梅毒螺旋体基因分型的相关性研究

梅毒螺旋体基因分型是研究梅毒螺旋体株多样性和流行病学的重要工具。梅毒螺旋体基因分型有助于显示梅毒疫情,评估与神经梅毒相关的基因亚型,监测大环内酯类抗生素的耐药情况,区别复发和再感染梅毒等。文章主要就梅毒螺旋体基因分型及近年的研究进展进行综述。     

梅毒螺旋体TpN47基因分析及实时荧光定量PCR检测方法的建立

目的 确定不同梅毒螺旋体TpN47基因序列的差异性及其跨膜结构分析,建立基于TpN47基因检测梅毒螺旋体的荧光定量PCR方法。方法 通过使用NCBI／Blast,Pfam,TMHMM Server v. 2.0等网络资源分析梅毒螺旋体TpN47基因编码蛋白的保守功能结构域、跨膜区域。根据参考序列设计引物,采用PCR技术从梅毒螺旋体基因组DNA中扩增TpN47基因,将其连接入克隆载体pMD18-T进行测序,并用DNASTAR软件比较不同梅毒螺旋体菌株TpN47基因的核苷酸序列。根据梅毒螺旋体TpN47基因保守区域设计引物,建立基于该目的基因的荧光定量分析PCR检测方法并分析其灵敏度、特异性和稳定性。同时,采用基于TpN47基因的荧光定量PCR对梅毒螺旋体感染患者血液样本进行检测。结果 研究表明,梅毒螺旋体TpN47基因为梅毒螺旋体外膜蛋白编码基因,其产物定位于外膜表面。不同梅毒螺旋体菌株中TpN47基因的核苷酸序列保守,相似度分别达99％以上。基于TpN47基因的荧光定量PCR方法可有效地检测梅毒螺旋体感染患者血清及泌尿道分泌物样本中的梅毒螺旋体。结论 TpN47基因为梅毒螺旋体外膜蛋白编码基因,建立的基于TpN47基因的荧光定量PCR方法具有快速、敏感、稳定等优点,适用于梅毒螺旋体临床实验室诊断。     

梅毒螺旋体编码抗氧化蛋白基因及其编码产物的研究进展

梅毒是由苍白密螺旋体引起的慢性、全身性疾病。由于梅毒螺旋体体外培养困难,很大程度上限制了对于梅毒致病机制、实验室诊断及治疗等方面的研究。随着梅毒螺旋体基因组序列解析、基因重组技术及免疫学发展,使梅毒螺旋体的研究取得一定进展。对于梅毒螺旋体脂蛋白、膜蛋白的研究层出不穷,但对于抗氧化相关蛋白的阐述仍较少,抗氧化相关蛋白对于明确梅毒致病机制及早期诊断梅毒均有一定意义,故现对编码抗氧化蛋白基因及其编码产物的研究进展作一简要阐述。     

2007年广东省性病实验室梅毒血清学室间质评结果分析

目的了解2007年广东省性病实验室梅毒血清学检测能力的总体情况,分析影响检测能力的相关因素和存在问题。方法制备并发放梅毒血清样本,各性病实验室按照分级管理要求,分别做非梅毒螺旋体和梅毒螺旋体血清学定性和定量试验,统计分析各实验室的检测结果。结果2007年,共计186家性病实验室参与了非梅毒螺旋体定性（930份）和定量（930份）样本的检测,其中104家实验室同时进行了梅毒螺旋体定性（520份）和定量（520份）样本的检测,共计2900份样本中,符合的2650份,全省总体符合率为91.4％。非梅毒螺旋体和梅毒螺旋体血清学定性试验的总体符合率分别为94．7％和95．4％,两者的假阴性率和假阳性率分别只有6．3％和3．8％、7．4％和0．5％。非梅毒螺旋体和梅毒螺旋体血清学定量试验总体符合率分别为92．7％和91．2％,总体几何标准差分别为2．29和2．57。结论全省性病实验室梅毒血清学总体检测能力较好,但仍需加强室内质控,促进梅毒血清学检测能力的进一步提高。     

我国梅毒血清学诊断试剂临床质量评估

目的了解我国目前梅毒血清学诊断试剂的质量,为性病检测选用合适的试剂提供参考依据。方法以日本Fuji公司梅毒螺旋体明胶凝集试验（TPPA）及美国BD公司快速血凝反应素试验（RPR）试剂作为参比试剂,广西和福建两家省级性病中心实验室参与,对11种梅毒血清学试剂进行了评估。结果非梅毒螺旋体抗原血清学检测用试剂的敏感性为90.9%～100%,特异性79.6%～100%;梅毒螺旋体血清学检测用试剂敏感性为91.8%～100%,特异性96.1%～100%。结论非梅毒螺旋体抗原及梅毒螺旋体抗原血清学检测用试剂质量参差不齐,部分国产梅毒诊断试剂质量有待提高。     

梅毒反向筛查和ECDC筛查在恶性肿瘤患者中的应用

<正>梅毒是由苍白密螺旋体(treponema pallidum,TP)主要通过性活动传播,其诊断依靠临床表现及病史,但血清学检测仍是主要的诊断依据。梅毒血清学试验分为两种:非梅毒螺旋体试验(NTT)如快速血浆反应素环状卡片试验(RPR)、梅毒甲苯胺红不加热血清试验(TRUST),梅毒螺旋体试验(TT),如梅毒螺旋体明胶颗粒凝集试验(TPPA)、时间分辨荧光     

螺旋体传染病

梅毒螺旋体特异性抗体对梅毒早期诊断和治疗的评价，温江县钩端螺旋体病发病率大幅下降原因，妊娠期梅毒螺旋体感染11例对围生结局的影响。     

梅毒血清学实验室间质量评价结果分析

目的通过梅毒血清学实验室间质量评价活动和现场督导,了解海南省梅毒实验室血清学检测总体水平。方法 2008年9月,由省卫生厅组织专家到各实验室现场督导,11月发放梅毒质控血浆标本共185份,各单位根据自己开展梅毒血清学试验的情况,分别做非梅毒螺旋体抗原血清定性试验和半定量试验,梅毒螺旋体抗原血清定性试验。结果 37家单位参加室间质评活动,非梅毒螺旋体抗原血清定性试验和半定量试验结果符合率分别为85.95%和60.54%;梅毒螺旋体抗原血清定性试验结果符合率为90.43%。结论此次质评活动表明,非梅毒螺旋体抗原血清半定量试验合格率较低,现场督导中发现部分试验室未按标准操作规程操作、加样器长期未校准、水平摇床不合格等,造成实验结果存在不同差异,因此海南省梅毒血清学试验检测水平有待提高。     

螺旋体传染病

斑点金免疫渗滤试验同步检测抗梅毒螺旋体IgM和IgG抗体的研究；钩端螺旋体LAg42膜蛋白基因的克隆及原核表达；甲苯胺红不加热血清试验和梅毒螺旋体抗体明胶颗粒凝集试验在梅毒诊治中的应用；伯氏疏螺旋体与嗜吞噬细胞无浆体感染抑制Th1型细胞因子产生。     

螺旋体传染病

梅毒螺旋体嵌合抗原的克隆表达及其临床应用；梅毒螺旋体Tp0453重组蛋白的表达纯化及免疫活性研究；钩端螺旋体疫苗鉴别试验及其国家参考品的建立；中国莱姆病螺旋体PD91重组外膜蛋白A的动物免疫效果分析；两种检测梅毒螺旋体抗体方法的比较；重庆市钩端螺旋体病流行因素监测分析。[编按]     

An experimental model of early central nervous system syphilis

Although up to 40% of patients with early syphilis have evidence of central nervous system (CNS) invasion by Treponema pallidum, the pathogenesis of CNS syphilis is not understood. A rabbit model that mimics early CNS involvement in humans was developed and characterized. Mild cerebrospinal fluid pleocytosis was evident 2 weeks after intracisternal inoculation of T. pallidum and peaked at 9 weeks. The VDRL test in cerebrospinal fluid was reactive in 24% of animals, most commonly at 9 weeks after infection. T. pallidum could be isolated from the CNS of animals infected for 4, 6, or 9 weeks but not from animals infected for 12 or 20 weeks. Clinically, 6% of animals developed uveitis, similar to the frequency in patients with secondary syphilis. Thus, this model of meningeal and ocular syphilis seems to be analogous to the early CNS infection in humans and can be used for studies of pathogenesis and treatment.     

Shared care approach to managing ophthalmological disease in patients with positive treponemal serology: a case series

Ocular syphilis presenting initially as various manifestations of intraocular inflammation is a rare but an important manifestation of syphilis. Ocular phenotypes are varied and mimic other infectious and non-infectious ocular diseases. Uncertainties exist in optimal management of ocular manifestations of syphilis due to a lack of evidence from randomized controlled trials. In this article we report seven cases of syphilis representing a spectrum of ophthalmic manifestations and highlight key issues around diagnosis and management. We underscore the importance of interdisciplinary approach by ophthalmologists and genitourinary (GU) physicians in improving the outcome of this subgroup of patients in the absence of robust evidence.     

新生儿先天性梅毒30例临床分析

目的：探讨新生儿先天性梅毒的早期诊治与预后的关系。方法对该院2005～2012年收治的30例新生儿先天性梅毒的临床资料进行回顾性分析。结果新生儿梅毒的临床表现以皮疹、黄疸为主。梅毒血清学检查快速血浆反应素环状卡片试验和梅毒螺旋体血球凝集试验均阳性。选用青霉素静滴2～3周治疗,全部治愈。结论新生儿先天性梅毒早期使用青霉素静滴,疗效满意。常规开展孕期梅毒检测,早发现、早治疗,可明显降低先天性梅毒的发病率和病死率。     

La syphilis oculaire,une pathologie ré-émergente : série de 12 patients au CHU de Marseille en 2017

IntroductionSyphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis only occurs in 0.6 percent of patients. We collected all cases of ocular syphilis requiring hospitalization at the University Hospital Center (UHC) in Marseille in 2017.Patients and methodsThis was a retrospective monocentric study. The diagnosis of ocular syphilis was based on the combination of ocular inflammation with a positive syphilitic serology. For each patient, sex, age, HIV status, ocular and extraocular symptoms, initial visual acuity, syphilis serology, cerebrospinal fluid (CSF) analysis if done, treatment and clinical response were collected.ResultsTen men and two women, aged 28 to 86 years, were hospitalized. Two patients were HIV-positive. Ophtalmological lesions were heterogeneous the posterior structures were most affected. Anterior uveitis was isolated in one patient. Five patients had extraocular signs with cutaneous and/or mucosal involvement. No patient had neurological symptoms. Diagnosis of neurosyphilis through CSF analysis was definite for one patient, probable for 5 patients and ruled out for 2 patients. Six patients received treatment with penicillin G and six with ceftriaxone. Visual acuity improved in all cases.DiscussionOphtalmic cases of syphilis have become more frequent over the past few years in France. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Our study shows that ceftriaxone remains an effective alternative to penicillin G.     

Ophthalmic manifestations of pulmonary diseases

Patients suffering from pulmonary diseases often have ophthalmic manifestations, some of which may be critical and disabling. The purpose of this article is to discuss the ophthalmologic manifestations of pulmonary diseases. This is achieved by describing a typical ophthalmologic examination, starting with the external structures and ocular adnexae and proceeding through the structures of the eye, including the retina, optic nerve, and orbit.     

梅毒实验室检测技术及策略的进展

梅毒螺旋体作为梅毒的病原体,可侵犯人体形成一种慢性的性传播疾病.本病临床表现复杂,可侵犯人体全身器官,既能产生各种各样的症状和体征,又可多年无症状而呈潜伏状态.梅毒的实验室检测方法主要有病原学检测法和血清学检测法.针对不同人群以及疾病的不同进展,应合理选用一种或多种检测方法,提高梅毒实验室检测的准确率.     

Acute syphilitic blindness in an HIV-positive patient

This case report describes a rare manifestation of syphilis. An HIV-positive patient with severe immunosuppression presented with rapid loss of vision due to eye involvement of Treponema pallidum infection. The ophthalmologic examination on admittance showed a chorioretinitis, an uveitis, and a swollen optical disc of both eyes. Reconstitution of vision after application of intravenous penicillin occurred within 3 weeks. Despite low HIV prevalence in central Europe, behaviors that promote transmission of HIV and other sexually transmitted diseases tend to increase. The clinical presentation of syphilis may be atypical and the rate of complications is often higher in HIV-infected patients. Thus, Treponema pallidum infection should be considered in immunosuppressed HIV-positive patients presenting with chorioretinitis. Patients should receive treatment similar to that for neurosyphilis if there is suspicion of involvement of the central nervous system.     

Malignant syphilis with ocular involvement in an HIV-infected patient

Malignant syphilis is now considered a rare disease, more commonly affecting individuals with poor health, malnutrition or HIV infection. We present a 34-year-old man with HIV infection who developed multiple atypical cutaneous ulcerations, leonine facies, a scleral nodule and keratitis with visual loss. The diagnosis of malignant syphilis was delayed due to the insidious presentation, but was confirmed via immunohistochemical (IHC) staining with anti-Treponema antibodies of a skin biopsy. Significant clinical improvement was observed following a 15-day course of penicillin and tigecycline therapy. In advanced HIV disease, cutaneous manifestations are often difficult to identify and present a challenge for the clinician. Clinical manifestations of secondary syphilis vary greatly, earning the epigram of 'the great imitator'. It is important to recognize atypical presentations of syphilis, especially among HIV-infected individuals. Unlike historical cases of malignant syphilis, Treponema pallidum was found in the tissue section using IHC staining methods. We emphasize the importance of lues maligna in the differential diagnosis of HIV-infected patients with diffuse ulceronodular lesions as well as the usefulness of histological investigations and IHC studies.     

重组梅毒螺旋体诊断抗原的研究进展

梅毒是一种多阶段发展的性传播疾病,临床表现复杂,实验室诊断主要依赖血清学方法。近十余年来,基于重组梅毒螺旋体(Tp)诊断抗原的血清学方法大力促进了梅毒特异性实验室诊断的快速发展。但目前所采用的重组抗原对诊断早/晚期梅毒,或区分不同感染阶段,或疗效判断仍然存在不足。本文综述重组Tp脂蛋白及新型候选抗原(包括膜表面暴露蛋白、黏附蛋白、周质间隙蛋白和鞭毛蛋白等)在梅毒诊断中的应用价值及局限性,并概括了最佳候选Tp诊断抗原组的条件,为进一步研究其他Tp诊断抗原提供参考。     

Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment

STUDY OBJECTIVES: To determine the prevalence of Treponema pallidum in cerebrospinal fluid (CSF) of patients with syphilis, to determine the effect of concurrent HIV infection on central nervous system involvement by T. pallidum, and to examine the efficacy of conventional therapy for asymptomatic neurologic involvement. PATIENTS: Fifty-eight patients with untreated syphilis who consented to lumbar puncture, representing approximately 10% of new cases of syphilis during the study period. INTERVENTIONS: Lumbar puncture was done on all patients. Rabbit inoculation was used to test cerebrospinal fluid for viable T. pallidum. Patients with normal fluid received recommended benzathine penicillin therapy according to the stage of syphilis; patients with CSF abnormalities were offered 10-day therapy for neurosyphilis. RESULTS: Treponema pallidum was isolated from the CSF of 12 (30%) of 40 patients (95% CI, 17 to 46) with untreated primary and secondary syphilis; isolation of T. pallidum was significantly associated (P = 0.008) with the presence of two or more abnormal laboratory variables (among leukocyte count, protein concentration, and CSF-Venereal Disease Research Laboratory [VDRL] test). Two (67%) of 3 early latent (CI, 13 to 100) and 3 (20%) of 15 late latent syphilis patients (CI, 5 to 47) also had reactive CSF-VDRL tests and elevated cell and protein levels, although T. pallidum was not isolated. Concurrent infection with the human immunodeficiency virus (HIV) was not associated with isolation of T. pallidum, increased number of CSF abnormalities, or reactive CSF serologic tests for syphilis, although CSF pleocytosis was commoner in subjects infected with HIV. Treatment with conventional benzathine penicillin G (2.4 mIU) failed to cure 3 of 4 patients with secondary syphilis from whom T. pallidum was isolated before therapy; all 3 patients in whom treatment failed were HIV seropositive when treated or seroconverted during follow-up. CONCLUSIONS: Central nervous system invasion by T. pallidum is common in early syphilis, and is apparently independent of HIV infection. Examination of the CSF may be beneficial in patients with early syphilis, and therapy should be guided by knowledge of central nervous system involvement. Conventional benzathine penicillin G therapy may have reduced efficacy in patients with early syphilis who are also infected with HIV.