Transmission of Syphilis by Solid Organ Transplantation

Two organ recipients developed serologic evidence of syphilis infection after renal transplantation from a common deceased donor with a history of treated syphilis. Testing of donor serum for syphilis, which occurred after transplantation, gave results interpreted as consistent with past infection. However, subsequent serologic results in the recipients suggested transmission of infection at transplantation due to active infection of the donor. This may be explained by recent donor re-infection in view of the current syphilis epidemic in the United Kingdom. An initial error in the treatment of recipients further served to highlight unfamiliarity in managing this resurgent infection in the context of organ transplantation.     

PCR扩增梅毒螺旋体poIA基因及其在一期梅毒诊断中的应用

目的提高对梅毒诊断的灵敏性和特异性。方法运用PER扩增了梅毒螺旋体(Tp)的DNA多聚酶I基因(polA)的特异性片段,检测了该方法的特异性和灵敏性;用该方法检测了118例生殖器溃疡,同时用Tp PCR试剂盒和血清学方法平行检测同批病人的溃疡或血清标本。结果polA PCR只在扩增Tp时有特异性产物,灵敏性约为20个Tp拷贝;检测118例生殖器溃疡标本,用Tp PCR试剂盒为对照,polA PCR方法的特异性和灵敏性分别为96.8％和95.7％,两种PCR检验结果差异无显著性(x2=0.25,P>0.05);polA PCR方法与血清学方法对一期梅毒诊断结果差异有显著性(x2=4.45,P<0.05)。结论polA PCR方法高度敏感、特异,在一期梅毒诊断中优于血清学方法,可作为血清学方法的补充用于梅毒的诊断。     

3例神经梅毒的临床特征分析

目的分析3例神经梅毒的临床特征为早期诊断提供参考。方法回顾性分析3例神经梅毒患者的临床症状、神经影像学和实验室检查特点。结果(1)脑血管梅毒1例,脊髓痨2例;(2)3例血和脑脊液的梅毒抗体均为阳性;脑脊液蛋白含量增加、细胞数增多(以单核细胞为主);(3)脑血管梅毒患者MRA及DSA显示左大脑中动脉M1段闭塞;左大脑前动脉及左大脑后动脉通过皮层支向左大脑中动脉供血区代偿供血;(4)2例脊髓痨患者头颅及胸髓MRI无特殊发现,肌电图及周围神经活检不支持周围神经受损。结论神经梅毒的临床表现与其分型密切相关;首诊易误诊。临床表现及血和脑脊液梅毒抗体阳性是确诊的依据。     

Specific and sensitive diagnosis of syphilis using a real-time PCR for Treponema pallidum

A real-time PCR assay with a Taqman probe was developed that targeted the polA gene of Treponema pallidum. The test was validated using an analytical panel (n = 140) and a clinical panel of genital samples (n = 112) from patients attending a sexually transmitted infections clinic. High sensitivities and specificities of 94-100% were achieved using two real-time PCR platforms, the Rotor-Gene and the iCycler. The assay can be completed within 2 h, enabling reporting in <8 h. This fast and robust assay is suitable for implementation in routine laboratories for diagnosing primary syphilis.     

Trancranial Doppler Monitoring of Response to Therapy for Meningovascular Syphilis

Meningovascular syphilis is now quite uncommon, but there have been increasing reports in patients immunocompromised with human immunodeficiency virus. The response of syphilis affecting the central nervous system to antibiotic therapy remains a challenge. This is an even greater challenge in patients who have underlying compromise of the immune system. The authors present a 46-year-old male with recurrent stroke who was found to have cerebrospinal fluid compatible with syphilitic involvement of the central nervous system and a cerebral arteriogram, which revealed focal narrowing of the right middle cerebral artery. The baseline transcranial Doppler study demonstrated increased mean and peak flow velocity within the right middle cerebral artery. Despite a 10-day course of intravenous penicillin, with substantial improvement in the cerebrospinal fluid results, this flow velocity elevation persisted, in a remarkably consistent pattern, over a 4-month follow-up period. Thus, the involved vessel remained patent following treatment, but no clear resolution of the stenotic lesion was observed.     

烟台口岸74例梅毒感染者检测结果分析

目的了解烟台口岸出入境人群梅毒感染的流行分布状况和趋势,确定重点监测对象,为口岸传染病监测和预防控制提供依据。方法对受检者血清样本采用甲苯胺红不加热血清试验（TRUST）和梅毒螺旋体抗体血凝实验法（TPPA）进行梅毒血清学检测。结果在检测对象中检出的74例梅毒感染者,梅毒感染率为0.20%,男女感染者无显著性差异（P〉0.05）,介于21-50岁的中青年感染者构成比为78.39%,入境人员梅毒感染率较往年显著增高。传播途径依然以性传播为主,临床表现不明显,感染以潜伏梅毒居多。结论做好传染病监测的同时,应积极做好性传播疾病的防治宣传工作和咨询工作,加强对远洋船员、劳务人员等高危人群的行为干预,做好入境人员的疾病监测和监管,提高出入境人员的防病意识,降低梅毒感染率。     

2011—2019年不同时期荆州市一二期梅毒时空特征对比分析

目的 分析荆州市不同时期一二期梅毒的时空分布变化情况,为合理配置卫生资源提供参考。方法 收集2011—2019年荆州市一二期梅毒疫情资料,根据发病率高低,将荆州市一二期梅毒疫情分为2011—2013年（高）、2014—2016年（中）、2017—2019年（低）3个时期,采取趋势面、空间自相关和时空扫描分析3个时期一二期梅毒在时空上的变化趋势。结果 2011—2019年,荆州市累计报告一二期梅毒4 715例,年均发病率为9.19/10万,发病率呈下降趋势（P<0.01）。趋势面分析得出荆州市一二期梅毒的高发区域逐步从西北部（2011—2013年）向中部转移（2017—2019年）。全局空间自相关分析显示,荆州市一二期梅毒发病率在2011—2013年、2014—2016年呈正相关,且有空间聚集性（Moran’s I=0.333 6、0.210 5,均P<0.01）。局部空间自相关分析显示,一二期梅毒高值聚集区2011—2013年主要集中在公安县、荆州区、沙市区、江陵县的部分乡镇（P<0.05）,2014—2016年主要集中在荆州区、沙市区、监利县的部分乡镇（P<0.05）,2017—2019年主要集中在监利县、沙市区的部分乡镇（P<0.05）。时空扫描结果显示,主聚集区在公安县、江陵县,共24个乡镇（街道）,聚集时间为2011年4月11日至2011年8月15日（RR=4.14,LLR=93.55）。结论 3个时期荆州市一二期梅毒均存在空间聚集性,高发区域逐步缩小,2017—2019年监利县、沙市区的部分乡镇为疫情高发地区,应加强对该地区的防控工作。     

内蒙古4盟市后天梅毒报告病例数据质量调查

目的　了解内蒙古自治区梅毒报告病例数据的质量,发现存在的问题,提出改进措施。方法　选取2018年7月1日—2019年6月30日内蒙古自治区4个盟市的30家医疗机构的895例后天梅毒报告病例进行调查,包括核对传染病报告卡、临床和实验室原始资料等,评价其信息质量指标和诊断质量指标。结果　4个盟市的报卡填写完整率、正确率、信息录入正确率、病例报告及时率、过度报告率、重复报告率分别为97.65%、92.63%、89.16%、91.06%、13.85%、3.46%。不同盟市的报告卡的填写正确率、病例报告及时率、过度报告率和重复报告率的差异均有统计学意义（P均＜0.05）。后天梅毒病例诊断正确率为66.93%,不同地区间差异有统计学意义（χ2=45.963,P=0.000）。不同地区间一期梅毒分期正确率、隐性梅毒分类正确率的差异均有统计学意义（P均＜0.05）。皮肤性病科、非皮肤性病科报告病例正确率分别为74.90%、57.63%,差异有统计学意义（χ2=29.967,P=0.000）。结论　内蒙古自治区梅毒疫情报告质量参差不齐,梅毒诊断正确率、分期正确率低,影响梅毒发病率与发病趋势的分析,须加强梅毒报告、诊断标准的培训,切实提高病例数据的质量。     

Sexually transmitted diseases in Bauchi,Nigeria

Sexually transmitted diseases pose a health threat to families, society and the nation but there is no report of these diseases to help health planners in Bauchi. Medical records were examined from 1983 to 1988 in two major health institutions, the University Medical Centre and the Specialist Hospital to determine the extent and types of these diseases in Bauchi.

Urethritis, syphilis, candidiasis, pelvic inflammatory diseases, trichomoniasis were very common. Gonorrhoea was the least reported disease.

The cases of syphilis reported at the Specialist Hospital nearly doubled from 111 in 1983 to 214 in 1988, urethritis increased from 141 to 232. In the University Medical Centre, all reported cases of sexually transmitted diseases decreased from 1983 to 1988.

Data analysis of cases common to the Specialist Hospital and the University Medical Centre gave no significant difference between the institutions at the 95% level of confidence.     

梅毒患者外周血单核细胞体外诱导树突状细胞的形态学与功能研究

目的探讨梅毒患者外周血单个核细胞(PBMC)向树突状细胞(DC)分化的形态学与功能特征。方法分别分离健康人(10例,对照组)和梅毒患者(10例,实验组)外周血中PBMC,与粒细胞巨噬细胞集落刺激因子(GM-CSF)、白介素-4(IL-4)共同培养。用倒置显微镜观察细胞形态,用流式细胞仪测定细胞表型,同时进行混合淋巴细胞反应(MLR),观察其刺激同种异体未致敏T淋巴细胞增殖的能力。结果梅毒患者PBMC经GM-CSF与IL-4诱导获得的细胞具有典型的DC形态特征。细胞表面的CD80、CD83、CD86及HLA-DR的表达率分别为77.92%、39.34%、75.78%和95.42%。与对照组相比,CD80表达明显增高(P<0.05)、CD86表达明显降低(P<0.05),CD83及HLA-DR的表达与对照组比较差异无统计学意义(P>0.05)。MLR结果显示,梅毒患者PBMC诱导分化的DC可以刺激同种异体T细胞增殖。结论经GM-CSF、IL-4刺激后,梅毒患者的PBMC可以诱导分化为具有典型形态特征及抗原呈递功能的DC,DC表型的特征可能影响梅毒患者的细胞免疫状态。