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Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
CSF examination: Used for investigation of neurosyphilis. Those with symptomatic neurosyphilis will typically have abnormal CSF WCC (>5 cells (lymphocytes)/mm). CSF ab testing can be helpful (if not bloody tap), VDRL being more sensitive than RPR, but false negatives and positives are not uncommon.
Sexually Transmitted Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Aarthy K. Uthayakumar, Christopher B. Bunker
Laboratory studies: The diagnosis is most commonly made serologically, using a technique first described by August von Wasserman (1866–1925) in 1906. The 2 types of serologic tests include nontreponemal and treponemal specific tests. Non-treponemal tests are cheaper and therefore more commonly used—usually the rapid plasma reagin (RPR) or venereal disease research laboratory tests, which detect the titer of antibody present. Treponemal tests are serologic tests which once positive, remain positive for life, and therefore cannot be used to confirm possible reinfection of syphilis in prior treated disease. Darkfield microscopy can be used in primary, secondary, or tertiary syphilis to identify the T. pallidum organism and its characteristic corkscrew movements.
Neuroinfectious Diseases
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Jeremy D. Young, Jesica A. Herrick, Scott Borgetti
First, obtain a serum treponemal test, such as the syphilis enzyme-linked immunosorbent assay (ELISA), fluorescent treponemal antibody (FTA), or microhemagglutination for antibodies to T. pallidum (MHA-TP) assay. If reactive, a rapid plasma reagin (RPR) titer should be performed.7 If there is a very high load of spirochetes, such as during secondary syphilis, the prozone effect may be present, creating a false-negative RPR. If this is suspected, the laboratory should dilute the sample and repeat the test. Importantly, specific treponemal tests typically remain positive for life, regardless of treatment, while nontreponemal tests such as the RPR will have fluctuating values in response to time since infection or treatment and can become nonreactive. It is important to follow the RPR response after treatment.
Early congenital syphilis: missed opportunities in a mother owing to many problems during pregnancy – a case report
Published in Paediatrics and International Child Health, 2022
Shilpa Krishnapura Lakshminarayana, Sahana Devadas, K. Bharath, Mallesh Kariyappa, Bindushree Byadarahalli Keshavamurthy, Megha S. Bagewadi, Sushma Veeranna Sajjan, Dadegal Vineet, Thanzir Mohammed
A 26-year-old multigravida with a poor obstetric history was admitted in labour in the 7th month of her fourth pregnancy. Her first pregnancy was delivered at term but the infant died of sepsis in the early neonatal period, the second was a spontaneous miscarriage in the 2nd month and the third a stillbirth at 7 months gestation. Records of the previous pregnancies were not available. Her present pregnancy was registered for ANC in the 5th month. She said she had avoided the health facilities, fearing infection by COVID19. Screening for syphilis on admission for delivery using the qualitative RPR test was negative. She reported having genital ulcers before the second pregnancy, a febrile illness in the 7th month of her third pregnancy and recurrent genital ulcers 2 months before and in the 5th month of her present pregnancy for which she had visited healthcare facilities for treatment. Her clinical examination was normal.
Alopecia syphilitica, from diagnosis to treatment
Published in Baylor University Medical Center Proceedings, 2022
Mojahed Mohammad K. Shalabi, Brooke Burgess, Samiya Khan, Eric Ehrsam, Amor Khachemoune
Methods currently used for diagnosis of AS include serological screening, immunohistochemistry, and polymerase chain reaction (PCR). Serological, nontreponemal tests such as Venereal Disease Research Laboratory (VDRL) and rapid plasma reagin (RPR) tests diagnose secondary syphilis at 100% sensitivity.10 When used to screen for syphilis, VDRL and RPR have a high sensitivity; however, false-positives are common due to the cross-reactivity with antigens associated with other conditions, such as infectious mononucleosis, rheumatoid arthritis, lupus, and leprosy. Because false-positives may occur with screening tests, the fluorescent treponemal antibody absorption (FTA-ABS) test serves as a specific, confirmatory test to rule out false-positives.11,12
Clinical Manifestations and Cerebrospinal Fluid Status in Ocular Syphilis
Published in Ocular Immunology and Inflammation, 2019
Steven Lapere, Hamzah Mustak, Jonel Steffen
Syphilis testing at our hospital follows a reverse sequence testing algorithm. A serum treponemal specific test is performed first (TPAb). If this test result is negative, no further testing is required, and the diagnosis of syphilis is ruled out. If this test result is positive, an undiluted serum rapid plasma reagent test (s-RPR) is performed. In specimens with a positive s-RPR, a titration test is performed to determine the titre. Testing of cerebrospinal fluid at our hospital follows a similar reverse sequence testing algorithm to the serum test, where a treponemal test (FTA) is performed first and, if positive, it is followed by a non-treponemal test (VDRL). Lumbar puncture findings were considered abnormal if there was a positive FTA or VDRL. Protein and lymphocyte levels in the cerebrospinal fluid were analyzed for statistical purposes. All tests were performed on site by the National Health Laboratory Services.