Treatment efficacy in patients with secondary recurrent and latent early syphilis based on a new abbreviated method

The authors analyze the findings of clinical and serological follow-up of 370 patients with secondary relapsing and early latent syphilis treated with a new rapid method. This method consists in intramuscular injections of water-soluble penicillin in high daily doses (4,000,000, 6,000,000, 8,000,000 U) made for 3-4 weeks. The follow-up period of 1-6 years has confirmed a high therapeutic efficacy of this method.     

The clinical characteristics of patients with Reiter's disease

The authors analyze 46 case histories of patients with Reiter's disease. They describe the clinical, bacteriological, serological, and x-ray examinations and the features of the disease course. The majority (97.7%) of patients have developed the disease after casual sexual intercourse. Fifteen patients suffered from an acute disease, in the rest it coursed without manifest general symptoms. The principal and permanent symptom of Reiter's disease is urethritis complicated by prostatitis and vasculitis. The drugs for this disease are listed. The authors necessitate examinations and sanitation of the patients' sexual partners.     

Case for diagnosis. Atypical genital lesion

We present a case of a penile lesion with a clinical appearance similar to Mondor penile disease (thrombosis of the dorsal vein of the penis) or penile sclerosing lymphangitis. Laboratory evaluation, however, showed a solid lesion, with no vascular component to Doppler ultrasonography and no treponema to immunohistochemistry. Histological and serological tests were compatible with secondary syphilis. The authors reinforce the need for the inclusion of syphilis in the differential diagnosis of penile cord injuries.     

抗RNP抗体与结缔组织病

本文报告以小牛胸腺提取物(ENA),并用被动血凝法和对流免疫电泳法,测定5家医院785例患者,分析150例抗体阳性患者的结果.抗RNP抗体在混合性结缔组织病(MCTD)中阳性率最高,为100%.该抗体也见于其他结缔组织病(CTD),偶见于非CTD,但血清效价低.高效价的抗RNP抗体有助丁MCTD的诊断,可作为该病的血清学标记.抗RNP抗体同某些临床表现相伴,可能同其发病机理有关.通过本研究,我们认为MCTD为一个独立疾病,其具有一组特征性临床表现和免疫学异常. Sharp(1983)提出的MCTD诊断标准具有一定的实用意义,值得进一步探讨.     

Serological response to syphilis treatment in HIV-positive and HIV-negative patients attending sexually transmitted diseases clinics

BACKGROUND: HIV-positive patients treated for syphilis may be at increased risk for serological failure. OBJECTIVE: To compare follow-up serologies and serological responses to treatment between HIV-positive and HIV-negative patients attending two sexually transmitted disease (STD) clinics. STUDY DESIGN: Existing records were reviewed from HIV-positive patients who were diagnosed and treated for syphilis at the public STD clinics in Baltimore, Maryland, USA, between 1992 and 2000. Results of their serological follow-up were compared with those of HIV-negative clinic patients at the time of syphilis treatment. Failure was defined as lack of a fourfold drop in rapid plasma reagin (RPR) titre by 400 days after treatment or a fourfold increased titre between 30 and 400 days. RESULTS: Of the 450 HIV-positive patients with syphilis, 288 (64%) did not have documented follow-up serologies and 129 (28.5%) met the inclusion criteria; 168 (17%) of 1000 known HIV-negative patients were similarly eligible. There were 22 failures in the HIV-positive group and 5 in the HIV-negative group (p<0.001). The median times to successful serological responses in both groups were 278 (95% confidence interval (CI) 209 to 350) and 126 (95% CI 108 to 157) days, respectively (p<0.001). A multivariate Cox's proportional hazards model showed an increased risk of serological failure among the HIV-positive patients (hazards ratio 6.0, 95% CI 1.5 to 23.9; p = 0.01). CONCLUSION: HIV-positive patients treated for syphilis may be at higher risk of serological failure. Despite recommendations for more frequent serological follow-up, most patients did not have documentation of serological response after standard treatment for syphilis.     

Are serological tests of value in diagnosing and monitoring response to treatment of syphilis in patients infected with human immunodeficiency virus?

To assess the value of serological tests in diagnosing and monitoring the response to treatment of syphilis in patients infected with the human immunodeficiency virus (HIV), case notes of eight homosexual men with a history of treated syphilis, positive reactions to serological tests for syphilis, and documented subsequent conversion to HIV seropositivity were studied. No change was noted in serological markers of syphilis after HIV infection. The case notes of one man with primary syphilis, four men with secondary syphilis, and three men with latent syphilis, of whom all were HIV seropositive, were also studied. In seven of these patients the serological responses to infection and after treatment were consistent with the experience of syphilis in HIV seronegative patients. In one man treated for secondary syphilis, and confirmed as HIV seropositive eight months after treatment, the rapid plasma reagin (RPR) test result continued to be positive at a high titre for up to 20 months after treatment.     

False positive VDRL (BFP-STS) and systemic lupus erythematosus; new data in clinico-laboratory associations

AIM: To investigate the relationships between clinical features and serological parameters in systemic lupus erythematosus (SLE) patients with false positive venereal disease research laboratory (VDRL) test (BFP-STS) and those without. METHODS: The records of 74 patients with SLE were reviewed. These were divided on the basis of the presence of a biologically false positive serological test (BFP-STS) (n = 18) or its absence (n = 56). The clinical features and serological parameters were subsequently evaluated in each group. RESULTS: A biologically false positive serological test was found in 18 patients (24.5%). Clinically, they had a significantly higher frequency of malar rash (P < 0.02), hemolytic anaemia (P < 0.02) and SLE-related antiphospholipid (APL) syndrome (P < 0.02). Neuropsychiatric lupus was more frequent in the group without BFP-STS. Moreover, subacute cutaneous LE (SCLE), Raynaud's phenomenon, livedo reticularis (LR) and cardiopulmonary complications were present only in the latter group. There was no significant association between BFP-STS and other autoantibodies including Extractable nuclear antigen (ENAs), however, there was a significant association with C3 hypocomplementemia (P < 0.05). Half of the patients with BFP-STS were positive for anticardiolipin antibodies (aCL Abs) vs. 28% in the negative group (P = NS). CONCLUSIONS: The study suggests that the clinical and serological relevance of BFP-STS in lupus patients may vary from those described in relation to other antiphospholipid determinants. Our patients appeared to have sparing of certain major organ systems, yet there was a greater tendency to developing Antiphospholipid (APL) syndrome and hemolytic anaemia.     

Immunoglobulin A, G, and M responses to L1 and L2 capsids of human papillomavirus types 6, 11, 16, 18, and 33 L1 after newly acquired infection

OBJECTIVES: We performed a study to establish the pattern of serological reactivity for immunoglobulins (Ig), to capsids of human papilloma virus (HPV) after new HPV infection in two groups of subjects. METHODS: The pattern of serological reactivity after acquisition of infection with HPV was investigated by measuring IgA, IgM, and IgG antibodies to capsids containing L1 and L2 proteins of HPV types 6, 11, 16, 18, and 33 in longitudinal studies of groups with different patterns of sexual activity. Individuals who tested negative for HPV DNA by the polymerase chain reaction at enrolment, but who became HPV DNA positive during follow up, were examined for antibodies to HPV capsids by enzyme linked immunosorbent assay. One group consisted of 15 young girls (with eight controls who remained HPV DNA negative) who were becoming sexually active and the other comprised 12 male (with five controls) and 35 female (with seven controls) heterosexual attenders of a sexually transmitted disease clinic who had had multiple sexual partners. RESULTS: The sexually inexperienced girls showed IgA and IgG responses, but seldom an IgM response to infection with HPV types 6/11, 16, and 18. No consistent pattern of serological reactivity was apparent for the heterosexuals with multiple partners. The lack of association between current HPV DNA positivity and detectable antibodies in these individuals was possibly related to the duration of infection or to prior exposure to HPV. For the latter group serological reactivity to HPV capsids was significantly greater in women than in men (p = 0.001, p = 0.003, and p = 0.024, for IgG to HPV 6, 11, and 16, respectively). CONCLUSION: The sex difference in antibody response detected in previous studies with assays based on peptide antigens was thus corroborated in the present study with capsid based serological assays. This sex difference might reflect a difference in sexual activity and prior exposure to HPV between men and women in this particular group.     

梅毒患者治疗后血清学转归的影响因素探讨

目的探讨影响梅毒治疗后血清转归的相关因素。方法回顾性研究226例HIV阴性梅毒患者的临床资料,观察驱梅治疗1年后血清痊愈或血清固定发生的情况,对影响血清固定的患者年龄、病期、性别、快速血浆反应素环状卡片试验（RPR）初始滴度、治疗用药等因素进行多因素Logistic分析。结果226例患者中,154例（68．1％）血清痊愈,72例（31．9％）发生血清固定,随着病期延长,血清固定发生率增加。多因素Logistic分析结果显示,驱梅治疗后发生血清固定的因素包括：女性患者（OR=2．517,95％CI：1．159～5．464）、初始RPR滴度≤1：16（OR=4．370,95％C1：1．311-14．562）和非苄星青霉素治疗（OR=4．959,95％CI：1．650-14．901）,而与血清学痊愈相关的临床特征包括：一期梅毒和二期梅毒患者和年轻患者（≤25岁）（均P〈0．05）。结论梅毒治疗后血清学痊愈或固定与患者病期、性别、年龄、RPR基线滴度、治疗药物有关。     

Re Facial aesthetic injections in clinical practice: Pretreatment and post-treatment consensus recommendations to minimise adverse outcome Region-specific changes in line with the Covid-19 pandemic

Despite the recent publication in March 2020 of guidelines for facial injectable treatments, the speed of the COVID-19 pandemic and its safety implications necessitate changes to these guidelines The authors described what would constitute safest practice in the provision of facial injectable treatments and summarised these in table form. Adherence to a high standard of asepsis and infectious disease precautions remain a key patient safety requirement when performing facial aesthetic injections. A revision and update of these guideline summary tables follows. Changes made should enhance both patient and staff safety regarding COVID-19/SARS-CoV-2, a highly infective respiratory pathogen transmitted by respiratory droplets, respiratory/mucosal secretions and contaminated fomites. Some of the additions are COVID-19 specific and are likely to evolve and change, particularly should serological tests determining acquired immunity become available. Other additions represent further tightening of our infection control precautions.     

疱疹样皮炎的血清学研究进展

疱疹样皮炎是一种与肠病有关的谷胶敏感性皮肤病，皮损表现为瘙痒性的红斑、丘疹、水疱，直接免疫荧光所见的IgA在真皮乳头层颗粒状沉积对疱疹样皮炎诊断有重要价值。尽管病理学检查和直接免疫荧光一直被认为是疱疹样皮炎诊断的金标准，但对于一些症状不典型或取材位置不当无法确诊的病例，血清学检查有着不可替代的作用，血清学检查对于疱疹样皮炎患者的疗效评估和随访均具有重要价值。随着对疱疹样皮炎发病机制的不断认识，新的血清学检测技术也在不断进步，同时通过血清学检查对DH患者血清中多种抗体水平的分析，为疱疹样皮炎发病机制的研究提供了更多线索。     

疑似梅毒患者血液47KDa和15KDa膜免疫原基因的测定

目的研究巢式聚合酶链反应(PCR)在排除梅毒血清学试验假阳性中的作用。方法用巢式PCR和常规PCR扩增90例疑似梅毒患者全血中梅毒螺旋体(TP)的47KDa和15KDa的膜免疫原基因,并与血清学方法(RPR,TPPA)的检验结果作比较。结果巢式PCR检测TP的敏感性和特异性分别为93.33%和96.67%,两者符合率为96.67%;两种PCR方法检测结果差异有统计学意义(P<0.01),巢式PCR敏感性高于常规PCR。结论巢式PCR检测全血中TP较常规PCR灵敏,通过检测47KDa和15KDa的膜免疫原基因,有助于排除梅毒血清学试验假阳性,提高了梅毒诊断的准确率。     

The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas

Patients diagnosed as suffering from erysipelas or cellulitis were subjected to bacteriological and serological investigations. The serological tests used included the anti-streptolysin O reaction (ASO), the anti-deoxyribonuclease B test (ADB) and the anti-hyaluronidase tests (AHT) that are specific both for the group A streptococcus (Streptococcus pyogenes) and for the human pyogenic streptococci of group C or group G. Antibody tests to the alpha-lysin and the nuclease of Staphylococcus aureus were also employed. Conventional bacteriological culture methods were used plus needle aspiration of injected saline in most patients with erysipelas, but recognized pathogens were isolated in only 42% of cases. Our results indicate the limitations of these tests for making initial diagnoses and deciding treatment. Serial serological testing was very successful in differentiating cellulitis due to group A, C or G haemolytic streptococci, or occasionally Staphylococcus aureus, but was positive in only 40% of cases of erysipelas.     

Autoimmune diabetes recurrence should be routinely monitored after pancreas transplantation

Autoimmune type 1 diabetes recurrence in pancreas grafts was first described 30 years ago, but it is not yet completely understood. In fact, the number of transplants affected and possibly lost due to this disease may be falsely low. There may be insufficient awareness to this entity by clinicians, leading to underdiagnosis. Some authors estimate that half of the immunological losses in pancreas transplantation are due to autoimmunity. Pancreas biopsy is the gold standard for the definitive diagnosis. However, as an invasive procedure, it is not the ideal approach to screen the disease. Pancreatic autoantibodies which may be detected early before graft dysfunction, when searched for, are probably the best initial tool to establish the diagnosis. The purpose of this review is to revisit the autoimmune aspects of type 1 diabetes and to analyse data about the identified autoantibodies, as serological markers of the disease. Therapeutic strategies used to control the disease, though with unsatisfactory results, are also addressed. In addition, the author’s own experience with the prospective monitoring of pancreatic autoantibodies after transplantation and its correlation with graft outcome will be discussed.     

Hepatitis B virus infection among Chinese residents in the United Kingdom

OBJECTIVE: To determine prevalence of hepatitis B virus (HBV) serological markers in Chinese residents in the United Kingdom. METHOD: Retrospective case-controlled study between January 1997 and June 2000 in two genitourinary medicine (GUM) clinics. RESULTS: 117 Chinese and 234 non-Chinese controls were studied. Baseline characteristics except marital status showed no difference. Overall prevalence of HBV serological markers was 35.8% in Chinese, controls 5.5% (p<0.001). Hepatitis B surface antigen (HBsAg) positive carrier rate was 12.8% in Chinese, controls 0.4% (p<0.001); 1.7% of Chinese patients were also hepatitis B e antigen (HBeAg) positive, none in controls. Natural immunity was acquired in 23.0% of Chinese, controls 5.1% (p<0.001). Prevalence of HBV serological markers in UK born Chinese was 6.7%, non-UK born Chinese 40.1% (p<0.011). Only 7.6% of Chinese had a history of previous HBV vaccination. CONCLUSIONS: Prevalence of HBV serological markers among Chinese patients attending two GUM clinics in London was high and only a minority of Chinese had immunisation against HBV. Although the prevalence of HBV markers in UK born Chinese was lower than non-UK born Chinese, they may be at continuous risk of HBV infection. Non-UK born Chinese patients attending GUM services in the United Kingdom should be targeted for screening and vaccination to reduce HBV transmission.     

Terbinafin-induzierter subakut-kutaner Lupus erythematodes

We report on a patient with terbinafine-induced SCLE covering clinical, histopathological and serological findings. Positive serological results included ANA, SS-A (Ro)-antibodies and anti-histone-antibodies with specificity for H1 and H3. The literature on terbinafine-induced SCLE is reviewed. We discuss H1- and H3-specific anti-histone antibodies as a possible diagnostic criterion of drug-induced SCLE.     

深圳市南山区684例妊娠梅毒患者随访率影响因素分析

目的:明确深圳市南山区妊娠梅毒患者抗梅毒治疗后随访率的影响因素。方法:对684例规则治疗后的妊娠梅毒患者进行健康宣教和发放随访通知卡。结果:一年内规则随访率为74.56%。年龄、职业、文化程度、血清学滴度、妊娠结局与随访率相关,具有统计学意义(均P0.0001)。结论:梅毒患者随访率的影响因素包括年龄、职业、文化程度、妊娠结局、血清学滴度。     

The course of early syphilis in morphine base-dependent rabbits

Eleven rabbits made dependent on morphine base were observed which were infected with syphilis studying the clinical and serological course of the infection. The control group comprised five non-dependent rabbits infected with syphilis. After 30 days from the infection all animals were given procaine penicillin in daily doses of 75,000 mu/kg. The treatment was carried on for 20 days. In all animals the following serological tests: VDRL, IgG, FTA, TPHA, and TPI were done before the treatment and 1, 3, 6, and 12 months after it. Ulcerations at the site of injection of Nichols strain of spirochetae in all morphinedependent rabbits developed earlier (5-6 days after infection) than in controls (9-10 days), were much larger and persisted longer, while the antibody titres were lower, as a rule, in the morphine-dependent animals. The results presented justify the conclusion that the clinical and serological course of the early stages of syphilis is different in the morphine-dependent animals when compared with controls.     

Gumma of the testis and penis.

The case is described of a patient suffering from gummata of the testes and of the penis, and asymptomatic neurosyphilis. The diagnosis was made on the clinical findings and the strongly positive serological tests for syphilis. It was further supported by the response to penicillin.     

Serological detection of leprosy employing Mycobacterium leprae derived serine-rich 45 kDa, ESAT-6, CFP-10 and PGL-I: a compilation of data from studies in Indian populations

This article is a compilation of our findings recorded in the recent past where we have investigated the serological performance of Mycobacterium leprae antigens like-serine-rich 45 kDa protein (45 kD), early secretary antigenic target-6 (ESAT-6), culture filtrate protein-10 (CFP-10) and phenolic glycolipid-I (PGL-I) for detection (employing antibody detecting ELISA) of leprosy patients, particularly those belonging to the paucibacillary (PB) group. All of these antigens were capable of detecting, by themselves the majority (82-100%) of multibacillary (MB) patients. However, with respect to PB patients, only 18-47% (i.e. less than half) of the cases could be detected. Based on the results of serological assays for each of the four antigens separately a combinatorial approach was performed for these antigens, which increased the sensitivity for detection of PB patients to 73%, giving 36% improvement over conventional PGL-I based ELISA. Thus, the multi-antigenic serological approach is worthwhile for its establishment for detection of leprosy patients. Since ESAT-6 and CFP-10 are secreted proteins by nature, antibodies against them are worth exploring for detection of early infections and for monitoring of treatment efficiency. Nevertheless, efforts towards identification of more new antigens with serological potential are still desirable in order to further improve the detection rate of leprosy.