Syphilis :An Ancient. Disease Revisited HARVINDER KAUR LAKHBEER SINGH LAB TECHNOLOGIST MIRCOBIOLOGY PPUM. wadsworth.org

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1 Syphilis :An Ancient Disease Revisited wadsworth.org HARVINDER KAUR LAKHBEER SINGH LAB TECHNOLOGIST MIRCOBIOLOGY PPUM

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3 Treponema pallidum The Agent of Syphilis KINGDOM: BACTERIA PHYLUM: SPIROCHAETAE CLASS: SPIROCHAETES ORDER: SPIROCHAETALES FAMILY : SPIROCHAERACECAE GENUS: TREPONEMA

4 - Origin of syphilis has not been agreed on by researchers 1.Christopher Columbus and his crew brought it back with them from the new world. 2. Syphilis was always present in the old world but it wasn t yet identified as a separate disease from leprosy. Greece Lit 3.Syphilis developed from the related diseases bejel and yaws.? The first reference to the French sickness is made during Charles VIII s Italian campaign A complete description of the French sickness wa given by Juan de Virgo # of cases in Europe reach epidemic proportions 1530 The disease recieves the name syphilis from a poem entitled Syphilis Sive Morbus Gallicus by Jerome Francastor Christopher Columbus Fernandez de Oviedo was the first person to mention the American origin of syphilis

5 History Sir Alexander Fleming discovers penicillin while working on the influenza virus. so few cases that the medical and scientific community is prepared to consider it eradicated 1928 Sir Alexander Fleming Treponema Pallidum, the bacteria that causes syphilis is discovered on March 3 in Berlin by Chauvinand Hoffmann rising of cases on the rise in western countries WHO 12 MIL NEW CASES EVERY YEAR the rising occurrence of syphilis around the world causes hope of eradicating the disease to lessen after being raised by the success of penicillin

6 Transmission Sexual Trans-placental/In Utero Percutaneous following contact with infectious lesions Blood Transfusion very rare

7 Infectious Dose: ~57 organisms Incubation Period 21 days (median) 3 clinical stages of syphilis Primary: Painless sore (chancre) at inoculation site Secondary: Rash, Fever, Lymphadenopathy, Malaise Tertiary/Latent: CNS invasion, organ damage The physician that knows syphilis knows medicine. Sir William Osler 1 Magnuson HJ, et al. Inoculation of syphilis in human volunteers. Medicine 1956;35:

8 Laboratory Diagnosis 6-15 micrometer in length and 0.2 micrometer in width obligate parasite, needs a host to conduct metabolic process and life cycle. It thrives under in vitro conditions, O 2 between 10 to 20 % - microaerophilic Not only oxygen dependent it also prefers temp that is relative to human body circular genome smaller compared to other prokaryotes

9 SYPHILIS DIAGNOSTIC TEST FALLS INTO FOUR CATEGORIES (i) direct microscopic examination, (ii) nontreponemal tests, used for screening; (iii) treponemal tests that are confirmatory; and (iv) Direct antigen detection tests currently used in research settings and as gold standards for test evaluation

10 Laboratory Diagnosis The Uncommon Methods Rabbit Infectivity Test (RIT) High Sensitivity and Specificity Long turn-around-time Limited to research settings Magnuson, H. J., H. Eagle, and R. Fleischman The minimal infectious inoculum of Spirochaeta pallida (Nichols strain and a consideration of its rate of multiplication in vivo. Am. J. Syph. 32:1 18.

11 Dark Field Microscopy Useful only during primary infection Technician expertise required

12 Immunostaining Direct fluorescent antibody or silver stain IN THE MID 1960 the direct fluorescent antibody test (DFA) was developed, later it was modified for use with monoclonal antibodies and tissues sections in the direct fluorescent antibody tissue test(dfat-tp) Kellogg, D. S., Jr., and S. M. Mothershed Immunofluorescent detection of Treponema pallidum: a review. JAMA 107:

13 Polymerase Chain Reaction (PCR) PCR is now commercially available but not used routinely in diagnostic medical laboratories. PCR is useful mainly in early acute disease Emily L Ho et al. Syphilis: using modern approaches to understand an old disease, J Clin Invest, 2011

14 Laboratory Diagnosis of Syphilis The Common Methods Serology Mainstay for syphilis testing Two classes of serologic tests Non-treponemal Treponemal S Ratnam. The laboratory diagnosis of syphilis. Can J Infect Dis Med Microbiol 2005;16(1):45-51

15 Serologic Tests for Syphilis: Non-Treponemal Assays Principle: T. pallidum infection leads to the production of reagin Reagin Antibodies to substances released from cells damaged by T. pallidum Reagin reacts with cardiolipin Cardiolipin a phospholipid component of certain eukaryotic and prokaryotic membranes Examples of non-treponemal tests: Rapid Plasma Reagin (RPR) Venereal Disease Research Laboratory (VDRL)

16 Falcone, V. H., G. W. Stout, and M. B. M. Moore Evaluation of rapid plasma reagin (circle) card test. Public Health Rep. 79:

17 CAN BE USED IN FIELD Portnoy, J., W. Carson, and C. A. Smith Rapid plasma reagin test for syphilis. Public Health Rep. 72:

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19 NON TREPONEMAL TEST : LIMITATIONS Neimeister, R. P., R. Teschemacher, I. J. Yankevitch, and J. Cocklin Proficiency testing, trouble schooting and quality control for the RPR test. Am. J. Med. Technol. 41:13 17.

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24 EIA (AUTOMATED ENZYME IMMUNOASSAY)

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29 Reverse Sequence Syphilis Screening Performance and clinical data for the use of reverse sequence screening MMWR February 11, 2011 / 60(05); JID 2011

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31 A FEW PUBLICATIONS ON THE REVRESE ALGORITHM :

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36 THANK YOU