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OUR FINAL REPORT IN Group-7-syphilis.pptx
- 1. Syphilis Immuno-sero Presented by: Jaziel March Mendoza, Nishe Sumbe, May Lin Lo, Rhomela Zason, Juvel Baringui, Nesah Ando
- 2. Etiology T pallidum is a member of the order Spirochaetales and the family treponemataceae Treponoma includes number of species that reside in human gastrointestinal and genital tracts. T. pallidum , treponema pertenue , and Treponema carateum are human pathogens responsible for significant world wide morbidity Yaws is the common in the Caribbean Latin America and infection is limited to the skin Bejel- is found in eastern Mediterranean countries ,the Balkans and the cooler areas of North
- 3. Treponemes is most often performed with darkfield microscopy Pathogenic treponemes appear as fine , spiral (8 to 24 coils ) organism approximately 6 to 15 um long Treponemes may remain viable for up to 5 days in tissue specimen removed from diseased animals and from the frozen cryoprotected specimens
- 4. Sexually transmitted diseases ( STDs) remain a major public health challenge in the United States Centers for Disease Control and Prevention (CDC) includes data on the three STDs that physicians are required to report to the agency chlamydia, gonorrhea, and syphilis Syphilis is considered to be primarily a venereal disease . The three treponematoses yaws , pinta and bejel - are rarely seen in the United states but are prevalent Epidemiology
- 5. In 2009, for the first time in 5 years the CDC reported that syphilis cases did not increase overall women . In the the surveillance period of 2004 to 2008 rates of P&S syphilis increased among 15 to 24 years old men and women Syphilis develops in 30 % to 50 % of the sexual partners of person with syphilitic A high percentage of partners do seek medical treatment within 90 days contact Spirochetes do not appear to survive units of
- 6. Sign and Symptoms 揃Untreated syphilis is chronic disease with subacute symptomatic periods seprated by asymptomatic intervals, during which the diagnosis can be made serologically. 揃T.pallidum penetrated intact mucous membranes or enters the body through tiny defects in the epithelium. Stages of untreated syphilis: Primary Secondary
- 9. The secondary stage is characterized by a generalized illness that usually begins with symptoms: Headache, Sore throat, Low-grade fever Occasionally, nasal discharge Macular lesions are common and a rash invariably involves the genitalia; this rash often is prominent on the palms and soles. Hepatitis and immune complex In males, spirochetes are present in lesion on the penis or discharge from deeper sites with semen. In females, infected lesions are usually located in the perineal region or on the labia, vaginal wall, or cervix. The primary chancre will persist for 1 to 5 weeks and will heal Secondary Syphilis Primary Syphilis
- 10. After resolution of untreated secondary syphilis, the patient enters a latent noninfectious state Relapses (in 1st 2-4 years) --> infectious and are extremely rare after 4 years of latency 1/3 --> spontaneously cured 1/3 --> never develop further clinical manifestations 1/3 --> develop late syphilis The first manifestations are usually seen from 3 to 10 years after primary infection 15% - late benign syphilis 10% - cardiovascular manifestations 8% - involves the CNS; initially asymptomatic and detected in CSF Meningovascular syphilis Latent Syphilis Late (Tertiary) Syphilis
- 11. caused by maternal spirochetemia and transplacental transmission Untreated syphilis during pregnancy, lead to stillbirth, neonatal death, or infant disorders can be prevented by early detection of maternal infection and treatment at least 30 days before delivery Congenital Syphilis Early stage: children younger than 2 years rash, condyloma latum, bone changes, hepatosplenomegaly, jaundice, and/or anemia Late stage: children older than 2 years eighth nerve deafness, keratitis,
- 12. Neurosyphilis Meningeal syphilis, usually less than 1 year after infection Meningovascular syphilis, usually 5 to 10 years after infection Immunologic Manifestations Two classes of antigen have been recognized: Antigens restricted to one or a few species Antigens shared by many different spirochetes Antitreponemal antibodies specific antibodies against T. pallidum nonspecific antibodies Nontreponemal antibodies (reagin antibodies) are produced by infected patients against components of their own or Parenchymatous syphilis meningeal neurosyphilis involves the brain or spinal cords
- 13. Diagnostic Evaluation Depends on clinical skills, demonstration of microorganisms in a lesion, and serologic testing Classic serologic methods for syphilis measure the presence of two types of antibodies, nontreponemal methods and treponemal methods. Direct Observation of Spirochetes Darkfield microscopy - the test of choice for symptomatic patient with primary syphilis Fluorescent antibody microscopy - an alternate indirect method uses antibody specific for T. pallidum and a second labeled anti-immunoglobulin antibody.
- 14. determine the presence of reagin, an antibody formed against cardiolipin agglutination tests in which soluble antigen particles coalesce to form larger particles that are visible as clumps when they are aggregated by antibody. Rapid Plasma Reagin (RPR) is the most widely used nontreponemal serologic procedure Use a serum specimen; cannot be used for CSF more sensitive than the VDRL test for the detection of primary syphilis Nontreponemal Methods
- 15. The VDRL test, a flocculation test, is a qualitative and quantitative screening procedure. Flocculation is a specific type of precipitation reaction that takes place over a narrow range of antigen concentration. Serum for testing must be heated to 56属 C (133属 F) for 30 minutes to inactivate complement. The test serum should be used promptly after inactivation. Venereal Disease Research Laboratory Test
- 16. Treponemal assays can confirm reactive (positive) reagin tests but should not be used as primary screening methods. Ihe most common assays in this category are the following: Fluorescent treponemal antibody absorption (F'TA-ABS) I. pallidum particle agglutination (TP-PA) T. pallidum antibody by enzyme-linked immunosorbent assay (ELISA) T. pallidum antibody by immunoblot (Western blot) test Treponemal Methods
- 17. Is a laboratory test used to detect antibodies produced by the body in response to Treponema pallidum, the bacterium that causes syphilis. Fluorescent treponemal antibody absorption (F'TA-ABS) Pallidum particle agglutination (TP-PA) A serological test used in the diagnosis of syphilis It compares favorably to the PTA test but is slightly less sensitive in untreated early primary syphilis. This assay is excellent for resolving inconclusive FTA-ABS results
- 18. How does FTA-ABS and TP-PA work? 1.Sample Collection 2.Treponemal Antigen 3.Fluorescent Tagging 4.Visualization
- 23. Treponema pallidum Antibody, Immunoglobulin G, by Enzyme-Linked Immunosorbent Assay The ELISA assay can discriminate maternally derived IgG antibodies that cross the placenta from IgM antibodies. sensitivity is approximately 80%. Hence, congenital syphilis. Treponema pallidum Antibody, Immunoglobulin G, by Immunoblot (Western Blot) Test A negative result is seen when no specific IgG antibodies against T. pallidum are detected. Repeat testing in 2 to 4 weeks is recommended if results are equivocal.The presence of IgG antibody to T.
- 24. Sensitivity of Representative Procedures for Syphilis Primary stage, about 30% of cases become serologically active after 1 week and 90% of patients demonstrate reactivity after 3 weeks. Reagin titers increase rapidly during the first 4 weeks of infection and then remain stable for about 6 months. Patients in the secondary stage of syphilis are serologically positive. During latent syphilis, there is a gradual return of nonreactive serologic manifestations, as seen with
- 25. Traditional versus Reverse-Screening Algorithm Protocols The traditional protocol for syphilis screening is to use a nontreponemal test followed by a treponemal antibody test for confirmation of a reactive specimen. reverse protocol, most patient specimen are negative with only small percentage of specimens requiring a manual nontreponemal test. Proponents of an automated, reverse protocol cite workflow advantages and an increase detection rate of late- stage syphilis. If discordant results are encountered. The CDC suggests confirmation of discordant results by using
- 26. VDRL QUALITATIVE TEST During the period of infection with syphilis, reagin, a substance with the properties of an antibody, appears in the serum of infected patients. Reagin has the ability to combine with a colloidal suspension extracted from animal tissue and clump together to form visible masses , a process known as flocculation. Sources of Error False Positive Reactions 1. Technical Error (e.g., unsatisfactory antigen or te 2. Low Antibody Titers 3. Presence of Inhibitors in the patient's serum 4. Reduced Ambient Temperature (<23属 C to 29属 C) 5. Prozone Reaction
- 27. False Positive VDRL reactions: 1. Lupus erythematosus 2. Rheumatic fever 3. Vaccinia and viral pneumonia 4. Pneumococcal pneumonia 5. Infectious mononucleosis 6. Infectious hepatitis 7. Leprosy 8. Malaria 9. Rheumatoid arthritis 10. Pregnancy 11. Older
- 28. RAPID PLASMA REAGIN CARD TEST (RPR) The RPR Test is designed to detect reagin, an antibody- like substance present in serum. In this procedure, the serum is mixed with an antigen suspension of the carbon particles of antigen. If the specimen contains antibody, flocculation occurs with a coagglutination of carbon particles of antigen. The flocculation appears as black clumps against the white background of a plastic coated card. The cards are viewed
- 29. False Positive VDRL reactions: 1. Lupus erythematosus 2. Rheumatic fever 3. Vaccinia and viral pneumonia 4. Pneumococcal pneumonia 5. Infectious mononucleosis 6. Infectious hepatitis 7. Leprosy 8. Malaria 9. Rheumatoid arthritis 10. Pregnancy 11. aging individuals False Negative Reactions 1. Poor technique 2. Ineffective reagents 3. Improper rotation
- 30. Fluorescent Treponemal Antibody Absorption Test (FTA - ABS) The FTA - ABS test is a direct method of observation. Although not recommended for screening, it is the most sensitive serologic procedure in the detection of primary syphilis.