Board index » arthritis-lyme » Failure of penicillin in a newborn with congenital syphilis.

2005-12-14 02:18:44 AM
JAMA. 1970 May 25;212(8):1345-9.
Failure of penicillin in a newborn with congenital syphilis.
Hardy JB, Hardy PH, Oppenheimer EH, Ryan SJ Jr, Sheff RN.
PMID: 4910820 [PubMed - indexed for MEDLINE]
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Sex Transm Dis. 2004 Feb;31(2):123-6.
Evaluation of a Treponema pallidum-specific IgM enzyme immunoassay
and Treponema pallidum western blot antibody detection in the diagnosis
of maternal and congenital syphilis.
Rawstron SA, Mehta S, Bromberg K.
Division of Pediatric Infectious Diseases, Department of
Pediatrics, Children's Medical Center of Brooklyn (Kings County
Hospital Center and SUNY Downstate), Brooklyn, New York 11203-2098,
USA. Sarah.Rawston@downstate.edu
BACKGROUND: Congenital syphilis (CS) is a result of untreated or
inadequately treated maternal syphilis. CS is more likely with early
stages of maternal syphilis, but most mothers lack signs or symptoms
and the risk of CS is unclear. GOAL: The goal of this study was to
evaluate Treponema pallidum IgM Western blot (TP IgM WB) and a T.
pallidum IgM enzyme immunoassay (TP IgM ELISA) in mothers with syphilis
to determine if positive tests better indicate a risk of CS than a
rapid plasma reagin titer>/=1:16. STUDY DESIGN: Ninety-seven
mother-baby pairs with reactive syphilis serology were evaluated.
RESULTS: TP IgM WB tests were positive in 18 pregnancies (7 of 18
babies had CS) and negative in 79 pregnancies (7 of 82 babies had CS).
Thirty-two mothers had titers>/=1:16 (6 babies with CS) and 65 mothers
had titers </=1:8 (8 babies with CS). CONCLUSION: TP IgM tests better
identify mothers at risk of delivering babies with CS than maternal
titer>/=1:16.
Publication Types:
* Evaluation Studies
PMID: 14743076 [PubMed - indexed for MEDLINE]
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Sex Transm Infect. 2003 Dec;79(6):479-83.
Use of PCR in the diagnosis of early syphilis in the United
Kingdom.
Palmer HM, Higgins SP, Herring AJ, Kingston MA.
Genitourinary Infections Reference Laboratory, Public Health
Laboratory, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
OBJECTIVES: To evaluate a Treponema pallidum polymerase chain
reaction (PCR) test in the laboratory diagnosis of early syphilis in
the United Kingdom. Subjects and setting: Men and women attending
genitourinary medicine clinics in England. METHODS: A trial PCR service
was offered for the analysis of swabs of ano-genital or oral ulcers
suspected to be syphilitic in origin. Clinical details, results of
treponemal serology, and other relevant laboratory tests carried out by
the sending laboratories were obtained retrospectively by
questionnaire. RESULTS: Data from 98 patients, representing 100
episodes of ulceration, were analysed. The majority of patients (70)
attended clinics in the Greater Manchester area. Eighty six patients
were male and 58 were men who have sex with men (MSM), of whom 24 were
HIV positive. PCR results agreed with the clinical diagnosis for 95
patients; samples from 26 patients were PCR positive and serologically
diagnosed as primary (18) or secondary (8) syphilis, whereas 70
patients had PCR negative samples and were not diagnosed as having
active syphilis. These data include two HIV positive patients who were
PCR positive 12 and 21 days before their treponemal seroconversion. One
positive PCR result was not supported by positive treponemal serology
(this patient coincidentally received a 10 day course of co-amoxiclav 1
week after sampling). Three patients had negative PCR results but
positive syphilis serology. The sensitivity, specificity, positive and
negative predictive value for primary syphilis were 94.7%, 98.6%,
94.7%, and 98.6%, respectively, and for secondary syphilis these were
80.0%, 98.6%, 88.9%, and 97.2%, respectively.
CONCLUSION: PCR is a sensitive and specific test for T pallidum, and an
important adjunct to dark ground microscopy and treponemal serology in
diagnosing infectious syphilis in the United Kingdom.
Publication Types:
* Evaluation Studies
* Multicenter Study
PMID: 14663125 [PubMed - indexed for MEDLINE]
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med diseases lyme
Lyme Disease: patient support, research & information

J Biol Chem. 2004 Apr 9;279(15):14917-21. Epub 2004 Jan 27.
A novel beta-lactamase activity from a penicillin-binding protein
of Treponema pallidum and why syphilis is still treatable with
penicillin.
Cha JY, Ishiwata A, Mobashery S.
Department of Chemistry and Biochemistry, University of Notre Dame,
Notre Dame, Indiana 46556, USA. mobashery@nd.edu
Treponema pallidum, the causative agent of syphilis, is sensitive
to penicillins. Yet, an abundant membrane-bound protein of this
organism, Tp47, turns over penicillins. It is shown herein that the
turnover process is a hydrolytic reaction that results in the
corresponding penicilloates, products that have their beta-lactam bonds
hydrolyzed. This is the reaction of beta-lactamases, bona fide
resistance enzymes to beta-lactam antibiotics. Remarkably, the x-ray
structure of Tp47 bears no resemblance to any other beta-lactamases or
the related penicillin-binding proteins. Furthermore, evidence is
presented that the reaction of Tp47 takes place in the absence of the
zinc ion and does not involve intermediary acyl enzyme species. Hence,
the beta-lactamase activity of Tp47 is the fifth known mechanism for
turnover of beta-lactam antibiotics. Tp47 also exhibits a penicillin
binding reaction, in the process of which the enzyme is covalently
modified in the active site. The two reactions take place in two
different active sites, and the events of the beta-lactamase activity
are over 2,000-fold more rapid than the penicillin binding reaction.
The level of beta-lactamase activity is high and is held back only by a
strong product-inhibition component to the catalytic process. If
natural selection would result in a mutant variant of Tp47 that
overcomes product inhibition for the beta-lactamase activity, a novel
bona fide resistance to penicillins will emerge in Treponema, which
will be a disconcerting clinical development. The physiological
functions of Tp47 are not known, but it is likely that this is at least
a bifunctional enzyme involved in the processing of the Treponema
peptidoglycan as a substrate.
PMID: 14747460 [PubMed - indexed for MEDLINE]
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Expert Opin Pharmacother. 2005 Oct;6(13):2271-80.
Syphilis treatment: old and new.
Dayan L, Ooi C.
Sexual Health Department, Royal North Shore Hospital, Clinic 16,
Block 3, Pacific Highway, St Leonards, Sydney, 2065, Australia.
Syphilis has challenged scientists and clinicians since its first
appearance in the late 1400s and debate continues to surround the best
practice in management. Difficulties in defining the goals of
successful treatment have contributed to problems in determining
recommendations for the ideal management. Treatment regimens currently
in use were developed before randomised controlled trials became
standard. This, combined with national differences in disease
definition, staging and varying interpretations of the studies, as well
as the emergence of complicating comorbid conditions, such as HIV, has
resulted in a lack of consensus for treatment. This paper will discuss
the history and current treatment of syphilis focusing on dilemmas
faced by clinicians today, including the emergence of a resistant
strain. Despite the difference between current national guidelines,
penicillin G largely remains the treatment of choice. Close follow up,
monitoring and ensuring adequate compliance remain the most important
aspects in the treatment of syphilis.
PMID: 16218887 [PubMed - in process]
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Sex Transm Dis. 2004 Mar;31(3):196-9.
Relapse of secondary syphilis after benzathine penicillin G:
molecular analysis.
Myint M, Bashiri H, Harrington RD, Marra CM.
Department of Medicine (Infectious Diseases), University of
Washington School of Medicine, Seattle, Washington, USA.
BACKGROUND AND OBJECTIVES: It is difficult to distinguish between
relapse and reinfection in patients who develop a second episode of
syphilis after treatment. GOAL: The goal of this study was to use
molecular methods to distinguish between relapse and reinfection in a
patient with recurrent secondary syphilis. STUDY DESIGN: Treponema
pallidum tprK sequences were amplified from cerebrospinal fluid (CSF),
skin, and blood from the initial presentation and from blood from the
second presentation. Neighbor-joining clustering analysis was performed
for deduced tprK sequences from the case patient and for sequences
derived from blood and CSF of a different patient with secondary
syphilis. RESULTS: The case patient's tprK sequences from both episodes
of syphilis clustered together with a high degree of similarity.
CONCLUSION: Our patient likely relapsed despite treatment.
Publication Types:
* Case Reports
PMID: 15076935 [PubMed - indexed for MEDLINE]
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Interesting post. doing some research? Drawn any conclusions?
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the hiv-test tracks latent 3rd stage syphilis.
see www.colman.net video 3 and 4
and misc.health.aids
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Watched the video on syphilis and aids, learned some things. Don't
understand why seronegative syphilis would make the HIV/AIDS causation
questionable. But it is very interesting that immune suppressed AIDS
patients all test negative for syphilis when that is a population that
would have many cases presumably. And when these people were treated
with abx for suspected seronegative syphilis they had what sounded like
a JH reaction.
It was also news to me that the VDRL test is not specific, it measures
inflammation, anti-cardiolipin antibodies.
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overman74@hotmail.com wrote:
syphilis causes kaposi, pcp and dementia (neurosyphilis),
while non-syphilis hiv-positive people like magic johnson,
christine maggiore and kimbannon.com dont get aids.
isnt that convincing?
But it is very interesting that immune suppressed AIDS
"syphilis as aids":
www.robertbenmitchell.com/books/saa/
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Good thing it is winter and not a lot to do outdoors because you are
keeping me stuck at this computer, looking at more and more stuff!
Actually, I acquired a used copy of the Stokes classic reference on
syphilis from the 40s, because it seemed like maybe I could learn
something about Lyme by studying syphilis. Haven't dived into it yet
because it smells kinda musty and my de-stink efforts have not yet
succeeded. My next look at the book will be to see if anything like
Karposi's syndrome occurs in syphilis. Never heard this before.
Why couldn't you just have syphilis as one of the diseases that causes
such damage in AIDS patients, along with TB, etc? Immune suppression
could cause any number of latent diseases and opportunists to surface,
and no antibodies produced for measuring in tests.
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in 1943 is very interesting (kaposi ...). Penicilin seems to shift the
illness
a little behind the blood-brain-limes.
ICL..
So we have the same testing problem in lyme and aids.
for example www.virusmyth.net/aids/data/pdbiotech93.htm
"Instead of considering the potential usefulness of HIV-free AIDS cases
in the search for the cause of AIDS, the CDC and the NIH's director for
AIDS hid in 1992 the then rapidly growing numbers of HIV-free AIDS
cases (Duesberg, P.H., 1992, op. cit.) under a new name, "idiopathic
CD4 lymphocytopenia" or ICL. Indeed, the new name has sent HIV-free
AIDS cases into obscurity. But efforts to set apart HIV-free from
HIV-positive AIDS cases by the new term are not based on clinical or
scientific arguments."
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