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Ke W, Ao C, Wei R, Zhu X, Shui J, Zhao J, Zhang X, Wang L, Huang L, Leng X, Zhu R, Wu J, Huang L, Huang N, Wang H, Weng W, Yang L, Tang S. Evaluating the clinical utility of semi-quantitative luciferase immunosorbent assay using Treponema pallidum antigens in syphilis diagnosis and treatment monitoring. Emerg Microbes Infect 2024; 13:2348525. [PMID: 38661428 PMCID: PMC11100446 DOI: 10.1080/22221751.2024.2348525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/23/2024] [Indexed: 04/26/2024]
Abstract
To assess the clinical applicability of a semi-quantitative luciferase immunosorbent assay (LISA) for detecting antibodies against Treponema pallidum antigens TP0171 (TP15), TP0435 (TP17), and TP0574 (TP47) in diagnosing and monitoring syphilis. LISA for detection of anti-TP15, TP17, and TP47 antibodies were developed and evaluated for syphilis diagnosis using 261 serum samples (161 syphilis, 100 non-syphilis). Ninety serial serum samples from 6 syphilis rabbit models (3 treated, 3 untreated) and 110 paired serum samples from 55 syphilis patients were used to assess treatment effects by utilizing TRUST as a reference. Compared to TPPA, LISA-TP15, LISA-TP17, and LISA-TP47 showed a sensitivity of 91.9%, 96.9%, and 98.8%, specificity of 99%, 99%, and 98%, and AUC of 0.971, 0.992, and 0.995, respectively, in diagnosing syphilis. Strong correlations (rs = 0.89-0.93) with TPPA were observed. In serial serum samples from rabbit models, significant differences in the relative light unit (RLU) were observed between the treatment and control group for LISA-TP17 (days 31-51) and LISA-TP47 (day 41). In paired serum samples from syphilis patients, TRUST titres and the RLU of LISA-TP15, LISA-TP17, and LISA-TP47 decreased post-treatment (P < .001). When TRUST titres decreased by 0, 2, 4, or ≥8-folds, the RLU decreased by 17.53%, 31.34%, 48.62%, and 72.79% for LISA-TP15; 8.84%, 17.00%, 28.37%, and 50.57% for LISA-TP17; 22.25%, 29.79%, 51.75%, and 70.28% for LISA-TP47, respectively. Semi-quantitative LISA performs well for syphilis diagnosis while LISA-TP17 is more effective for monitoring syphilis treatment in rabbit models and clinical patients.
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Affiliation(s)
- Wujian Ke
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Cailing Ao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
- Guangzhou Baiyun District Center for Disease Control and Prevention, Guangzhou, Guangdong Province, People’s Republic of China
| | - Ran Wei
- Department of Dermatology, Tianjin Children Hospital, Tianjin, People’s Republic of China
| | - Xiaozhen Zhu
- Center of Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, People’s Republic of China
- Institute of Infectious Disease, Medical College of Xiamen University, Xiamen, Fujian Province, People’s Republic of China
| | - Jingwei Shui
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jianhui Zhao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xiaohui Zhang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Liuyuan Wang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Liping Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xinying Leng
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Rui Zhu
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jiaxin Wu
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Lixia Huang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Nanxuan Huang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Haiying Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Wenjia Weng
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ligang Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
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Xu D, Jiang Y, Lun W, Cao Y, Xu X, Wang B, Li R, Chen C, Huang Y, Zeng H. Characteristic Profiling of Soluble Factors in the Cerebrospinal Fluid of Patients With Neurosyphilis. J Infect Dis 2024; 230:221-230. [PMID: 39052737 DOI: 10.1093/infdis/jiae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/17/2023] [Accepted: 01/15/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Soluble inflammatory factors in the cerebrospinal fluid (CSF) of patients with neurosyphilis have been investigated with low-throughput technology. This study aimed to illustrate the characteristics of soluble factor profiles in CSF of patients with neurosyphilis. METHODS We measured the concentrations of 45 cytokines, chemokines, and growth factors in CSF from 112 untreated syphilis cases, including latent syphilis (LS), asymptomatic neurosyphilis (ANS), meningeal neurosyphilis (MNS), meningovascular neurosyphilis (MVNS), paralytic dementia (PD), and ocular syphilis (OS). RESULTS Thirty-three differentially expressed soluble factors (DeSFs) were categorized into 3 clusters. DeSF scores of clusters 1 and 2 (DeSFS1 and DeSFS2) were positively correlated with elevated neopterin and neurofilament light subunit (NF-L) concentration, respectively. DeSF scores of cluster 3 were positively correlated with white blood cells, protein, NF-L, and neopterin. Patients with LS, ANS, and OS exhibited an overall lower abundance of DeSFs. Patients with PD exhibited significantly increased levels of clusters 1 and 3, and the highest total DeSF score, whereas patients with MNS and MVNS showed enhanced levels of cluster 2. Receiver operating characteristic analysis revealed that DeSFS1 effectively discriminated PD, and DeSFS2 discriminated MNS/MVNS with high accuracy. CONCLUSIONS Patients with neurosyphilis at different stages have distinctive patterns of soluble factors in CSF, which are correlated with immune status and neuronal damage.
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Affiliation(s)
- Dongmei Xu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yu Jiang
- Biomedical Innovation Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
- Beijing Key Laboratory for Therapeutic Cancer Vaccines, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Wenhui Lun
- Department of Dermatology and Venereology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yu Cao
- Biomedical Innovation Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
- Beijing Key Laboratory for Therapeutic Cancer Vaccines, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Xiaoxue Xu
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Beibei Wang
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Rui Li
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Chen Chen
- Biomedical Innovation Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
- Beijing Key Laboratory for Therapeutic Cancer Vaccines, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yuming Huang
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Hui Zeng
- Biomedical Innovation Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
- Beijing Key Laboratory for Therapeutic Cancer Vaccines, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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Maldonado-Barrueco A, Sanz-González C, Falces-Romero I, Gutiérrez-Arroyo A, Montero-Vega D, Quiles-Melero I. Increase in congenital syphilis in a tertiary-care centre from Madrid, Spain: Back to the classics. Int J STD AIDS 2024:9564624241264581. [PMID: 39038264 DOI: 10.1177/09564624241264581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Globally, an increase in sexually transmitted diseases worldwide has been reported, including acquired Treponema pallidum infection. Congenital syphilis is the mother-to-child transmission syphilis infection, experiencing an increase in cases returning to incidence rates of years ago. We report three cases of symptomatic congenital syphilis occurring in a tertiary-care hospital in Madrid (Spain). Cases were diagnosed by serology and molecular biology methods. The use of molecular techniques in specimens such as skin lesion, subplacental exudate swabs, bronchoalveolar aspirate, or cerebrospinal fluid could favour the diagnosis of this clinical entity, especially in symptomatic newborns with systemic involvement.
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Affiliation(s)
| | - Claudia Sanz-González
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Iker Falces-Romero
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Dolores Montero-Vega
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, Madrid, Spain
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Allan-Blitz LT, Villarreal D, Klausner JD. IgM tests for detecting Treponema pallidum infection in newborns: time to establish a reference comparator. J Clin Microbiol 2024:e0055124. [PMID: 38990039 DOI: 10.1128/jcm.00551-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Diana Villarreal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Kaminiów K, Kotlarz A, Kiołbasa M, Pastuszczak M. Lack of Serological Response by Delivery to Syphilis Treatment Does Not Impact Pregnancy Outcomes. J Clin Med 2024; 13:4031. [PMID: 39064071 PMCID: PMC11277448 DOI: 10.3390/jcm13144031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/04/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Objectives: Maternal syphilis can lead to serious adverse pregnancy outcomes, including neonatal death. A 4-fold decline in blood non-treponemal titer at six months after the treatment of syphilis compared to the baseline is considered as an adequate serological response. However, the duration of normal human gestation does not allow the ascertainment of an adequate serological response. Aim: The aim of this study was to assess correlations between the lack of a 4-fold decrease in non-treponemal titer by delivery after syphilis treatment and fetal and newborns' condition and serological outcomes. Methods: Fourteen pregnant patients (gestational age 16-22 weeks) diagnosed with early syphilis (secondary or latent) were treated with intramuscular benzathine penicillin and subsequently monitored clinically, serologically, and ultrasonographically at monthly intervals. Based on the non-treponemal test results at delivery, patients were stratified into two groups: those with a 4-fold decline in titers and those without such a decline. All newborns were clinically and serologically assessed for congenital syphilis at birth and then monitored until serological tests became negative. Results: Fifty percent of the included women did not achieve a 4-fold decline in non-treponemal titer by delivery. Patients from the group showing a 4-fold decline in RPR titer at delivery and those without such a decline did not differ in basic demographic and clinical characteristics or in ultrasound parameters used for fetal assessment. Based on the clinical and laboratory assessments of newborns on the day of delivery and during a 6-month follow-up, none were diagnosed with congenital syphilis or required treatment for syphilis. Conclusions: The lack of an adequate serological response to syphilis therapy by delivery among patients treated between 16 and 22 weeks of pregnancy does not appear to be associated with adverse fetal and neonatal outcomes.
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Affiliation(s)
- Konrad Kaminiów
- Clinical Department of Dermatology, Medical University of Silesia, Marii Curie-Skłodowskiej 10, 41-800 Zabrze, Poland; (M.K.); (M.P.)
| | - Agnieszka Kotlarz
- Chair of Gynaecology and Obstetrics, Jagiellonian University Medical College, Mikołaja Kopernika 23, 31-501 Krakow, Poland;
| | - Martyna Kiołbasa
- Clinical Department of Dermatology, Medical University of Silesia, Marii Curie-Skłodowskiej 10, 41-800 Zabrze, Poland; (M.K.); (M.P.)
| | - Maciej Pastuszczak
- Clinical Department of Dermatology, Medical University of Silesia, Marii Curie-Skłodowskiej 10, 41-800 Zabrze, Poland; (M.K.); (M.P.)
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6
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Li HY, Wang HY, Duan YF, Gou Y, Liu XQ, Gao ZX. Neurosyphilis Presenting as Psychiatric Symptoms at Younger Age: A Case Report. Int Med Case Rep J 2024; 17:647-650. [PMID: 38974881 PMCID: PMC11227323 DOI: 10.2147/imcrj.s477459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/23/2024] [Indexed: 07/09/2024] Open
Abstract
Neurosyphilis is a central nervous system infection caused by Treponema pallidum that imitates various neurological and mental disorders. Therefore, patients with this disease are prone to misdiagnoses. Here, we report a case of neurosyphilis with a psychotic disorder as the main manifestation. A young girl exhibited mental and behavioural abnormalities after a heartbreak, which manifested as alternating low mood, emotional irritability, and a lack of interest in social relations, followed by memory loss. The cerebrospinal fluid protein - Treponema pallidum particle agglutination test was positive, the toluidine red unheated serum test titre was 1:4, the white blood cell count was 5 × 10^6/L, the cerebrospinal fluid protein level was 0.97 g/L, and the brain CT was abnormal. After admission, the possibility of neurosyphilis was considered and the patient received intravenous penicillin G treatment. The patient's clinical symptom ms improved. This case emphasises that doctors should maintain clinical suspicion of Treponema pallidum infection in adolescent patients with mental abnormalities.
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Affiliation(s)
- Hong-Yan Li
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
| | - Hao-Yu Wang
- Department of Radiology, The First People’s Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan, People’s Republic of China
| | - Yi-Fei Duan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yu Gou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xiao-Qin Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zheng-Xiang Gao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Hembert R, Salle R, Grange PA, Ollagnier G, Benhaddou N, Heller U, Saule J, Del Giudice P, Fouéré S, Bertolotti A, Dupin N. Evaluation of the usefulness of routine molecular biology for the diagnosis of primary syphilis by assessing the serological status of patients with PCR-confirmed syphilitic ulcers. J Eur Acad Dermatol Venereol 2024; 38:e590-e592. [PMID: 38131606 DOI: 10.1111/jdv.19761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Affiliation(s)
- R Hembert
- Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
| | - R Salle
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris Cité, Paris, France
- Department of General and Oncologic Dermatology, Ambroise-Paré Hospital, AP-HP, EA4340-BECCOH, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - P A Grange
- Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris Cité, Paris, France
| | - G Ollagnier
- Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris Cité, Paris, France
| | - N Benhaddou
- Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
- Service de Bactériologie, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
| | - U Heller
- Service de Chirurgie Maxillo-Faciale, Hôpital Beaujon, APHP, Clichy, France
| | - J Saule
- CeGIDD-Conseil Départemental 13 Joliette, Marseille, France
| | - P Del Giudice
- Infectiology and Dermatology Unit, Centre Hospitalier Intercommunal de Fréjus-Saint-Raphaël, Fréjus, France
| | - S Fouéré
- Centre for Genital and Sexually Transmitted Diseases - Dermatology Department, Saint-Louis Hospital, Paris, France
| | - A Bertolotti
- Département de Maladies Infectieuses-Médecine Interne-Dermatologie, CHU de La Réunion, Saint Pierre, La Réunion, France
| | - N Dupin
- Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris Cité, Paris, France
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Jensen JS, Unemo M. Antimicrobial treatment and resistance in sexually transmitted bacterial infections. Nat Rev Microbiol 2024; 22:435-450. [PMID: 38509173 DOI: 10.1038/s41579-024-01023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/22/2024]
Abstract
Sexually transmitted infections (STIs) have been part of human life since ancient times, and their symptoms affect quality of life, and sequelae are common. Socioeconomic and behavioural trends affect the prevalence of STIs, but the discovery of antimicrobials gave hope for treatment, control of the spread of infection and lower rates of sequelae. This has to some extent been achieved, but increasing antimicrobial resistance and increasing transmission in high-risk sexual networks threaten this progress. For Neisseria gonorrhoeae, the only remaining first-line treatment (with ceftriaxone) is at risk of becoming ineffective, and for Mycoplasma genitalium, for which fewer alternative antimicrobial classes are available, incurable infections have already been reported. For Chlamydia trachomatis, in vitro resistance to first-line tetracyclines and macrolides has never been confirmed despite decades of treatment of this highly prevalent STI. Similarly, Treponema pallidum, the cause of syphilis, has remained susceptible to first-line penicillin.
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Affiliation(s)
- Jorgen S Jensen
- Department of Bacteria, Parasites and Fungi, Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark.
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London, London, UK
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Ciccarese G, Capello E, Varesano S, Giacani L, Capurro N, Drago F. Persistence of Treponema pallidum IgM antibodies in serum: What is their meaning? Diagn Microbiol Infect Dis 2024; 109:116341. [PMID: 38728874 DOI: 10.1016/j.diagmicrobio.2024.116341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 05/12/2024]
Abstract
We studied the detection of Treponema pallidum (TP)-IgM antibodies in the serum of 69 patients treated for syphilis. The persistence of TP-IgM antibodies in serum for more than 3 years was the only clue to suspect an active infection and, therefore, to investigate a central nervous system involvement.
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Affiliation(s)
- Giulia Ciccarese
- Section of Dermatology, Department of Medical and surgical sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy.
| | - Elisabetta Capello
- Clinica Neurologica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Serena Varesano
- Hygiene Section, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Niccolò Capurro
- Section of Dermatology, Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Drago
- Section of Dermatology, Department of Health Sciences, University of Genoa, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
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10
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Ke W, Ao C, Wang L, Zhang X, Shui J, Zhao J, Huang L, Leng X, Zhu R, Wang H, Weng W, Zheng L, Ligang Yang, Tang S. Refining a non-invasive prediction model for neurosyphilis diagnosis by using immunoassay to detect serum anti-TP0435 (TP17) and TP0574 (TP47) IgG antibodies: two-centre cross-sectional retrospective study in China. Clin Microbiol Infect 2024:S1198-743X(24)00293-3. [PMID: 38909686 DOI: 10.1016/j.cmi.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/12/2024] [Accepted: 06/16/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES Invasive lumbar puncture is the conventional method for diagnosing neurosyphilis (NS). We investigated a non-invasive alternative method to detect serum Treponema pallidum-specific antibodies against highly immunogenic antigens TP0171 (TP15), TP0435 (TP17), and TP0574 (TP47) by using luciferase immunosorbent assay. METHODS A total of 816 HIV-negative patients suspected of NS from the Beijing and Guangzhou cohorts were retrospectively selected and tested for serum anti-TP15, TP17, and TP47 IgG antibodies. Two diagnostic prediction models were developed using stepwise logistic regression in the Beijing cohort, and evaluated in the Guangzhou cohort for external validation. RESULTS Serum antibodies against TP15, TP17, and TP47 showed moderate capability for NS diagnosis in the Beijing cohort and the corresponding area under the receiver operating characteristic curves (AUCs) were 0.722 [95% confidence interval (CI): 0.680-0.762)], 0.780 (95% CI: 0.741-0.817), and 0.774 (95% CI: 0.734-0.811), respectively. An expanded NS prediction model integrated with anti-TP17 and anti-TP47 antibodies showed better performance than the base NS diagnostic model without anti-TP17 and anti-TP47 antibodies with the AUC of 0.874 (95% CI: 0.841-0.906) vs. 0.845 (95% CI: 0.809-0.881) (p = 0.007) in the development cohort, and 0.934 (95% CI: 0.909-0.960) vs. 0.877 (95% CI: 0.840-0.914) (p < 0.001) in validation cohort, respectively. Decision curve analysis revealed that the net benefit of the expanded model exceeded that of the base model when the threshold probability was between 0.10 and 0.95 in both the development and external validation cohorts. DISCUSSION Serum antibodies against TP17 and TP47 exhibited promising diagnostic capability for NS and significantly enhanced the predictive accuracy of model for NS diagnosis. Our study highlights the potential of serum treponemal antibody detection as a non-invasive method for NS diagnosis to substitute invasive lumbar puncture in NS diagnosis.
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Affiliation(s)
- Wujian Ke
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China; Guangzhou Key Laboratory for Sexually Transmitted Diseases Control, Guangzhou, Guangdong, China
| | - Cailing Ao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China; Guangzhou Baiyun District Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Liuyuan Wang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaohui Zhang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jingwei Shui
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianhui Zhao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Liping Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xinying Leng
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Rui Zhu
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Haiying Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Wenjia Weng
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Lianhong Zheng
- Department of Neurology, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
| | - Ligang Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.
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11
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Nanoudis S, Pilalas D, Tziovanaki T, Constanti M, Markakis K, Pagioulas K, Papantoniou E, Kapiki K, Chrysanthidis T, Kollaras P, Metallidis S, Tsachouridou O. Prevalence and Treatment Outcomes of Syphilis among People with Human Immunodeficiency Virus (HIV) Engaging in High-Risk Sexual Behavior: Real World Data from Northern Greece, 2019-2022. Microorganisms 2024; 12:1256. [PMID: 39065024 PMCID: PMC11278651 DOI: 10.3390/microorganisms12071256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/15/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
In this study, we aimed to assess the prevalence of syphilis among people with human immunodeficiency virus (HIV; PWH) engaging in high-risk sexual behavior, determine the stage of syphilis, and evaluate treatment efficacy. A retrospective single-center cohort study was conducted at the AHEPA University General Hospital of Thessaloniki, focusing on PWH at high risk for sexually transmitted infections (STIs) attending outpatient care from January 2019 to December 2022. Sociodemographic and clinical data were collected, incident syphilis rates were identified, associations with HIV-related characteristics were explored, and the treatment response was assessed. Among 991 participants, 94 PWH were diagnosed with syphilis, representing 9.4% of the cohort. Incident syphilis cases experienced a decrease in the early COVID-19 era compared to 2019, followed by a gradual increase leading up to 2022. The majority of syphilis cases were asymptomatic latent syphilis (71.1%). Men who have sex with men (MSM) and younger individuals exhibited higher rates of co-infection during the study period. No significant association was found between incident syphilis and HIV-related factors. Most syphilis cases (86%) were treated with benzathine penicillin G (BPG). Treatment with BPG and doxycycline showed an increased success rate (96.7% vs. 92.9%), with no statistically significant difference observed between them (p = 0.438). This study highlights the alarming incidence of syphilis among PWH engaging in high-risk sexual behavior, particularly among younger MSM. BPG remains effective, and alternative regimens like doxycycline show promise, especially in settings with penicillin shortages or patient allergies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Olga Tsachouridou
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 554 36 Thessaloniki, Greece; (S.N.); (D.P.); (T.T.); (M.C.); (K.M.); (K.P.); (E.P.); (K.K.); (T.C.); (S.M.)
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12
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Zhu Z, Gong H, Liu M, Zhang H, Yang L, Zhang X, Zheng H, Li Y, Li M, Li J. Diagnosing Tabes Dorsalis in HIV-Negative Patients: Clinical Features, Neuroimaging, and Laboratory Insights in the Modern Antibiotic Era. Infect Drug Resist 2024; 17:2567-2577. [PMID: 38919834 PMCID: PMC11197998 DOI: 10.2147/idr.s464581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
Background Tabes dorsalis is a late manifestation of neurosyphilis, characterized by progressive ataxia, lightning pains, loss of proprioception, and urinary incontinence. The absence of a definitive diagnostic standard and the non-specific clinical manifestations have led to a significant rate of misdiagnoses. Methods Hospitalized patients with tabes dorsalis at Peking Union Medical College Hospital between January 2010 and December 2023 were reviewed. Results A total of 13 patients were included, with 10 males and 3 females. The median age was 50 years (range, 34-64). The most frequent initial symptoms were limb numbness (30.8%) and lightning pains (30.8%). Eleven patients (84.6%) received misdiagnoses prior to the final diagnosis. The most frequently observed physical sign was positive Romberg's sign (84.6%). Notably, Argyll Robertson pupil was presented in 7 subjects (53.8%). Serological tests revealed positive rapid plasma regain (RPR) and Treponema pallidum particle agglutination (TPPA) for all patients. All CSF samples were TPPA-reactive. Intramedullary hyperintensity on T2-weighted imaging of spinal MRI was found in 5 patients (38.5%). All patients received anti-syphilitic treatment, with effective treatment recorded in five cases. Conclusion This study underscores the importance of neurological symptoms and signs in diagnosing tabes dorsalis. Individuals with progressive ataxia and positive Romberg's sign should be closely monitored for potential neurosyphilis. Integrating clinical features, laboratory tests, and neuroimaging could reduce misdiagnosis and expedite the initiation of anti-syphilitic therapy.
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Affiliation(s)
- Zhou Zhu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Huizi Gong
- Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Mingjuan Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Leyan Yang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Xinyi Zhang
- Departments of Internal Medicine and Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Heyi Zheng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Yanfeng Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Mingli Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
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13
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Yang Y, Gu X, Zhu L, Cheng Y, Lu H, Guan Z, Shi M, Ni L, Peng RR, Zhao W, Wu J, Qi T, Long F, Chai Z, Gong W, Ye M, Zhou P. Clinical spectrum of late symptomatic neurosyphilis in China: an 11-year retrospective study. Sex Transm Infect 2024:sextrans-2024-056117. [PMID: 38902025 DOI: 10.1136/sextrans-2024-056117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/26/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES This study aimed to describe the clinical features of neurosyphilis in Chinese patients in an attempt to find clinical features that are helpful for the early identification of neurosyphilis. METHODS This retrospective study included people with syphilis who visited Shanghai Skin Disease Hospital between January 2010 and December 2020. Lumbar puncture was performed on those who met the inclusion and exclusion criteria. The diagnosis of neurosyphilis was based on clinical and laboratory findings. The parameters were analysed statistically. RESULTS Of the 3524 patients with neurosyphilis, 2111 (59.9%) and 1413 (40.1%) were asymptomatic and symptomatic neurosyphilis, respectively. General paresis was the most common type of symptomatic neurosyphilis (46.8%). The clinical manifestations of symptomatic neurosyphilis include psychiatric and neurotic symptoms, among which general paresis predominantly presented as psychiatric symptoms such as affective (66.7%) and memory disorder (72.9%). Tabes dorsalis is often presented as neurotic symptoms. One hundred fifty patients (10.6%) with symptomatic neurosyphilis presented candy signs, a rare and specific neurosyphilis symptom that is common in general paresis. Girdle sensation was presented in 13 patients, mainly with tabes dorsalis, which had not been reported in previous studies. CONCLUSIONS Notably, the candy sign is identified as a specific symptom of general paresis, while girdle sensations are highlighted as a particular symptom of tabes dorsalis. This is the largest study describing the clinical spectrum of neurosyphilis since the onset of the penicillin era and could help doctors learn more about the disease. A comprehensive description of the possible clinical manifestations of late symptomatic neurosyphilis, particularly highlighting rare symptoms, can identify suspicious patients and prevent diagnostic delays.
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Affiliation(s)
- Yilan Yang
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Xin Gu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Lin Zhu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Yuanyuan Cheng
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Haikong Lu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Zhifang Guan
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Mei Shi
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Liyan Ni
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Rui-Rui Peng
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Wei Zhao
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Juan Wu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Tengfei Qi
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Fuquan Long
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Zhe Chai
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Weiming Gong
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Meiping Ye
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Pingyu Zhou
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
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14
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Luo X, Xie X, Zhang L, Shi Y, Fu B, Yuan L, Zhang Y, Jiang Y, Ke W, Yang B. Uncovering the mechanisms of host mitochondrial cardiolipin release in syphilis: Insights from human microvascular endothelial cells. Int J Med Microbiol 2024; 316:151627. [PMID: 38908301 DOI: 10.1016/j.ijmm.2024.151627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/21/2024] [Accepted: 06/16/2024] [Indexed: 06/24/2024] Open
Abstract
The release of host mitochondrial cardiolipin is believed to be the main factor that contributes to the production of anti-cardiolipin antibodies in syphilis. However, the precise mechanism by which mitochondria release cardiolipin in this context remains elusive. This study aimed to elucidate the mechanisms underlying mitochondrial cardiolipin release in syphilis. We conducted a cardiolipin quantitative assay and immunofluorescence analysis to detect mitochondrial cardiolipin release in human microvascular endothelial cells (HMEC-1), with and without Treponema pallidum (Tp) infection. Furthermore, we explored apoptosis, a key mechanism for mitochondrial cardiolipin release. The potential mediator molecules were then analyzed through RNA-sequence and subsequently validated using in vitro knockout techniques mediated by CRISPR-Cas9 and pathway-specific inhibitors. Our findings confirm that live-Tp is capable of initiating the release of mitochondrial cardiolipin, whereas inactivated-Tp does not exhibit this capability. Additionally, apoptosis detection further supports the notion that the release of mitochondrial cardiolipin occurs independently of apoptosis. The RNA-sequencing results indicated that microtubule-associated protein2 (MAP2), an axonogenesis and dendrite development gene, was up-regulated in HMEC-1 treated with Tp, which was further confirmed in syphilitic lesions by immunofluorescence. Notably, genetic knockout of MAP2 inhibited Tp-induced mitochondrial cardiolipin release in HMEC-1. Mechanically, Tp-infection regulated MAP2 expression via the MEK-ERK-HES1 pathway, and MEK/ERK phosphorylation inhibitors effectively block Tp-induced mitochondrial cardiolipin release. This study demonstrated that the infection of live-Tp enhanced the expression of MAP2 via the MEK-ERK-HES1 pathway, thereby contributing to our understanding of the role of anti-cardiolipin antibodies in the diagnosis of syphilis.
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Affiliation(s)
- Xi Luo
- Dermatology Hospital, Southern Medical University, Guangzhou, PR China
| | - Xiaoyuan Xie
- Dermatology Hospital, Southern Medical University, Guangzhou, PR China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, PR China
| | - Litian Zhang
- Dermatology Hospital, Southern Medical University, Guangzhou, PR China
| | - Yanqiang Shi
- Dermatology Hospital, Southern Medical University, Guangzhou, PR China
| | - Bo Fu
- Dermatology Hospital, Southern Medical University, Guangzhou, PR China
| | - Liyan Yuan
- Dermatology Hospital, Southern Medical University, Guangzhou, PR China
| | - Yan Zhang
- Dermatology Hospital, Southern Medical University, Guangzhou, PR China
| | - Yinbo Jiang
- Dermatology Hospital, Southern Medical University, Guangzhou, PR China.
| | - Wujian Ke
- Dermatology Hospital, Southern Medical University, Guangzhou, PR China.
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, PR China.
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15
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Salomè S, Cambriglia MD, Montesano G, Capasso L, Raimondi F. Congenital Syphilis: A Re-Emerging but Preventable Infection. Pathogens 2024; 13:481. [PMID: 38921779 PMCID: PMC11206692 DOI: 10.3390/pathogens13060481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
Congenital syphilis presents a significant global burden, contributing to fetal loss, stillbirth, neonatal mortality, and congenital infection. Despite the target established in 2007 by the World Health Organization (WHO) of fewer than 50 cases per 100,000 live births, the global incidence is on the rise, particularly in low- and middle-income regions. Recent data indicate a rate of 473 cases per 100,000 live births, resulting in 661,000 total cases of congenital syphilis, including 355,000 adverse birth outcomes such as early fetal deaths, stillbirths, neonatal deaths, preterm or low-birth-weight births, and infants with clinical congenital syphilis. Alarmingly, only 6% of these adverse outcomes occurred in mothers who were enrolled, screened, and treated. Unlike many neonatal infections, congenital syphilis is preventable through effective antenatal screening and treatment of infected pregnant women. However, despite available screening tools, affordable treatment options, and the integration of prevention programs into antenatal care in various countries, congenital syphilis remains a pressing public health concern worldwide. This review aims to summarize the current epidemiology, transmission, and treatment of syphilis in pregnancy, as well as to explore global efforts to reduce vertical transmission and address the reasons for falling short of the WHO elimination target.
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Affiliation(s)
- Serena Salomè
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (M.D.C.); (G.M.); (L.C.); (F.R.)
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16
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Shiferaw W, Martin BM, Dean JA, Mills D, Lau C, Paterson D, Koh K, Eriksson L, Furuya-Kanamori L. A systematic review and meta-analysis of sexually transmitted infections and blood-borne viruses in travellers. J Travel Med 2024; 31:taae038. [PMID: 38438164 PMCID: PMC11149723 DOI: 10.1093/jtm/taae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/18/2024] [Accepted: 02/29/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) and blood-borne viruses (BBVs) impose a global health and economic burden. International travellers facilitate the spread of infectious diseases, including STIs. Hence, this review assessed the prevalence/proportionate morbidity of travellers with STIs and sexually transmitted BBVs and factors associated with the infection in this population. METHODS PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Cochrane Library were searched from inception of the databases until November 2022. Published analytical observational studies reporting the prevalence/proportionate morbidity of travellers with STIs and factors associated with STIs by type of traveller [i.e. tourists, business travellers, students, visiting friends or relatives (VFRs), international truck drivers, backpackers, expatriates and men who have sex with men (MSM)] were included. The selection of articles, data extraction and risk of bias assessment were conducted by two independent reviewers. Meta-analyses were conducted for each STI by clinical presentation and type of traveller. RESULTS Thirty-two studies (n = 387 731 travellers) were included; 19 evaluated the proportionate morbidity of STIs among symptomatic travellers, while 13 examined the prevalence of STIs in asymptomatic travellers. The highest proportionate morbidity was found among VFRs (syphilis, 1.67%; 95% CI: 1.03-2.81%), backpackers (Chlamydia trachomatis, 6.58%; 95% CI: 5.96-7.25%) and MSM (HIV [2.50%;95% CI: 0.44-12.88%], gonorrhoea [4.17%; 95% CI: 1.1.5-13.98%], lymphogranuloma venereum [4.17%;95% CI: 1.1.5-13.98%] and HAV [20.0%; 95% CI: 14.99-26.17%]). The highest prevalence of STIs among asymptomatic were found in MSM (HIV [25.94%; 95% CI: 22.21-30.05%] and HBV [24.90%; 95% CI: 21.23-28.96%]) and backpackers (C. trachomatis, 3.92%; 95% CI: 2.72-5.32%). Short duration of the trip (<1 month), not having pre-travel consultation, travelling to Southeast Asia and being unvaccinated for HBV were identified as risk factors for STIs. CONCLUSION Strategies to prevent STIs and sexually transmitted BBVs should be discussed at pre-travel consultations, and recommendations should be prioritized in high-risk groups of travellers, such as backpackers, VFRs and MSMs. Additionally, healthcare providers should tailor recommendations for safe sex practices to individual travellers' unique needs.
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Affiliation(s)
- Wondimeneh Shiferaw
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Asrat Woldeyes Health Science Campus, Debre Berhan University, Ethiopia
| | - Beatris Mario Martin
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Judith A Dean
- UQ Poche Centre for Indigenous Health, Faculty of Health, and Behavioural Sciences, The University of Queensland, Toowong, Australia
| | - Deborah Mills
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, Australia
| | - Colleen Lau
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - David Paterson
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Kenneth Koh
- Gladstone Road Medical Centre, Brisbane, Australia
| | - Lars Eriksson
- Herston Health Sciences Library, The University of Queensland, Herston, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
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17
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Peng RR, Wu J, Zhao W, Zhu L, Guan Z, Gu X, Shi M, Yu J, Cheng Y, Zhou P. An observational prospective study based on a large cohort of HIV-negative neurosyphilis patients with particular reference to the Jarisch-Herxheimer reaction. Eur J Clin Microbiol Infect Dis 2024; 43:1073-1080. [PMID: 38557924 PMCID: PMC11178573 DOI: 10.1007/s10096-024-04810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE The purpose of this study is to outline a complete picture of Jarisch-Herxheimer reaction (JHR) in the central nervous system among HIV-negative neurosyphilis patients. METHODS A prospective study cohort of 772 cases with almost all stages of neurosyphilis depicted the features of JHR including occurrence rate, risk profiles, clinical manifestations, medical management and prognosis. RESULTS The total occurrence rate of JHR was 9.3% (95% CI, 7.3-11.4%), including 4.1% (95% CI, 2.7-5.6%) with severe JHR. The reaction started 5 h after treatment initiation, peaked after 8 h, and subsided after 18 h. Patients with severe JHR experienced a longer recovery time (26 h). Patients with general paresis (OR = 6.825), ocular syphilis (OR = 3.974), pleocytosis (OR = 2.426), or a high CSF-VDRL titre (per log2 titre increase, OR = 2.235) were more likely to experience JHR. Patients with general paresis had an 11.759-fold increased risk of severe JHR. Worsening symptoms included cognitive impairment, mania, nonsense speech, and dysphoria, while symptoms of hallucination, urination disorder, seizures, myoclonus, or aphasia appeared as new-onset symptoms. Neurosyphilis treatment did not need to be interrupted in most patients with JHR and could be reinstated in patients with seizures under supportive medication when JHR subsided. CONCLUSION Severe JHR displayed a 4.1% occurrence rate and clinicians should pay particular attention to patients at a higher risk of JHR. The neurosyphilis treatment regime can be restarted under intensive observation for patients with severe JHR and, if necessary, supportive medication should be initiated and continued until the end of therapy.
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Affiliation(s)
- Rui-Rui Peng
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Juan Wu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Wei Zhao
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Lin Zhu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Zhifang Guan
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Xin Gu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Mei Shi
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Junjun Yu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Yanchun Cheng
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Pingyu Zhou
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China.
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18
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Sandoval-Garcés M, Wang A, Martin-Gorgojo A. Comparative Study of Clinical Practice Guidelines on the Management of Venereal Infection: Different Periodic Screenings, Therapeutic Approaches, and Follow-up Care After Treatment Across the CDC, IUSTI and BASHH Guidelines on the Most Frequent STIs. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:639-645. [PMID: 38387644 DOI: 10.1016/j.ad.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/04/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Affiliation(s)
- M Sandoval-Garcés
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas. Ayuntamiento de Madrid, Madrid, España; Departamento de Dermatología, Facultad de Medicina. Universidad de Chile, Santiago de Chile, Chile
| | - A Wang
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas. Ayuntamiento de Madrid, Madrid, España; Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Martin-Gorgojo
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas. Ayuntamiento de Madrid, Madrid, España.
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19
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Sandoval-Garcés M, Wang A, Martin-Gorgojo A. [Translated article] Comparative Study of Clinical Practice Guidelines on the Management of Venereal Infection: Different Periodic Screenings, Therapeutic Approaches, and Follow-up Care After Treatment Across the CDC, IUSTI and BASHH Guidelines on the Most Frequent STIs. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T639-T645. [PMID: 38648928 DOI: 10.1016/j.ad.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/04/2023] [Accepted: 02/06/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- M Sandoval-Garcés
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas, Ayuntamiento de Madrid, Madrid, Spain; Departamento de Dermatología, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile.
| | - A Wang
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas, Ayuntamiento de Madrid, Madrid, Spain; Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Martin-Gorgojo
- Servicio de ITS/Dermatología, Sección de Especialidades Médicas, Ayuntamiento de Madrid, Madrid, Spain
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20
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Hamill MM, Ghanem KG, Tuddenham S. State-of-the-Art Review: Neurosyphilis. Clin Infect Dis 2024; 78:e57-e68. [PMID: 37593890 DOI: 10.1093/cid/ciad437] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Indexed: 08/19/2023] Open
Abstract
We review key concepts in the diagnosis, treatment, and follow-up of individuals with neurosyphilis. We describe the epidemiology of syphilis in the United States, highlight populations that are markedly affected by this infection, and attempt to estimate the burden of neurosyphilis. We describe the cardinal clinical features of early and late (tertiary) neurosyphilis and characterize the clinical significance of asymptomatic neurosyphilis in the antibiotic era. We review the indications for cerebrospinal fluid (CSF) examination and the performance characteristics of different CSF assays including treponemal and lipoidal antibodies, white cell count, and protein concentration. Future biomarkers and the role of imaging are briefly considered. We review preferred and alternative treatments for neurosyphilis and evidence for their use, including evidence for the use of enhanced intramuscular benzathine penicillin G to supplement intravenous penicillin.
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Affiliation(s)
- Matthew M Hamill
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khalil G Ghanem
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Tuddenham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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21
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Li Y, Okayama A, Hagi T, Muto C, Raber S, Nagashima M. Pharmacokinetics and Safety of Intramuscular Injectable Benzathine Penicillin G in Japanese Healthy Participants. J Clin Pharmacol 2024. [PMID: 38736032 DOI: 10.1002/jcph.2454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
An intramuscular (IM) suspension of benzathine penicillin G (BPG) has been used as first-line therapy for the treatment of syphilis worldwide since its approval in the 1950s. However, there are limited reports about the pharmacokinetics of BPG. A Phase 1 study was conducted on eight Japanese healthy participants to investigate the pharmacokinetics (samples collected predose to 648 h post-dose) and safety of 2.4 million units of BPG after a single IM injection. Following administration, penicillin G, the active moiety of BPG, was absorbed slowly from the injection site with a median time to Cmax (tmax) of 48 h post-dose. After the achievement of Cmax, concentrations of penicillin G declined slowly in a monophasic fashion with a mean apparent terminal half-life of 189 h. Geometric mean AUCinf and Cmax were 50770 ng•h/mL and 259 ng/mL, respectively. Median time (range) above the well-accepted therapeutic concentration (18 ng/mL) for syphilis treatment was 561 h (439-608 h [18-25 days]), which reached and exceeded the necessary duration of 7-10 days for syphilis treatment. Two participants were underdosed with residual drug left in the syringe due to the high viscosity of the drug product. Only one (12.5%) participant reported a mild adverse event of nasopharyngitis, which was considered not related to the study treatment. The study results supported BPG approval in Japan as an option for syphilis treatment.
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22
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Gu X, Lu H, Yang Y, Zhu L, Shi M, Guan Z, Ni L, Peng R, Zhao W, Wu J, Qi T, Zhou P. Could ceftriaxone be a viable alternative to penicillin for the treatment of ocular syphilis? Antimicrob Agents Chemother 2024:e0008024. [PMID: 38709007 DOI: 10.1128/aac.00080-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
This study was conducted to compare the effectiveness of ceftriaxone with that of aqueous crystalline penicillin G in treating ocular syphilis. We conducted a retrospective study from 2010 to 2021. Syphilis patients were administered either ceftriaxone (2 g intravenously daily for 14 days) or aqueous crystalline penicillin G [4 million units (MU) intravenously every 4 h for 14 days] as therapeutic interventions. Subsequently, we utilized these two groups to assess the serological results, cerebrospinal fluid analysis, and visual acuity at time intervals spanning 3 to 6 months post-treatment. A total of 205 patients were included, with 34 assigned to the ceftriaxone group and 171 to the penicillin group. The median age of patients was 56 years, with an interquartile range of 49-62 years, and 137 of them (66.8%) were male. Between 3 and 6 months after treatment, 13 patients (38.2%) in the ceftriaxone group and 82 patients (48.0%) in the penicillin group demonstrated effective treatment based on the clinical and laboratory parameters. The crude odds ratio (OR) was 0.672 (95% confidence interval [CI]: 0.316-1.428, P = 0.301), indicating no significant difference in effectiveness between the two groups. Thirty patients (17.5%) in the penicillin group and six patients (17.6%) in the ceftriaxone group did not experience successful outcomes. Notably, no serious adverse effects were reported in both the groups. There was no significant difference in the effectiveness of ceftriaxone and aqueous crystalline penicillin G in treating ocular syphilis. The administration of ceftriaxone without requiring hospitalization presents a convenient and safe alternative treatment option for ocular syphilis.
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Affiliation(s)
- Xin Gu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Haikong Lu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yilan Yang
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lin Zhu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mei Shi
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhifang Guan
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liyan Ni
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruirui Peng
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Zhao
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Juan Wu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tengfei Qi
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Pingyu Zhou
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
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23
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Moursi MO, Hamam W, Hajjar A, Es‐Salim M, Aboukhalaf S, Jamil O, Zahid M. Ischemic stroke as an initial presentation of neurosyphilis in a newly diagnosed HIV patient: A case report and literature review. Clin Case Rep 2024; 12:e8794. [PMID: 38736579 PMCID: PMC11087217 DOI: 10.1002/ccr3.8794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/02/2024] [Accepted: 04/02/2024] [Indexed: 05/14/2024] Open
Abstract
With syphilis resurgence, physicians should be more vigilant to infection-induced cerebral vasculitis in high-risk patients presenting with neurological symptoms. In this case, neurosyphilis should not be missed. Thorough serologic screening and lumbar puncture are crucial for diagnosis, and further research is needed for safe and effective treatments in these populations.
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Affiliation(s)
- Moaz O. Moursi
- Department of Internal MedicineHamad General HospitalDohaQatar
- College of Medicine, QU HealthQatar UniversityDohaQatar
| | - Wael Hamam
- Department of Internal MedicineHamad General HospitalDohaQatar
| | - Adnan Hajjar
- Department of Internal MedicineHamad General HospitalDohaQatar
| | | | - Soha Aboukhalaf
- Department of Internal MedicineHamad General HospitalDohaQatar
- College of Medicine, QU HealthQatar UniversityDohaQatar
| | - Omar Jamil
- College of Medicine, QU HealthQatar UniversityDohaQatar
- Department of RadiologyHamad General HospitalDohaQatar
| | - Muhammad Zahid
- Department of Internal MedicineHamad General HospitalDohaQatar
- College of Medicine, QU HealthQatar UniversityDohaQatar
- Weill Cornell Medical CollegeDohaQatar
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24
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Shields MK, Furtado JM, Lake SR, Smith JR. Syphilitic scleritis and episcleritis: A review. Asia Pac J Ophthalmol (Phila) 2024; 13:100073. [PMID: 38795870 DOI: 10.1016/j.apjo.2024.100073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/28/2024] Open
Abstract
Scleritis and episcleritis are rare, but potentially sight-threatening forms of syphilis. To provide a full description of this neglected subset of ocular syphilis, we evaluated the English literature for reports of syphilitic scleritis and episcleritis, recording the demographics, clinical characteristics, serological data, management practices, treatment responses, and visual outcomes. Previously published descriptions of 44 patients with syphilitic scleritis (50 eyes) and 9 patients with syphilitic episcleritis (14 eyes) were identified. The predominant type of scleritis was anterior scleritis, accounting for 92.9% of cases, with nodular anterior scleritis being the most frequent subtype at 58.1%. Almost one-quarter of patients were co-infected with human immunodeficiency virus (HIV). Initial misdiagnosis was common and led to delays in initiating treatment with appropriate antibiotics. Visual outcomes were often good in both scleritis and episcleritis, irrespective of HIV infection status, although complications including scleral thinning, keratitis, and uveitis, along with permanent visual loss and an association with neurosyphilis, were reported. Response to antibiotic treatment was typically rapid, often within 1 week. With the rising global incidence of syphilis, testing patients with scleritis or episcleritis for this infectious disease is important to ensure prompt diagnosis and treatment for best ocular and systemic outcomes.
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Affiliation(s)
- Melissa K Shields
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.
| | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Stewart R Lake
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Justine R Smith
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.
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25
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Català A, Hernández DG. AEDV Expert Recommendations on the Management of Suppurative Sexually Transmitted Infections. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00340-5. [PMID: 38663731 DOI: 10.1016/j.ad.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024] Open
Abstract
The incidence of sexually transmitted infections (STIs) is increasing in Spain. Suppurative STIs are one of the most frequent reasons for consultation in specialized centers. The reason for suppurative STIs is multiple and their empirical treatment varies with the currently growing problem of antimicrobial resistance. Dermatologists are trained and prepared to treat these diseases, but their correct management requires active knowledge of national and international guidelines. The present document updates, reviews and summarizes the main expert recommendations on the management and treatment of these STIs.
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Affiliation(s)
- A Català
- Servicio de Dermatología y Venereología, Grupo Español de Investigación en ITS y VIH de la Academia Española de Dermatología y Venereología, España; Programa de Salud Sexual, Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Barcelona, España; Grupo Español de Investigación en ITS y VIH de la Academia Española de Dermatología y Venereología,spaña.
| | - D García Hernández
- Programa de Salud Sexual, Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Barcelona, España; Grupo Español de Investigación en ITS y VIH de la Academia Española de Dermatología y Venereología,spaña
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26
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Fuertes de Vega L, de la Torre García JM, Suarez Farfante JM, Ceballos Rodríguez MC. AEDV Expert Consensus for the Management of Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00339-9. [PMID: 38663730 DOI: 10.1016/j.ad.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/28/2024] [Accepted: 03/16/2024] [Indexed: 05/26/2024] Open
Abstract
Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.
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Affiliation(s)
- L Fuertes de Vega
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV.
| | - J M de la Torre García
- Grupo investigación en ITS y VIH de la AEDV; Centro Diagnóstico y Prevención Enfermedades de Trasmisión Sexual, Servicio Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J M Suarez Farfante
- Grupo investigación en ITS y VIH de la AEDV; Antigua Unidad ITS Campo Gibraltar, Algeciras, Cádiz, España
| | - M C Ceballos Rodríguez
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV
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Wu MY, Chen L, Liu LC, Liu MJ, Li YF, Zheng HY, Leng L, Zou YJ, Chen WJ, Li J. Using circulating microbial cell-free DNA to identify persistent Treponema pallidum infection in serofast syphilis patients. iScience 2024; 27:109399. [PMID: 38523794 PMCID: PMC10959656 DOI: 10.1016/j.isci.2024.109399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/06/2024] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
The question of whether serofast status of syphilis patients indicates an ongoing low-grade Treponema pallidum (T. pallidum) infection remains unanswered. To address this, we developed a machine learning model to identify T. pallidum in cell-free DNA (cfDNA) using next-generation sequencing (NGS). Our findings showed that a TP_rate cut-off of 0.033 demonstrated superior diagnostic performance for syphilis, with a specificity of 92.3% and a sensitivity of 71.4% (AUROC = 0.92). This diagnosis model predicted that 20 out of 92 serofast patients had a persistent low-level infection. Based on these predictions, re-treatment was administered to these patients and its efficacy was evaluated. The results showed a statistically significant decrease in RPR titers in the prediction-positive group compared to the prediction-negative group after re-treatment (p < 0.05). These findings provide evidence for the existence of T. pallidum under serofast status and support the use of intensive treatment for serofast patients at higher risk in clinical practice.
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Affiliation(s)
- Meng Yin Wu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Lu Chen
- Beijing Macro & Micro-test Bio-Tech Co., Ltd, Beijing 100083, China
| | - Li Cheng Liu
- Beijing Macro & Micro-test Bio-Tech Co., Ltd, Beijing 100083, China
| | - Ming Juan Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yan Feng Li
- Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China
| | - He Yi Zheng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ling Leng
- State Key Laboratory of Complex Severe and Rare Diseases, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yi Jun Zou
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Wei Jun Chen
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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28
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Grauenfels Cohen G, Cohen MJ, Dveyrin Z, Mor Z, Rorman E, Kaliner E. Serological follow-up after syphilis diagnosis in Israel. Epidemiol Infect 2024; 152:e63. [PMID: 38606644 PMCID: PMC11062779 DOI: 10.1017/s0950268824000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024] Open
Abstract
The global incidence of syphilis is increasing. Continuity of care challenges the control of sexually transmitted diseases. In this study, we assessed the follow-up and serological decline differences between community- and hospital-diagnosed patients in Israel. A historical cohort study was conducted using the Israel National Syphilis Center (NSC) repository. Patients with a positive non-specific Venereal Disease Research Laboratory (VDRL) test between 2011 and 2020 were included. Rates of serological follow-up and serological titre decreases were compared between hospital- and community-diagnosed patients. The study included 4,445 patients, 2,596 (58.4%) were diagnosed in community clinics and 1,849 (41.6%) in hospitals. Of community-diagnosed patients, 1,957 (75.4%) performed follow-up testing, compared with 834 (51.2%) hospital-diagnosed patients (p < 0.001). On multivariate analysis, the odds ratio of serology follow-up among community-diagnosed patients was 2.8 (95 per cent confidence interval (95% CI): 2.2-3.5) that of hospital-diagnosed patients. There were 1,397 (71.4%) community-diagnosed patients with serological titre decrease, compared with 626 (74.9%) hospital-diagnosed patients (p = 0.03). On multivariate analysis, this difference diminished. Serological follow-up testing is suboptimal and was performed more often among patients initially diagnosed in the community compared to hospitals. Continuity of care should be improved to promote successful patient care and prevent disease spread.
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Affiliation(s)
| | - Matan J. Cohen
- Faculty of Medicine, Hebrew University, Clalit Health Services, Jerusalem district, Israel
| | - Ze’ev Dveyrin
- National Public Health Laboratory Tel Aviv, Ministry of Health, Tel-Aviv Jaffa, Israel
| | - Zohar Mor
- Central Department of Health, Ministry of Health, Ramla, Israel
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
| | - Efrat Rorman
- National Public Health Laboratory Tel Aviv, Ministry of Health, Tel-Aviv Jaffa, Israel
| | - Ehud Kaliner
- Central Department of Health, Ministry of Health, Ramla, Israel
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Elkhider O, Abdalla M, Ibrahim OA, Mustafa A, Abdelatif S. A Neurosyphilis Case Mimicking Herpes Simplex Virus Encephalitis in an African American Male. Cureus 2024; 16:e59093. [PMID: 38800158 PMCID: PMC11128315 DOI: 10.7759/cureus.59093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Neurosyphilis is one form of a multisystemic sexually transmitted disease caused by Treponema pallidum. Although typical presentations of neurosyphilis have become less common in the post-antibiotic era, a rising trend of atypical presentations can mimic other diagnoses like herpes simplex and autoimmune encephalitis. In this case, we diagnosed neurosyphilis in a patient with clinical and radiological features similar to herpes simplex encephalitis. We emphasize the need for a diagnostic approach combining imaging namely MRI, lumbar puncture, and use of treponemal and non-treponemal tests so that neurosyphilis cases with atypical neuroimaging findings are not overlooked.
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Affiliation(s)
- Osama Elkhider
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Monzer Abdalla
- Internal Medicine, Ascension Saint Francis Hospital, Evanston, USA
| | - Omer A Ibrahim
- Internal Medicine, Omdurman Military Hospital, Khartoum, SDN
| | | | - Shamsa Abdelatif
- Internal Medicine, University of Medical Sciences and Technology, Khartoum, SDN
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30
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Minetti C, Rocha M, Duque LM, Meireles P, Correia C, Cordeiro D, João I, Manita C, Soeiro S, Santos JA, Matos R, Almeida C, Martins HC, Vinagre E, Lopo S, Borrego MJ. Orogenital and anal infection by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and other sexually transmitted infections in men who have sex with men in Lisbon. Int J STD AIDS 2024; 35:379-388. [PMID: 38166231 DOI: 10.1177/09564624231221591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
BACKGROUND Men who have sex with men (MSM) are at risk for sexually transmitted infections (STIs), but more data on extragenital carriage are needed. AIM We assessed the genital and extragenital prevalence of bacterial and other STIs in MSM in a Lisbon sexual health clinic. METHODS We screened oral, anal, and urine samples of MSM visiting the GAT-CheckpointLX clinic June 2017-December 2021 for Chlamydia trachomatis (including lymphogranuloma venereum, LGV), Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, and U. parvum. Ano-oro-genital lesions were tested for LGV, Treponema pallidum, and Herpes Simplex Virus. Blood was tested for HIV and T. pallidum antibodies. RESULTS N. gonorrhoeae was found in 16.6% of the MSM followed by C. trachomatis (13.2%), M. genitalium (10.3%) and T. vaginalis (0.2%). The most frequent occurrence was anorectal (C. trachomatis, M. genitalium) and oral (N. gonorrhoeae). We found high carriage of U. urealyticum (36.1%) and M. hominis (22.1%). LGV was detected in 21.8% of chlamydia-positive anorectal swabs. Syphilis was detected in 22.6% of tested MSM, while 13.8% had HIV. Gonorrhoea and chlamydia were significantly more prevalent in MSM with concomitant HIV or syphilis. CONCLUSION The substantial extragenital prevalence of bacterial STIs in MSM, and HIV and syphilis coinfections, suggest screening has value in identifying hidden carriage and in contributing for providing better care.
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Affiliation(s)
- Corrado Minetti
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
- ECDC fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Miguel Rocha
- GAT-CheckpointLX, Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Luís Miguel Duque
- GAT-CheckpointLX, Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Paula Meireles
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Cristina Correia
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Dora Cordeiro
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Inês João
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Carla Manita
- Laboratório de Imunologia para Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Sofia Soeiro
- Laboratório de Imunologia para Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - João Almeida Santos
- Laboratório de Imunologia para Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Rita Matos
- Laboratório de Imunologia para Doenças Infecciosas, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Catarina Almeida
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Helena Cortes Martins
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Elsa Vinagre
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Sílvia Lopo
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Maria José Borrego
- Laboratório Nacional de Referência das Infeções Sexualmente Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
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Ubals M, Nadal-Baron P, Arando M, Rivero Á, Mendoza A, Descalzo Jorro V, Ouchi D, Pérez-Mañá C, Álvarez M, Alemany A, Hoyos-Mallecot Y, Nunley E, Lieberman NAP, Greninger AL, Galván-Casas C, Suñer C, G-Beiras C, Paredes R, Rodríguez-Gascón A, Canut A, García-Patos V, Farré M, Marks M, Giacani L, Vall-Mayans M, Mitjà O. Oral linezolid compared with benzathine penicillin G for treatment of early syphilis in adults (Trep-AB Study) in Spain: a prospective, open-label, non-inferiority, randomised controlled trial. THE LANCET. INFECTIOUS DISEASES 2024; 24:404-416. [PMID: 38211601 PMCID: PMC10954560 DOI: 10.1016/s1473-3099(23)00683-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Management of syphilis, a sexually transmitted infection (STI) with increasing incidence, is challenged by drug shortages, scarcity of randomised trial data, an absence of non-penicillin alternatives for pregnant women with penicillin allergy (other than desensitisation), extended parenteral administration for neurosyphilis and congenital syphilis, and macrolide resistance. Linezolid was shown to be active against Treponema pallidum, the causative agent of syphilis, in vitro and in the rabbit model. We aimed to assess the efficacy of linezolid for treating early syphilis in adults compared with the standard of care benzathine penicillin G (BPG). METHODS We did a multicentre, open-label, non-inferiority, randomised controlled trial to assess the efficacy of linezolid for treating early syphilis compared with BPG. We recruited participants with serological or molecular confirmation of syphilis (either primary, secondary, or early latent) at one STI unit in a public hospital and two STI community clinics in Catalonia (Spain). Participants were randomly allocated in a 1:1 ratio using a computer-generated block randomisation list with six participants per block, to receive either oral linezolid (600 mg once per day for 5 days) or intramuscular BPG (single dose of 2·4 million international units) and were assessed for signs and symptoms (once per week until week 6 and at week 12, week 24, and week 48) and reagin titres of non-treponemal antibodies (week 12, week 24, and week 48). The primary endpoint was treatment response, assessed using a composite endpoint that included clinical response, serological response, and absence of relapse. Clinical response was assessed at 2 weeks for primary syphilis and at 6 weeks for secondary syphilis following treatment initiation. Serological cure was defined as a four-fold decline in rapid plasma reagin titre or seroreversion at any of the 12-week, 24-week, or 48-week timepoints. The absence of relapse was defined as the presence of different molecular sequence types of T pallidum in recurrent syphilis. Non-inferiority was shown if the lower limit of the two-sided 95% CI for the difference in rates of treatment response was higher than -10%. The primary analysis was done in the per-protocol population. The trial is registered at ClinicalTrials.gov (NCT05069974) and was stopped for futility after interim analysis. FINDINGS Between Oct 20, 2021, and Sept 15, 2022, 62 patients were assessed for eligibility, and 59 were randomly assigned to linezolid (n=29) or BPG (n=30). In the per-protocol population, after 48 weeks' follow-up, 19 (70%) of 27 participants (95% CI 49·8 to 86·2) in the linezolid group had responded to treatment and 28 (100%) of 28 participants (87·7 to 100·0) in the BPG group (treatment difference -29·6, 95% CI -50·5 to -8·8), which did not meet the non-inferiority criterion. The number of drug-related adverse events (all mild or moderate) was similar in both treatment groups (five [17%] of 29, 95% CI 5·8 to 35·8 in the linezolid group vs five [17%] of 30, 5·6 to 34·7, in the BPG group). No serious adverse events were reported during follow-up. INTERPRETATION The efficacy of linezolid at a daily dose of 600 mg for 5 days did not meet the non-inferiority criteria compared with BPG and, as a result, this treatment regimen should not be used to treat patients with early syphilis. FUNDING European Research Council and Fondo de Investigaciones Sanitarias.
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Affiliation(s)
- Maria Ubals
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Facultat de Medicina, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Dermatology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Patricia Nadal-Baron
- Facultat de Medicina, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maider Arando
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ángel Rivero
- Fundació Lluita Contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Barcelona Checkpoint, Projecte dels NOMS, Hispanosida, Barcelona
| | - Adrià Mendoza
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Fundació Lluita Contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Vicent Descalzo Jorro
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Dan Ouchi
- Fundació Lluita Contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Clara Pérez-Mañá
- Clinical Pharmacology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marlene Álvarez
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Andrea Alemany
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Ethan Nunley
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA, USA
| | - Nicole A P Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA, USA
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Cristina Galván-Casas
- Fundació Lluita Contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Hospital Universitario de Mostoles, Madrid, Spain
| | - Clara Suñer
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Fundació Lluita Contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Camila G-Beiras
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Roger Paredes
- Fundació Lluita Contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain; Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Alicia Rodríguez-Gascón
- Pharmacokinetic, Nanotechnology, and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy Group, Vitoria-Gasteiz, Spain
| | - Andrés Canut
- Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy Group, Vitoria-Gasteiz, Spain; Microbiology Service, Araba University Hospital, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain
| | | | - Magí Farré
- Clinical Pharmacology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Michael Marks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK; Division of Infection and Immunity, University College London, London, UK
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Martí Vall-Mayans
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oriol Mitjà
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Fundació Lluita Contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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Vanbaelen T, Tsoumanis A, Kenyon C. Total Antimicrobial Consumption in Doxycycline Postexposure Prophylaxis Cohorts and the Intensity of Screening for Bacterial Sexually Transmitted Infections. Clin Infect Dis 2024; 78:803-805. [PMID: 37721151 DOI: 10.1093/cid/ciad553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Thibaut Vanbaelen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Santos-Coelho M, Alves Barbosa J, Valejo Coelho MM, João A. An unusual case of extragenital primary syphilis. An Bras Dermatol 2024; 99:289-290. [PMID: 38061961 PMCID: PMC10943323 DOI: 10.1016/j.abd.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 03/11/2024] Open
Affiliation(s)
- Miguel Santos-Coelho
- Service of Dermatovenereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
| | - Joana Alves Barbosa
- Service of Dermatovenereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Margarida Moura Valejo Coelho
- Service of Dermatovenereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Alexandre João
- Service of Dermatovenereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Abstract
Dermatologists are familiar with the classic aspects of syphilis. Our objective in this update is to display novel features of sexually acquired syphilis, its pathophysiology, natural history, atypical clinical variants, skin of color, clinical pearls, and prospects. Textbook knowledge, congenital syphilis, epidemiology, and historical data are excluded.
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Affiliation(s)
- Jorge Navarrete
- Department of Dermatology, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; Department of Dermatology and Sexually Transmitted Infections Clinic, Hospital Padre Hurtado, Santiago, Chile.
| | - Stephanie Saavedra-Portales
- Department of Dermatology and Sexually Transmitted Infections Clinic, Hospital San Juan de Dios, Santiago, Chile
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Lin Y, Yang J, Wang X, Yang J, Dong L. Establishment of reference measurement procedure and reference material for Treponema pallidum. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2024; 16:1244-1251. [PMID: 38319302 DOI: 10.1039/d3ay01906c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Stem cell preparations, as a new type of biotherapeutic product, should be subject to strict quality control in terms of cell safety. The testing of stem cell donors and blood products used in stem cell cultures, including but not limited to Treponema pallidum, is needed to reduce the risk of transmission of infectious diseases by stem cell medical products. In this study, a reference measurement procedure (RMP) was established based on digital PCR (dPCR). A homogeneous reference material (RM) of TP containing the tpp47 gene has been developed and characterized. Two dPCR assays (A and B) show ideal linearity within five orders of magnitude. The limit of quantification (LoQ) for both assays is 57 copies/reaction; the limits of detection (LoD) are 9.69 and 9.59 copies/reaction, respectively. The quantitative results of the established duplex dPCR assay are in good agreement. The RM of TP containing the tpp47 gene has been developed and characterized. The reference value with its expanded uncertainty is (2.21 ± 0.22) × 106 copies per μL determined by the established dPCR RMP. The developed dPCR was validated by applying a simulated stem cell matrix, and no impact was observed on the accuracy of dPCR. By providing an accurate reference value for the absolute copy number of the target gene, the developed RM can be used to improve the reliability of TP testing in the production of stem cell preparations and clinical diagnostics.
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Affiliation(s)
- Yanmin Lin
- College of Food Science and Technology, Shanghai Ocean University, 201306, Shanghai, P. R. China.
- Center for Advanced Measurement of Science, National Institute of Metrology, 100029, Beijing, P. R. China.
| | - Jiayi Yang
- Center for Advanced Measurement of Science, National Institute of Metrology, 100029, Beijing, P. R. China.
| | - Xia Wang
- Center for Advanced Measurement of Science, National Institute of Metrology, 100029, Beijing, P. R. China.
| | - Jingya Yang
- College of Food Science and Technology, Shanghai Ocean University, 201306, Shanghai, P. R. China.
- Marine Biomedical Science and Technology Innovation Platform of Lin-gang Special Area, 201306, Shanghai, P. R. China
| | - Lianhua Dong
- Center for Advanced Measurement of Science, National Institute of Metrology, 100029, Beijing, P. R. China.
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Alberto C, Lambeng N, Deffert C, Breville G, Gayet-Ageron A, Lalive P, Calmy A, Coste A, Papadimitriou-Olivgeris M, Braun D, Lienhard R, Bosshard PP, Fontao L, Toutous Trellu L. Multicentric evaluation of a specific intrathecal anti- Treponema pallidum IgG index as a diagnostic biomarker of neurosyphilis: results from a retro-prospective case-control study. Sex Transm Infect 2024; 100:63-69. [PMID: 38071543 DOI: 10.1136/sextrans-2023-055913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/07/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The diagnosis of neurosyphilis (NS) lacks a true 'gold standard', making the diagnosis challenging while consequences of a misdiagnosis are potentially severe. The aim of this study was to evaluate the diagnostic performance of measuring an antibody index (AI) for the intrathecal synthesis of specific anti-Treponema pallidum (T. pallidum) IgG for the diagnosis of NS. METHODS Specific anti-T. pallidum IgG were measured simultaneously in paired cerebrospinal fluid (CSF)-serum samples collected retrospectively and prospectively between 2007 and 2022, from patients suspected of NS, in Switzerland. An AI was calculated to account for blood-brain barrier integrity. Area under the receiver operating characteristic curve, sensitivity/specificity and positive/negative predictive values of AI test were estimated. Two NS definitions were used: NS1 included patients with NS suspicion presenting with neurological symptoms and/or acute neurosensory signs, and positive T. Pallidum Hemagglutinations Assay (TPHA)/T. pallidum particle agglutination assay (TPPA) serology and CSF-TPHA/TPPA ≥320, and either CSF-leucocytes >5 cells/mm3 and/or CSF-protein >0.45 g/L and/or a reactive CSF-venereal disease research laboratory (VDRL)/rapid plasma reagin (RPR) test. NS2 included patients with suspected NS presenting with acute ocular and/or otologic symptoms, and positive TPHA/TPPA serology, and a favourable response to NS treatment. Controls were patients diagnosed with any other central nervous system (CNS) pathologies and with positive TPHA/TPPA serology. RESULTS The study included 71 NS (43 NS1 and 28 NS2) and 110 controls. With a threshold of ≥1.7, sensitivity and specificity of the specific AI test were 90.7% (CI 77.7 to 97.4) and 100% (CI 96.7 to 100.0), respectively, for NS1 and 14.3% (CI 4 to 32.7) and 100% (CI 96.7 to 100.0) for NS2. In patients suspected of NS with a CNS involvement (NS1 group), NS could be confirmed by the positivity of this specific AI. CONCLUSIONS Measurement of an intrathecal synthesis index of specific anti-T. pallidum IgG in patients with CSF inflammatory signs appears to be a valuable diagnostic test. However, in otic or ocular syphilis, presenting few CSF abnormalities, AI is not sufficient alone to confirm NS diagnosis. TRIAL REGISTRATION Swiss Association of Research Ethics Committees number 2019-00232.
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Affiliation(s)
- Chloé Alberto
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - Nathalie Lambeng
- Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Deffert
- Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Gautier Breville
- Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Angèle Gayet-Ageron
- CRC & Division of Clinical Epidemiology, Department of Community Health and Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Patrice Lalive
- Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Alix Coste
- Microbiology Institute, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Dominique Braun
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Lionel Fontao
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
- Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
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Hartmane I, Ivdra I, Mikazans I, Princevs A, Teterina I, Bondare-Ansberga V, Reinberga L. Use of ceftriaxone as an alternative treatment method in pregnant women diagnosed with syphilis - a single centre experience. Int J STD AIDS 2024; 35:130-135. [PMID: 37870192 DOI: 10.1177/09564624231206845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND There are few data on the use of ceftriaxone in pregnant women diagnosed with syphilis. The aim of this study was to investigate the safety and efficacy of ceftriaxone as an alternative treatment option for syphilis during pregnancy. METHODS A retrospective analysis of 79 pregnant women diagnosed with syphilis and treated with ceftriaxone was conducted. RESULTS No cases of intolerance, Jarisch-Herxheimer reactions, or allergic reactions were recorded. The average time to seronegativation for secondary syphilis with symptoms was 6.14 months ± 2.76, and for latent forms, it was 7.52 months ± 1.84. Patients received no additional treatment. No serious adverse drug reactions were reported. CONCLUSIONS Data from our study support the use of ceftriaxone as an effective and safe alternative treatment for pregnant women diagnosed with syphilis when penicillin therapy is contraindicated or unavailable.
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Affiliation(s)
- Ilona Hartmane
- Clinic for Dermatology and Sexually Transmitted Diseases, Riga 1st Hospital, Rīga, Latvia
- Department of Dermatology and Venereology, Faculty of Medicine, Rīga Stradiņš University, Rīga, Latvia
| | - Iveta Ivdra
- Clinic for Dermatology and Sexually Transmitted Diseases, Riga 1st Hospital, Rīga, Latvia
- Department of Dermatology and Venereology, Faculty of Medicine, Rīga Stradiņš University, Rīga, Latvia
| | - Ingmars Mikazans
- Clinic for Dermatology and Sexually Transmitted Diseases, Riga 1st Hospital, Rīga, Latvia
- Department of Dermatology and Venereology, Faculty of Medicine, Rīga Stradiņš University, Rīga, Latvia
| | - Aleksejs Princevs
- Clinic for Dermatology and Sexually Transmitted Diseases, Riga 1st Hospital, Rīga, Latvia
| | - Irena Teterina
- Department of Pharmacology, Rīga Stradiņš University, Rīga, Latvia
| | - Vanda Bondare-Ansberga
- Clinic for Dermatology and Sexually Transmitted Diseases, Riga 1st Hospital, Rīga, Latvia
- Department of Dermatology and Venereology, Faculty of Medicine, Rīga Stradiņš University, Rīga, Latvia
| | - Lelde Reinberga
- Clinic for Dermatology and Sexually Transmitted Diseases, Riga 1st Hospital, Rīga, Latvia
- Department of Dermatology and Venereology, Faculty of Medicine, Rīga Stradiņš University, Rīga, Latvia
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Großschädl K, Weiland T, Schöffl C, Gorkiewicz G, Sadoghi B. Adenoidectomy Due to Hyperplasia of Adenoids. Treponema Pallidum as a Potential Causative Pathogen. Laryngoscope 2024; 134:762-763. [PMID: 37334862 DOI: 10.1002/lary.30833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Katja Großschädl
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Thomas Weiland
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Graz, Graz, Austria
| | - Clemens Schöffl
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | | | - Birgit Sadoghi
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
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Luan X, Du Y, Luo D. Diagnostic value of cerebrospinal fluid chemokine c-x-c motif ligand 13 for neurosyphilis: A systematic review and meta-analysis. Int J STD AIDS 2024; 35:96-102. [PMID: 37795953 DOI: 10.1177/09564624231205328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
The diagnostic value of cerebrospinal fluid chemokine c-x-c motif ligand 13 (CSF CXCL13) for neurosyphilis was assessed by meta-analysis in this study. PubMed, Web of Science and Embase databases were searched to identify relevant articles by using MeSH and free terms of CXCL13 and neurosyphilis. A total of 720 syphilis and 338 neurosyphilis individuals in 6 articles were involved in this meta-analysis. The pooled sensitivity and specificity were 0.82 (95% confidence intervals (CI), 0.77-0.87) and 0.84 (95% CI, 0.79-0.87). The pooled positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and the area under receiver operating characteristic curve were 5.10 (95% CI, 3.90-6.60), 0.21 (95% CI, 0.16-0.28), 24.00 (95% CI, 14.00-39.00) and 0.88 (95% CI, 0.84-0.90), respectively. In subgroup analysis, human immunodeficiency virus infection and diagnostic criteria for neurosyphilis were identified to be associated with heterogeneity. Based on limited evidence, CSF CXCL13 can be helpful in diagnosing neurosyphilis.
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Affiliation(s)
- Xingbao Luan
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanru Du
- Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dan Luo
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Lakhey K, Kumar A, Manoj R, Puttur NB, Malik N. Response to Ceftriaxone in Asymptomatic Neurosyphilis Refractory to Doxycycline and Benzathine Penicillin. Cureus 2024; 16:e55196. [PMID: 38558728 PMCID: PMC10980906 DOI: 10.7759/cureus.55196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
An asymptomatic male in his mid-30s presented with a positive Venereal Disease Research Laboratory (VDRL) test report. He was investigated and detected to be reactive for human immunodeficiency virus (HIV)-1 antibodies. A lumbar puncture revealed cerebrospinal fluid (CSF) VDRL to be reactive at a titer of 1:160 which led to a diagnosis of asymptomatic neurosyphilis. The unavailability of first-line antibiotics necessitated the search for alternative regimens. The patient was administered oral doxycycline 200 mg twice daily for 28 days along with intramuscular benzathine penicillin 2.4 million units once weekly for three weeks. A repeat CSF-VDRL performed six months later with raised titers of 1:320 indicated treatment failure. The patient was then administered ceftriaxone 1 g intramuscularly for 14 consecutive days. A final CSF-VDRL examination performed six months later showed non-reactive titers.
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Affiliation(s)
- Kshitiz Lakhey
- Dermatology, Venereology and Leprosy, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Ajay Kumar
- Dermatology, Venereology and Leprosy, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Rohan Manoj
- Dermatology, Venereology and Leprosy, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Namratha B Puttur
- Dermatology, Venereology and Leprosy, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Nishtha Malik
- Dermatology, Venereology and Leprosy, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
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Yang Y, Gu X, Zhu L, Cheng Y, Lu H, Guan Z, Shi M, Ni L, Peng R, Zhao W, Wu J, Qi T, Long F, Chai Z, Gong W, Ye M, Zhou P. Clinical parameter-based prediction model for neurosyphilis risk stratification. Epidemiol Infect 2024; 152:e21. [PMID: 38224151 PMCID: PMC10894895 DOI: 10.1017/s0950268824000074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024] Open
Abstract
Accurately predicting neurosyphilis prior to a lumbar puncture (LP) is critical for the prompt management of neurosyphilis. However, a valid and reliable model for this purpose is still lacking. This study aimed to develop a nomogram for the accurate identification of neurosyphilis in patients with syphilis. The training cohort included 9,504 syphilis patients who underwent initial neurosyphilis evaluation between 2009 and 2020, while the validation cohort comprised 526 patients whose data were prospectively collected from January 2021 to September 2021. Neurosyphilis was observed in 35.8% (3,400/9,504) of the training cohort and 37.6% (198/526) of the validation cohort. The nomogram incorporated factors such as age, male gender, neurological and psychiatric symptoms, serum RPR, a mucous plaque of the larynx and nose, a history of other STD infections, and co-diabetes. The model exhibited good performance with concordance indexes of 0.84 (95% CI, 0.83-0.85) and 0.82 (95% CI, 0.78-0.86) in the training and validation cohorts, respectively, along with well-fitted calibration curves. This study developed a precise nomogram to predict neurosyphilis risk in syphilis patients, with potential implications for early detection prior to an LP.
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Affiliation(s)
- Yilan Yang
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xin Gu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lin Zhu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuanyuan Cheng
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Haikong Lu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhifang Guan
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mei Shi
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liyan Ni
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruirui Peng
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Zhao
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Juan Wu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tengfei Qi
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fuquan Long
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhe Chai
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Weiming Gong
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Meiping Ye
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Pingyu Zhou
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
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Zheng X, Yang J, Hou Y, Shi X, Liu K. Prediction of clinical progression in nervous system diseases: plasma glial fibrillary acidic protein (GFAP). Eur J Med Res 2024; 29:51. [PMID: 38216970 PMCID: PMC10785482 DOI: 10.1186/s40001-023-01631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/29/2023] [Indexed: 01/14/2024] Open
Abstract
Glial fibrillary acidic protein (GFAP), an intracellular type III intermediate filament protein, provides structural support and maintains the mechanical integrity of astrocytes. It is predominantly found in the astrocytes which are the most abundant subtypes of glial cells in the brain and spinal cord. As a marker protein of astrocytes, GFAP may exert a variety of physiological effects in neurological diseases. For example, previous published literatures showed that autoimmune GFAP astrocytopathy is an inflammatory disease of the central nervous system (CNS). Moreover, the studies of GFAP in brain tumors mainly focus on the predictive value of tumor volume. Furthermore, using biomarkers in the early setting will lead to a simplified and standardized way to estimate the poor outcome in traumatic brain injury (TBI) and ischemic stroke. Recently, observational studies revealed that cerebrospinal fluid (CSF) GFAP, as a valuable potential diagnostic biomarker for neurosyphilis, had a sensitivity of 76.60% and specificity of 85.56%. The reason plasma GFAP could serve as a promising biomarker for diagnosis and prediction of Alzheimer's disease (AD) is that it effectively distinguished AD dementia from multiple neurodegenerative diseases and predicted the individual risk of AD progression. In addition, GFAP can be helpful in differentiating relapsing-remitting multiple sclerosis (RRMS) versus progressive MS (PMS). This review article aims to provide an overview of GFAP in the prediction of clinical progression in neuroinflammation, brain tumors, TBI, ischemic stroke, genetic disorders, neurodegeneration and other diseases in the CNS and to explore the potential therapeutic methods.
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Affiliation(s)
- Xiaoxiao Zheng
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 1#, Changchun, China
| | - Jingyao Yang
- Institute of Physiology, School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Yiwei Hou
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 1#, Changchun, China
| | - Xinye Shi
- Department of Cardiology, Shanxi Yingkang Yisheng General Hospital, Renmin North Road 5188#, Yuncheng, China
| | - Kangding Liu
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 1#, Changchun, China.
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Wu S, Ye F, Wang Y, Li D. Neurosyphilis: insights into its pathogenesis, susceptibility, diagnosis, treatment, and prevention. Front Neurol 2024; 14:1340321. [PMID: 38274871 PMCID: PMC10808744 DOI: 10.3389/fneur.2023.1340321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Background and aim Invasion of the central nervous system by Treponema pallidum can occur at any stage of syphilis. In the event that T. pallidum is not cleared promptly, certain individuals may experience progression to neurosyphilis, which manifests as cognitive and behavioral abnormalities, limb paralysis, and potentially fatal outcomes. Early identification or prevention of neurosyphilis is therefore crucial. The aim of this paper is to conduct a critical and narrative review of the latest information focusing exclusively to the pathogenesis and clinical management of neurosyphilis. Methodology To compile this review, we have conducted electronic literature searches from the PubMed database relating to neurosyphilis. Priority was given to studies published from the past 10 years (from 2013 to 2023) and other studies if they were of significant importance (from 1985 to 2012), including whole genome sequencing results, cell structure of T. pallidum, history of genotyping, and other related topics. These studies are classic or reflect a developmental process. Results Neurosyphilis has garnered global attention, yet susceptibility to and the pathogenesis of this condition remain under investigation. Cerebrospinal fluid examination plays an important role in the diagnosis of neurosyphilis, but lacks the gold standard. Intravenous aqueous crystalline penicillin G continues to be the recommended therapeutic approach for neurosyphilis. Considering its sustained prominence, it is imperative to develop novel public health tactics in order to manage the resurgence of neurosyphilis. Conclusion This review gives an updated narrative description of neurosyphilis with special emphasis on its pathogenesis, susceptibility, diagnosis, treatment, and prevention.
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Affiliation(s)
| | | | | | - Dongdong Li
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
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Oliveira R, Carvalho L, Ramos A, Cardoso MJ, Guimarães JT. A rare case of syphilitic uveitis in a 61-year-old non-HIV woman. Porto Biomed J 2024; 9:242. [PMID: 38264519 PMCID: PMC10803014 DOI: 10.1097/j.pbj.0000000000000242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
- Rita Oliveira
- Serviço de Patologia Clínica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Lídia Carvalho
- Serviço de Patologia Clínica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Angélica Ramos
- Serviço de Patologia Clínica, Centro Hospitalar Universitário de São João, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Maria João Cardoso
- Serviço de Patologia Clínica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Tiago Guimarães
- Serviço de Patologia Clínica, Centro Hospitalar Universitário de São João, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Salle R, Grange PA, Ollagnier G, Hembert R, Benhaddou N, Heller U, Dupin N. Treponema pallidum resistance to azithromycin in France: A nationwide retrospective study from 2010 to 2022. J Eur Acad Dermatol Venereol 2024; 38:e20-e21. [PMID: 37561930 DOI: 10.1111/jdv.19399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Romain Salle
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris Cité, Paris, France
- Department of General and Oncologic Dermatology, Université Paris-Saclay, UVSQ, EA4340-BECCOH, AP-HP, Ambroise-Paré Hospital, Boulogne-Billancourt, France
| | - Philippe A Grange
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris Cité, Paris, France
- Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
| | - Guillaume Ollagnier
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris Cité, Paris, France
- Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
| | - Romain Hembert
- Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
| | - Nadjet Benhaddou
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris Cité, Paris, France
- Service de Bactériologie, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
| | - Ugo Heller
- Service de Chirurgie Maxillo-Faciale, Hôpital Beaujon, APHP, Clichy, France
| | - Nicolas Dupin
- INSERM, Institut Cochin U1016-CNRS UMR8104, Équipe Biologie Cutané, Université de Paris Cité, Paris, France
- Service de Dermatologie-Vénéréologie et CeGIDD, Hôpital Cochin, APHP, CNR IST Bactériennes - Expertise Syphilis, Paris, France
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Balaji S, Chakraborty R, Aggarwal S. Neurological Complications Caused by Human Immunodeficiency Virus (HIV) and Associated Opportunistic Co-infections: A Review on their Diagnosis and Therapeutic Insights. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:284-305. [PMID: 37005520 DOI: 10.2174/1871527322666230330083708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 12/28/2022] [Accepted: 01/25/2023] [Indexed: 04/04/2023]
Abstract
Neurocognitive disorders associated with human immunodeficiency virus (HIV) infected individuals increase the risk of mortality and morbidity that remain a prevalent clinical complication even in the antiretroviral therapy era. It is estimated that a considerable number of people in the HIV community are developing neurological complications at their early stages of infection. The daily lives of people with chronic HIV infections are greatly affected by cognitive declines such as loss of attention, learning, and executive functions, and other adverse conditions like neuronal injury and dementia. It has been found that the entry of HIV into the brain and subsequently crossing the blood-brain barrier (BBB) causes brain cell damage, which is the prerequisite for the development of neurocognitive disorders. Besides the HIV replication in the central nervous system and the adverse effects of antiretroviral therapy on the BBB, a range of opportunistic infections, including viral, bacterial, and parasitic agents, augment the neurological complications in people living with HIV (PLHIV). Given the immuno-compromised state of PLHIV, these co-infections can present a wide range of clinical syndromes with atypical manifestations that pose challenges in diagnosis and clinical management, representing a substantial burden for the public health system. Therefore, the present review narrates the neurological complications triggered by HIV and their diagnosis and treatment options. Moreover, coinfections that are known to cause neurological disorders in HIV infected individuals are highlighted.
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Affiliation(s)
- Sivaraman Balaji
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research-Headquarters, Ansari Nagar, New Delhi, 110029, India
| | - Rohan Chakraborty
- Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi 110062, India
| | - Sumit Aggarwal
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research-Headquarters, Ansari Nagar, New Delhi, 110029, India
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Xiong S, Liu Z, Zhang X, Huang S, Ding X, Zhou J, Yao J, Li W, Liu S, Zhao F. Resurgence of syphilis: focusing on emerging clinical strategies and preclinical models. J Transl Med 2023; 21:917. [PMID: 38105236 PMCID: PMC10726518 DOI: 10.1186/s12967-023-04685-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Syphilis, a sexually transmitted disease (STD) caused by Treponema pallidum (T. pallidum), has had a worldwide resurgence in recent years and remains a public health threat. As such, there has been a great deal of research into clinical strategies for the disease, including diagnostic biomarkers and possible strategies for treatment and prevention. Although serological testing remains the predominant laboratory diagnostic method for syphilis, it is worth noting that investigations pertaining to the DNA of T. pallidum, non-coding RNAs (ncRNAs), chemokines, and metabolites in peripheral blood, cerebrospinal fluid, and other bodily fluids have the potential to offer novel perspectives on the diagnosis of syphilis. In addition, the global spread of antibiotic resistance, such as macrolides and tetracyclines, has posed significant challenges for the treatment of syphilis. Fortunately, there is still no evidence of penicillin resistance. Hence, penicillin is the recommended course of treatment for syphilis, whereas doxycycline, tetracycline, ceftriaxone, and amoxicillin are viable alternative options. In recent years, efforts to discover a vaccine for syphilis have been reignited with better knowledge of the repertoire of T. pallidum outer membrane proteins (OMPs), which are the most probable syphilis vaccine candidates. However, research on therapeutic interventions and vaccine development for human subjects is limited due to practical and ethical considerations. Thus, the preclinical model is ideal for conducting research, and it plays an important role in clinical transformation. Different preclinical models have recently emerged, such as in vitro culture and mouse models, which will lay a solid foundation for clinical treatment and prevention of syphilis. This review aims to provide a comprehensive summary of the most recent syphilis tactics, including detection, drug resistance treatments, vaccine development, and preclinical models in clinical practice.
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Affiliation(s)
- Shun Xiong
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Zhaoping Liu
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Xiaohong Zhang
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Shaobin Huang
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Xuan Ding
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Jie Zhou
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Jiangchen Yao
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Weiwei Li
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China
| | - Shuangquan Liu
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China.
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital, Institution of Microbiology and Infectious Diseases, Hengyang Medical College, University of South China, Hengyang, 421001, China.
| | - Feijun Zhao
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang, 421001, China.
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital, Institution of Microbiology and Infectious Diseases, Hengyang Medical College, University of South China, Hengyang, 421001, China.
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Jacobsson S, Golparian D, Oxelbark J, Kong FYS, Da Costa RMA, Franceschi F, Brown D, Louie A, Drusano G, Unemo M. Pharmacodynamics of zoliflodacin plus doxycycline combination therapy against Neisseria gonorrhoeae in a gonococcal hollow-fiber infection model. Front Pharmacol 2023; 14:1291885. [PMID: 38130409 PMCID: PMC10733441 DOI: 10.3389/fphar.2023.1291885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Antimicrobial resistance in the sexually transmitted bacterium Neisseria gonorrhoeae is compromising the management and control of gonorrhea globally. Optimized use and enhanced stewardship of current antimicrobials and development of novel antimicrobials are imperative. The first in class zoliflodacin (spiropyrimidinetrione, DNA Gyrase B inhibitor) is a promising novel antimicrobial in late-stage clinical development for gonorrhea treatment, i.e., the phase III randomized controlled clinical trial (ClinicalTrials.gov Identifier: NCT03959527) was recently finalized, and zoliflodacin showed non-inferiority compared to the recommended ceftriaxone plus azithromycin dual therapy. Doxycycline, the first-line treatment for chlamydia and empiric treatment for non-gonococcal urethritis, will be frequently given together with zoliflodacin because gonorrhea and chlamydia coinfections are common. In a previous static in vitro study, it was indicated that doxycycline/tetracycline inhibited the gonococcal killing of zoliflodacin in 6-h time-kill curve analysis. In this study, our dynamic in vitro hollow-fiber infection model (HFIM) was used to investigate combination therapies with zoliflodacin and doxycycline. Dose-range experiments using the three gonococcal strains WHO F (susceptible to relevant therapeutic antimicrobials), WHO X (extensively drug-resistant, including ceftriaxone-resistant; zoliflodacin-susceptible), and SE600/18 (zoliflodacin-susceptible strain with GyrB S467N substitution) were conducted simulating combination therapy with a single oral dose of zoliflodacin 0.5-4 g combined with a doxycycline daily oral dose of 200 mg administered as 100 mg twice a day, for 7 days (standard dose for chlamydia treatment). Comparing combination therapy of zoliflodacin (0.5-4 g single dose) plus doxycycline (200 mg divided into 100 mg twice a day orally, for 7 days) to zoliflodacin monotherapy (0.5-4 g single dose) showed that combination therapy was slightly more effective than monotherapy in the killing of N. gonorrhoeae and suppressing emergence of zoliflodacin resistance. Accordingly, WHO F was eradicated by only 0.5 g single dose of zoliflodacin in combination with doxycycline, and WHO X and SE600/18 were both eradicated by a 2 g single dose of zoliflodacin in combination with doxycycline; no zoliflodacin-resistant populations occurred during the 7-day experiment when using this zoliflodacin dose. When using suboptimal (0.5-1 g) zoliflodacin doses together with doxycycline, gonococcal mutants with increased zoliflodacin MICs, due to GyrB D429N and the novel GyrB T472P, emerged, but both the mutants had an impaired biofitness. The present study shows the high efficacy of zoliflodacin plus doxycycline combination therapy using a dynamic HFIM that more accurately and comprehensively simulate gonococcal infection and their treatment, i.e., compared to static in vitro models, such as short-time checkerboard experiments or time-kill curve analysis. Based on our dynamic in vitro HFIM work, zoliflodacin plus doxycycline for the treatment of both gonorrhea and chlamydia can be an effective combination.
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Affiliation(s)
- Susanne Jacobsson
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Joakim Oxelbark
- Division of Clinical Chemistry, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Fabian Y. S. Kong
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Francois Franceschi
- Global Antibiotic Research and Development Partnership (GARDP), Geneva, Switzerland
| | - David Brown
- College of Medicine, Institute for Therapeutic Innovation, University of Florida, Orlando, FL, United States
| | - Arnold Louie
- College of Medicine, Institute for Therapeutic Innovation, University of Florida, Orlando, FL, United States
| | - George Drusano
- College of Medicine, Institute for Therapeutic Innovation, University of Florida, Orlando, FL, United States
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London (UCL), London, United Kingdom
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Tantalo LC, Lieberman NAP, Pérez-Mañá C, Suñer C, Vall Mayans M, Ubals M, González-Beiras C, Rodríguez-Gascón A, Canut A, González-Candelas F, Mueller J, Tapia K, Greninger AL, Giacani L, Mitjà O. Antimicrobial susceptibility of Treponema pallidum subspecies pallidum: an in-vitro study. THE LANCET. MICROBE 2023; 4:e994-e1004. [PMID: 37827185 PMCID: PMC10686905 DOI: 10.1016/s2666-5247(23)00219-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The increasing incidence of syphilis and the limitations of first-line treatment with penicillin, particularly in neurosyphilis, neonatal syphilis, and pregnancy, highlight the need to expand the therapeutic repertoire for effective management of this disease. We assessed the in-vitro efficacy of 18 antibiotics from several classes on Treponema pallidum subspecies pallidum (T pallidum), the syphilis bacteria. METHODS Using the in-vitro culture system for T pallidum, we exposed the pathogen to a concentration range of each tested antibiotic. After a 7-day incubation, the treponemal burden was evaluated by quantitative PCR targeting the T pallidum tp0574 gene. The primary outcome was the minimum inhibitory concentration (MIC) at which the quantitative PCR values were not significantly higher than the inoculum wells. We also investigated the susceptibility of macrolide-resistant strains to high concentrations of azithromycin, and the possibility of developing resistance to linezolid, a proposed candidate for syphilis treatment. FINDINGS Amoxicillin, ceftriaxone, several oral cephalosporins, tedizolid, and dalbavancin exhibited anti-treponemal activity at concentrations achievable in human plasma following regular dosing regimens. The experiments revealed a MIC for amoxicillin at 0·02 mg/L, ceftriaxone at 0·0025 mg/L, cephalexin at 0·25 mg/L, cefetamet and cefixime at 0·0313 mg/L, cefuroxime at 0·0156 mg/L, tedizolid at 0·0625 mg/L, spectinomycin at 0·1 mg/L, and dalbavancin at 0·125 mg/L. The MIC for zoliflodacin and balofloxacin was 2 mg/L. Ertapenem, isoniazid, pyrazinamide, and metronidazole had either a poor or no effect. Azithromycin concentrations up to 2 mg/L (64 times the MIC) were ineffective against strains carrying mutations associated to macrolide resistance. Exposure to subtherapeutic doses of linezolid for 10 weeks did not induce phenotypic or genotypic resistance. INTERPRETATION Cephalosporins and oxazolidinones are potential candidates for expanding the current therapeutic repertoire for syphilis. Our findings warrant testing efficacy in animal models and, if successful, clinical assessment of efficacy. FUNDING European Research Council.
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Affiliation(s)
- Lauren C Tantalo
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Nicole A P Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Clara Pérez-Mañá
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol, Badalona, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clara Suñer
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain; Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
| | - Marti Vall Mayans
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Maria Ubals
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Camila González-Beiras
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Alicia Rodríguez-Gascón
- Pharmacokinetic, Nanotechnology, and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy Group, Vitoria-Gasteiz, Spain
| | - Andrés Canut
- Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy Group, Vitoria-Gasteiz, Spain; Microbiology Service, Araba University Hospital, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain
| | - Fernando González-Candelas
- Joint Research Unit Infection and Public Health, FISABIO-Universitat de València, València, Spain; Institute for Integrative Systems Biology, Universitat de València-CSIC, Paterna, Spain; CIBER Epidemiology and Public Health, Madrid, Spain
| | - John Mueller
- Innoviva Specialty Therapeutics, Waltham, MA, USA
| | - Kenneth Tapia
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Oriol Mitjà
- Sexually Transmitted Infections and Skin Neglected Tropical Diseases Section, Fight Infectious Diseases Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain; Universitat de Vic-Universitat Central de Catalunya, Vic, Spain; School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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50
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Scherler G, Tomaske M, Cannizzaro V, Steppacher A, Zucol F, Theiler M, Toutous Trellu L, Labutin A, Bosshard PP, Berger C, Meyer Sauteur PM. Congenital syphilis in Switzerland: a retrospective cohort study, 2010 to 2019. Swiss Med Wkly 2023; 153:40121. [PMID: 37988348 DOI: 10.57187/smw.2023.40121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
AIMS OF THE STUDY We previously reported a re-emergence of syphilis from 2006 to 2009 with detection of congenital syphilis in Switzerland. This study aimed to reassess the incidence of children exposed to maternal syphilis during pregnancy and congenital syphilis in a following 10-year period in the canton of Zurich, the most populous canton in Switzerland with the highest incidences of syphilis. METHODS Children were identified both by reviewing medical records at the four major neonatal and paediatric hospitals providing acute care in the canton of Zurich and by the serological database of the syphilis reference laboratory. Inclusion criteria for children were (a) date of birth in the period 2010-2019, (b) place of birth in the canton of Zurich, (c) evaluation for syphilis due to positive syphilis pregnancy screening and (d) age <1 year at diagnosis. Results were compared with epidemiological data provided by the Federal Office of Public Health (FOPH). RESULTS We identified and evaluated 17 children after potential exposure to maternal syphilis. Residual antibodies of a past infection were found in 11 mothers. Six children were identified as having had real exposure to asymptomatic maternal syphilis. From an epidemiological perspective, the distribution of the cases followed a similar pattern as confirmed syphilis cases in women of childbearing age reported to the FOPH. No cases of congenital syphilis were observed. CONCLUSIONS In contrast to the rise in syphilis infections, this study identified no cases of congenital syphilis in the canton of Zurich, Switzerland, in the period 2010-2019. Syphilis pregnancy screening may have prevented congenital syphilis by diagnosing and allowing adequate treatment of asymptomatic maternal syphilis.
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Affiliation(s)
- Gioia Scherler
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Maren Tomaske
- Department of Paediatrics, Triemli Hospital Zurich, Zurich, Switzerland
| | - Vincenzo Cannizzaro
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna Steppacher
- Department of Paediatrics, Triemli Hospital Zurich, Zurich, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Martin Theiler
- Paediatric Skin Centre, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
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