Congenital Syphilis and Fluorescent Treponemal Antibody Test Reactivity After the Age of 1 Year

Rawstron, Sarah A.; Mehta, Swati; Marcellino, Linda; Rempel, James; Chéry, Florence; Bromberg, Kenneth

doi:10.1097/00007435-200107000-00009

Cited by 25 publications

(13 citation statements)

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“…A titer in the infant's serum that is higher than the mother's titer by 4-fold or greater at delivery is strongly suggestive of congenital infection (107). However, the absence of an infant's titer that is higher than the mother's titer by 4-fold or greater does not exclude the possibility of congenital infection as studies of serum pairs from infected mothers and infants show that fewer than 30% of infants have higher titers than their mothers (110). IgM antibodies can be detected in more than 80% of symptomatic infants, but data on the sensitivity of antibody assays in asymptomatic infants are limited (111,112).…”

Section: Prenatal Syphilis Screening and Congenital Syphilismentioning

confidence: 99%

“…Passively transferred antibodies can persist in an infant up to age 15 months, and, as such, a reactive TT after age 18 months is diagnostic of congenital syphilis; such infants require full evaluation and treatment for congenital syphilis if treatment was not provided or if treatment can be deemed to have been inadequate by a review of the treatment history (116). A study using the FTA-ABS test showed that only about half of the group of infants with clinical or laboratory evidence of congenital syphilis at birth had reactive FTA-ABS results at 12 months of age (110). A recent Canadian case series of infants with congenital syphilis reported that 69% of infants showed seroreversion in their treponemal tests by 18 months and that infants who did not show seroreversion in their TT were statistically more likely to have had delayed treatment and to have had higher maternal RPR titers at birth (117).…”

Section: Prenatal Syphilis Screening and Congenital Syphilismentioning

confidence: 99%

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Recent Trends in the Serologic Diagnosis of Syphilis

Morshed

Singh

2014

Clin. Vaccine Immunol.

158

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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Section: Prenatal Syphilis Screening and Congenital Syphilismentioning

confidence: 99%

Section: Prenatal Syphilis Screening and Congenital Syphilismentioning

confidence: 99%

Recent Trends in the Serologic Diagnosis of Syphilis

Morshed

Singh

2014

Clin. Vaccine Immunol.

158

156

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“…Treponemal tests include the serum fluorescent treponemal antibody absorption (FTA-ABS) test, the T. pallidum hemagglutination (TPHA) test, the enzyme immunoassay (EIA), and the Western blot (WB) assay (12, 13). In addition, chemiluminescent immunoassays (CLIA), such as the chemiluminescent microparticle assay (CMIA), and an even newer multiplex flow immunoassay (MFI), performed with recombinant antigens, are widely used in developed countries, where many laboratories have adopted the "reverse algorithm" for syphilis diagnosis (14,15).A Ն4-fold titer in the nontreponemal tests in the infant at delivery as opposed to that in the mother's serum is strongly suggestive of congenital infection, but the absence of a Ն4-fold titer does not exclude congenital infection (8)(9)(10)(11).Immunoglobulins M are considered key markers of fetal infection since they cannot cross the placental barrier. IgM antibodies can be found at birth in Ͼ80% of symptomatic infected infants, while data on the sensitivity in asymptomatic babies are limited (8).…”

mentioning

confidence: 99%

“…Due to the frequent absence of specific signs of infection at birth, serology has a pivotal role in CS diagnosis: all infants born to mothers with reactive syphilis test results should be tested in parallel with their own mothers (8)(9)(10)(11). Serological tests for syphilis are divided into nontreponemal and treponemal.…”

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confidence: 99%

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Contribution of a Comparative Western Blot Method to Early Postnatal Diagnosis of Congenital Syphilis

Marangoni

Foschi

Capretti

et al. 2016

Clin Vaccine Immunol

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c Serology has a pivotal role in the diagnosis of congenital syphilis (CS), but problems arise because of the passive transfer of IgG antibodies across the placenta. The aim of this study was to assess the diagnostic value of a comparative Western blot (WB) method finalized to match the IgG immunological profiles of mothers and their own babies at birth in order to differentiate between passively transmitted maternal antibodies and antibodies synthesized by the infants against Treponema pallidum. Thirty infants born to mothers with unknown or inadequate treatment for syphilis were entered in a retrospective study, conducted at St. Orsola-Malpighi Hospital, Bologna, Italy. All of the infants underwent clinical, instrumental, and laboratory examinations, including IgM WB testing. For the retrospective study, an IgG WB assay was performed by blotting T. pallidum antigens onto nitrocellulose sheets and incubating the strips with serum specimens from mother-child pairs. CS was diagnosed in 11 out of the 30 enrolled infants; 9/11 cases received the definitive diagnosis within the first week of life, whereas the remaining two were diagnosed later because of increasing serological test titers. The use of the comparative IgG WB testing performed with serum samples from mother-child pairs allowed a correct CS diagnosis in 10/11 cases. The CS diagnosis was improved by a strategy combining comparative IgG WB results with IgM WB results, leading to a sensitivity of 100%. The comparative IgG WB test is thus a welcome addition to the conventional laboratory methods used for CS diagnosis, allowing identification and adequate treatment of infected infants and avoiding unnecessary therapy of uninfected newborns.T reponema pallidum infection in pregnant women can lead to stillbirth, early fetal death, low birth weight, preterm delivery, neonatal death, or congenital syphilis (CS) in their babies. The effectiveness of serological testing and treatment in preventing mother-to-child transmission of syphilis is well recognized (1). In 2007, the WHO launched its Initiative for the Global Elimination of Congenital Syphilis, with the goal that by 2015 at least 90% of pregnant women are being tested for syphilis and at least 90% of seropositive pregnant women are receiving adequate treatment (http://www.who.int/reproductivehealth/publications/rtis/97892 41595858/en/index.html). Despite that huge effort, CS persists as a public health problem (2, 3), and in recent years, CS cases have also been reported in high-income countries (4-6).The diagnosis of CS is complex and is based on a combination of maternal history and clinical and laboratory criteria in both mother and infant (4, 6). Infected infants may be asymptomatic or may have subtle and insidious findings or multiple-organ involvement. Even asymptomatic newborns may have early or late postnatal manifestations (7).Due to the frequent absence of specific signs of infection at birth, serology has a pivotal role in CS diagnosis: all infants born to mothers with reactive syphilis test resu...

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