultados da PCR versus FTA-Abs Ig Mmostraram-se concordantes, sugerindo que a sífilis materna era uma infecção ativa. A causa básica de morte dos conceptos não foi relatada em 97,2% (35/36) dos casos. Entre as mulheres que foram submetidas ao VDRL no pré-natal, somente quatro das nove soropositivas receberam tratamento. CONCLUSÕES: A elevada frequência de sífilis no grupo de estudo indica a fragilidade do serviço no diagnóstico, tratamento e monitoramento da infecção, comprometendo o controle epidemiológico.
Assuntos
Feminino , Humanos , Gravidez , Anticorpos Antibacterianos/sangue , Cardiolipinas/sangue , Colesterol/sangue , Fosfatidilcolinas/sangue , Complicações Infecciosas na Gravidez/diagnóstico , Sífilis/diagnóstico , Treponema pallidum/genética , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Reação em Cadeia da Polimerase , Resultado da Gravidez , Estudos Retrospectivos , Sorodiagnóstico da Sífilis/métodos , Treponema pallidum/imunologiaRESUMO
Background: Congenital syphilis is acquired from an infected mother in utero or through the birth canal. With the diagnosis of the disease and the advent of penicillin, it becomes a significant reduction. Nontreponemal serologic evidence as the VDRL (Venereal Disease Research Laboratory) or RPR (Rapid Plasma Reagin) are easy to determined, economic cost, are useful for diagnosis and essential to monitor response to treatment, which needs to the study is quantitative. The aim of this study was to investigate the incidence of syphilis infection in the pregnant population in 6 cities of Alto Paraná, in 2008. Materials and methods: Study retrospective, descriptive cross-sectional. We reviewed the files of maternal and child services private and public, of 7,380 pregnant women who attended the pre-natal control 2,028 serology for syphilis. Results: Of a total of 7,380 chips analyzed, 5,310 were public institutions, where 17% of pregnant women, presented in the medical record VDRL test. In private institutions, of 2,070 pregnant, 54% of them had registered VDRL test. In Ciudad del Este, (capital of Alto Paraná) pregnant women in public institutions were 2,445, of which, only 36% made 4 or more controls during pregnancy, 0.80% tested positive for VDRL test, 7.20% was negative and 92% did not record data, this scenario is repeated in all major cities of the department and the percentage is even lower in public institutions. Conclusion: The situation of pregnant women in Alto Paraná is alarming because it represents a significant and unnecessary risk to the newborn, because they account for many years with appropriate pharmacological and economic weapons to avoid.
La sífilis congénita se adquiere a partir de una madre infectada in útero o por el canal del parto. Con el diagnóstico de la enfermedad y el advenimiento de la penicilina, se torna una reducción significativa. Existen pruebas serológicas no treponémicas como el VDRL (Venereal Disease Research Laboratory) o RPR (Rapid Plasma Reagin) fáciles de realizar, tienen escaso costo económico, son útiles para el diagnóstico y esenciales para controlar la respuesta al tratamiento, para lo cual se necesita que el estudio sea cuantitativo. El objetivo del trabajo consistió en investigar la incidencia de la infección por sífilis, en la población embarazada, en 6 ciudades del Alto Paraná, durante el año 2008. Materiales y métodos: Se realizó un estudio retrospectivo, descriptivo, de corte transversal. Se revisaron los archivos de Servicios materno-infantil privado y público, de 7.380 embarazadas que concurrieron al control pre-natal, donde se registraba la serología para sífilis. Resultados: De un total de 7.380 fichas analizadas, 5.310 fueron de Instituciones Públicas, en donde el 17% de las embarazadas, presentaban en la historia clínica registro de test de VDRL. En Instituciones privadas, de 2.028 embarazadas, el 54% de ellas tenían registrado test de VDRL. En Ciudad del Este, (capital del Alto Paraná) las embarazadas de Instituciones Públicas, fueron 2.445, de las cuales: solo el 36% realizaron 4 o más controles durante la gestación, el 0,80% dio positivo el test para VDRL, el 7,20% dio negativo, y 92 % no registra datos, este panorama se repite en las grandes ciudades del departamento y el porcentaje es menor en Instituciones públicas. Conclusión:La situación de las embarazadas en el Alto Paraná es alarmante ya que supone un riesgo importante e innecesario para el recién nacido, debido a que se cuenta, hace muchos años con las armas farmacológicas adecuadas y económicas para evitarlas.
RESUMO
Neurosyphilis follows a more aggressive and different clinical course in HIV-infected patients compared to patients with normal immunity. Two historical series of patients with a diagnosis of neurosyphilis between 1995 and 2008 were compared: they included a group of 15 patients with y and 28 patients without HIV infection. Probability of neurosyphilis in patients with positive serum VDRL was increased in patients infected with HIV comparedto HIV negative patients (OR: 62.37 IC:95 percent (32.1-119.1) p value:< 0,001). Predominant clinical manifestations in neurosyphilis in the HIV negative group were ocular abnormality, vascular encephalic and spinal cord lesions. In the HIV positive group, they were fever, ocular abnormalities and headache. There were no differences in cerebrospinal fluid characteristics between both groups. Neurosyphilis was diagnosed even in patients with blood VDRL of < 1:32, that happened in 17.8 percent of the HIV positive patients with blood and in 60 percent of t he HIV negative patients. Penicillin sodium given at dose ¡Ý than 18.000.000 IU/day IV during 14 days was the most common treatment. In patients with clinical neurosyphilis, 93 percent of HIV negative group, and 54.2 percent of HIV positive group had persistent neurological after-effects. Three HIV positive patients died due to causes not related to neurosyphilis.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Soronegatividade para HIV , Neurossífilis/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antibacterianos , Estudos de Coortes , Neurossífilis/complicações , Neurossífilis/tratamento farmacológico , Penicilina G Benzatina/uso terapêutico , Estudos Retrospectivos , Sorodiagnóstico da Sífilis , Adulto JovemRESUMO
A sifilis congenita, por ser considerada importante causa de morbimortalidade perinatal e resultar em sequelas ao neonato, tornou-se uma doenca de notificacao compulsoria no Brasil e meta de erradicacao. Portanto, visando diagnosticar casos de sifilis entre gestantes da rede publica de Anapolis-Goias e avaliar o perfil socioeconomico das mesmas, aplicou-se um questionario e coletou-se sangue para realizacao do VDRL nas gestantes da Unidade de Saude do Progresso. A amostragem foi composta por 59 gestantes com idade media de 23 anos, casadas, com residencia propria e consideravel nivel de instrucao. Foram identificadas 44,1% de gestantes no primeiro trimestre gestacional, sendo que 49,2% nao relatavam teste anterior para a infeccao e 35,6% desconheciam sua sorologiapara HIV/AIDS. A frequencia da utilizacao de preservativos e o conhecimento geral sobre a sifilis mostraram-se insatisfatorios. Apenas uma gestante foi soro-reagente puro no VDRL. Os dados da Secretaria Municipal de Saude e do SINAN sobre a sifilis congenita apresentaram divergencias (p<0,05). Portanto, torna-se evidente a necessidade de fortalecer a vigilancia epidemiologica do municipio,atraves da implementacao de medidas capazes de prevenir a sifilis congenita e erradica-la.
The congenital syphilis, for being considered an important cause of newborn morbidity and mortality, became an illness of obligatory notification in Brazil and purpose of eradication of the Health department. Therefore, aiming at to diagnosis cases of gestational syphilis in women attended in a public unit at Anápolis city-Goiás and to evaluate the socioeconomic profile of them, it was applied a socioeconomic questionnaire to the pregnants and collected a blood sample to make the non-treponemic test (VDRL - Venereal Diseases Research Laboratory) for diagnosis of syphilis. The group of study was composed by 59 pregnant women with averageage 23 years, married, with own residence, and a good educational level. 44.1% of pregnants were in the first trimester of gestational age, 49.2% of those ones had never carried through previous test for the infection and 35.6% were unaware of their HIV serology. Among them the frequency of use of condoms was very low, as well as the common knowledge of syphilis. A pregnant was identified as pure serum-reagent in test VDRL. The data gotten in the City department of Health on of notification of congenital syphilishad shown different when compared with the data of the referring SINAN. Therefore, becomes evident the necessity to improve the epidemiological vigilance through the implementation of capable measures to prevent congenital syphilis and to promote its eradication.