Syphilis in the AIDS era.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
E Stolz
Publications and source records attributed to E Stolz.
Psychologic characteristics of men with alopecia androgenetica and their modification.
Psychologic characteristics were studied in a sample of 168 men with alopecia androgenetica who participated in a clinical trial on the efficacy of minoxidil gel. In general, no evidence of psychologic malfunctioning was found. Instead, a slightly more adequate psychologic state was indicated. However, specific problems associated with hair loss were reported by a substantial number of men. Responders with cosmetic improvement in the group over 35 years of age improved more regarding general psychologic maladjustment, inadequacy, and self-evaluation than those who did not respond. A reverse trend was, however, found in the group younger than 35 years of age, where the nonresponders improved more. An explanation for these findings is derived from the theory of cognitive dissonance.
Adolescent↗
Performance of a nonisotopic DNA probe for detection of Chlamydia trachomatis in urogenital specimens.
The Gen-Probe PACE 2 assay (GP), a nonisotopic DNA probe, was evaluated by using cell culture as the method of reference. Specimens were collected from 260 men and 482 women visiting the outpatient department for sexually transmitted diseases at the University Hospital in Rotterdam, The Netherlands. The prevalences of Chlamydia culture-positive men and women were 13.2 and 8.6%, respectively. Sensitivity values for the male and female patients were 70.6 and 92.7%, respectively. Specificity values for these groups were 98.2 and 97.7%, respectively. Sensitivity was significantly lower when the number of inclusions in cell culture was low. Samples which showed a discordance between cell culture and GP results were retested by the polymerase chain reaction. If the results of the polymerase chain reaction were considered as the points of reference, the sensitivity and specificity of both GP and cell culture could be calculated. The performance of GP for females was comparable to that of cell culture. In males, the sensitivity of GP was considerably lower than that of cell culture (77.2 versus 91.4%), while specificity was somewhat higher (99.6 versus 99.1%). Compared with cell culture, the GP is a relatively simple and rapid test that is suitable for diagnosing Chlamydia infections in urogenital specimens.
Base Sequence↗
Ultrastructural aspects of infection with Treponema pallidum subspecies pertenue (Pariaman strain).
OBJECTIVE: To study ultrastructural aspects of infection with Treponema pertenue (Pariaman strain), originating from West Sumatra, Indonesia. MATERIALS AND METHODS: Biopsy material originating from skin lesions in ten young children suffering from early infectious yaws in Indonesia, and rabbit testicular tissue inoculated with T pertenue. Human skin as well as rabbit testicular tissue was examined by means of conventional electron microscopy. RESULTS: In human skin, treponemes were found in interepidermal spaces in 5 out of 10 specimens. In two of five positive specimens, treponemes were also seen in the dermis. In one out of five specimens from rabbit testicular tissue a profusion of treponemes was found lying in the interstitial myxomatous tissue. Microorganisms showed no adhesion to fibroblasts. CONCLUSION: This ultrastructural study of T pertenue demonstrated the scarcity and focal distribution of treponemes in tissue and did not reveal any morphological differences from the Gauthier strain of T pertenue. No differences from the ultrastructure of T pallidum were observed either.
Animals↗
Treatment of molluscum contagiosum using a lidocaine/prilocaine cream (EMLA) for analgesia.
Eighty-three 4- to 12-year-old children, scheduled for curettage of at least five molluscum contagiosum lesions, participated in a double-blind study. The children were randomly allocated to receive lidocaine/prilocaine (EMLA) cream (n = 58) or placebo cream (n = 25), applied 15, 30, or 60 minutes before treatment. The pain was assessed by the children and the physician as none, slight, moderate, or severe. In addition, the children rated the pain on a visual analog scale. EMLA cream effectively prevented the pain after all three application times (p less than 0.01). No significant difference in pain was observed among the 15-, 30-, and 60-minute EMLA-treated groups, but the proportion of children reporting no pain on the verbal scale increased from 36% in the 15-minute group to 61% in the 60-minute group. In the placebo group, only one of 24 children (4%) reported no pain. Transient local redness was the only skin reaction noted. In conclusion, an application time of EMLA cream of less than 60 minutes is satisfactory for the curettage of molluscum contagiosum in children.
Anesthetics, Local↗
Placebo-controlled study of psoriasis patients treated topically with a 10% cyclosporine gel.
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Administration, Cutaneous↗
Pefloxacin compared with cefotaxime for treating men with uncomplicated gonococcal urethritis.
In a randomized comparative study, 83 male patients suffering from acute uncomplicated gonococcal urethritis were treated with a single dose of either 0.8 g pefloxacin, given orally, or 1.0 g cefotaxime, given intramuscularly. The cure rates were 100% in both treatment groups four to seven days and 21 to 31 days, respectively, after therapy. The MICs of the isolated Neisseria gonorrhoeae ranged from 0.008 to 0.06 mg/l for pefloxacin and from 0.0005 to 0.03 mg/l for cefotaxime. Postgonococcal urethritis was found in 9% of the patients treated with pefloxacin and in 20% of the patients treated with cefotaxime. Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum were isolated from 15%, 7% and 22% of the patients, respectively, before therapy and from 22%, 11% and 20% of the patients, respectively, 21 to 31 days after therapy. Both antibiotics had no effect on the presence of these microorganisms. No side effects were recorded in either groups of patients except that 46% of the patients treated with cefotaxime reported mild pain at the injection site. In conclusion, pefloxacin and cefotaxime are safe and effective agents in the treatment of uncomplicated gonococcal urethritis in men.
Administration, Oral↗
Anti-Mycobacterium leprae monoclonal antibodies cross-react with human skin: an alternative explanation for the immune responses in leprosy.
A panel of 17 mouse monoclonal antibodies (MoAb) raised against Mycobacterium leprae (M. leprae) antigens was used to detect antigenic determinants in normal human skin. An indirect immunoperoxidase technique was used. Eight of the MoAb detected epidermal antigens similar to patterns well known for human sera. Five of these MoAb detected determinants in the dermis, too. These observations may indicate a certain degree of similarity between the antigenic determinants occurring in M. leprae and in the human host. We propose that such a similarity on the one hand may facilitate the survival of M. leprae in the human host when the antigens are not recognized as "non-self," a situation which seems to occur in lepromatous leprosy, when the patients' tissues are loaded with bacteria virtually without any immune response. On the other hand, M. leprae antigens which mimic host antigens may induce an auto-immune reaction against the host's own antigens, which could explain the immune reaction in tuberculoid leprosy and during a "reversal reaction" when M. leprae is not observed in the host tissues, but extensive granuloma formation occurs.
Animals↗
Leprosy and human immunodeficiency virus infection. A closer look at the lesions.
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Acquired Immunodeficiency Syndrome↗
Disseminated early yaws: report of a child with a remarkable genital lesion mimicking venereal syphilis.
A 3 1/2-year-old boy, born and living in Indonesia, experienced disseminated skin lesions and an ulcerated, crusted, papillomatous lesion on the prepuce of his penis. This location suggested venereal syphilis, but on clinical, serologic, and epidemiologic grounds a diagnosis of early yaws was made. This treponemal disease should be considered in children who have traveled to or migrated from remote tropical regions, and who have unusual skin lesions in combination with a positive treponemal serology. Although yaws is considered a rare and exotic disease in the United States and Europe, it is still widespread in some parts of the world.
Child, Preschool↗
Different doses of cefetamet pivoxil (Ro 15-8075) in the treatment of acute uncomplicated gonococcal urethritis in men.
In an open, dose-finding study, a 100% cure rate was observed in patients suffering from uncomplicated gonococcal urethritis who were treated with a single oral dose of either 1.2 g (n = 10), 0.8 g (n = 11), or 0.4 g (n = 10) of cefetamet pivoxil. The MICs of cefetamet for all gonococcal strains ranged from 0.001 to 0.12 micrograms/ml, and the MIC for 90% of the strains tested was 0.008 micrograms/ml. Cefetamet pivoxil was ineffective against Chlamydia trachomatis in 3 of 31 patients. Side effects were minor.
Administration, Oral↗
A new attempt to distinguish serologically the subspecies of Treponema pallidum causing syphilis and yaws.
In an effort to serologically differentiate syphilis from yaws, 69 monoclonal antibody species raised against Treponema pallidum subsp. pallidum were tested by immunoblotting for their reactivity with Treponema pallidum subsp. pertenue. All monoclonal antibodies reacted with antigens with the same molecular weight of both subspecies. Furthermore, no differences in reactivity between sera from yaws patients and from syphilis patients were found by Western blot (immunoblot) analysis of cell lysates of T. pallidum subsp. pallidum and T. pallidum subsp. pertenue. We tried to exploit the only known molecular difference between the subspecies. The subunits of the 190-kilodalton multimeric proteins TpF1 and TyF1 of T. pallidum subsp. pallidum and T. pallidum subsp. pertenue, respectively, have previously been shown to differ in one amino acid residue at position 40. In this study, no difference was found in immunoreactivity of TpF1 or TyF1 with either syphilis sera or yaws sera. Synthetic peptides based on the sequence of TpF1 and of TyF1 were used in an enzyme-linked immunosorbent assay with syphilis sera and yaws sera. Again, no difference in reactivity between the T. pallidum subsp. pallidum- and T. pallidum subsp. pertenue-derived peptides was observed.
Amino Acid Sequence↗
The inaccessibility of the outer membrane of adherent Treponema pallidum (Nichols strain) to anti-treponemal antibodies, a possible role of serum proteins.
Fresh and aged adherent T pallidum were used to study the accessibility of their outer membrane to antibodies by means of an indirect immunofluorescent technique. The integrity of the outer membrane was demonstrated by the non-reactivity with a monoclonal antibody directed against the axial filaments. Using the sera from patients with sero-positive primary and secondary syphilis no binding of IgG and IgM antibodies was observed. However, IgG and IgM antibody fractions isolated from the sera of patients with secondary syphilis, gave with the fresh fibroblast-adhering treponemes a mean of 14.5% IgG- and of 43.2% IgM positive treponemes. These means were 32.1% and 87.3% respectively for aged treponemes. Lower percentages were observed when fibronectin adhering treponemes were used. This demonstrates the inability of the outer membrane to bind antibodies in a majority of the fresh treponemes. This is partly lost on in vitro aging. Absence of IgG- and IgM fluorescence was also observed when sequential incubations with the antibody fractions and control sera were used. This was accompanied by the deposition of the third complement factor (C3) around the treponemes. Incubations of IgG- or IgM pre-coated adherent treponemes with heat-inactivated control sera or a C3 deficient serum did not result in the deposition of C3, and partially restored the detection of human antibodies. The most likely explanation for the absence of fluorescence is that antibodies become buried in an extra-cellular layer of serum proteins. The deposition of C3 from control sera alone most probably points to the classical pathway of complement activation and suggests that antibodies of rabbit origin constitute a part of the extracellular layer of treponemes.
Antibodies, Bacterial↗
Radiological and dermatological findings in two patients suffering from early yaws in Indonesia.
Two children suffering from early yaws in Indonesia are presented. Apart from skin lesions and a positive treponemal serology in both patients, involvement of tubular bones, particularly of the hands, was revealed by radiological examination. In one patient involvement of a distal phalanx was remarkable. Early diagnosis and treatment of yaws is important since a delay in treatment may result in severe and irreversible bone deformities of the late stage of the disease. This report illustrates that radiological changes, although rare, can still be detected in the early stage of yaws in areas where yaws is resurgent nowadays.
Adolescent↗
Early yaws: a light microscopic study.
This paper presents the light microscopic findings in biopsies of skin lesions from 45 patients, in whom a diagnosis of early yaws was suspected. In 27 cases typical light-microscopic features of yaws were observed, consisting of parakeratosis or crust containing exudate, marked acanthosis with widening and elongation of the rete ridges or pseudo-carcinomatous hyperplasia and spongiosis. Intraepidermal microabscesses consisting of polymorphonuclear leucocytes were frequently encountered. In a large majority a moderate to dense infiltrate was present, composed mainly of lymphocytes and plasma cells. Vascular changes consisted of only slight endothelial cell proliferation and thickening of vessel walls. Steiner staining revealed the presence of treponemes in the epidermis in 23 of 27 cases. Remarkably, clusters of treponemes were also seen in the papillary dermis in three out of 23 cases. Seven other cases were strongly suggestive of yaws. Other histopathological diagnoses were made in 6 patients, due to the simultaneous occurrence of other skin diseases. The remaining five specimens did not contain enough tissue to allow conclusions to be made.
Adolescent↗
Screening for cervical Chlamydia trachomatis infections in two Dutch populations.
Endocervical cultures for Chlamydia trachomatis and Neisseria gonorrhoeae were taken from 492 women attending an outpatient clinic for sexually transmitted diseases (group I) and 560 women seeking legal abortion (group II). Possible risk factors for C trachomatis infection were evaluated by multivariate analysis. The prevalence rates for C trachomatis and N gonorrhoeae were 7.3% and 2.5% in group I and 9.4% and 0.4% in group II. From multivariate analysis it was found that age (p less than 0.01), number of sexual partners (p less than 0.01), abnormal vaginal discharge (p less than 0.01), and endocervical mucopus (p = 0.02) were independently associated with chlamydial infection in group I. In the abortion clinic age (p = 0.03) and endocervical mucopus (p = 0.03) were the only significant independent predictors of C trachomatis. In all women vaginal discharge was collected for Gram staining. A significant higher number of polymorphonuclear cells was seen in the smears of C trachomatis positive women (group I: p = 0.04; group II: p = 0.03). In group II there was also a significant association between C trachomatis and Gardnerella type bacterial flora (p = 0.02) and the presence of comma-shaped rods (p = 0.04). Screening for C trachomatis infection may help to decrease the incidence of (post-abortal) pelvic inflammatory disease. Because screening in abortion clinics is not always possible, decreasing the incidence of postabortal pelvic inflammatory disease could be achieved by using prophylactic antibiotics. Selective use of prophylaxis in high risk patients can minimise costs and the incidence of side effects.
Adult↗
Rapid in vitro immobilisation of purified Treponema pallidum (Nichols strain), and protection by extraction fluids from rabbit testes.
The use of Percoll-purified treponemes in an assay similar to the Treponema pallidum Immobilisation test demonstrated that immobilisation of purified treponemes by seronegative normal human serum proceeded at a much higher rate than that of unpurified treponemes. This suggests that the removal of the testicular extract makes the treponemes more vulnerable to this action. A preincubation of the purified treponemes with the testicular extract from infected or uninfected testes delayed their rate of immobilisation to that demonstrated by the unpurified treponemes. This showed that substances produced during the infection are probably not responsible for the delay in immobilisation. Discrimination between the classical and the alternative pathway of complement activation, studied by the ethylene glycol-bis (beta-aminoethyl ether) N,N,N',N'-tetraacetic acid (EGTA) method, showed that the classical pathway was responsible for the rapid immobilisation of the purified treponemes. However, the slow immobilisation in the EGTA-serum samples suggested a minor role of the alternative pathway in the immobilisation of the purified treponemes. Since the testicular extracts exerted an anti-complement activity, it needs to be investigated whether the protection offered to the purified treponemes by the testicular extracts is based on their deteriorating effect on the classical complement pathway or is due to a re-establishment of the protective cover around the treponemes.
Animals↗
Evaluation of an enzyme immunoassay for detection of Chlamydia trachomatis in urogenital specimens.
Chlamydiazyme (Abbott), an enzyme-linked immunoassay (EIA), was evaluated using cell culture on Hela 229 cells as the method of reference. Samples were acquired from 611 female and 280 male patients attending the outpatient clinic for sexually transmitted disease at the University Hospital in Rotterdam, The Netherlands. The prevalences of chlamydia culture-positive female and male patients were 7.8% and 14.4% respectively. The overall sensitivity and specificity values of the EIA were respectively 68.1% and 95.8% in the female and 92.1% and 92.0% in the male population. Samples which were culture-negative but EIA-positive were re-examined by a second direct test (IDEA; Boots Celltech). If the samples from 12 females and 11 males which were negative on culture but positive with both direct tests are considered as failures of cell culture, the sensitivity of the EIA in females almost equalled cell culture (74.6% versus 79.9%) and in males was even higher (93.9% versus 77.6%). Serotyping of the cultured strains revealed that all serovars of Chlamydia trachomatis occurring in this study could be detected by the EIA. The EIA offers a relatively simple and rapid test for diagnosis of C. trachomatis infections in high-risk populations.
Cervix Uteri↗