[The discovery of a cutaneous focus of enchocerciasis in taking the serodiagnosis for treponematosis in French West Africa].
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Africa, Western↗
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Alternative case-finding methods in a crack-related syphilis epidemic--Philadelphia.
Use of crack cocaine and exchange of drugs for sex have been identified as substantial contributors to the syphilis epidemic in Philadelphia and other locations in the United States. In Philadelphia, from 1985 through 1989, the number of reported cases of early syphilis (primary, secondary, and early latent stages) increased 551%, from 696 to 4528 cases per year. Among 2473 persons with early syphilis interviewed by the Philadelphia Department of Public Health (PDPH) from January through July 1990, 48% reported they or a sex partner used crack cocaine, and 31% reported exchanging drugs or money for sex (not all of those interviewed answered both questions). Traditional approaches to the control of syphilis that emphasize partner notification have not been effective in halting this epidemic. The partner notification approach requires public health workers to identify sex partners of a person with a sexually transmissible disease (e.g., syphilis) and then to contact these sex partners to provide examination and curative or preventive treatment. However, because persons who are involved in the exchange of drugs and/or money for sex often cannot or will not provide sufficient information about sex partners to enable public health authorities to locate those partners (2,4,5), alternative case-finding methods are needed. This report describes efforts by the PDPH to identify persons infected with Treponema pallidum by using serologic screening at locations where crack cocaine is used.
Cluster Analysis↗
Syphiloma/gumma of the optic nerve and human immunodeficiency virus seropositivity.
A 68-year-old man developed the sudden onset of transient obscurations of vision in the right eye in November 1988. Two weeks later he noted floaters, photophobia, and blurred vision in the left eye. He presented with unilateral optic disc edema in the right eye. The left eye showed anterior uveitis but a normal optic disc. He was found to be violently seroreactive for Treponema pallidum infection and was also human immunodeficiency virus (HIV) seropositive. Ultrasonography confirmed the presence of a solid thickening of the anterior optic nerve sheath in the right eye. An interesting and dramatic response to penicillin therapy occurred. This is the first instance of a gumma or solid syphiloma of the optic nerve documented by ophthalmic ultrasonography.
Aged↗
[The cytoarchitectonics of hard chancre in rabbits with experimental syphilis exposed to soliusul'fon and cefamezine].
Twenty rabbits were infected with Treponema pallidum suspension. Ten animals were injected with solusulfone, the rest with cefamezin. Specific features of syphilis induced by a pool of Treponemas are described, such as T. pallidum ultrastructure, formation of a specific granule, form of the agent aggression. Solusulfone treatment was associated with activation of phagocytosis, that manifested by a shift of the incomplete/complete phagocytosis ratio towards the reaction completion; however, intact T. pallidum were detectable even in 72 hrs after the drug injection. Cefamezin had no effect on the cysts and cyst-like formations at the beginning of the treatment course but these forms of the agent were already undetectable in 48 hours.
Animals↗
The prevalence of Lyme disease in a nonendemic area. A comparative serologic study in a south Florida eye clinic population.
Serologic tests for Lyme borreliosis and for syphilis were performed on 75 patients seen in a 1-week period at the Bascom Palmer Eye Institute in Miami. The incident of syphilis was 8% and of Lyme borreliosis 3% in this study in a nonendemic area. The most common cause for a high titer serologic response for Lyme borreliosis in this group was a prior Treponema pallidum infection. The importance of getting VDRL, FTA-ABS, Lyme IFA, and Lyme ELISA tests in all suspected cases was emphasized.
Adult↗
[Experimental syphilis in white mice infected with different strains of Treponema pallidum].
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Animals↗
[The past, present and future of arterial infection].
Today, the pathology of large and medium-sized arteries is in most part considered as degenerative or inflammatory. The role of infection has been preponderant (syphilis) but has become quite modest now, restricted to infectious aneurysms. According to certain observations, infections may participate in initiating arterial inflammation, whether it be specific (Kawasaki's disease, Takayasu's arteritis, coronary artery disease of cardiac grafts) or less so ("plain" atherosclerosis). Suspected microbes (herpes viruses, Chlamydia pneumoniae, etc.) would damage the arterial wall either directly by infecting it, or indirectly by provoking an autoimmune reaction against some of its components (e.g. heat shock proteins). These hypotheses are worth serious consideration because, if established as correct, they would modify radically our etiologic, therapeutic and prophylactic conceptions of arterial diseases, including of course the main one, atherosclerosis.
Acquired Immunodeficiency Syndrome↗
Alzheimer's disease--a spirochetosis?
The aetiology of Alzheimer's disease (AD), which affects a large proportion of the aged population is unknown and the treatment unresolved. The role of beta amyloid protein (beta A4), derived from a larger amyloid precursor protein (APP) in AD is the subject of intense research. Here I report observations that in 14 autopsy cases with histopathologically confirmed AD, spirochetes were found in blood and cerebrospinal fluid and, moreover, could be isolated from brain tissue. Thirteen age-matched control cases were without spirochetes. Reference strains of spirochetes and those isolated from brains of AD patients, showed positive immunoreaction with monoclonal antibody against the beta amyloid precursor protein. These observations suggest that spirochetes may be one of the causes of AD and that they may be the source of the beta amyloid deposited in the AD brain.
Aged↗
Unusual skin ulceration in an HIV-positive patient who had cutaneous syphilis and neurosyphilis.
We present a case of a patient coinfected with syphilis and the human immunodeficiency virus (HIV) who had unusual and severe cutaneous ulceration. The profound immune defects associated with HIV may lead to an altered clinical presentation and a more aggressive course in patients infected with Treponema pallidum. Despite non-confirmatory histological findings, we feel our patient's cutaneous ulcers probably represent superficial gummata, which have failed to resolve completely following currently accepted high-dose antisyphilis chemotherapy.
Adult↗
Primary and secondary syphilis--United States, 1997.
Syphilis is an acute and chronic sexually transmitted disease (STD) caused by infection with Treponema pallidum. The disease is characterized by skin and mucous membrane lesions in the acute phase (primary and secondary [P&S] syphilis) and lesions of the bone, viscera, and cardiovascular and neurologic systems in the chronic phase. Because syphilis enhances transmission of human immunodeficiency virus (HIV), prevention of syphilis is important for controlling HIV. During 1986-1990, an epidemic of syphilis occurred throughout the United States. Syphilis rates began to decline in 1991 and have declined each year since that time. To determine whether this decline is reflected in changes in the epidemiology of syphilis, CDC analyzed notifiable disease surveillance data for 1997. This report summarizes the findings of the analysis, which indicate that 8551 cases of primary and secondary (P&S) syphilis were reported in 1997, an 83% decline in cases from the peak of the epidemic in 1990, and that syphilis remains substantially more common in non-Hispanic blacks than in other racial/ethnic groups and continues to be concentrated in the Southern region of the United States [corrected].
Black or African American↗
Experimental neonatal syphilis. I. Evidence of resistance to symptomatic infection in neonatal rabbits following intradermal inoculation with Treponema pallidum (Nichols strain).
Resistance of 5- to 8-day-old neonatal rabbits to dermal lesion development after intradermal inoculation of Treponema pallidum was demonstrated. Clinical evidence of infection following inoculation of 1 X 10(6) Treponema pallidum at each of two sites was either minimal or absent. Atypical, nonprogressive, nonulcerative lesions occurred in 59% of the inoculated neonates and at 45% of inoculated sites. Differences in incubation periods, duration, and maximum diameters of lesions among adult controls versus neonatal rabbits were significant. The age of waning resistance was determined by inoculating groups of neonates ranging from 1 to 7 weeks of age. Five-week-old (31-36 days) neonates demonstrated waning resistance by the appearance of typically ulcerative, progressive lesions, though their parameters (duration, size) were not yet those of adult control lesions. The resistance demonstrated by neonates may be due in part to group housing (nesting) which could create unfavorable temperatures for T. pallidum survival; comparison of lesion development between nesting and individually housed neonates, 31 to 46 days of age, revealed a greater percentage of typical lesions developing among those individually housed (95 versus 52%). However, these differences may reflect the variability of typical lesion development found among animals of this age when resistance begins to wane. In both groups, the duration of typical lesions was significantly shorter than for adult controls. A heat-stable serum factor(s) was demonstrated in 19 of 20 basal sera from neonates 4 to 6 days of age; this presented another possible mechanism of resistance. The neutralizing serum factor(s) was not demonstrable in the sera of does either before mating, during gestation, or shortly after kindling.(ABSTRACT TRUNCATED AT 250 WORDS)
Aging↗
Biology of the treponematoses based on studies carried out at the International Treponematosis Laboratory Center of the Johns Hopkins University under the auspices of the World Health Organization.
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Biology↗
[Cataract in dark Africa; incidence of associated ocular endemic diseases and their surgical management].
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Africa↗
[Scientific facts and their public: the history of the diagnosis of syphilis].
In the 1910's and 1920', thanks to the conjunction of scientific views concerning the specificity of anti-bacterial antibodies, of lay ideas about the existence of anti-bacterial antibodies and of the perceived importance of developing a syphilis test for public health officials, the community of serologists collectively transformed a relatively inefficient diagnostic test described by Wassermann in 1906 into an "incontestable scientific fact". This "scientific fact" established the equivalence: Wassermann positive individual=person infected with the germ Treponema pallidum, the etiological agent of syphilis. It modified the boundaries of the nosologic entity "syphilis", medical practices, professional attitudes, lay perceptions of syphilis, and health policies. In the 1950's, however, discrepancies between Wassermann test data and epidemiological data and, on the other hand, the development of specific anti-treponemal tests, destabilized the previously stabilized "scientific fact". A high percentage of Wassermann positive individuals were redefined as "biological false positifs", that is persons who suffered from chronic affections able to induce positive results of the Wassermann test. The equivalence Wassermann positive person=individual infected by Treponema pallidum was replaced by the equation: Wassermann positive person=individual infected by Treponema pallidum or biological false positive. The new perception of the Wassermann test again changed scientific views, professional practices and lay beliefs. The history of the Wassermann reaction illustrates the complicated interaction between "scientific facts" and "social facts", and the mutual shaping of both.
Diagnostic Tests, Routine↗
Swine dysentery. Comparison of experimental diseases produced by infection with colonic mucosa or with Treponema hyodysenteriae, French strains, and of "natural" disease.
Oral inoculation of colonic mucosa scrapings and intestinal contents of animals affected with swine dysentery, or of pathogenic strains of Treponemia hyodysenteriae, as well as spontaneous contamination in infected pens caused in average swine dysentery to appear in 359 out of 409 SPF piglets. The morbidity is high irrespective of the method of contamination: after pen contamination, 75 out of 83 piglets were dysenteric; after only one ingestion of contaminated matter, 265 out of 280 animals were ill; and after inoculation of T. hyodysenteriae, 25 out of 35. Mortality in dysentery was always higher than 80%, respectively 48 out of 60 animals, 132 out of 154, and 13 out of 14. Very few animals were self-cured. The average incubation period varied according to the mode of contamination between 9 and 13 days. Animals having contracted an acute form of the disease died 16 to 23 days after contamination, and those with a chronic from 19 days, also after contamination. The increase in the number of Treponema, of Campylobacter and of Balantidium observed after the onset of the disease was approximately equivalent for all three modes of contamination. This disease was characterized by an alternance of dysentery stricto sensu and of mucoid diarrhea, the latter occurring more frequently in cases of self-cure and in chronic forms.
Animals↗
Experimental infection of man with rabbit-virulent Treponema paraluis-cuniculi.
Virulent Treponema paraluis-cuniculi was inoculated intradermally into the arm of a human volunteer and into the shaved backs of 10 rabbits. An identical, but heat-killed, preparation was inoculated into the opposite arm of the volunteer as control. A superficial and transient infection developed in the volunteer, shown by a small zone of erythema that persisted for 24 days. The control preparation caused a smaller zone of erythema that disappeared after five days. A very poor immune response was detected by standard serological tests for syphilis. The inoculated rabbits developed lesions about six days after infection and seroconverted by 84 days. The poor antitreponemal antibody response to T paraluis-cuniculi infection in the volunteer suggests that this naturally attenuated treponeme may not be suitable as a vaccine against infection with t pallidum in humans.
Animals↗
Avoidance of host defences by Treponema pallidum in situ and on extraction from infected rabbit testes.
Electron microscopic observations of acutely infected rabbit testes showed that the majority of Treponema pallidum were extracellular, and confined to interstitial regions of the tissue. Organisms were often adjacent to small blood vessels, where they should be freely accessible to non-specific humoral and cellular defence mechanisms. However, there was no accumulation of leucocytes in blood vessels or infiltration of inflammatory cells into infected areas. Inoculation of live treponemes into perforated plastic chambers which had been implanted subcutaneously in rabbits or guinea-pigs did not incite significant infiltration into the chamber fluid of inflammatory cells, in contrast to that seen after inoculation of Neisseria gonorrhoeae. Interaction of antibody from infected rabbits with live treponemes freshly extracted from rabbit testes could not be detected by an indirect fluorescent antibody method. These observations suggest that T., pallidum escapes recognition by host defences.
Animals↗
Inability of spleen cells from chancre-immune rabbits to confer immunity to challenge with Treponema pallidum.
Although several lines of evidence suggest that cellular immune mechanisms play a role in controlling infection due to Treponema pallidum, recent studies have shown that induction of acquired cellular resistance by antigenically unrelated organisms fails to protect rabbits against syphilitic infection, thereby casting doubt on this hypothesis. In the present paper we describe attempts to transfer immunity to syphilis by using spleen cells from chancre-immune rabbits. Intravenous infusion of 2 X 10(8) spleen lymphocytes was capable of transferring acquired cellular resistance to Listeria and delayed hypersensitivity to tuberculin. However, in eight separate experiments using outbred or inbred rabbits, 2 X 10(8) spleen cells from syphilis-immune animals failed to confer resistance to T. pallidum whether by intravenous or intradermal challenge. Mixing immune lymphocytes with treponemes immediately before intradermal inoculation also failed to confer resistance. Despite the fact that syphilitic infection stimulates cellular immune mechanisms and induces acquired cellular resistance to antigenically unrelated organisms, cellular immunity may not play an important role in immunity to syphilis.
Animals↗