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[Extraction of the soluble protein fraction from Treponema Reiter for use as antigen in syphilis serodiagnosis].

The present paper reports on two methods for extraction of the protein antigen from Treponema Reiter and shows the chemical and immunochemical characteristics of the extracts. Serologic testing of 1810 sera from syphilitic patients in various stages of the disease, from healthy subjects and from subjects with a false positive reaction to lipoid antigens, showed the value of the Reiter antigen to be equal to the cardiolipin antigens and those prepared from pathogenic Treponema. It is recommended to associate this antigen, in view of its qualities, to the cardiolipin tests used in the serodiagnosis of syphilis, especially in the laboratories that do not currently apply other treponema tests.

Antigens

[Practical significance of syphilis serodiagnosis].

Recent developments in syphilis serology are set down. The new specific tests for treponema pallidum are described. Reactivity in different stages of the disease including congenital and neurosyphilis is discussed. An outline is given of the possibilities of the IgM-FTA-ABS and 19 S IgM-FTA-ABS tests. Syphilis serology today requires only 3 tests: a screening procedure, where the specific AMHA-TP is the method of choice, FTA-ABS test should be used for confirmation, and the quantitative VDRL in order to follow up the effectiveness of treatment.

Complement Fixation Tests

Serodiagnosis of syphilis: antibodies to recombinant Tp0453, Tp92, and Gpd proteins are sensitive and specific indicators of infection by Treponema pallidum.

Syphilis serodiagnosis relies on a combination of nonspecific screening tests (antilipoidal antibodies) and Treponema pallidum-specific tests (anti-T. pallidum antibodies). We studied a group of six recombinant T. pallidum antigens for their sensitivities and specificities with sera from individuals with syphilis (n = 43), relapsing fever (n = 8), Lyme disease (n = 8), and leptospirosis (n = 9) and from uninfected individuals (n = 15). Three recombinant proteins, Tp0155, Tp0483, and Tp0751, demonstrated sensitivity values that ranged from 28 to 42%. In contrast, three other recombinant proteins exhibited the following sensitivity and specificity values: Tp0453, 100% sensitivity and 100% specificity; Tp92 (Tp0326), 98% sensitivity and 97% specificity; and Gpd (Tp0257), 91% sensitivity and 93% specificity. Tp0453, Tp92, and Gpd also were recognized by sera from individuals with early primary syphilis that were nonreactive with the antilipoidal Venereal Disease Research Laboratory test. The reactivities of syphilis patient sera with Tp0453, Tp92, and Gpd were proportional to the titers of these sera with the treponemal test MHA-TP (microhemagglutination assay for T. pallidum). Thus, the recombinant T. pallidum antigens Tp0453, Tp92, and Gpd show promise as diagnostic antigens in the enzyme-linked immunosorbent assay-based assay.

Antigens, Bacterial

Treponema pallidum immune adherence test for serodiagnosis of syphilis. 1: An improved method of the TPIA test.

Clinical investigations using the Treponema pallidum immune adherence (TPIA) test as reported by Nelson (1953) were performed only by Olansky et al in 1954. In this paper an improved method of the TPIA test is described. The test was simple to perform and was highly specific for antitreponemal antibody. Furthermore, as it was possible to use heated T. pallidum as antigen the antigen suspension could be preserved for long periods. The TPIA test for syphilis was evaluated by examining the sera from 40 healthy subjects and from 166 patients with syphilis.

Complement System Proteins

Treponema pallidum immune adherence test for serodiagnosis of syphilis. 2: Comparison with glass plate, TPHA, and FTA-ABS tests.

Using sera from 340 patients with syphilis the Treponema pallidum immune adherence (TPIA) test was compared with the glass plate, T. pallidum haemagglutination (TPHA), and fluorescent treponemal antibody-absorbed (FTA-ABS) tests. The results of the TPIA test agreed with those of the glass plate, TPHA, and FTA-ABS tests in 65%, 82%, and 73% of cases respectively. In the quantitative TPIA test no significant correlation with the other tests was observed, and it is, therefore, concluded that the TPIA test has highly individual characteristics. From gel filtration the particular feature of the test was its high sensitivity to the IgM antibody. The TPIA test thus appears to be suitable for estimating antibody in the early stages of the disease.

Chromatography, Gel

Treponema pallidum immune adherence test for serodiagnosis of syphilis. 3: Clinical significance and evaluation of treatment.

Antibody titres were measured in patients with clinical syphilis, and the effect of treatment on the results of the Treponema pallidum immune adherence (TPIA) test is reported. In the Treponema pallidum haemagglutination (TPHA) test little change in antibody titre occurred after treatment while in the fluorescent treponemal antibody-absorbed (FTA-ABS) test only a slight decrease occurred. The decrease in the antibody titre in the TPIA test was similar to that in the glass plate test, but the findings were different. From the results of gel filtration of sera obtained from patients with syphilis at different intervals after treatment it was apparent that the decrease in antibody titre after treatment mainly concerned the IgM antibody; thus, because of the high sensitivity of the TPIA test to IgM antibody the test is useful in evaluating the effect of treatment.

Antibodies, Bacterial

[Serodiagnosis of syphilis from the viewpoint of the immunologist].

A review of the immunology of the serological diagnosis of syphilis is given and modern methods for the demonstration of treponema-specific antibodies are shown. The possible combinations of test results and interpretations of these are discussed. The importance of the demonstration of treponema-specific IgM-antibodies not only for diagnosis but also for basis of treatment is finally pointed out.

Adult

[Passive haemagglutination test in serodiagnosis of syphilis. Survey of a one-year trial in a venereal diseases prophylactic center (author's transl)].

We report here a one-year study of the reliability of the Treponema pallidum Haemagglutination Test (TPHA) in the serological diagnosis of syphilis. By comparing TPHA data with the diagnosis based on a set of grouped criteria, we were able to determine TPHA accuracy. All studies were conducted at the Antivenereal Prophylactic Center, in Nice, France, on 1,775 sera. The grouped data consisted of:--Serological Test for Syphilis (STS) using cardiolipin antigen,--medical and epidemiological records;--two specific reactions; namely the Fluorescent Antibody Test (FTA) and the Treponema Immobilisation Test (TIT). Reliability is excellent in 98.58 p. 100: the TPHA either proves syphilis or eliminates this diagnosis. The TPHA was particularly useful in investigating "problem sera" for which there existed conflicts in the grouped data. The applicability of TPHA is limited, however, in that it has low sensitivity during early primary syphilis, and it cannot be used to monitor antibodies during treatment. Nevertheless, TPHA, based on a standard specific antigen, is assured of a high place among the tools of serological diagnosis of syphilis because of its high accuracy and sensitivity, its objective and easily read results, and the simplicity of its technique.

False Negative Reactions

[Passive hemagglutination test in the serodiagnosis of syphilis].

Passive haemagglutination test with pathogenic Treponema pallidum antigen in the serodiagnosis of syphilis, carried out on 752 sera (518 syphilitic patients and 234 subjects without evidence of syphilis) showed a greater general sensitivity as compared the cardiolipin tests and complement fixation test with Reiter protein antigen, and lower, to immunofluorescence (FTA--ABS). Its specificity is relatively lower than that of the cardiolopin and treponemal tests. Associated with the cardiolipin test it may be preferably used for the detection of syphilis, and moreover, passive haemagglutination may confirm the diagnosis in case of weak positive results with the FTA--ABS test. The latter is, however, essential for problem cases.

Antigens, Bacterial

[Syphilis serology: "ELISA", a third generation test].

The characteristics and the working modalities of ELISA (Enzyme Linked Immunosorbent Assay) are outlined at the onset. Subsequently, the Authors refer the data relevant to the use of ELISA in the syphilis serodiagnosis, by describing the operative phases for the working out of the test with the enzyme peroxidase, and reporting the results of the clinical investigation performed on primary and secondary syphilis in progress, on treated primary and secondary syphilis (examinations performed 1 to 10 years after the end of therapy), on healthy blood donors, and on samples of false biological positivities. On the basis of the analysis of the results, the Authors feel that ELISA for its characteristics of sensitivity, easiness in carrying out, rapidity and reproducibility, might find a rational indication in the modern serodiagnosis of the syphilis.

Blood Donors

Reinfection primary and secondary syphilis: the post treatment serologic response.

It has long been observed that patients with reinfection primary and secondary syphilis have a slower serologic response to treatment than those with an initial infection. The case records of three patients with reinfection primary and seven patients with reinfection secondary syphilis were examined and confirmed the clinical observation.

Fluorescent Antibody Technique

Evaluation of hysterectomized women seen at a clinic for treatment of sexually transmitted diseases.

Thirty-one women who had had total hysterectomies, seen in a venereal disease clinic, were interviewed and examined. Thirteen (31%) of the 31 women had acquired one or more venereal infections after hysterectomy. The diseases, listed in order of decreasing frequency, were trichomoniasis (four cases), gonorrhea (three), early latent syphilis (three), vaginal candidiasis (three), secondary syphilis (two), late latent syphilis (two), and condyloma acuminatum (one). These results indicate that clinicians working in venereal disease clinics must maintain as high an index of suspicion of sexually transmissible diseases for women with hysterectomies as for all other women.

Adult