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Diagnosis of treponemal co-infection in HIV-infected West Africans.
Trop Med Int Health. 2012 Dec; 17(12):1521-6.TM

Abstract

OBJECTIVES

To evaluate the performance of two enzyme immunoassays (EIA), Murex and ICE, and the Determine TP point-of-care test (POCT) in diagnosing treponemal infection (syphilis or yaws) in patients attending a large HIV clinic in Ghana; to determine the prevalence of treponemal co-infections; and to characterise demographic and clinical features of patients with infection.

METHODS

Samples were tested with EIAs and rapid plasma reagin (RPR), then POCT and reference assays for Treponema pallidum to determine prevalence of active and past infection. Sensitivity and specificity of each assay were calculated and demographic and clinical characteristics of patients compared. Data were collected from case notes of patients retrospectively.

RESULTS

Overall, 45/284 patient samples (14.8%, 95% CI, 11.1-19.4%) were Treponema pallidum particle agglutination (TPPA) positive, and of these, 27 (64.3%) were RPR positive and 4 (8.9%) were treponemal IgM positive. Both EIAs and Determine TP POCT showed high sensitivities and specificities for identifying infection although RPR was less reliable. Clinical features of syphilis or yaws were rarely identified in TPPA-positive patients suggesting most had previous or late latent infection. Treatment of various intercurrent infections using short courses of antibiotics active against T. pallidum was common in the clinic.

CONCLUSIONS

A high proportion of this HIV-infected cohort showed evidence of treponemal infection. Both EIAs as well as the POCT were practical and effective at diagnosing treponemal co-infection in this setting. RPR alone was unreliable at identifying active treponemal co-infection, however might be useful in some settings where treponemal-specific assays are unaffordable.

Authors+Show Affiliations

The James Cook University Hospital, Middlesbrough, UK Komfo Anokye Teaching Hospital, Kumasi, Ghana Health Protection Agency South West Regional Laboratory, Bristol, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22994205

Citation

Mamoojee, Yaasir, et al. "Diagnosis of Treponemal Co-infection in HIV-infected West Africans." Tropical Medicine & International Health : TM & IH, vol. 17, no. 12, 2012, pp. 1521-6.
Mamoojee Y, Tan G, Gittins S, et al. Diagnosis of treponemal co-infection in HIV-infected West Africans. Trop Med Int Health. 2012;17(12):1521-6.
Mamoojee, Y., Tan, G., Gittins, S., Sarfo, S., Stephenson, L., Carrington, D., Bedu-Addo, G., Phillips, R., Appiah, L. T., & Chadwick, D. (2012). Diagnosis of treponemal co-infection in HIV-infected West Africans. Tropical Medicine & International Health : TM & IH, 17(12), 1521-6. https://doi.org/10.1111/j.1365-3156.2012.03090.x
Mamoojee Y, et al. Diagnosis of Treponemal Co-infection in HIV-infected West Africans. Trop Med Int Health. 2012;17(12):1521-6. PubMed PMID: 22994205.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis of treponemal co-infection in HIV-infected West Africans. AU - Mamoojee,Yaasir, AU - Tan,Grace, AU - Gittins,Sandra, AU - Sarfo,Stephen, AU - Stephenson,Lisa, AU - Carrington,David, AU - Bedu-Addo,George, AU - Phillips,Richard, AU - Appiah,Lambert T, AU - Chadwick,David, Y1 - 2012/09/20/ PY - 2012/9/22/entrez PY - 2012/9/22/pubmed PY - 2014/2/8/medline KW - Africa KW - Afrique KW - HIV KW - VIH KW - diagnosis KW - diagnostic KW - diagnóstico KW - pian KW - pián KW - sensibilidad y especificidad KW - sensibilité et spécificité KW - sensitivity and specificity KW - syphilis KW - sífilis KW - yaws KW - África SP - 1521 EP - 6 JF - Tropical medicine & international health : TM & IH JO - Trop Med Int Health VL - 17 IS - 12 N2 - OBJECTIVES: To evaluate the performance of two enzyme immunoassays (EIA), Murex and ICE, and the Determine TP point-of-care test (POCT) in diagnosing treponemal infection (syphilis or yaws) in patients attending a large HIV clinic in Ghana; to determine the prevalence of treponemal co-infections; and to characterise demographic and clinical features of patients with infection. METHODS: Samples were tested with EIAs and rapid plasma reagin (RPR), then POCT and reference assays for Treponema pallidum to determine prevalence of active and past infection. Sensitivity and specificity of each assay were calculated and demographic and clinical characteristics of patients compared. Data were collected from case notes of patients retrospectively. RESULTS: Overall, 45/284 patient samples (14.8%, 95% CI, 11.1-19.4%) were Treponema pallidum particle agglutination (TPPA) positive, and of these, 27 (64.3%) were RPR positive and 4 (8.9%) were treponemal IgM positive. Both EIAs and Determine TP POCT showed high sensitivities and specificities for identifying infection although RPR was less reliable. Clinical features of syphilis or yaws were rarely identified in TPPA-positive patients suggesting most had previous or late latent infection. Treatment of various intercurrent infections using short courses of antibiotics active against T. pallidum was common in the clinic. CONCLUSIONS: A high proportion of this HIV-infected cohort showed evidence of treponemal infection. Both EIAs as well as the POCT were practical and effective at diagnosing treponemal co-infection in this setting. RPR alone was unreliable at identifying active treponemal co-infection, however might be useful in some settings where treponemal-specific assays are unaffordable. SN - 1365-3156 UR - https://www.unboundmedicine.com/medline/citation/22994205/Diagnosis_of_treponemal_co_infection_in_HIV_infected_West_Africans_ L2 - https://doi.org/10.1111/j.1365-3156.2012.03090.x DB - PRIME DP - Unbound Medicine ER -