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Enhanced primary resistance to Treponema pallidum infection and increased susceptibility to toxoplasmosis in T-cell-depleted guinea pigs.

Strain 2 guinea pigs made T-cell deficient by thymectomy and irradiation and protected with syngeneic bone-marrow cells (TXB guinea pigs) have a surprisingly high level of resistance to cutaneous syphilis and to the dissemination of treponemes to the draining lymph node. Compared with normal euthymic controls infected with Treponema pallidum Nichols, syphilitic TXB guinea pigs developed fewer and less severe skin lesions and their lymph nodes contained lower numbers of treponemes. Associated with this evidence for enhanced innate resistance was the ability of the TXB host to produce, during each test interval of a primary infection, more antitreponemal antibodies than that of their euthymic counterparts. Similar levels of partial protection against cutaneous and disseminated syphilitic infection and elevated antibody levels occurred in challenged normal guinea pigs passively immunized with lymphocytes from T. pallidum-infected TXB donors. In contrast, the capacity of the TXB host to be protected against a lethal infection with the unrelated intracellular protozoan parasite Toxoplasma gondii was greatly impaired unless it received an intravenous infusion of normal syngeneic thymocytes. These seemingly paradoxical results are explained primarily in terms of a residual T-helper-cell population in the TXB guinea pig which is large and competent enough to generate antisyphilis, but not anti-Toxoplasma, immunity.

Animals↗

[Specific IgM tests in syphilis diagnosis].

A total of 359 sera of untreated patients with syphilis were examined by three methods for the detection of Treponema pallidum specific IgM antibodies, the 19S-IgM-FTA-ABS test, the IgM solid phase haemadsorption assay (IgM-SPHA), and the IgM Captia assay. The results were compared and evaluated. In primary syphilis, the 19S-IgM-FTA-ABS and IgM-captia yielded reactive results in all patients, whereas only 40% were positive in the IgM-SPHA; the corresponding values for early latent syphilis wee 96.0%, 89.8% and 73.1%, respectively. In secondary syphilis, the reactivity of one serum out of 27 was missed by IgM captia and that of another, by the IgM-SPHA. Mean values (ELISA units = extinction/cut-off) of IgM-captia were higher in primary (2.25) than in secondary syphilis (1.70). In neurosyphilis, only the IgM-SPHA test detected reactivity in all sera, sensitivity for 19S-IgM FTA-ABS and IgM-Captia was 50.0% and 23.1%, respectively. Specificity of the IgM-Captia test results, determined in 386 sera, was 91.2%. The results of specific IgM tests are essential in the diagnosis of congenital syphilis as well as in the recognition of reinfection; they indicate the need for treatment and are useful in the assessment of the effectiveness of therapy.

Antibody Specificity↗

Syphilis in the HIV-infected patient: an update on epidemiology, diagnosis, and management.

After a decade of unprecedented declines, incidence of early-stage syphilis in the United States and Europe has increased significantly since 2000. These cases have occurred at disproportionately elevated rates among people infected with HIV. Speculation continues as to whether the clinical spectrum of syphilis is qualitatively different among those individuals who are HIV infected. Recent data suggest that individuals who are immune compromised because of HIV have a higher likelihood of developing neurosyphilis. Recommendations for treatment of syphilis remain the same for patients with and without HIV.

AIDS-Related Opportunistic Infections↗

Syphilis: uncommon presentations in adults.

The clinical manifestations of syphilis are variable in appearance and have been described for centuries. The disease has been arbitrarily divided mainly into three stages. Uncommon presentations of syphilis in adults include (a) primary syphilis-atypical forms of chancre vary in size, shape, morphology, and color. Small ulcus durum is single or multiple, grouped, or herpetiform. Giant necrotic and phagedenic chancres are resolved with scar formation. In intratriginous areas, ulcus durum is rhagadiform, linear, "rocket type," or bilateral. (b) Secondary syphilids include macular (roseolas, leukomelanoderma), papular (small miliar or lichenoid, or with large size-lenticular or nummular), papulosquamous, syphilis cornee, psoriasiform, annular en cockade, nodular, condylomata lata, malignant syphilis, and others; there are also mucosal lesions, loss of the hairs, and alteration of the nails. (c) Tertiary syphilis occurs decades after infection in three main forms: gummatous, cardiovascular, and neurosyphilis (asymptomatic, meningeal, meningovascular, and parenchymatous-such as general paresis or tabes dorsalis). Early recognition of the clinical manifestations of syphilis is important for the start of treatment, recovery of patients, and the prevention of the spread of disease.

AIDS-Related Opportunistic Infections↗

Detection of the 47-kilodalton membrane immunogen gene of Treponema pallidum in various tissue sources of patients with syphilis.

Polymerase chain reaction (PCR) was used to detect the 47-kDa immunogen gene of Treponema pallidum in peripheral blood mononuclear cells (PBMCs), skin lesions, and serum, but less consistently in purified granulocytes or ejaculates of patients with manifest and latent syphilis. Therefore, skin lesions and PBMCs may serve as the most reliable sources for a PCR-based diagnosis of syphilis.

Base Sequence↗

Syphilis in adults.

This article reviews the clinical manifestations of syphilis, diagnostic tests that might help to diagnose accurately the disease, and current recommendations for therapy. The association of syphilis and human immunodeficiency virus infection raises additional questions related to transmission, diagnosis, and therapy of both diseases.

Adult↗

[Clinical and serological findings of syphilis in HIV-infected patients].

To identify the characteristic features of lues in patients infected with HIV, 402 HIV-positive patients were examined for serological and clinical signs of lues. 141 patients (133 male, 8 female, mean age 36 [18-69] years) had a positive lues serology. Treatment for lues was required in 20 of the 141 cases (14%). In ten patients (one case of lues I, nine cases of lues II) dermatological signs were predominant, macular exanthemas (n = 4) and palmo-plantar syphilides (n = 3) being most frequent. Three patients had seropositive latent lues. Eight patients presented with signs of an active neurolues (lues II: n = 1; lues III: n = 6; lues IV: n = 1). In three of the eight cases the serum FTA-ABS-IgM findings were negative. In these three patients the need for a specific treatment was realized only on the basis of cerebrospinal fluid (CSF) examination in conjunction with the clinical findings and the anamnesis. This result makes it very clear that indication for CSF puncture should be more liberal in some HIV infected patients. The markedly high proportion of cases of neurolues (40% of the luetic patients requiring treatment) is possibly due to reactivation of old lues infections.

AIDS-Related Complex↗

Questionnaire survey of reported early congenital syphilis: problems in diagnosis, prevention, and treatment.

A retrospective questionnaire survey of a sample of 173 of the 360 cases of early congenital syphilis reported in 1972 revealed serious problems with diagnostic certainty, prevention, and treatment of congenital syphilis. Only 24 (13.9%) of the reported cases could be categorized as probably or definite cases based on criteria developed from a literature review. Forty percent of the mothers received no prenatal care and an additional 19% received no prenatal care until the third trimester. Initial and followup serologic testing was inadequate in those who received care. Eighty-three different penicillin treatment schedules were used in the treatment of 128 infants. Carefully reasoned diagnostic and therapeutic decision making about the management of congenital syphilis appears to be lacking.

Adolescent↗

Transfer of resistance to syphilitic infection from maternal to newborn guinea pigs.

Partial protection against cutaneous syphilis and dissemination of treponemes to the regional lymph nodes was achievable in Treponema pallidum-infected neonatal strain 2 guinea pigs having syphilis-immune mothers. This evidence for enhanced resistance was associated with the natural transfer of antitreponemal, maternally derived immunoglobulins before parturition.

Animals↗