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The 47-kDa major lipoprotein immunogen of Treponema pallidum is a penicillin-binding protein with carboxypeptidase activity.

The recent model of Treponema pallidum molecular architecture proposes that the vast majority of the bacterium's integral membrane proteins are lipoprotein immunogens anchored in the cytoplasmic membrane while the outer membrane contains only a limited number of surface-exposed transmembrane proteins. This unique model explains, in part, the organism's remarkable ability to evade host immune defenses and establish persistent infection. Our strategy for refining this model involves demonstrating that the physiological functions of treponemal membrane proteins are consistent with their proposed cellular locations. In this study, we used an ampicillin-digoxigenin conjugate to demonstrate by chemiluminescence that the 47-kDa lipoprotein immunogen of T. pallidum (Tpp47) is a penicillin-binding protein. Reexamination of the Tpp47 primary sequence revealed the three amino acid motifs characteristic of penicillin-binding proteins. A recombinant, nonlipidated, soluble form of Tpp47 was used to demonstrate that Tpp47 is a zinc-dependent carboxypeptidase. Escherichia coli expressing Tpp47 was characterized by cell wall abnormalities consistent with altered peptidoglycan biosynthesis. Though the inability to cultivate T. pallidum in vitro and the lack of genetic exchange systems continue to impede treponemal research, this study advances strategies for utilizing E. coli molecular genetics as a means of elucidating the complex relationships between syphilis pathogenesis and T. pallidum membrane biology.

Amino Acid Sequence↗

Seroepidemiological study on sexually transmitted diseases and hepatitis B in African promiscuous heterosexuals in relation to HTLV-III infection.

A seroepidemiological study was performed on HTLV-III, T. pallidum, C. trachomatis and Hepatitis B virus (HBV), in Butare, Rwanda, among 33 female prostitutes, 25 male customers of prostitutes, and 60 male and female controls. As compared with female controls the prostitutes had a higher prevalence of antibodies to HTLV-III (29/33 versus 4/33, p less than 0.001), T. pallidum (TPHA: 27/33 versus 6/33, p less than 0.001; RPR: 19/33 versus 2/33, p less than 0.001; FTA-Abs: 27/33 versus 5/33, p less than 0.001) and C. trachomatis (IgG IF: 31/33 versus 13/33, p less than 0.001). HBV serological markers were more often detected in the prostitutes than in the female controls (31/33 versus 18/33, p less than 0.001) although HBs antigen carriage rate was similar in both groups. As compared with male controls, the male customers of prostitutes had more frequently detectable antibodies to HTLV-III (7/25 versus 2/27, p = 0.05), and a positive RPR (10/25 versus 1/27, p less than 0.01). Among the 118 individuals studied, odds ratios and trend analysis disclosed a significant association between HTLV-III seropositivity and a positive TPHA, RPR, FTA-Abs, Chlamydia IgG IF test and serological markers to HBV. No association was found between HTLV-III seropositivity and HBs Ag carriage. This study suggests that HTLV-III has to be considered as an infectious agent transmitted among promiscuous Central African heterosexuals by sexual contact and/or parenteral contact with unsterile needles used for STD treatments.

Acquired Immunodeficiency Syndrome↗

Prevalence of anti-hepatitis C virus in the blood donor population of Rio de Janeiro.

The prevalence of hepatitis C virus (HCV) antibodies in 2,557 asymptomatic volunteer Brazilian blood donors is reported. Using the line immunoassay (Inno-LIA) as a confirmatory test on ELISA anti-HCV-positive reacting sera, a prevalence rate of 2.7% for anti-HCV positivity was found. By comparison, prevalences of 1.6% for hepatitis B surface antigen, 0.9% for Treponema pallidum, 0.4% for human immunodeficiency virus and 0.04% for Trypanosoma cruzi were observed. Only 57% of the HCV-positive donors had elevated alanine aminotransferase (ALT) levels. Using previous criteria, based on surrogate markers (ALT > or = 50 IU/l and for anti-hepatitis B core antibody), for HCV infection at that time, only 25% of the HCV-positive donations would have been eliminated. In view of the high prevalence of anti-HCV reactivity among the Brazilian blood donor population and the poor reliability of surrogate markers, it is recommended that routine screening for anti-HCV in Brazilian blood donors is introduced.

Alanine Transaminase↗

Pituitary gland gumma in congenital syphilis after failed maternal treatment: a case report.

A preterm, very low birth weight infant was born to a mother with early latent syphilis who was treated 10 days and 3 days before delivery with 2.4 mU of benzathine penicillin. The infant had clinical, laboratory, and radiographic abnormalities consistent with congenital syphilis, ie, a Venereal Disease Research Laboratory test titer that was fourfold greater than was the maternal titer, hepatosplenomegaly, abnormal liver function tests, pneumonitis, osteochondritis of the long bones, and cerebrospinal fluid (CSF) examination showing a reactive Venereal Disease Research Laboratory test, pleocytosis, and elevated protein content. The infant died on the third day of life, and an autopsy revealed an evolving gumma of the anterior pituitary. Immunoglobulin M immunoblotting of serum and CSF was positive, and polymerase chain reaction detected Treponema pallidum DNA in endotracheal aspirate and CSF. This case highlights the pathologic abnormalities observed in congenital syphilis and focuses on the rare finding of an evolving anterior pituitary gumma. Furthermore, it documents the failure of maternal syphilis treatment during the last 4 weeks of pregnancy to cure fetal infection and supports the recommendation that all infants born to mothers with syphilis treated during the last 4 weeks of pregnancy should receive penicillin therapy.

Female↗

Prevalence of selected bacterial named species and uncultivated phylotypes in endodontic abscesses from two geographic locations.

Evidence is mounting that the prevalence of some putative endodontic pathogens can significantly vary according to the geographic location in which samples were taken. This study aimed to provide additional knowledge on this subject by comparing the frequencies of 10 selected candidate endodontic pathogens in samples of acute apical abscesses obtained from two distinct geographic locations; Portland, OR, and Rio de Janeiro, Brazil. DNA was extracted from aspirates and used as template in nested PCR assays using 16S rRNA gene taxon-specific oligonucleotide primers. Of the target species/phylotypes, Treponema denticola (73% of the cases), Porphyromonas endodontalis (70%), and Tannerella forsythia (57%) were the most prevalent taxa found in Brazilian samples. Dialister invisus (70% of the cases), P. endodontalis (63%) and Dialister pneumosintes (55%) were the most frequent taxa in the Portland, OR samples. Data analysis revealed that T. denticola and T. forsythia were significantly more detected in Brazilian samples than in the Portland, OR samples. Although D. invisus, Filifactor alocis, and Synergistes oral clone W090 were detected in many more samples from the Portland, OR patients, differences were not found to be statistically significant. These findings confirmed that some bacterial taxa can markedly differ in the frequencies they occur in samples from different locations. It remains to be clarified whether this observation translates into relevant therapeutic implications.

Bacterial Infections↗

The spirochete in erythema chronicum migrans. Demonstration by light and electron microscopy.

A lesion of erythema chronicum migrans was examined by light and electron microscopy. Spirochetes were identified by light microscopy with Steiner silver stain. Electron microscopy was performed on deparaffinized tissue of the biopsy specimen and a spirochete was identified in the tissue. This treponema-like spirochete has morphological characteristics similar to those described previously for spirochetes obtained from ticks in areas endemic for Lyme disease.

Erythema↗

The protective function of cell-mediated immunity in syphilis.

Experimental evidence has been obtained to show that the cell-mediated response in syphilis is protective. The use of chemical immunosuppressors (cyclophosphamide, 5-fluorouracil) resulted in the abolition of the cell-mediated response measured by the macrophage migration inhibition test (MMI test), and was accompanied by an enhancement in the severity of the lesions during the course of experimental syphilis in the rabbit. Successful adoptive transfer of resistance to syphilitic infection from immune donor rabbits to normal recipient rabbits employing lymph node lymphocytes was accomplished.

Animals↗

Evaluation of the antimicrobial effects of sodium benzoate and dichlorobenzyl alcohol against dental plaque microorganisms. An in vitro study.

Evaluation of antimicrobial agents is based on in vivo and in vitro studies. The minimum inhibitory concentrations (MICs) of sodium benzoate and dichlorobenzyl alcohol to 115 strains of plaque microorganisms were determined by a broth-dilution method. Sodium benzoate did not inhibit growth of any gram-positive cocci (MIC > 106,590 microM). MICs for Porphyromonas gingivalis and two strains of Treponema socranskii were 26,650 microM. The MIC of dichlorobenzyl alcohol to the reference strain of Actinobacillus actinomycetemcomitans was 723 microM and to P. gingivalis, two strains of T. socranskii, and Candida albicans 1,446 microM. MICs for other organisms were 2,892 to 5,784 microM. Saliva samples from 10 volunteers, collected at various times after toothbrushing with a dentifrice containing 10% sodium benzoate and 0.3% dichlorobenzyl alcohol, were analyzed gas-chromatographically. Immediately after toothbrushing mean levels of sodium benzoate and dichlorobenzyl alcohol were 372,626 microM and 7,529 microM, respectively. After 5 min mean levels were 38,700 microM and 734 microM. In conclusion, the concentrations of both antimicrobials dropped rapidly during the first 30 min, but for 5-10 min they were high enough to inhibit growth of potential periodontal pathogens.

Adult↗

Similarities of periodontal clinical and microbiological parameters in mother-child pairs.

The aim of this study was to verify the association between children and their mothers (N = 28) for periodontal clinical and microbiological measures. Periodontal clinical parameters (probing depth and bleeding on probing) were obtained from six reference teeth from each mother-child pair. In addition, subgingival plaque samples taken from the same reference teeth were collected and placed on the Perioscan test for the detection of Treponema denticola, Porphyromonas gingivalis and Bacteroides forsythus. There were statistically significant differences between children and mothers regarding probing depth; there was an overall tendency for mothers to exhibit average probing depths greater than their children. In contrast, if a child had a bleeding site, the respective site on the mother usually also bled on probing, implying that there was an association in terms of bleeding between the mother-child pairs. Similar findings were observed for the Perioscan test. It is concluded that the occurrence of bleeding and periodontal anaerobic infections (as determined by the Perioscan test) were similar in reference teeth of mother-child pairs. These data suggest that parents with periodontal disease may serve as a reservoir of periodontopathic organisms for their children.

Adult↗

Anti-hepatits B core antigen testing, viral markers, and occult hepatitis B virus infection in Pakistani blood donors: implications for transfusion practice.

BACKGROUND: The purpose of this study was to determine the seroprevalence of anti-hepatitis B core antigen (HBc) and the impact of its testing along with other markers of hepatitis B, hepatitis B virus (HBV) DNA, hepatitis C virus antibody (anti-HCV), and syphilis in Pakistani blood donors. STUDY DESIGN AND METHODS: The study design was cross-sectional. A total of 966 donors were selected randomly for testing of anti-HBc and HBV markers, including HBV DNA, of 94,177 blood donors who were routinely screened for hepatitis B surface antigen (HBsAg), anti-HCV, human immunodeficiency virus antibody (anti-HIV), Treponema pallidum hemagglutination assay (TPHA), and malarial parasites from 2003 to October 2005. RESULTS: The seroprevalence of various infectious markers was as follows: HBsAg, 2.16 percent; anti-HCV, 4.16 percent; anti-HIV, 0.004 percent; TPHA, 0.75 percent; and malaria, 0.002 percent. Anti-HBc prevalence in HBsAg-negative, HBV DNA-negative blood donors was 167 of 966 (17.28%), with 76 percent demonstrating anti-HBs positivity. Younger donors with mean age of 25 years were exposed to HBV to a lesser extent compared to those with a mean age of 29 years. Anti-HBc positivity was significantly higher in anti-HCV-reactive individuals. HBV DNA was detectable in 5 blood donors who were HBsAg-, anti-HBc-positive and were categorized as having occult HBV infection. CONCLUSIONS: The study shows that more than 17 percent of healthy, young blood donors in Pakistan are already exposed to HBV, with two-thirds showing anti-HBs levels of greater than 100 mIU per mL. One in 200 blood donors who are HBsAg-, anti-HBc-positive, however, have occult HBV infection, with likelihood of transmission of hepatitis B in recipients of blood components derived from them. HBsAg-negative individuals who are anti-HBc-negative and those who are anti-HBc-positive, anti-HBs-positive, and HBV DNA-negative should be selected as regular blood donors to minimize transmission due to occult hepatitis B infection.

Adult↗

Crystal structure of the Tp34 (TP0971) lipoprotein of treponema pallidum: implications of its metal-bound state and affinity for human lactoferrin.

The Tp34 (TP0971) membrane lipoprotein of Treponema pallidum, an obligate human pathogen and the agent of syphilis, was previously reported to have lactoferrin binding properties. Given the non-cultivatable nature of T. pallidum, a structure-to-function approach was pursued to clarify further potential relationships between the Tp34 structural and biochemical properties and its propensity to bind human lactoferrin. The crystal structure of a nonacylated, recombinant form of Tp34 (rTp34), solved to a resolution of 1.9A(,) revealed two metaloccupied binding sites within a dimer; the identity of the ion most likely was zinc. Residues from both of the monomers contributed to the interfacial metal-binding sites; a novel feature was that the delta-sulfur of methionine coordinated the zinc ion. Analytical ultracentrifugation showed that, in solution, rTp34 formed a metal-stabilized dimer and that rTp34 bound human lactoferrin with a stoichiometry of 2:1. Isothermal titration calorimetry further revealed that rTp34 bound human lactoferrin at high (submicromolar) affinity. Finally, membrane topology studies revealed that native Tp34 is not located on the outer surface (outer membrane) of T. pallidum but, rather, is periplasmic. How propensity of Tp34 to bind zinc and the iron-sequestering lactoferrin may relate overall to the biology of T. pallidum infection in humans is discussed.

Crystallography, X-Ray↗

[Incidence and diagnostic significance of reactive syphilis antibodies in systemic lupus erythematodes and other immunologic diseases].

Serum samples of 78 patients with systemic lupus erythematosus, systemic sclerosis and other immunological diseases were tested for antibodies to syphilis. Reactive or weak reactive results were observed in 10% by means of the treponema pallidum hemagglutination (TPHA) test, in 27% by the FTA-Abs test, in 40% applying the IgM-FTA-Abs test, in 10% by the VDRL test and in 3% of the cases using the cardiolipin CF test. Only in 3 patients (4%) we found an antibody pattern characteristic of syphilitic patients (TPHA and FTA-Abs test simultaneously undoubtedly reactive). Neither the comparative qualitative and quantitative determination of antibodies to ANA, nDNS and ENA (extractable salinesoluble nuclear antigen) nor elimination of nDNS and ENA antibodies, or incubation of the treponemal test antigen with DNase lead to a conclusion whether the reactive results of the TPHA, FTA-Abs, and IgM-FTA-Abs tests specifically indicate a syphilitic infection. The low incidence of reactive syphilis tests in SLE and the presence of syphilitic antibodies in other immunological diseases limitate the significance for the criterium in the diagnosis of SLE.

Antibodies, Bacterial↗

Humoral immunity in experimental syphilis. I. The demonstration of resistance conferred by passive immunization.

Evidence of a role for human factor(s) in immunity to experimental syphilis has been provided by the demonstration that passive immunization of rabbits by daily i.v. injections of immune serum significantly delays the appearance and markedly diminishes the severity and duration of lesions which develop after challenge with Treponema pallidum. Five rabbits were injected daily over 37 days with 3 ml/kg body weight of pooled immune rabbit serum injection with 1.1 X 10(3) T. pallidum, Nichols strain, at each of four sites. The animals developed atypical lesions of short duration after an average delay in onset of 28 days short duration after an average delay in onset of 28 days beyond the development of typical lesions in control animals similarly injected with nonimmune serum or saline. The failure of passive immunization to provide complete protection was evident not only in the development of the atypical lesions, but also in the demonstration of disseminated infection in the tissues of three of the four surviving animals 7 months after challenge. The possibility that incomplete protection may have been due to 1) insufficient immune serum levels, 2) intracellular location of T. pallidum, and/or 3) cell-mediated mechanisms is discussed.

Animals↗

A serosurvey of Haemophilus ducreyi, syphilis, and herpes simplex virus type 2 and their association with human immunodeficiency virus among female sex workers in Lagos, Nigeria.

BACKGROUND AND OBJECTIVES: To determine the prevalence rates of serological reactivity of Haemophilus (H.) ducreyi, Treponema pallidum, and herpes simplex virus type 2 (HSV-2) antibodies among female sex workers (FSWs) and their association with human immunodeficiency virus (HIV) antibody status. STUDY DESIGN: Cross-sectional, standard serological assays were used for syphilis, HSV-2 and HIV; a modified enzyme-linked immunosorbent assay (ELISA) was used to detect specific anti-H. ducreyi immunoglobulin (Ig) G and IgA antibodies. RESULTS: Seroprevalence rates were 86% for anti-H. ducreyi IgG and 69% for anti-H. ducreyi IgA; 4% for rapid plasma reagin (RPR) and Treponema palladium hemagglutination assay (TPHA) confirmed syphilis; 59% for HSV-2; 12% for HIV-1 and 2% for HIV-2. Lower-class FSWs were significantly more likely than upper-class FSWs to be H. ducreyi seropositive (IgG: OR = 42.7; IgA: OR = 7.6) and have current or past syphilis infection (RPR: OR = 3.5; RPR and TPHA: OR = 4.5). The presence of syphilis increased significantly with older age (P-trend < 0.001). Non-Nigerian FSWs had significantly higher reactivity to chancroid (IgG: OR = 3.5; IgA: OR = 1.8) and borderline reactivity to syphilis (RPR: OR = 1.6; TPHA: OR = 2.0). A history of sex with non-Nigerian Africans was significantly associated with chancroid reactivity and borderline significant with syphilis serostatus. H. ducreyi seropositivity was significantly more likely in FSWs with HSV-2 (OR = 2.4) and syphilis (OR = 5.6). Chancroid and HSV-2 antibodies were also more common in HIV-infected FSWs. CONCLUSION: The prevalence of H. ducreyi antibodies is the highest rate that has been reported. Our findings underscore the importance of an effective program to control GUDs as part of the strategy to prevent the potentially explosive spread of HIV in Nigeria.

Adolescent↗

Characterization of new periodontal and endodontic isolates of spirochetes.

Gas chromatographic analysis of cellular fatty acids (CFA), biochemical reactions, electrophoresis of soluble cellular proteins, as well as immunodiffusion were used to discriminate between 16 fresh spirochete isolates from periodontal and endodontic infections. CFA patterns were compared by the Hewlett Packard MIDI library to all available reference strains, and results of the biochemical tests were compared to VPI's records for treponemal strains. The electrophoretograms of soluble proteins of the fresh isolates were compared to those of previously well described strains of Treponema denticola, T. pectinovorum, T. vincentii, T. socranskii subsp. socranskii, T. socranskii subsp. paredis, T. socranskii subsp. buccale, and T. socranskii 04. Immunodiffusion was carried out by using adsorbed polyclonal rabbit antibodies to representative strains of the species mentioned. These methods separated most clinical strains from approved species strains, suggesting that new species had been isolated.

Bacterial Proteins↗

Sexually transmitted diseases treatment guidelines, 2006.

These guidelines for the treatment of persons who have sexually transmitted diseases (STDs) were developed by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta, Georgia, during April 19-21, 2005. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2002 (MMWR 2002;51[No. RR-6]). Included in these updated guidelines are an expanded diagnostic evaluation for cervicitis and trichomoniasis; new antimicrobial recommendations for trichomoniasis; additional data on the clinical efficacy of azithromycin for chlamydial infections in pregnancy; discussion of the role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications; emergence of lymphogranuloma venereum protocolitis among men who have sex with men (MSM); expanded discussion of the criteria for spinal fluid examination to evaluate for neurosyphilis; the emergence of azithromycin- resistant Treponema pallidum; increasing prevalence of quinolone-resistant Neisseria gonorrhoeae in MSM; revised discussion concerning the sexual transmission of hepatitis C; postexposure prophylaxis after sexual assault; and an expanded discussion of STD prevention approaches.

Humans↗