VDRL Research Articles

The Rationale for Discarding Blood and Its Components in a Tertiary Care Hospital Blood Bank in North Karnataka.

Background Human blood is an essential human element for which no substitute has yet been discovered. This study aims to determine the causes of discarding blood and its components. Material and methods A retrospective study of three years (January 1, 2018, to December 31, 2020) was performed in a tertiary care hospital blood bank. Data were retrieved from the various registers and analysed. Results During this study, a total of 3280 units, 1868 units, and 486 units of whole blood were collected in 2018, 2019, and 2020, respectively. It was observed that the discard rate of whole blood was 9.48%, 17.23%, and 43% in 2018, 2019, and 2020, respectively. The discard rate for components varied, such as for packed red blood cells (PRBC), it was 1.76% in 2018, 1.73% in 2019, and 3.03% in 2020, for fresh frozen plasma (FFP), it was 4.08% in 2018, 4.36% in 2019, and 2.20% in 2020, and for platelets, it was 43.08% in 2018, 31.56% in 2019, and 45.03% in 2020. A total of 311, 322, and 209 units of whole blood were discarded in 2018, 2019, and 2020, respectively. The total whole blood and blood components were discarded for various reasons such as undiagnosed sterility (HIV, hepatitis B surface antigen, hepatitis C virus, Venereal Disease Research Laboratory), quality control, underweight, hemolysis unit, expiry, and polycythemia. Conclusion The wastage of stored blood and its components is inevitable. Still, it can be minimised by optimum utilisation and implementation of blood transfusion services (BTS) along with the education and training of blood bank staff. There are various reasons for the wastage of blood and its components, such as unscreened transfusion-transmitted diseases, sterility, storage, less bleeding, expiry, hemolysis samples and polycythemia. Self-regular audits, coordination between hospital and blood bank staff, proper storage and handling of blood units, strict donor selection and deferral criteria, along with appropriate history taking, will help minimise the wastage of blood or its components.

Gut Microbiota Alternation in Disease Progression of Neurosyphilis.

The gut microbiota plays an important role in the development of neurological disorders such as Parkinson's disease and Alzheimer's disease. However, studies on the gut microbiota of patients with neurosyphilis (NS) were rarely reported. In this study, we collected fecal samples from 62 syphilis patients, including 39 with NS and 23 with non-NS. Among the NS patients, 18 were general paresis (GP). The white blood cell counts, protein concentrations, and Venereal Disease Research Laboratory test positive rates of cerebrospinal fluid from patients in NS or GP group were significantly higher than those from patients in non-NS group. 16S ribosomal RNA sequencing results revealed that the alpha and beta diversities of the gut microbiota were similar between NS and non-NS patients or GP and non-NS patients. Linear discriminant analysis with effect size (LEfSe) analysis showed that some taxa, such as Coprobacter, were increased in both NS group and GP group, compared with non-NS group. Besides, the clade of Akkermansia was also overrepresented in GP Patients. Meanwhile, some taxa such as Clostridia_UCG-014 and SC-I-84 were underrepresented in NS patients. The abundances of class Bacilli and genus Alloprevotella were decreased in GP patients. Among them, the abundances of some taxa such as Coprobacter and Akkermansia have been reported to be associated with other neuropsychiatric disorders. Our findings suggest that the alternation of the gut microbiota in NS patients may contribute to the course of NS, which will deepen our understanding of NS.

Prevalence of Syphilis in Pregnancy using a Rapid Treponemal Specific Test in a Low Resource Setting

Background: The rapid treponemal specific test such as immunochromatographic (ICS) test is being recommended as a point of care (POC) test as alternative to the non-specific Treponemal test such as Venereal Disease Research Laboratory (VDRL) commonly used in most developing countries. Objectives: To determine the yields of the ICS test for syphilis among pregnant women. Method: This was a crosssectional study. One hundred and sixty consecutive pregnant women who satisfied the inclusion criteria were recruited into the study. Blood samples obtained from respondents were tested for the presence of Treponema pallidum antibodies using both, Diaspot®syphilis ultra-rapid test kit and MAST-TPHATM TPHA (Treponema pallidum Haemaglutination Assay) test. Results: Out of the 160 pregnant women studied, 4 (2.5%) were sero-reactive for syphilis using the Treponema pallidum haemmaglutination assay (TPHA) while only 2 (1.25%) were sero-reactive to syphilis using the (immunochromatographic screening) ICS method of screening. The sensitivity of the ICS method in detecting syphilis infection was 50% (95% CI: 6.76% – 93.24%) whereas it was 100% specific for syphilis (95% CI: 97.66% -100%). The Positive Predictive Value of the ICS for syphilis screening was 100% while its Negative Predictive value was 98.73% (95% CI: 96.70% – 99.52%). There was no statistically significant difference in the yield of a positive syphilis serology test result comparing the rapid immunochromatographic screening test with the TPHA (P= 0.479). Conclusion: The rapid immunochromatographic screening test (ICS) for syphilis is highly specific and compares favorably with TPHA test in excluding syphilis infection but has a lower sensitivity.

Treponema pallidum infection among women with macerated stillbirth in Mwanza Tanzania: an underestimated tragedy in Tanzania.

Treponema pallidum is one of the commonest cause of stillbirths world-wide. This study investigated the magnitude of T. pallidum among women with macerated stillbirth in Mwanza, Tanzania. A cross-sectional study involving 301 women with macerated stillbirths attending selected health facilities in the region of Mwanza was conducted between October-2017 and March-2018. Detection of T. pallidum was done using venereal diseases research laboratory (VDRL) and T. pallidum hemagglutination test (TPHA). Data were analyzed by the STATA version 13. The median age of the enrolled women was 27 (IQR: 22 - 34) years. Eighteen (6.0%, 95% CI: 3.0-8.0) of women were T. pallidum seropositive. Seropositivity of T. pallidum was significantly higher among women residing in rural areas than urban areas (p=0.010), and among HIV seropositive than HIV seronegative women (p=0.036). By multivariable regression analysis, the odds of being T. pallidum seropositive were significantly high among women with positive HIV serostatus (OR: 3.9, 95% CI: 1.2-14.1, p=0.036) and those residing in rural areas (OR: 5.6, 95% CI: 1.5-20.3, p=0.010). Seropositivity of T. pallidum is higher among women with macerated stillbirth than in normal pregnant women as previously reported which calls for the need to improve screening services in rural areas of Tanzania.

Comparison of molecular and serological assays on cerebrospinal fluid for the diagnosis of neurosyphilis.

Many assays are available on cerebrospinal fluid (CSF) for the diagnosis of neurosyphilis (NS) but there is no 'gold standard'. The aim of this study was to evaluate different molecular and serological assays used in NS. We evaluated two PCR assays and three serological techniques in parallel on CSF samples collected between 2019 and 2020 from patients suspected of NS. The study included 143 patients comprising 30 early NS, 7 late NS and 106 patients without a diagnosis of NS. All patients with NS were symptomatic and had either neurological (67.6%) or ophthalmological signs (54.1%). The qPCR and nPCR assays had overall sensitivities (Se) of 41% and 27%, respectively; with each an overall specificity (Sp) of 100%. VDRL had a Se of 51% and a Sp of 92%. Immunoblot had a Se of 62% and a Sp of 85%. Finally, treponemal tests (TT) had a Se of 96% and a Sp of 69%. Our study confirms the excellent specificity of molecular techniques allowing to avoid overdiagnosis of NS, and thus, unjustified intensive antibiotic therapy protocols. CSF TT, although not very specific, has an excellent Se confirming that there is almost never NS with negative CSF TT. VDRL and immunoblot tests have better overall diagnostic performance. However, none of these techniques has sufficient diagnostic performance to represent a 'gold standard'. Thus, the diagnosis of NS relies on a combination of clinical and biological parameters with the association of PCR with serology, associating VDRL and immunoblot, in CSF.

S3020 Hepatitis From a Sexually Transmitted Bacterial Infection

Introduction: Syphilis is a multisystemic, sexually transmitted infection (STI) that is caused by the spirochete Treponema pallidum. Hepatic involvement is rare. We present a patient who was diagnosed with syphilitic hepatitis (SH). Case Description/Methods: A 54-year-old male presented to the hospital with one week of sharp upper abdominal pain, jaundice, poor appetite, and a 25-lb. weight loss. He also reported multiple sexual partners and a rash that developed 2 months ago. Vital signs were within normal range. Physical examination revealed scleral icterus, a soft, non-tender abdomen, a plaque-like penile lesion and small, circular lesions on his palms and soles of feet. Laboratory studies revealed aspartate aminotransferase (AST) 164 U/L, alanine aminotransferase (ALT) 207 U/L, alkaline phosphatase (ALP) 1395 U/L, total bilirubin 5.6 mg/dL, gamma-glutamyl transferase 782 U/L. Hepatitis panel, acetaminophen and alcohol levels were negative. Chronic liver disease work-up was unremarkable. Treponemal antibody and rapid plasma reagin test were both positive. HIV test and cerebrospinal fluid venereal disease research laboratory (VDRL) test were negative. Abdominal ultrasound and CT scan of the abdomen were unremarkable. Magnetic resonance cholangiopancreatography was notable for hepatomegaly and hepatitis. Patient received 1 dose of penicillin G 2.4 million units intramuscularly with remarkable improvement in his symptoms and liver function tests. He was discharged home with close follow-up with gastroenterology and infectious disease. Discussion: SH occurs in 0.2-9.7% of patients with syphilis and is most commonly seen in the primary and secondary disease stages. Clinical manifestations include a maculopapular rash (involving the trunk, palms and/or soles of feet), fatigue, poor appetite, hepatomegaly and icterus. Liver function tests (LFTs) may reveal a marked increase in ALP and GGT in comparison to ALT and AST. SH is diagnosed with abnormal LFTs, serological evidence of syphilis, exclusion of other liver diseases and LFTs returning to normal after antibiotic therapy as in our patient. The histological features of SH include inflammatory infiltration of the bile duct and hepatic granulomas. Spirochetes are often difficult to identify in liver tissue. Penicillin is the mainstay of treatment. Clinicians should consider syphilitic hepatitis in a patient with abnormal LFTs (especially ALP) and a rash involving the palms and soles of feet in the appropriate clinical context.

Condilomata Lata as Clinical Manifestation of Secondary Syphillis In Pregnancy: Study Case Report

The bacterium Treponema pallidum, which causes the infectious disease syphilis, assaults people. Syphilis is a chronic, systemic disease that can affect all regions of the body, can remain dormant for years, is communicable, and can be treated. One of the symptoms of secondary syphilis is condyloma lata. The most typical location is in warm, muggy climates. We describe case G1P0A0, a 29-year-old woman who is 28 weeks pregnant. The patient's main complaint upon arrival was that he had been developing larger and more frequent warts on his genitalia for the past month. The patient, who has only ever been married once, denies having had any previous relationships with men other than her husband. The patient's husband allegedly had sex with prostitutes without wearing a condom in 2021 and admitted to having previously experienced genital injuries in November of that same year but choosing not to seek medical attention.
 Her vital signs and overall status were within normal ranges, and she appeared to be in good health. Multiple 2 cm grey circular plaques with a localized status were found on the labia majora. A VDRL serological examination was performed as a follow-up examination on June 16; the results were reactive.
 At 28 weeks of gestation, the patient was diagnosed with secondary syphilis in the form of condyloma lata based on the history, physical examination, and supportive examination. Erythromycin 500 mg 4x1, paracetamol 500 mg for pain, and a 0.9% NaCl compress were administered to the patient as treatment. Reevaluated after the first month. The VDRL test yielded a titer of 1: 16 and the complaints of lumps in the genitalia had vanished. The patient is advised to have the exam redone in three, six, twelve, and twenty-four months.

Syphilis and Co-Infections with HIV-1, HBV, and HCV among People Who Use Crack-Cocaine in Northern Brazil.

The rates of syphilis and viral co-infections among people who use crack-cocaine (PWUCC) were assessed in this study. This cross-sectional study relied on biological and self-reported socio-behavioral data from a convenience sample of 990 PWUCC from twenty-six municipalities in the states of Amapá and Pará, northern Brazil. Blood samples were collected to assess the presence of Treponema pallidum using the Rapid Qualitative Test (RQT) and the Venereal Disease Research Laboratory (VDRL). Reactive samples by RQT were used to assess the presence of HBV, HCV, and HIV-1 using Enzyme Immunoassay (EIA) and Polymerase Chain Reaction (PCR). Logistic regression models were used to determine the association of variables assessed with syphilis. In total, 287 (29.0%) of the PWUCC sample had reactive results for syphilis. HBV (15.7%), HCV (5.9%), and HIV-1 (9.8%) were detected among PWUCC with syphilis. Young age, low monthly income and education level, long duration of crack-cocaine use, condomless sex, multiple sex partners, and exchange of sex for money/drugs were associated with syphilis. The present study provides unique insights on the epidemiological status of syphilis among PWUCC in northern Brazil, with multiple implications for improving urgent interventions for diagnosis, prevention, and treatment.

LUDWIG'S ANGINA ASSOCIATED TO CHEMICAL STOMATITIS DUE TO COCAINE USE

A 56-year-old White male smoker and drinker, addicted to cocaine and allergic to penicillin, reported 3 days of severe pain in the mandible, with difficulty eating and talking. Physical examination showed cachexia, dehydration, bilateral submandibular, sublingual, submental swelling, and submandibular lymphadenitis. Intraoral examination revealed an ulcer of 8 cm with a yellow pseudomembrane and an erythematosus halo in the floor of the mouth covering the sublingual gland ducts. The diagnostic hypotheses were secondary syphilis, necrotizing sialometaplasia, chemical stomatitis, and Ludwig's angina. Acetaminophen with codeine, intravenous hydration, clindamycin, metronidazole, and chlorhexidine mouthwash were prescribed. Complete blood count was normal, and human immunodeficiency virus and Venereal Disease Research Laboratory were negative. An incisional biopsy was performed, and histopathologic analysis was compatible with major aphthous stomatitis. The final diagnosis was Ludwig's angina associated to chemical stomatitis due to cocaine use. After 21 days, there was complete remission. One-year follow-up revealed no complications or injuries, and the patient is in addiction rehabilitation. A 56-year-old White male smoker and drinker, addicted to cocaine and allergic to penicillin, reported 3 days of severe pain in the mandible, with difficulty eating and talking. Physical examination showed cachexia, dehydration, bilateral submandibular, sublingual, submental swelling, and submandibular lymphadenitis. Intraoral examination revealed an ulcer of 8 cm with a yellow pseudomembrane and an erythematosus halo in the floor of the mouth covering the sublingual gland ducts. The diagnostic hypotheses were secondary syphilis, necrotizing sialometaplasia, chemical stomatitis, and Ludwig's angina. Acetaminophen with codeine, intravenous hydration, clindamycin, metronidazole, and chlorhexidine mouthwash were prescribed. Complete blood count was normal, and human immunodeficiency virus and Venereal Disease Research Laboratory were negative. An incisional biopsy was performed, and histopathologic analysis was compatible with major aphthous stomatitis. The final diagnosis was Ludwig's angina associated to chemical stomatitis due to cocaine use. After 21 days, there was complete remission. One-year follow-up revealed no complications or injuries, and the patient is in addiction rehabilitation.

RECURRENT ORAL ERYTHEMA MULTIFORME: AN UNUSUAL SUBTYPE OF ERYTHEMA MULTIFORME

Recurrent oral erythema multiforme (ROEM) is an unusual subtype of erythema multiforme, which is characterized by multiple, recurrent, self-limiting, and painful oral ulcers, evidence of herpes simplex virus (HSV) infection, and absence of cutaneous lesions. The diagnosis of ROEM is difficult and challenging, because other similar diseases should be carefully excluded. Acyclovir and/or corticoids are employed but with variable results. A 52-year-old woman presented with recurrent and painful oral ulcers in the buccal mucosa, soft palate, and gingiva in the last 12 months, with 6 to 8 recurrences during this period. The histopathologic analysis revealed an unspecified chronic lymphoplasmacytic infiltrate. Serologic tests were negative, among others, for Veneral Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) but positive for HSV 1/2 IgG and IgM. This report emphasizes the importance of identifying the subtypes of erythema multiforme, aiming to deal with its therapeutic and prognostic implications. Recurrent oral erythema multiforme (ROEM) is an unusual subtype of erythema multiforme, which is characterized by multiple, recurrent, self-limiting, and painful oral ulcers, evidence of herpes simplex virus (HSV) infection, and absence of cutaneous lesions. The diagnosis of ROEM is difficult and challenging, because other similar diseases should be carefully excluded. Acyclovir and/or corticoids are employed but with variable results. A 52-year-old woman presented with recurrent and painful oral ulcers in the buccal mucosa, soft palate, and gingiva in the last 12 months, with 6 to 8 recurrences during this period. The histopathologic analysis revealed an unspecified chronic lymphoplasmacytic infiltrate. Serologic tests were negative, among others, for Veneral Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) but positive for HSV 1/2 IgG and IgM. This report emphasizes the importance of identifying the subtypes of erythema multiforme, aiming to deal with its therapeutic and prognostic implications.

ORAL MANIFESTATION OF PRIMARY SYPHILIS

Syphilis is a bacterial infection caused by <i>Treponema pallidum</i>, which can be transmitted mainly through unprotected sexual contact or vertical transmission. This disease can manifest itself in the primary, secondary, and tertiary stages. The most important laboratory tests for diagnosis are treponemic and nontreponemic tests. A 23-year-old male patient attended the oral medicine clinic reporting an asymptomatic upper lip vermilion lesion. The physical examination revealed an ulcerated lesion with a clear base in the vermilion of the upper lip, on the right side, of approximately 1.0 cm. Clinically, the diagnostic hypothesis was chancre. Incisional biopsy and serological tests for syphilis and human immunodeficiency virus were performed. The histopathologic examination confirmed the diagnostic hypothesis, and the tests obtained positive results only for syphilis. Treatment was performed with a single dose of benzathine penicillin and the lesion regressed, testing negative in the Venereal Disease Research Laboratory after 3 months.

RAPID TEST FOR SYPHILIS: IS IT RELIABLE?

Syphilis is a sexually transmitted infection caused by a bacterium (<i>Treponema pallidum</i>) that may present oral manifestations. A 26-year-old male patient presented with a 2-month history of a painful ulcer on the tongue. Medical history revealed low levels of hemoglobin and hematocrit. Intraoral examination showed an ulcer with well-defined borders on the tip of the tongue, measuring 1 cm in diameter. Moreover, erosive lesions with typical characteristics of benign migratory glossitis were seen in the tongue dorsum. The hypotheses for the ulcerated lesion were primary syphilis or ulceration related to anemia. Rapid tests for human immunodeficiency virus and syphilis were negative. A teleconsultation was required, and the oral medicine teleconsultant recommended Venereal Disease Research Laboratory and fluorescent treponemal antibody absorption exams, which confirmed the diagnosis of primary syphilis. The treatment included penicillin G benzathine (2,400,000 UI once a week for 3 weeks). Cases showing features suggesting syphilis require serological tests when rapid tests are negative.

Congenital syphilis confirmed by PCR as a result of treatment failure for syphilis in pregnancy. Case report

Introduction: Congenital syphilis is a major public health problem, and early diagnosis and treatment are necessary to prevent it. Penicillin G benzathine is the treatment of choice in pregnant women; however, it may fail to prevent fetal infection, as in the present case. Case presentation: Male newborn, son of an HIV negative mother with gestational syphilis (venereal disease research laboratory (VDRL) 1:4 dilution, positive treponemal test) diagnosed at week 21 of gestation and treated with three doses of 2 400 000 IU of penicillin G benzathine. At delivery, the mother presented VDRL 1:1 dilution. The newborn was diagnosed with congenital syphilis due to VDRL 1:4 dilution, positive treponemal test, elevated aspartate aminotransferases, hyposthenuria, proteinuria, hematuria, and leukocyturia that resolved after treatment with crystalline penicillin for 10 days. The molecular testing in blood showed a high treponemal load. The VDRL test at 3 months was non-reactive. Conclusions: Preventing congenital syphilis with the recommended treatment for gestational syphilis may fail. Moreover, diagnosing this condition in an asymptomatic newborn is difficult. Therefore, clinical and serological tests are recommended to confirm whether maternal treatment was effective in the fetus.

Syphilitic Uveitis and Alopecia

A 60-year-old man presented to the eye emergency room with one month of blurry vision, hearing loss, and polyarthralgia. Eye examination revealed panuveitis of both eyes. There was optic disc edema with a retinal flame hemorrhage in the right eye (Fig. 1A). Scalp exam revealed alopecia and papulosquamous eruption with crusted and eroded papules (Fig. 1B). Serum rapid plasma reagin titer (RPR) was 1:1,024 and cerebrospinal fluid was positive for the venereal disease research laboratory (VDRL) test.

Ocular Syphilis: Our Experience in Selayang Hospital, Malaysia.

Objectives: This study aims to describe the demographic features, clinical profile, Human Immunodeficiency Virus (HIV) status, and visual outcome after completing treatment in patients diagnosed with uveitic syphilis. Methods: A retrospective review was conducted of all cases diagnosed with ocular syphilis from January 2014 to December 2019 at the ophthalmology clinic of Selayang Hospital, Selangor, Malaysia. A total of 31 cases were reviewed, and the collected data included demographic features, history of high-risk behavior, ocular symptoms and signs, visual acuity at presentation and after completing treatment, treatment received, complications, and HIV status. Serology tests to confirm the diagnosis were also included, such as the rapid plasma reagin (RPR), venereal disease research laboratory test (VDRL) titer, and treponema pallidum hemagglutination (TPHA) tests, and some cases also included the VDRL cerebrospinal fluid (CSF) test. Results: A total of 31 patients with ocular syphilis were identified within the study period. Male patients comprised the majority with 27 cases. Nineteen patients were below the age of 50. The majority were ethnic Malay (21 patients). Seventeen patients were identified to have HIV co-infection. Twenty patients reported high-risk behaviors, and among them, six cases were HIV-infected homosexuals. The commonest symptom was blurring of vision (61%), followed by eye redness (16%), floaters (13%), and incidental findings (10%). There were 18 bilateral cases and 13 unilateral cases. The larger share presented as panuveitis (14 cases), followed by intermediate uveitis (nine cases), anterior uveitis (four cases), posterior uveitis (two cases), endophthalmitis (one case), and branch retinal vein occlusion (one case). RPR and TPHA tests were done for all patients. Only 12 patients consented to lumbar puncture for a CSF VDRL test, and one tested positive. All patients received intravenous (IV) administration of 3.0 to 4.0 million units of benzylpenicillin every four hours for 14 days. All cases reported a good outcome with an improvement in visual acuity of at least two Snellen lines after treatment. Conclusion: Early detection and treatment of ocular syphilis will usually preserve visual acuity and ocular function. This study highlights the need for a high degree of suspicion of HIV co-infection, as the majority of our patients were discovered to be HIV-seropositive. Thus, HIV screening is mandatory in all patients presenting with syphilitic uveitis.

An appraisal of routine Antenatal laboratory parameters at booking in Bowen University Teaching Hospital, Ogbomoso, Oyo State Nigeria

Antenatal care (ANC) involves a planned and coordinated medical and psychosocial support that optimally begins before conception and extends throughout the antepartum period. Routine laboratory tests at booking are part of this range of evidence-based interventions to ensure healthy mothers and infants. The usual recommended routine ANC laboratory tests in low resource countries include; packed Cell Volume (PCV), Blood/Rhesus group, Hemoglobin genotype, Venereal Disease Research Laboratory (VDRL), Human Immunodeficiency Virus (HIV), Hepatitis B surface antigen (HBsAg) and urinalysis.&#x0D; A review of Antenatal booking investigation results of consecutive presenting pregnant women at Bowen University Teaching Hospital (BUTH), Ogbomoso between January 1, 2019 and June 30, 2021 were analyzed alongside with other relevant information such as age, parity, occupation, level of education, year of last childbirth.&#x0D; Eight hundred and fifty-two pregnant women participated in the study, out of which 522 (61.3%) were &lt;30 years while 312 (36.6%) and 18 (2.1%) were 30-39 years and ≥40 years respectively. Most of the women were age 20 – 29 years (60.6%) and only 2 (0.7%) were teenagers. Majority of the participants had parity of 1-4 (94.7%) while only 33 were grand multiparous. A total of 387 (45.4) women had normal PCV while 465 (54.6) had a PCV in the range of mild to moderate anaemia. None was severely anaemic. The commonest blood group was ‘O’ 390 (45.7%). Most of the mothers 771 (90.4%) were Rhesus D positive while 81 (9.6%) of them were negative. Only three women were positive for HIV while 6 and 78 women had a positive VDRL and HbSAg test results respectively.&#x0D; Most of the women are young (&lt;40 years), have blood group O rhesus D positive and were anaemic at booking. Most of the participants are non-reactive to VDRL, HIV and HBsAg tests. The high percentage of anaemic cases in this study have justified the critical role of routine ANC laboratory tests in providing prompt detection and thus modification or management of pre-existing conditions or risk factors that may influence the course and outcome of pregnancy and labour.

Case 302: Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids.

Part one of this case appeared 4 months previously and may contain larger images. A 21-year-old immunocompetent man who was a long-term resident of Qatar presented to the emergency department with recurrent episodes of unprovoked generalized tonic-clonic seizures lasting 2-3 minutes that spontaneously resolved and were associated with postictal confusion. The patient also had progressive mild diplopia, intermittent dizziness, and numbness in the left arm over the course of 3 months. The patient did not have any other systemic symptoms or chronic medical diseases. He did not have any history of intake of illicit drugs, supplements, or regular medications; he had not received any recent vaccinations; and he had not undergone any surgical procedures. He had no history of travel. At presentation, vital signs were normal. Neurologic examination showed mild left homonymous hemianopia, normal gait with no cerebellar signs, and preserved sensations, power, tone, and reflexes in all four limbs. An electroencephalogram showed no epileptiform discharges. Chest CT and extensive laboratory work-up, including viral, fungal, bacterial, and parasite work-up, thyroid function tests, and immunologic blood tests yielded normal results. Those included normal complete and differential blood counts and normal serum chemistry. Serum analysis was negative for antinuclear antibody, Sjögren syndrome antigens A and B, cytoplasmic antineutrophil cvtoplasmic antibody, and paraneoplastic profile. Serum evaluation was also negative for human immunodeficiency virus type 1 and type 2 RNA, and Brucella, Schistosoma, and toxoplasma antibodies. Venereal Disease Research Laboratory (VDRL) and rapid plasma regain (RPR) test results were negative. Cerebrospinal fluid (CSF) analysis revealed clear fluid and normal pressure and biochemistry, except for elevated protein concentration (0.48 g/L) (normal range, 0.15-0.45 g/L). There were 43 leukocytes/µL (99% lymphocytes) (normal range, 0-5 leukocytes/µL; lymphocytes range, 40%-80%), with no atypical or malignant cells. CSF Gram staining, acid-fast staining, cryptococcal antigen, varicella-zoster virus polymerase chain reaction (PCR), herpes simplex virus PCR, VDRL, and RPR test results were negative. CSF cultures did not show any evidence of growth of bacteria, fungi, or acid-fast bacillus. CSF flow cytometry did not show a monoclonal lymphoid population. No CSF oligoclonal bands were detected. Conventional brain MRI with intravenous administration of contrast material and perfusion study were performed and included different sequences (Figs 1-3).

SECONDARY PULMONARY SYPHILIS

TYPE: Late Breaking Case Report TOPIC: Chest Infections INTRODUCTION: Syphilis is a sexually transmitted disease that can affect any organ in its secondary stages. We describe a case of secondary syphilis with pulmonary involvement. CASE PRESENTATION: A 57 years old male came with SOB and cough since 1 week. He had history of fever, skin ulcers since1 month.He admits history of sexual exposure with commercial sex worker. CECT CHEST – Ground glass and nodular opacities in left upper and lower lobes. Punched out skin ulcers of 1x1 cm are seen over scrotum and right thigh. Veneral Disease Research Laboratory, Treponema Pallidum Haemagglutination,Flourescent Treponemal Antibody-Absorption - REACTIVE. • The diagnosis of secondary pulmonary syphilis was made based on History, Clinical examination, Serological tests for syphilis and Clinical improvement with anti syphilitic treatment. He was treated with BENZATHINE PENICILLIN 2.4 MU I.M per week for 4 weeks. Patient was followed for next 6 months.His skin lesions and lung infiltrates were completely cured in susequent examination. DISCUSSION: In 1983, Coleman et al.proposed five criteria for the clinical diagnosis of secondary syphilis with pulmonary involvement: [1] History and physical findings typical of secondary syphilis;[2] Serologic test results positive for syphilis;[3] Pulmonary abnormalities seen on radiographs with or without associated pulmonary symptoms or signs;[4] Exclusion of other forms of pulmonary disease when possible, using serologic tests, sputum smears and cultures, and cytologic examination of sputum; and[5] Therapeutic response to anti-syphilitic treatment visible on radiographs. CONCLUSIONS: Pulmonary syphilitic involvement should be suspected where clinical history along with pulmonary symptoms and radiological changes occur in cases positive for serological markers. DISCLOSURE: Nothing to declare. KEYWORD: SECONDARY PULMONARY SYPHILIS

Sero-prevalence of syphilis and assessment of haemoparasites among prospective blood donors at a tertiary hospital in Calabar, Southern Nigeria.

The prevalence of haemoparasites among blood donors in the studied area has not been previously documented. This study determined the prevalence of syphilis and haemoparasitic infections among blood donors in Calabar, Cross River State, Nigeria. This was a hospital-based cross-sectional study involving 200 consenting blood donors. Samples were processed using the Venereal Disease Research Laboratory (VDRL) screening technique for the detection of Treponema pallidum antibodies. Screening for microfilaria was conducted using Knott's concentration technique. Thick and thin blood films stained with 3% Giemsa solution were examined to confirm the presence of malaria parasites. All the 200 blood donors harboured trophozoites of Plasmodium falciparum, with low parasite counts per millilitre of blood. One hundred and thirteen (56.5%) blood donors had microfilaria Loa. 21(10.5%) blood donors were positive for antibodies homologous to T. pallidum antigens. Mixed infections of P. falciparum + Microfilaria; P. falciparum + Microfilaria + T. pallidum and Microfilaria + T. pallidum occurred at the prevalence rates of 50%, 16.5% and 4%, respectively. The prevalence of haemoparasites was higher among male blood donors than in their female counterparts. The most prevalent infection based on the frequency of blood donation was the malaria parasite (45.5%). Among the first-time blood donors, the most prevalent infections were malaria (54.5%) and Loa loa (24.5%). This study has shown a significantly (p &lt; 0.05) high prevalence of malaria parasite and Loa loa infection in the studied group, it also showed malaria parasite and Loa loa as the major haemoparasites found among blood donors in the health institution studied.

Health Information and Monitoring of Sexually Transmitted Infections (SIM study): a single-center, parallel, three-arm randomized controlled trial protocol for enhancing adherence to syphilis treatment and follow-up

BackgroundSyphilis has recently resurfaced as a significant public health problem. Since the 2000s, isolated syphilis outbreaks have increasingly occurred in North America, Europe, and Australia; in Brazil, there have been progressive increases in both congenital and acquired syphilis. There are several possible explanations, such as misdiagnosis of acquired syphilis, which could increase the number of untreated transmitters in the population; failure to initiate or complete treatment; and nontreatment of sexual partners (leading to reinfection). Mobile technologies have been successfully used to promote behavior changes and can positively impact treatment and follow-up adherence in patients with infectious diseases. The purpose of this clinical trial is to evaluate treatment and monitoring methods in patients with syphilis, including follow-up by telephone, via a game in a smartphone app, and at public health centers.MethodsThe SIM study is a single-center, randomized controlled trial with a 12-month follow-up period. The aim is to identify the most effective method of follow-up regarding patient compliance with treatment. The tests will be performed in a mobile unit in easily accessible locations. The goal is to perform 10,000 rapid tests for syphilis. Patients with a confirmed diagnosis according to VDRL tests will be randomized to one of three arms: telephone, smartphone game, or conventional in-person follow-up. All analyses will follow the intention-to-treat principle.ConclusionIf we find differences in effectiveness, a major change in the conventional approach for this patient population may be needed, potentially affecting current Brazilian health policy strategies.Trial registrationNTC04753125. Version 1 of protocol 1/09/2020.