Seronegative secondary syphilis in a patient with AIDS: Identification of Treponema pallidum in biopsy specimen

Tikjøb, G; Russel, Michael; Petersen, C S; Gerstoft, Jan; Kobayasi, T

doi:10.1016/s0190-9622(08)80082-5

Cited by 50 publications

(14 citation statements)

References 10 publications

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“…25 Women with untreated syphilis, particularly if co-infected with HIV, are at risk of having syphilis complications (i.e. neurosyphilis and other tertiary manifestations) 34,39,40 and may pass on the infection to their child or to their sexual partners. In settings of high HIV seroprevalence and poor availability of syphilis diagnosis and treatment, patients who are TPHA-positive/RPR-negative would probably benefit from treatment.…”

Section: Discussionmentioning

confidence: 99%

Syphilis screening in Mozambique

Montoya

Lukehart

Brentlinger

et al. 2006

Bull World Health Organ

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Objective Programmes to control syphilis in developing countries are hampered by a lack of laboratory services, delayed diagnosis, and doubts about current screening methods. We aimed to compare the diagnostic accuracy of an immunochromatographic strip (ICS) test and the rapid plasma reagin (RPR) test with the combined gold standard (RPR, Treponema pallidum haemagglutination assay and direct immunofluorescence stain done at a reference laboratory) for the detection of syphilis in pregnancy. Methods We included test results from 4789 women attending their first antenatal visit at one of six health facilities in Sofala Province, central Mozambique. We compared diagnostic accuracy (sensitivity, specificity, and positive and negative predictive values) of ICS and RPR done at the health facilities and ICS performed at the reference laboratory. We also made subgroup comparisons by human immunodeficiency virus (HIV) and malaria status. Findings For active syphilis, the sensitivity of the ICS was 95.3% at the reference laboratory, and 84.1% at the health facility. The sensitivity of the RPR at the health facility was 70.7%. Specificity and positive and negative predictive values showed a similar pattern. The ICS outperformed RPR in all comparisons (P<0.001). Conclusion The diagnostic accuracy of the ICS compared favourably with that of the gold standard. The use of the ICS in Mozambique and similar settings may improve the diagnosis of syphilis in health facilities, both with and without laboratories.Keywords Syphilis serodiagnosis; Prenatal diagnosis; Mozambique (source: MeSH, NLM). Mots clés Séro-diagnostic syphilis; Diagnostic prénatal; Mozambique (source: MeSH, INSERM). Palabras clave Serodiagnóstico de la sífilis; Diagnóstico prenatal; Mozambique (fuente: DeCS, BIREME). Voir page 103 le résumé en français. En la página 103 figura un resumen en español.

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Section: Discussionmentioning

confidence: 99%

Syphilis screening in Mozambique

Montoya

Lukehart

Brentlinger

et al. 2006

Bull World Health Organ

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“…We observed that among patients with positive CSF VDRL, those with early NS had significantly higher titers; thus, if we take this as the only criterion, a number of cases of NS could be missed, mostly later forms. This would be especially important in HIV-infected patients, in whom false-negative serologic tests have been reported [21, 22, 23]and may have other confounding factors as the AIDS dementia complex or coinfection with other opportunistic pathogens.…”

Section: Discussionmentioning

confidence: 99%

Current Clinical Spectrum of Neurosyphilis in Immunocompetent Patients

et al. 2004

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Background: Neurosyphilis (NS) is nowadays a less frequent disease. Its incidence and clinical spectrum have changed over time. Objective: To estimate the incidence of NS and describe the clinical spectrum of NS in immunocompetent patients in the last decade. Methods: Demographic and clinical features, cerebrospinal fluid (CSF) changes, neuroimaging findings and outcome were retrospectively analyzed. Results: Forty-three patients met NS criteria. The yearly incidence was 0.2– 2.1 cases per 100,000 inhabitants. The mean age was 48.1 years, males being more frequently involved. The most frequent clinical patterns were meningovascular (30.2%), meningeal (25.6%) and general paresis (25.6%). Compared to prepenicillin series, we observed a decrease in late forms, mainly tabes dorsalis. CSF titers studied by the Venereal Disease Research Laboratory were higher in early NS. Neuroimaging findings were nonspecific. Outcome was better for early forms. Conclusions: Compared to the preantibiotic era, a lower frequency of late NS was observed, similar to that reported in other modern series which include patients with HIV infection. Therefore, this trend seems to be due to the impact of antibiotics rather than to HIV infection.

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“…Rare cases have been reported of biopsy-proven secondary syphilis in HIV-infected patients with negative serology. Tikjob, 1991 Higher mean serologic serum nontreponemal antibody levels than non-HIVinfected Rolfs, 1997 Serum non-treponemal antibody levels may decline more slowly after treatment in HIVinfected patients than non-infected patients Rolfs, 1997, Yinnon 1996 Pro-zone reaction more commonly in HIVinfected persons Schöfer, 1996 Table 7. Considerations for serology in HIV-infected patients.…”

Section: Case Reportmentioning

confidence: 99%