梅毒孕妇分娩的新生儿血清学随访

目的 探讨梅毒孕妇分娩的新生儿血清学转归和治疗对未感染梅毒婴儿血清阴转时间的影响。 方法 梅毒孕妇分娩的新生儿115例,出生时进行甲苯胺红不加热血清试验（TRUST）、梅毒螺旋体明胶凝集试验（TPPA）、19S IgM-TPPA检测。在1、3、6、9、12、18、24月龄时进行TRUST和TPPA血清学监测和随访。当TRUST和TPPA均阴性时,终止随访。采用SPSS13.0软件进行Kaplan-Meiter生存分析和两独立样本比较的Wilcoxon秩和检验。结果 115例新生儿出生时TPPA均阳性;97例TRUST阳性,滴度从1 ∶ 1到1 ∶ 256不等;3例19S IgM-TPPA阳性。出生时确诊胎传梅毒3例,TRUST均在12 ～ 18月龄内转阴,2例24月龄时TPPA仍阳性,另1例20月龄时TPPA阳性,仍在随访中。112例疑似病例随访后均排除梅毒感染,90例TRUST在0 ～ 3、4 ～ 6、7 ～ 9月龄时的累计阴转率分别为82.2%、98.9%、100%。96例TPPA在0 ～ 3、4 ～ 6、7 ～ 9、10 ～ 12月龄时的累计阴转率分别为3.1%、30.2%、85.4%、100%。余16例缺部分复查,TRUST和TPPA在15月龄时均转阴。血清阳性未感染梅毒婴儿,出生后苄星青霉素G治疗组与未治疗组TRUST阴转时间差异无统计学意义（χ2 = 0.54,P ＞ 0.05）,TPPA阴转时间差异亦无统计学意义（χ2 = 2.41,P ＞ 0.05）。TRUST阴转时间显著早于TPPA阴转时间（Z = 10.45,P ＜ 0.01）。 结论 梅毒孕妇分娩的未感染梅毒婴儿,大多数婴儿TRUST在6月龄内转阴,TPPA在12月龄内转阴;TRUST阴转时间早于TPPA,治疗对TRUST和TPPA阴转时间无影响。     

Internal quality control in serological tests for syphilis.

The importance of syphilis serological tests demands that laboratory reports are reliable. Internal quality control applied to the organisation of a syphilis serology service improves laboratory bench performance and reporting. Described here are internal quality control procedures of a department that serves a genitourinary medicine clinic and conducts 70 000 tests a year to investigate for syphilis.     

Circulating anticoagulant and serological tests for syphilis

Circulating anticoagulant (CA) and particularly lupus anticoagulant are commonly associated with biological false-positive tests for syphilis (BFP-STS) in patients with collagen diseases. CA was presently found in the sera of 8 out of 30 subjects with chronic BFP-STS without collagen or autoimmune diseases. It was not found in any of the 21 patients with various stages of syphilis. In 5 out of 21 elderly subjects (age greater than 70 years) in whom a positive BFP-STS was detected, there was no CA. It is concluded that the association between CA and BFP-STS is found only in patients with collagen and autoimmune diseases and in some of the younger chronic BFP-STS reactors. It is not detected in syphilitic patients or elderly subjects in whom a high incidence of BFP-STS can be found. The difference in the incidence of this association is probably due to the differing biologic behaviour of these autoantibodies.     

Biological false positive serological tests for syphilis in the Jamaican population.

A total of 19,067 sera were screened for biological false positive (BFP) reactivity by the Venereal Disease Research Laboratory (VDRL) test. Sera which were reactive in the VDRL test were confirmed by the fluorescent treponemal antibody absorption (FTA-ABS) test. BFP reactions were detected in 0.59% of the general population, 0.72% of pregnant women and 11.8% of patients with systemic lupus erythematosus (SLE). The rate of BFP reactors among pregnant women did not differ significantly from the general population. The female to male ratio of BFP in the general population was 2:1 whilst that in the group of patients with SLE was 8:1. The overall seroprevalence of syphilis was 2.2%.     

Essential mixed cryoglobulinaemia with false-positive serological tests for syphilis.

Analysis of serum from a patient with cutaneous leukocytoclastic vasculitis showed a mixed cryoglobulin with a monoclonal IgM kappa-antiglobulin component (6.5 mg/ml), strong rheumatoid factor activity (latex titre 1/5000), and positive serological tests for syphilis (fluorescent treponemal antibody-absorbed and Treponema pallidum haemagglutination assay). After removal of antiglobulin activity by immunoabsorption with heat-aggregated gammaglobulin all serological test results for treponemal infection became negative. Serological tests for syphilis and rheumatoid factor on the supernatant from whole serum (minus cryoglobulin) remained positive though at a lower titre (latex 1/1250). Cryoglobulin isolated from whole serum retained rheumatoid and TPHA reactivity but was negative in the FTA-ABS test. The IgM and IgG cryoglobulin components purified by gel filtration on Sepharose showed no antitreponemal reactivity even when tested individually. Reducing the concentration of cryoglobulin to 1.5 mg/ml by plasma exchange converted the test results for syphilis to doubtful-positive or negative. These results indicated that high concentrations of antiglobulin activity may be associated with falsely positive specific antitreponemal test results and that this phenomenon depends on the concentration of cryoglobulin in the test sample.     

Positive serological tests for syphilis and administration of intravenous immunoglobulin

We report the case of a man who tested positive for syphilis following the intravenous administration of human normal immunoglobulin as part of the treatment of Guillain-Barré syndrome. The chronology of the testing suggested the passive acquisition of treponemal antibody. This phenomenon is not widely documented in the medical literature, but is a theoretical risk of treatment, and serves as a reminder to be cautious in the interpretation of such serological tests.     

Screening tests for syphilis. A comparison of the Treponema pallidum haemagglutination assay with two automated serological tests.

Two Treponema pallidum haemagglutination assay (TPHA) tests (Wellcome and Fuzizoki) were compared with the automated reagin test and the automated Reiter protein complement-fixation test in a routine screening system. The Wellcome TPHA was shown to lack sensitivity, and it is recommended that it should be used at a lower screening dilution. The Fuzizoki TPHA recorded a significant number of false positive and false negative results, and was therefore inferior to the fluorescent treponemal antibody absorption (FTA-ABS) test as a definitive test for syphilis. It is suggested that the TPHA be used in conjunction with a reagin test to replace some of the more inadequate screening tests currently in use. The automated screening tests were shown to have a similar sensitivity to the TPHA as well as several other advantages; they are recommended for testing large numbers of specimens.