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- Antigenic Variation of TprK Facilitates Development of Secondary Syphilis. [JOURNAL ARTICLE]
- Infect Immun 2014 Sep 15.
Although primary syphilis lesions heal spontaneously, the infection is chronic with subsequent clinical stages. Healing of the primary chancre occurs as antibodies against outer membrane antigens facilitate opsonophagocytosis of the bacteria by activated macrophages. TprK is an outer membrane protein that undergoes antigenic variation at 7 variable regions, and variants are selected by immune pressure. We hypothesized that individual TprK variants escape immune clearance and seed new disseminated lesions to cause secondary syphilis. As in human syphilis, infected rabbits may develop disseminated secondary skin lesions. This study explores the nature of secondary syphilis, specifically the contribution of antigenic variation to development of secondary lesions. Our data from the rabbit model shows that the odds of secondary lesions containing predominately TprK variant treponemes is 3.3 times higher than the odds of finding TprK variants in disseminated primary lesions (OR = 3.3 (95% CI: 0.98 - 11.0), p= 0.055) and that 96% of TprK variant secondary lesions are likely seeded by single treponemes. Analysis of antibody responses demonstrates significantly higher antibody titers to tprK variable region sequences found in the inoculum, compared to reactivity to tprK variant sequences found in newly arising secondary lesions. This suggests that tprK variants are escaping the initial immune response raised against the V regions expressed in the inoculum. These data further support a role for TprK in immune evasion, and suggest that the ability of TprK variants to persist despite a robust immune response is instrumental in the development of later stages of syphilis.
- The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women. [JOURNAL ARTICLE]
- Public Health Nutr 2014 Sep 15.:1-13.
To describe the aetiology of anaemia in pregnant Ugandan women and explore Fe deficiency and common infections as contributors to anaemia in this population.Cross-sectional study in which Hb, ferritin, transferrin receptor (sTfR), C-reactive protein, α-1 acid glycoprotein, hepcidin, malaria, hookworm infestation, syphilis and Helicobacter pylori infection were assessed.Antenatal care clinic at Kawempe Health Centre, Kampala, Uganda.HIV-negative women (n 151) in their first or second pregnancy at 10-16 weeks' gestation.The prevalence of anaemia was 29·1 %. Fe deficiency was 40·4 % and 14·6 % based on ferritin <30 μg/l and on adjusted ferritin <12 μg/l respectively, and 6·6 % based on sTfR >8·3 μg/ml. The prevalence of Fe-deficiency anaemia was 9·3 % based on ferritin <30 μg/l, 6·6 % based on adjusted ferritin <12 μg/l and 4·3 % based on sTfR >8·3 μg/ml. Hepcidin concentration was positively correlated with ferritin concentration (n 151, r=0·578, P<0·00001). H. pylori infection was highly prevalent (70 %) while malaria, hookworm infestation and syphilis were not common. Of all women, 60·3 % had α-1 acid glycoprotein >1 g/l and/or C-reactive protein >5 mg/l. Malaria parasitaemia (OR=6·85; 95 % CI 1·25, 37·41, P=0·026) and Fe deficiency defined using sTfR (OR=5·58; 95 % CI 1·26, 24·80, P=0·024) were independently and positively associated with anaemia. Population-attributable risk factors for anaemia for raised C-reactive protein, Fe deficiency defined by sTfR >8·3 μg/ml and presence of malaria parasites were 41·6 (95 % CI 11·1, 72·2) %, 13·5 (95 % CI 2·0, 25·0) % and 12·0 (95 % CI 1·4, 22·6) %, respectively.Infections and inflammation are of greater significance than Fe deficiency in the aetiology of anaemia in pregnant Ugandan women during the first trimester.
- Identifying Toll-like Receptor Expression in Cutaneous Sarcoidosis. [JOURNAL ARTICLE]
- Am J Dermatopathol 2014 Sep 12.
: Toll-like receptors (TLRs) are known to be expressed in the skin. Antigenic stimulation of TLRs in the skin has been implicated in several inflammatory dermatologic diseases including psoriasis, syphilis, atopic dermatitis, and cutaneous T-cell lymphoma. However, the expression of TLRs in cutaneous sarcoidosis has not yet been defined. Expression of TLRs 1-9 was examined in cutaneous sarcoid by immunohistochemical staining. It was found that TLRs 5 and 6 stained most intensely in both the granulomas and epidermis of the sarcoid cases. TLRs 2, 3, 4, 7, and 8 stained more intensely compared with normal skin. All sarcoidosis cases showed an increased level of staining compared with the control. The nuclear factor-kappa B activation pathway was confirmed by staining for p65. All cases strongly stained for p65 in the granulomas and varied in staining intensity in the epidermis. The identified TLR expression in cutaneous sarcoidosis indicates that a bacterial antigen could be an etiologic agent of the disease. Future studies that clearly define the etiology of sarcoid will lead to better therapies and a better prognosis for affected patients.
- Sy03-1-3isam fellowship prevalence of hiv infection among the over 18 year old substance abusers in mwanza urban, Tanzania. [Journal Article]
- Alcohol Alcohol 2014 Sep.:i5.
The problem of substance abuse is found all over the world. Abused substances are psychoactive and may drive abusers to engage into unsafe sexual practices and criminal activities. For injecting drugs, the apparatus used often unsterile and shared which predispose the users to blood borne infections. The purpose was to determine the role of substance abuse in transmission of HIV and its magnitude in Mwanza Urban Tanzania.A cross-sectional study of 774 substance abusers aged 18 years and above was conducted from March to June 2012. Data collection involved use of a questionnaire (Face to face approach) and collection of blood to determine the serological status, while urine samples were used to detect illegal drugs which had been used.Cannabis and alcohol were highly abused 83.0% and 74.2% respectively followed by khat 38.3 %. Heroin smoking was 34.0% and injection was 6.1%. HIV infection was detected in 8.6% of the substance abusers, while Hepatitis B and C were 3.8% and 2.9% respectively and 2.5% Syphilis.HIV infection in substance abusers was higher 8.6% with 6.3% among intravenous drug users. Education on consequences of psychoactive substances and unsafe sex should be given to the substance abusers.
- Sexually Transmitted Infections Among Incarcerated Women: Findings From a Decade of Screening in a Los Angeles County Jail, 2002-2012. [JOURNAL ARTICLE]
- Am J Public Health 2014 Sep 11.:e1-e7.
Objectives. We describe and report findings from a screening program to identify sexually transmitted infections (STIs) and HIV among female inmates in Los Angeles County Jail. Methods. Chlamydia and gonorrhea screening was offered to entering female inmates. Women were eligible if they were (1) aged 30 years or younger, or (2) pregnant or possibly pregnant, or (3) booked on prostitution or sex-related charges. Voluntary syphilis and HIV testing was offered to all women between 2006 and 2009. This analysis reports on data collected from 2002 through 2012. Results. A total of 76 207 women participated in the program. Chlamydia prevalence was 11.4% and gonorrhea was 3.1%. Early syphilis was identified in 1.4% (141 of 9733) and the overall prevalence of HIV was 1.1% (83 of 7448). Treatment levels for early syphilis and HIV were high (99% and 100%, respectively), but only 56% of chlamydia and 58% of gonorrhea cases were treated. Conclusions. Screening incarcerated women in Los Angeles County revealed a high prevalence of STIs and HIV. These inmates represent a unique opportunity for the identification of STIs and HIV, although strategies to improve chlamydia and gonorrhea treatment rates are needed. (Am J Public Health. Published online ahead of print September 11, 2014: e1-e7. doi:10.2105/AJPH.2014.302186).
- History of syphilis in women living with AIDS and associated risk factors in São Paulo, Brazil. [Journal Article]
- Rev Assoc Med Bras 2014 Jul; 60(4):342-8.
to describe the epidemiological profile, risk behaviors, frequency of prior history of syphilis in women living with AIDS and to investigate associated factors.a cross-sectional study conducted with women living with HIV attending at Reference Center for AIDS in São Paulo. Demographic, behavioral, and clinical data were analyzed based on medical records.a total of 598 women were included in the study and the prevalence of previous syphilis was 6.2% (95% CI 4,3-8,1). Seventy-three percent of women were less than 40 years of age when diagnosed with AIDS and 49.6% had more than eight years of formal education. 67.2% were white and 65.9% were not married or living with a partner, 53.2% reported that their first sexual intercourse aged more than 15 years, 56.5% reported having only one partner in the last year and 13% reported drug use. Regarding laboratory data, 83.8% had CD4+ <500 cells/ mm3 upon diagnosis of AIDS. Previous syphilis was associated with the use of crack cocaine [AOR = 6.8 (95% CI 1.7 - 27.5)], >1 sexual partner in the last year [AOR = 6.6 (95% CI 1.2 - 37.1)], CD4 + <500 cells/mm3 [AOR = 3.8 (women 1.1 - 13.6)], HIV diagnosis > 8 years [AOR = 2.4 (95% CI 1.0 - 5.8)].a high prevalence of previous syphilis was found in the population studied, and crack use was identified among the main associated risk factors. Interventions to reduce the risk of sexual transmission of HIV and syphilis must be strengthened, with the implementation of control actions, screening strategies, early diagnosis and treatment, preventing complications, reducing morbidity and improving sexual and reproductive health.
- Sexual partnership characteristics of african american women who have sex with women; impact on sexually transmitted infection risk. [Journal Article]
- Sex Transm Dis 2014 Oct; 41(10):611-7.
African American women who have sex with women (WSW) are emerging as a population at risk for sexually transmitted infections (STIs). The objectives of this study were to explore partnership characteristics for a cohort of African American WSW and evaluate those characteristics as potential risk factors for STIs. In addition, we aimed to determine STI diagnoses and identify predictors of STI infection.Women who have sex with women presenting to a sexually transmitted disease clinic in Birmingham, AL, completed a questionnaire and were tested for bacterial vaginosis, trichomoniasis, chlamydia, gonorrhea, Mycoplasma genitalium, syphilis, HIV, and herpes simplex virus type 2.A total of 163 women were enrolled: 78 WSW and 85 women who have sex with women and men (WSWM) (based on report of past year sexual behavior). Both WSW and WSWM reported similar numbers of female partners over the lifetime, past year, and past month; however, WSWM reported significantly more lifetime male partners, thus having a higher overall number of sexual partners. Women who have sex with women and men were more likely to report new or casual partner(s), group sex, history of STIs, and sex with partner(s) known to have STIs. Overall, WSWM were more likely to have a current diagnosis of bacterial vaginosis, a current diagnosis of a curable STI, or a diagnosis of a noncurable STI (85% vs. 56%, P < 0.01).African American WSW are not a homogeneous group, and their sexual health may be directly or indirectly influenced by male partners. A better understanding of the distinctions and differences between African American WSW and WSWM will enable health care providers to improve the quality of care provided.
- Evaluation of a rapid diagnostic test for yaws infection in a community surveillance setting. [Journal Article]
- PLoS Negl Trop Dis 2014 Sep; 8(9):e3156.
Yaws is a non-venereal treponemal infection caused by Treponema pallidum ssp. pertenue. The WHO has launched a worldwide control programme, which aims to eradicate yaws by 2020. The development of a rapid diagnostic test (RDT) for serological diagnosis in the isolated communities affected by yaws is a key requirement for the successful implementation of the WHO strategy. We conducted a study to evaluate the utility of the DPP test in screening for yaws, utilizing samples collected as part of a community prevalence survey conducted in the Solomon Islands. 415 serum samples were tested using both traditional syphilis serology (TPPA and quantitative RPR) and the Chembio DPP Syphilis Screen and Confirm RDT. We calculated the sensitivity and specificity of the RDT as compared to gold standard serology. The sensitivity of the RDT against TPPA was 58.5% and the specificity was 97.6%. The sensitivity of the RDT against RPR was 41.7% and the specificity was 95.2%. The sensitivity of the DPP was strongly related to the RPR titre with a sensitivity of 92.0% for an RPR titre of >1/16. Wider access to DPP testing would improve our understanding of worldwide yaws case reporting and the test may play a key role in assessing patients presenting with yaws like lesions in a post-mass drug administration (MDA) setting.
- Pustular secondary syphilis: report of three cases and review of the literature. [JOURNAL ARTICLE]
- Int J Dermatol 2014 Sep 10.
Pustular syphilis is an extremely rare manifestation of secondary syphilis. Failure to recognize the disease can have devastating consequences.We present three patients with pustular syphilis as the primary manifestation of secondary syphilis.Patient 1 was initially diagnosed by Venereal Disease Research Laboratory (VDRL) test (titers 1 : 32) and confirmed by enzyme immunoassay (EIA) for Treponema pallidum. Patient 2 was screened for syphilis by VDRL (titers 1 : 64), yielding a positive result, and tested negative for HIV. Secondary syphilis was confirmed by EIA. In Patient 3, a diagnosis of secondary syphilis was established by VDRL (titers 1 : 128) and EIA. Treponema pallidum was detected by dark field microscopy in three patients. Testing for HIV infection was negative in all patients.Diagnosis in secondary syphilis remains challenging because of the diversity of clinical presentations. The most commonly observed cutaneous presentation is a generalized, non-pruritic, papulosquamous eruption varying from pink to violaceous to brown, with mucous membrane involvement. The diagnostic methods used to identify secondary syphilis are the same as those used to diagnose other stages of syphilitic infection. The persistence of syphilis in both developed and underdeveloped regions highlights the importance of considering syphilitic infection in the setting of a cutaneous pustular eruption, especially one that fails to respond to standard therapy. Testing for other sexually transmitted diseases, including HIV, should be performed in all patients diagnosed with syphilis.
- Granulomatous disease in the head and neck: developing a differential diagnosis. [Journal Article]
- Radiographics 2014 Sep-Oct; 34(5):1240-56.
Granulomatous diseases have a varied etiology that includes autoimmune, infectious, idiopathic, and hereditary causes. The unifying factor in these diseases is the formation of granulomas, which histologically are mononuclear inflammatory cells or macrophages surrounded by lymphocytes. Granulomatous diseases often have systemic manifestations that affect organs throughout the body. Granulomatous diseases with head and neck manifestations include granulomatosis with polyangiitis, Churg-Strauss syndrome, Behçet disease, chronic granulomatous disease, and sarcoidosis. Infectious causes include tuberculosis, cat-scratch disease, syphilis, leprosy, actinomycosis, rhinoscleroma, and fungal infections. In the head and neck, granulomatous disease may affect the orbits, sinonasal cavities, salivary glands, aerodigestive tract, temporal bone, or skull base. Imaging findings include sinonasal opacification, ocular and other soft-tissue masses, osseous erosion, airway narrowing, lymphadenopathy, and salivary gland infiltration. Vascular involvement may also be evident, with displacement, narrowing, or occlusion of arteries and veins. Some radiologic findings of granulomatous processes have a considerable overlap with findings of malignancy, and a radiologic differential diagnosis inclusive of both is critical to avoid incorrect clinical treatment. Without the benefit of a prior clinical diagnosis, laboratory findings, or suggestive clinical signs and symptoms, granulomatous diseases may be difficult to differentiate radiologically. Although individual granulomatous diseases may have overlapping findings at imaging, certain radiologic findings should prompt the inclusion of granulomatous diseases in the differential diagnosis, thus facilitating appropriate clinical management. ©RSNA, 2014.