Cerebral Syphilitic Gumma Confirmed by the Polymerase Chain Reaction in a Man with Human Immunodeficiency Virus Infection

Horowitz, Harold W.; Valsamis, Marius P.; Wicher, Victoria; Abbruscato, Frank; Larsen, Sandra A.; Wormser, Gary P.; Wicher, Konrad

doi:10.1056/nejm199412013312204

Cited by 65 publications

(27 citation statements)

References 18 publications

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“…These genes include tpf-1 (14), the BMP gene (10,14,22), the tmpA and tmpB genes (7,8), and the 47-kDa protein gene (2,6,11,15,18,20); most recently RT-PCR has been performed by using the 16S rRNA (3). Most functions of the target genes are unknown or poorly characterized (e.g., those of tpf-1, the BMP gene, tmp, and the 47-kDa protein gene).…”

Section: Discussionmentioning

confidence: 99%

New Tests for Syphilis: Rational Design of a PCR Method for Detection of Treponema pallidum in Clinical Specimens Using Unique Regions of the DNA Polymerase I Gene

et al. 2001

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A sensitive and specific PCR method to detect Treponema pallidum in clinical specimens was developed. PCR primers were designed based on two unique features of the DNA polymerase I gene (polA). The first distinctive characteristic is that the region codes for a high cysteine content and has low homology with similar regions of DNA polymerase I gene from known microorganisms. The second unique feature is the presence of four insertions in the gene. PCR tests using primers designed on the basis these regions reacted with various pathogenic T. pallidum subspecies but did not react with nonpathogenic treponemal species or other spirochetes. An additional 59 species of bacteria and viruses, including those that cause genital ulcers, tested negative. This PCR method is extremely robust and sensitive. The detection limit is about 10 to 25 organisms when analyzed on gel. However, the analytic sensitivity can be increased by at least 1 log, to a detection limit of a single organism, when the ABI 310 Prism Genetic Analyzer is used to detect fluorescence-labeled amplicons. We further used this test in a clinical setting and compared the results with results from a previously reported multiplex-PCR test (for T. pallidum, Haemophilus ducreyi, and herpes simplex virus). We tested 112 genital ulcer specimens by the polA PCR, obtaining a sensitivity of 95.8% and a specificity of 95.7%. These results suggest that the polA PCR is applicable as a routine clinical diagnostic test for syphilis.

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Section: Discussionmentioning

confidence: 99%

New Tests for Syphilis: Rational Design of a PCR Method for Detection of Treponema pallidum in Clinical Specimens Using Unique Regions of the DNA Polymerase I Gene

et al. 2001

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“…T. pallidum DNA also can be detected in skeletal bones and various body fluids, including serum (2), cerebrospinal fluid, and urine (5,14,16,18,37). T. pallidum DNA also has been detected in specimens from placenta (15), gastric lesions (22), and neurons (21).…”

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confidence: 99%

Evaluation of a PCR Test for Detection of Treponema pallidum in Swabs and Blood

et al. 2012

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Syphilis diagnosis is based on clinical observation, serological analysis, and dark-field microscopy (DFM) detection of Treponema pallidum subsp. pallidum, the etiological agent of syphilis, in skin ulcers. We performed a nested PCR (nPCR) assay specifically amplifying the tpp47 gene of T. pallidum from swab and blood specimens. We studied a cohort of 294 patients with suspected syphilis and 35 healthy volunteers. Eighty-seven of the 294 patients had primary syphilis, 103 had secondary syphilis, 40 had latent syphilis, and 64 were found not to have syphilis. The T. pallidum nPCR results for swab specimens were highly concordant with syphilis diagnosis, with a sensitivity of 82% and a specificity of 95%. Reasonable agreement was observed between the results obtained with the nPCR and DFM methods (kappa ‫؍‬ 0.53). No agreement was found between the nPCR detection of T. pallidum in blood and the diagnosis of syphilis, with sensitivities of 29, 18, 14.7, and 24% and specificities of 96, 92, 93, and 97% for peripheral blood mononuclear cell (PBMC), plasma, serum, and whole-blood fractions, respectively. HIV status did not affect the frequency of T. pallidum detection in any of the specimens tested. Swab specimens from mucosal or skin lesions seemed to be more useful than blood for the efficient detection of the T. pallidum genome and, thus, for the diagnosis of syphilis.

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“…Polymerase chain reaction assays have been useful in detecting T. pallidum in lesions of late secondary syphilis and tertiary syphilis, including syphilitic gummas [57,58], and in gastric lesions [59]. They have also been used to detect T. pallidum in cerebrospinal fluid [60,61] and to diagnose congenital syphilis [61].…”

Section: Syphilismentioning

confidence: 98%

The use of molecular techniques for the diagnosis and epidemiologic study of sexually transmitted infections

Black

Morse

2000

Curr Infect Dis Rep

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Molecular diagnostic tests are more sensitive and, in many cases, more specific than conventional laboratory methods for the detection of sexually transmitted infections. Here, we review recently developed molecular methods for the diagnosis and subtyping of the most common sexually transmitted infections: infections caused by Chlamydia trachomatis, Neisseria gonorrhoeae, human papillomavirus, Trichomonas vaginalis, and the agents of genital ulcer disease (Haemophilus ducreyi, herpes simplex virus, Treponema pallidum, and Calymmatobacterium granulomatis). We also provide an overview of the laboratory diagnostic tests and clinical specimens to use when infection with these agents is suspected.

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Cerebral Syphilitic Gumma Confirmed by the Polymerase Chain Reaction in a Man with Human Immunodeficiency Virus Infection

Cited by 65 publications

References 18 publications

New Tests for Syphilis: Rational Design of a PCR Method for Detection of Treponema pallidum in Clinical Specimens Using Unique Regions of the DNA Polymerase I Gene

New Tests for Syphilis: Rational Design of a PCR Method for Detection of Treponema pallidum in Clinical Specimens Using Unique Regions of the DNA Polymerase I Gene

Evaluation of a PCR Test for Detection of Treponema pallidum in Swabs and Blood

The use of molecular techniques for the diagnosis and epidemiologic study of sexually transmitted infections

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