Gastric syphilis: Polymerase chain reaction detection of treponemal DNA in pseudolymphomatous lesions

Inagaki, Hiroshi; Kawai, Takashi; Miyata, Mitsuki; Nagaya, Sachiko; Tateyama, Hisashi; Eimoto, Tadaaki

doi:10.1016/s0046-8177(96)90446-3

Cited by 32 publications

(15 citation statements)

References 13 publications

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

et al. 2012

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“…These monoclonal antibodies did not react with nonpathogenic treponemes and other spirochetes. Inagaki et al (4) initially applied the use of conventional PCR as a confirmatory tool to detect T. pallidum DNA in formalin-fixed, paraffin-embedded gastric biopsy materials from two cases of gastric syphilis. A region of tmpA was used as the PCR target, as it was considered specific for members of the genus Treponema.…”

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Diagnosis of Gastric Syphilis by Direct Immunofluorescence Staining and Real-Time PCR Testing

et al. 2006

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We report on a case of gastric syphilis in a patient with chronic dyspepsia. The diagnosis was established by serology and the demonstration of spirochetes in diffusely inflammed gastric mucosa by staining with a fluorescent monoclonal antibody specific for pathogenic treponemes and by the detection of specific treponemal DNA sequences by a real-time PCR. CASE REPORTA 35-year-old man with dyspepsia of long duration was subjected to gastric endoscopy on two occasions in January and February 2005 at a private clinic in Portugal. He was found to have multiple, nonhealing, gastric ulcers that failed to respond to proton pump inhibitor therapy. A workup for Helicobacter pylori infection was negative, and no antibiotic therapy was prescribed. Subsequently, a diffuse gastric mucosal thickening was observed, raising suspicion for a neoplastic process. Eventually, a distal gastrectomy was performed on the patient at the University Hospital of Coimbra in Coimbra, Portugal. The antral mucosa appeared to be erythematous and edematous, with irregular nodular masses. The gastric body mucosa, however, had a normal appearance. Numerous lymph nodes were isolated from both curvatures of the stomach, as well as from the hepatic and celiac chains, for histopathologic examination. The resected gall bladder was unremarkable, and no stones were found.No evidence of neoplasia but, rather, a diffuse destructive inflammatory gastritis was found. Notably, no parasites, viral inclusions, or H. pylori was found on initial microscopic evaluation. Paraffin-embedded material and tissue sections were sent to the Gastrointestinal Pathology Service of the Massachusetts General Hospital for evaluation. The examination confirmed the presence of a dense diffuse mucosal lymphoplasmacytic infiltrate with only scattered residual glandular elements and intraluminal abscesses (Fig. 1). An ill-defined granulomatous process was also noted. Although the inflammation was primarily mucosal, some inflammation spilled over into the superficial submucosa, where a perivascular distribution of the lymphohistiocytic and plasma cellrich infiltrate raised the possibility of gastric syphilis. On the basis of this information, the patient was subsequently investigated and was found to be human immunodeficiency virus (HIV) negative; but serologic testing revealed a reactive polyclonal hypergammaglobulinemia, a positive Venereal Disease Research Laboratory blood test titer of 1:16, and a Treponema pallidum hemagglutination assay value of 1:1,028. Despite a noncontributory Warthin-Starry staining result, gastric syphilis was strongly considered; and the paraffin-embedded thin sections of resected tissue were forwarded to the Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention (CDC) in Atlanta, Ga., for direct fluorescent-antibody staining for pathogenic treponeme detection and PCR for treponemal DNA detection. At the CDC, formalin-fixed thin sections (thickness, 10 m) were deparaffinized by standard procedures a...

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“…2B). In some cases, the lymphocytic component of the inflammatory infiltrate can be so intense that it resembles a pseudolymphoma; thus, gastric syphilis should be considered in the differential diagnosis when atypical lymphoid infiltrate fails to show monoclonality [37].…”

Section: Other Infectious Gastritidesmentioning

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The spectrum of gastric disease associated with Helicobacter pylori and other infectious gastritides

Guarner

2004

Curr Gastroenterol Rep

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Helicobacter pylori is the most frequent infection of the stomach worldwide. Some of the people infected with H. pylori develop symptoms of dyspepsia that correlate with pathologic evidence of gastritis and peptic ulcers. In addition, H. pylori has been associated with preneoplastic lesions and with two neoplasias: intestinal-type gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma. Rarely, gastric pathology can also be caused by other infectious agents, including fungi, other bacteria, parasites, and viruses. This review describes H. pylori-associated pathology and pathologies related to other infectious agents.

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Gastric syphilis: Polymerase chain reaction detection of treponemal DNA in pseudolymphomatous lesions

Cited by 32 publications

References 13 publications

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

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

Diagnosis of Gastric Syphilis by Direct Immunofluorescence Staining and Real-Time PCR Testing

The spectrum of gastric disease associated with Helicobacter pylori and other infectious gastritides

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