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- Coexistence of Congenital Syphilis and Cytomegalovirus Infection: A Case Report. [JOURNAL ARTICLE]
- Acta Dermatovenerol Croat 2014 Sep; 22(3):215-217.
A 22-year-old pregnant woman with an intravenous drug abuse habit delivered a girl in the 26th gestational week with a fetal length and weight of 38 cm/990 g (pc. 75-91). She did not participate in prenatal care that included screening for congenital diseases, syphilis, and human immunodeficiency virus (HIV) infection during the pregnancy. Laboratory examinations revealed positive rapid plasma reagin (RPR) (1:128), Treponema pallidum particle agglutination assay (TPPA) and TpELISA results. Immediately before delivery, labial herpes simplex virus-1 (HSV-1), Streptococcus agalactiae, and genital yeast infections were detected. Hepatitis B surface antigen (HbsAG), HIV, and hepatitis C virus (HCV) serology remained negative. The preterm and immature newborn girl had mild jaundice, minimal edema, and gluteal hematomas with petechiae. The liver and spleen were extremely enlarged (reaching the plevic bones). Increased muscle tone and rigid elbow, knee, and hip joints were found (Figures 1, 2). Additionally, X-ray examination detected multiple jejunal atresia. Brainstem evoked response audiometry ruled out hearing loss. In laboratory investigations anisocytosis, thrombocytopenia, elevated liver enzymes (ASAT: 3850 U/L, ALAT: 558 U/L, GGT: 292 U/L, ALP: 436 U/L), elevated lactate dehydrogenase (LDH) (38180 mmol/L), and creatinine kinase (CK) (7.1 U/L) with elevated bilirubin levels (87.9 μmol/L) were found. In microbiology investigations a high CMV virus number was detected using a quantitative real-time polymerase chain reaction (PCR) method from the urine and blood. Syphilis serology was positive (RPR: 1:16 positive, TPPA, TpELISA, and T. pallidum IgM immunoblot positive). HSV PCR (in the oral mucosa, conjunctiva, and blood) remained negative. Intravenous penicillin-G (100.000 IU/kg/dose for 10 days) therapy was administered. Intravenous ganciclovir was started, but was discontinued after 2 weeks because of progressive thrombocytopenia and elevating liver enzymes. The newborn underwent transfusion due to anemia and extreme thrombocytopenia. Blue light therapy was administered for 3 days because of jaundice. The multiple jejunal atresia was treated by operation (terminoterminal jejuno-jejunostomia and ileal stricturaplastica) in the Semmelweis University Pediatrics Clinic. At the time of writing this report, the girl was 2 months old, growing and developing; her intestinal passage is satisfactory, but the liver enzymes are extremely high due to the CMV infection. Congenital syphilis and congenital CMV are preventable diseases, but they are still the most common causes of perinatal mortality and morbidity worldwide (4,5). Intravenous drug users and mothers of low socioeconomic status belong to the highest risk groups for vertical transmission of infections. Congenital syphilis may induce jaundice, hepatosplenomegaly, wrinkled skin, thrombocytopenia, and anemia, with symptoms that are clinically similar to congenital CMV infection, making the differential diagnosis difficult (1,5,6). Although syphilis screening tests are mandatory in the first trimester of pregnancy in Hungary, at least one congenital syphilis case was observed yearly since the mid-nineties. Therefore, a second syphilis test is strongly recommended after the 28th gestational week or before delivery, particularly in high risk groups (7). The prenatal diagnosis of fetal CMV infection is based on amniocentesis in the 21st gestational week, which is a risky and non-standard method. The widely used ultrasonography examination often yields a uncertain diagnosis (8). Intravenous penicilline-G is effective treatment for congenital syphilis, but there is no gold standard therapy for CMV infection. Treatment with ganciclovir may prevent hearing loss later in life, but it has several severe side effects (neutropenia, anemia, thrombocytopenia, elevated liver enzymes) (9). Furthermore, studies on the effect of prolonged valganciclovir therapy are still ongoing (10). Prevention is the most effective method of reducing the prevalence of congenital CMV: pregnant women should avoid contact with the saliva of young children. In our case, the mother of the newborn belonged to a high risk group and did not participate in the prenatal caring system; mandatory screening tests were not done, so congenital infections were diagnosed only at delivery. The treatment for congenital syphilis was effective, and resulted in decrease of RPR titers. Most of the clinical symptoms did not improve, and the liver enzymes were continuously increased, indicating that CMV infection was a major contributor in clinical manifestation. Further follow up is needed to evaluate the radiological findings of long bones. Our case draws attention to the importance of early and effective prenatal diagnosis, adequate treatment of prenatal infectious diseases, and the necessity of a multidisciplinary approach to congenital infections.
- Bacterial community composition of chronic periodontitis and novel oral sampling sites for detecting disease indicators. [Journal Article]
- Microbiome 2014.:32.
Periodontitis is an infectious and inflammatory disease of polymicrobial etiology that can lead to the destruction of bones and tissues that support the teeth. The management of chronic periodontitis (CP) relies heavily on elimination or at least control of known pathogenic consortia associated with the disease. Until now, microbial plaque obtained from the subgingival (SubG) sites has been the primary focus for bacterial community analysis using deep sequencing. In addition to the use of SubG plaque, here, we investigated whether plaque obtained from supragingival (SupG) and tongue dorsum sites can serve as alternatives for monitoring CP-associated bacterial biomarkers.Using SubG, SupG, and tongue plaque DNA from 11 healthy and 13 diseased subjects, we sequenced V3 regions (approximately 200 bases) of the 16S rRNA gene using Illumina sequencing. After quality filtering, approximately 4.1 million sequences were collapsed into operational taxonomic units (OTUs; sequence identity cutoff of >97%) that were classified to a total of 19 phyla spanning 114 genera. Bacterial community diversity and overall composition was not affected by health or disease, and multiresponse permutation procedure (MRPP) on Bray-Curtis distance measures only supported weakly distinct bacterial communities in SubG and tongue plaque depending on health or disease status (P < 0.05). Nonetheless, in SubG and tongue sites, the relative abundance of Firmicutes was increased significantly from health to disease and members of Synergistetes were found in higher abundance across all sites in disease. Taxa indicative of CP were identified in all three locations (for example, Treponema denticola, Porphyromonas gingivalis, Synergistes oral taxa 362 and 363).For the first time, this study demonstrates that SupG and tongue dorsum plaque can serve as alternative sources for detecting and enumerating known and novel bacterial biomarkers of CP. This finding is clinically important because, in contrast with SubG sampling that requires trained professionals, obtaining plaque from SupG and tongue sites is convenient and minimally-invasive and offers a novel means to track CP-biomarker organisms during treatment outcome monitoring.
- 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.
- [Cutaneous manifestation of late-type syphilis]. [English Abstract, Journal Article]
- Dtsch Med Wochenschr 2014 Sep; 139(38):1883-6.
A 49-year-old, otherwise healthy man presented at his dermatologist with tuberous skin changes that had be present for several weeks on head, arm and leg. These were asymptomatic, but disturbed him cosmetically. A skin biopsy was performed.The skin biopsy showed a granulomatous inflammation with prominent plasma cells, consistent with granulomatous infiltrate. Serologic tests confirmed a Treponema pallidum-infection. In addition, the patient was tested positive for hepatitis C and HIV (CDC stage A1). The clinical neurological examination did not show any pathological findings, however, analysis of the cerebrospinal fluid revealed a mild pleocytosis, elevation of protein and the glucose quotient and a normal Treponema pallidum TPPA-antibody index. A mesaortitis was excluded.We diagnosed a tertiary syphilis (stage III). The patient refused prolonged inpatient treatment with penicillin G i. v., as recommended as first-line therapy in the national guidelines for asymptomatic neurosyphilis. Therefore, after a single oral administration of 100 mg prednisolone he received ceftriaxone intravenously for 14 days. The skin changes resolved. With regard to the HIV infection anti-retro-viral therapy was not yet indicated.In view of the increasing incidence of syphilis in Germany clinicians should consider this diagnosis when confronted with oligosymptomatic skin lesions.
- [Comparison of the effects of Ginkgo biloba extract and minocycline hydrochlovide on periodontitis]. [English Abstract, Journal Article]
- Zhonghua Kou Qiang Yi Xue Za Zhi 2014 Jun; 49(6):347-51.
To compare the clinical effect of Ginkgo biloba extract gel (Ginkgo biloba extract,EGB) and minocycline hydrochloride (Periocline) on periodontitis and their inhibition on putative periodontal pathogens.Thirty patients with moderate-to-severe periodontitis were selected. The patients were divided into an experimental group and a positive control group (minocycline hydrochloride). Supragingival and subgingival scaling were performed on all patients. Subgingival plaque samples were collected before treatment, 1 week, 2 months and 4 months after treatment. The four major periodontal pathogens Porphyromonas gingivalis (Pg), Bacteroides forsythus (Bf), Prevotella intermedia (Pi), Treponema denticola (Td) were detected by polymerase chain reaction. Clinical indexes plaque index (PLI), bleeding index (BI) and probing depth (PD), attachment loss (AL) were examined before treatment, 3 months and 6 months after treatment. The results were statistically analyzed.The detection rates of the 4 periodontal pathogens were Td (83.3%), Tf (95.0%), Pi (80.0%), Pg (81.7% ) in experimental group and Td (83.3%), Tf (95.0%), Pi (80.0%), Pg (81.7%) in control group before treatment. The detection rates in experimental group were not significantly different with those in control group after treatment, except for the detection rate of Pg 1 week after treatment (P < 0.01, the detection of Pg was 56.7% in experimental group and 53.3% in control group 1 week after treatment). The PLI and BI were not significantly different between experimental group and control group after treatment (P > 0.05). The difference was statistically significant at 6 months after treatment [(3.5 ± 0.5) mm for experimental group and (3.2 ± 0.4) mm for control group, P = 0.00]. The mean of AL decreased with time. The difference was statistically significant at 6 months after treatment [ (4.5 ± 0.4) mm for experimental group and (4.3 ± 0.4) mm for control group at 6 months, P = 0.01].The inhibition effects of EGB and minocycline hydrochloride were comparable for major periodontal pathogens within short term.
- Yaws. [REVIEW]
- Int J STD AIDS 2014 Sep 4.
Yaws is a non-venereal endemic treponemal infection caused by Treponema pallidum sub-species pertenue, a spirochaete bacterium closely related to Treponema pallidum pallidum, the agent of venereal syphilis. Yaws is a chronic, relapsing disease predominantly affecting children living in certain tropical regions. It spreads by skin-to-skin contact and, like syphilis, occurs in distinct clinical stages. It causes lesions of the skin, mucous membranes and bones which, without treatment, can become chronic and destructive. Treponema pallidum pertenue, like its sexually transmitted counterpart, is exquisitely sensitive to penicillin. Infection with yaws or syphilis results in reactive treponemal serology and there is no widely available test to distinguish between these infections. Thus, migration of people from yaws-endemic areas to developed countries may present clinicians with diagnostic dilemmas. We review the epidemiology, clinical presentation and treatment of yaws.
- Primary syphilis of the oropharynx: unusual location of a chancre. [JOURNAL ARTICLE]
- Int J STD AIDS 2014 Sep 4.
A 33-year-old man presented with a two-week history of an asymptomatic ulcer of the oropharynx and submandibular lymph nodes swelling. Laboratory examinations resulted normal, but serological tests revealed positivity for rapid plasma reagin, Treponema pallidum haemagglutination assay and anti-T. pallidum IgM antibodies. Since the patient denied any homosexual relationship, a biopsy of the lesion was performed, which confirmed primary syphilis. The patient received intramuscular injection of Benzathine Penicillin G (2.4 MU) with complete resolution. Extragenital chancres occur in at least 5% of patients with primary syphilis, and the oral mucosa is the most frequent location as a consequence of orogenital/oroanal contact with an infectious lesion. Because their transient nature, these oral ulcerations are often underestimated by the patient or by any unsuspicious clinician. Health professionals should consider the recent sexual history of their patients and should be prepared to recognise oral and systemic manifestations of sexually transmitted diseases.
- Morphology and motility of the spirochetes. [Journal Article]
- Nihon Saikingaku Zasshi 2014; 69(3):527-38.
Spirochetes have flagella within the cell body and swim by wriggling the spiral cell body. Besides they have been known to be critical agents causing various infectious diseases, their eccentric appearances and motilities have been attracting many scientists in a wide variety of fields other than bacteriologists. Unlike externally flagellated bacteria that swim by using flagella as a screw propeller, spirochetes progress in a liquid by changing their cell shapes. To understand the unique motion mechanism of spirochetes, many experiments and theoretical studies are being carried out. In this review, I will summarize morphological and motile properties of various species of spirochete, such as Borrelia, Treponema and Brachyspira. I will also expound on the motion mechanism of Leptospira with our latest results obtained by high-resolution optical photometry.
- Bacterial Infection and Alzheimer's Disease: A Meta-Analysis. [JOURNAL ARTICLE]
- J Alzheimers Dis 2014 Sep 2.
The possibility of an infectious etiology for Alzheimer's disease (AD) has been repeatedly postulated over the past three decades. We provide the first meta-analysis to address the relationship between bacterial infection and AD. Studies examining the association between AD and spirochetal bacteria or Chlamydophila pneumoniae (Cpn) were identified through a systematic search of the databases MEDLINE, EMBASE, PubMed, and Google Scholar. Data combined from 25 relevant, primarily case-control studies demonstrated a statistically significant association between AD and detectable evidence of infection of either bacterial group. We found over a ten-fold increased occurrence of AD when there is detectable evidence of spirochetal infection (OR: 10.61; 95% CI: 3.38-33.29) and over a four-fold increased occurrence of AD in a conservative risk estimate (OR 4.45; 95% CI: 2.33-8.52). We found over a five-fold increased occurrence of AD with Cpn infection (OR 5.66; 95% CI: 1.83-17.51). This study shows a strongly positive association between bacterial infection and AD. Further detailed investigation of the role of bacterial infection is warranted.