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Arlene C Sena - One of the best experts on this subject based on the ideXlab platform.
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comparison of the cerebrospinal fluid csf toluidine red unheated serum test and the csf Rapid Plasma Reagin test with the csf venereal disease research laboratory test for diagnosis of neurosyphilis among hiv negative syphilis patients in china
Journal of Clinical Microbiology, 2014Co-Authors: Lin Zhu, Ruirui Peng, Cuini Wang, Zixiao Gao, Pingyu Zhou, Ying Gao, Mei Shi, Zhifang Guan, Arlene C SenaAbstract:ABSTRACT In this study, we aimed to investigate the performance of nontreponemal antibody tests in cerebrospinal fluid (CSF) specimens from syphilis patients. From September 2009 to September 2012, CSF specimens were collected at the Shanghai Skin Disease Hospital in Shanghai, China, from 1,132 syphilis patients without HIV infection, including 154 with symptomatic and 56 with asymptomatic neurosyphilis. All of the CSF specimens underwent testing with a Rapid Plasma Reagin (RPR) test, an RPR-V (commercial RPR antigen diluted 1:2 in 10% saline) test, the toluidine red unheated serum test (TRUST), and the Venereal Disease Research Laboratory (VDRL) test. Specificities, sensitivities, positive predictive values (PPVs), negative predictive values (NPVs), and kappa values were calculated to determine the performances of the tests. We compared results of the CSF-VDRL, CSF-RPR, CSF-RPR-V, and CSF-TRUST among patients with symptomatic and asymptomatic neurosyphilis who had reactive CSF-Treponema pallidum particle agglutination (TPPA) test results. Overall, the CSF-VDRL test was reactive in 261 patients (23.1%). There were no cases in which the CSF-VDRL was nonreactive and CSF-RPR, CSF-RPR-V, or CSF-TRUST was reactive. Agreement between the results of CSF-TRUST and CSF-RPR was almost perfect (κ = 0.861), with substantial agreement between the results of CSF-RPR and CSF-RPR-V (κ = 0.740). The sensitivities of CSF-VDRL, CSF-RPR, CSF-RPR-V, and CSF-TRUST were 81.4%, 76.2%, 79.5%, and 76.2%, respectively. Compared to CSF-VDRL, CSF-RPR, CSF-RPR-V, and CSF-TRUST had comparable PPVs and NPVs. However, the specificity of CSF-VDRL (90.3%) was significantly lower than those of the other tests (92.7 to 93.4%). Therefore, CSF-RPR, CSF-RPR-V, and CSF-TRUST can be considered alternative tests for neurosyphilis diagnosis in HIV-negative populations, particularly when the CSF-VDRL is not available.
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Rapid Plasma Reagin titer variation in the 2 weeks after syphilis therapy
Sexually Transmitted Diseases, 2012Co-Authors: Katherine M Holman, Frieda Behets, Mark Wolff, Arlene C Sena, David H Martin, Kathleen Van Damme, Peter A Leone, Linda Mcneil, Meredyth L Gehrig, Edward W HookAbstract:BACKGROUND Serologic tests for syphilis results at the time of diagnosis are the basis for evaluating response to syphilis therapy. After treatment, however, serologic tests for syphilis titers may continue to increase for several weeks. We evaluated Rapid Plasma Reagin (RPR) titer variation during the 14 days after therapy using data from a recent large, prospective randomized controlled trial. METHODS Prospectively enrolled participants in North America and Madagascar with primary, secondary, or early latent syphilis were randomly assigned to penicillin, doxycycline (in the case of penicillin allergy), or azithromycin treatment. Blood for RPR analysis was drawn at days 0, 7, and 14 posttreatment. All RPR titers were determined simultaneously at a central laboratory. RESULTS Four hundred and seventy patients had data available for at least 2 of 3 RPR measurements. Overall, 20% of patients showed a titer increase of at least 1 dilution in the 14 days after therapy. The greatest proportion of titer increases following therapy was observed in patients with primary syphilis. Comparing outcome of therapy using the initial (day 0) RPR titer versus the maximal RPR titer (during 14 days) resulted in outcome reclassification in 2.98% of participants. CONCLUSIONS Despite the fact that about 20% of early syphilis patients had increases in RPR titers immediately after treatment, these changes rarely influenced assessment of therapeutic outcome. Only 3% of patients treated would have been reclassified.
Jeffrey D Klausne - One of the best experts on this subject based on the ideXlab platform.
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cytokine expression in treponema pallidum infection
Journal of Translational Medicine, 2019Co-Authors: Noah Kojima, Kelika A Konda, Silve K Vargas, Carlos F Caceres, Jane Siebe, Holde T Maecke, Yael Rosenberghasso, Segundo R Leo, Jeffrey D KlausneAbstract:Background Current syphilis tests cannot distinguish between active and past syphilis among patients with serofast Rapid Plasma Reagin (RPR) titers. We investigated whether cytokine profiles might provide insight in the differentiation of active and treated syphilis.
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laboratory evaluation of a point of care downward flow assay for simultaneous detection of antibodies to treponema pallidum and human immunodeficiency virus
Journal of Clinical Microbiology, 2016Co-Authors: Sasha Herbs De Cortina, Kelika A Konda, Silve K Vargas, Claire C Istow, Carlos F Caceres, D G Perez, Jeffrey D KlausneAbstract:Combining the detection of syphilis and HIV antibodies into one point-of-care test integrates syphilis screening into already existing HIV screening programs, which may be particularly beneficial in settings such as antenatal care. Using the INSTI Multiplex downward-flow immunoassay, we tested 200 stored serum samples from high-risk patients enrolled in a longitudinal study on HIV infection and syphilis in Peruvian men who have sex with men and transgender women. This Rapid assay detected HIV and Treponema pallidum serum antibodies with sensitivities of 100% (95% confidence interval [CI], 95.9% to 100%) and 87.4% (95% CI, 81.4% to 92.0%), respectively, and specificities of 95.5% (95% CI, 89.9% to 98.5%) and 97.0% (95% CI, 84.2% to 99.9%), respectively (n = 200). The sensitivity for syphilis antibody detection was higher in patients with a Rapid Plasma Reagin titer of ≥1:8 (97.3%) than in those with a titer of ≤1:4 (90%) or a nonreactive titer (66.7%).
Kelika A Konda - One of the best experts on this subject based on the ideXlab platform.
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cytokine expression in treponema pallidum infection
Journal of Translational Medicine, 2019Co-Authors: Noah Kojima, Kelika A Konda, Silve K Vargas, Carlos F Caceres, Jane Siebe, Holde T Maecke, Yael Rosenberghasso, Segundo R Leo, Jeffrey D KlausneAbstract:Background Current syphilis tests cannot distinguish between active and past syphilis among patients with serofast Rapid Plasma Reagin (RPR) titers. We investigated whether cytokine profiles might provide insight in the differentiation of active and treated syphilis.
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laboratory evaluation of a point of care downward flow assay for simultaneous detection of antibodies to treponema pallidum and human immunodeficiency virus
Journal of Clinical Microbiology, 2016Co-Authors: Sasha Herbs De Cortina, Kelika A Konda, Silve K Vargas, Claire C Istow, Carlos F Caceres, D G Perez, Jeffrey D KlausneAbstract:Combining the detection of syphilis and HIV antibodies into one point-of-care test integrates syphilis screening into already existing HIV screening programs, which may be particularly beneficial in settings such as antenatal care. Using the INSTI Multiplex downward-flow immunoassay, we tested 200 stored serum samples from high-risk patients enrolled in a longitudinal study on HIV infection and syphilis in Peruvian men who have sex with men and transgender women. This Rapid assay detected HIV and Treponema pallidum serum antibodies with sensitivities of 100% (95% confidence interval [CI], 95.9% to 100%) and 87.4% (95% CI, 81.4% to 92.0%), respectively, and specificities of 95.5% (95% CI, 89.9% to 98.5%) and 97.0% (95% CI, 84.2% to 99.9%), respectively (n = 200). The sensitivity for syphilis antibody detection was higher in patients with a Rapid Plasma Reagin titer of ≥1:8 (97.3%) than in those with a titer of ≤1:4 (90%) or a nonreactive titer (66.7%).
Susan E Kikkert - One of the best experts on this subject based on the ideXlab platform.
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evaluation of a digital flocculation reader for the Rapid Plasma Reagin test for the serological diagnosis of syphilis
Sexually Transmitted Diseases, 2012Co-Authors: Arnold R Castro, Susan E Kikkert, David D Binks, Danny L Raymer, Heather Jost, Mahin M Park, Benjamin D Card, David L CoxAbstract:We described the ASiManager-AT digital flocculation reader to demonstrate concordance between visual and digital readings of the Rapid Plasma Reagin test for detection of antibodies in the serum of patients with syphilis. A qualitative and quantitative Rapid Plasma Reagin was performed on each serum samples giving a concordance of 98.6% and 99.7%, respectively, for reactives and 100% for nonreactives.
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comparison of the serodia treponema pallidum particle agglutination captia syphilis g and spirotek Reagin ii tests with standard test techniques for diagnosis of syphilis
Journal of Clinical Microbiology, 2000Co-Authors: Victoria Pope, Martha B Fears, W E Morrill, Arnold R Castro, Susan E KikkertAbstract:We compared the microhemagglutination assay for Treponema pallidum (MHA-TP), a treponemal test, with two other treponemal tests, the Serodia Treponema pallidum particle agglutination (TP-PA) assay and the Captia Syphilis-G enzyme immunoassay, using 390 clinical serum samples. We also compared two nontreponemal tests, the Rapid Plasma Reagin (RPR) card test and the SpiroTek Reagin II test. Agreements of the MHA-TP with the TP-PA test and the Syphilis-G test were 97.4 and 97.7%, respectively. There was 89.2% agreement between the RPR and Reagin II tests. The Reagin II test was more apt to be reactive if the treponemal test was also reactive. We conclude that either the Serodia TP-PA test or the Captia Syphilis-G test is an appropriate substitute for the MHA-TP and that the Spirotek Reagin II test could substitute for the RPR test as a screening test.
Ameeta E Singh - One of the best experts on this subject based on the ideXlab platform.
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primary syphilis serological treatment response to doxycycline tetracycline versus benzathine penicillin
The American Journal of Medicine, 2008Co-Authors: Tom Wong, Ameeta E Singh, Prithwish DeAbstract:Abstract Background Benzathine penicillin G is the treatment of choice for infectious syphilis, but tetracycline and doxycycline are believed to be effective second-line treatments. The objective of this study was to assess the serological response from treatment of primary syphilis with benzathine penicillin compared with doxycycline or tetracycline. Methods We examined Rapid Plasma Reagin serological test results of all first-time primary syphilis patients in Alberta, Canada from 1980 to 2001 and compared treatment with single dose of penicillin with 14-day course of oral doxycycline (100 mg twice a day) or oral tetracycline (500 mg 4 times a day). Serological treatment success was defined as a minimum 4-fold decrease in baseline Rapid Plasma Reagin test antibody titer within 6 months, or ≥8-fold decrease within 12 months, or ≥16-fold decrease by 24 months. The median time to successful response was estimated, and factors associated with treatment success were identified by unadjusted logistic regression. Results Of the 445 primary syphilis cases with available treatment outcome data, 420 (94.4%) received penicillin and 25 (5.6%) received doxycycline/tetracycline. The serological treatment success rate was 97.4% in the penicillin group (409/420) and 100% in the doxycycline/tetracycline group (25/25), and not significantly different. The estimated median time to serological treatment success was 72.0 days (mean=101.7, range 10-603) in penicillin and 43.0 days (mean=78.6, range 15-334) in doxycycline/tetracycline-treated patients; however, this difference was not statistically significant ( P =0.16). Conclusion Doxycycline/tetracycline had a similarly high serological treatment success rate when compared with penicillin in the treatment of primary syphilis.
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characteristics of primary and late latent syphilis cases which were initially non reactive with the Rapid Plasma Reagin as the screening test
International Journal of Std & Aids, 2008Co-Authors: Ameeta E Singh, Tom WongAbstract:SummaryThe aim of the study was to determine the characteristics of primary and late latent syphilis cases that were non-reactive on initial screening by Rapid Plasma Reagin (RPR) but reactive by treponemal tests. RPR test results of all primary and late latent syphilis cases in the province of Alberta, Canada during 1980–2001 were compiled. The proportion of syphilis cases that were non-reactive by RPR testing was compared with reactive cases. Multiple logistic regression was used to identify factors associated with non-reactive RPR results. Among primary syphilis cases, 224 (26%) were non-reactive on initial RPR and were compared with 639 reactive primary cases. Independent factors associated with a non-reactive result were male gender (odds ratio, [OR] = 1.99 [1.22–3.26]), Caucasian ethnicity (OR = 1.77 [1.20–2.61]) and diagnosis during the 1980–1986 syphilis outbreak period in Alberta (OR = 3.13 [1.45–6.74]). Of the late latent cases, 512 (39%) were non-reactive by RPR and 791 were reactive. A non-rea...
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an infant with seizures rash and hepatosplenomegaly
Clinical Infectious Diseases, 2008Co-Authors: Philip A Mackowiak, Maocheng Lee, Joan Robinson, Bonita E Lee, Ameeta E SinghAbstract:Diagnosis: congenital syphilis. The infant's Rapid Plasma Reagin test was reactive at a titer of 1 :256 dilutions; a Treponema pallidum particle agglutination assay and fluorescent treponemal antibody absorption test were also reactive. A CSF sample that was obtained after the patient had received 4 days of antibiotics revealed a WBC count of 6 cells/mm3 (7% polymorphonuclear cells, 70% lymphocytes, and 23% monocytes and macrophages), an RBC count of 32 cells/ mm3, a protein level of 0.43 g/L, and a glucose level of 2.2 mmol/L; a Venereal Disease Research Laboratory test was nonreactive. Long-bone radiographs and MRIs of the brain had normal findings. The patient was treated with penicillin G for 10 days. The rash (figures 1-3) had improved markedly at the time of hospital discharge, but the patient was still requiring supplemental nasogastric feeds because of a poor suck. A follow-up Rapid Plasma Reagin test that was performed 3 months after initiation of therapy was reactive at a titer of 1 :8 dilutions. The mother reported a history of having a macular rash on her trunk, upper extremities, and the dorsum of her hands 1 month postpartum. During her child's hospitalization, the mother had a Rapid Plasma Reagin test that was reactive at 1 : 128 dilutions, as well as a reactive T. pallidum particle agglutination assay and fluorescent treponemal antibody absorption test; she received a diagnosis of secondary syphilis, with her infection clearly having been acquired during pregnancy. Approximately 60% of infants with congenital syphilis are asymptomatic at birth [1]. Early manifestations typically occur at 2-13 weeks of age but can occur at up to 2 years of age, with more than one-half of cases involving a rash [2, 3]. Dermatologic manifestations range from desquamation alone to a generalized maculopapular rash (often presenting as bright red, raised, palpable lesions that gradually fade), mucous patches, papulosquamous lesions (especially on the palms and soles), or vesicobullous lesions. Syphilitic pemphigus is a term that refers to an increasingly rare and uniquely neonatal vesicobullous rash that is located primarily on the palms and soles and consists of dark red papules that evolve into bullae teeming with treponemes; the bullae are 1-5 cm in diameter with a red indurated base and leave a macerated brown crust following bullae rupture [2]. In a consecutive survey of 206 cases of congenital syphilis, none of the patients had syphilitic pemphigus [3]. In our case, because material from the bullae was not tested for treponemes, it is difficult to be certain whether the bullae constituted true syphilitic pemphigus. There was concern that the patient's hypoglycemia and hyponatremia could be indicative of syphilitic hypopituitarism, but