1/6. Nonimmune hydrops fetalis and fetal congenital syphilis. A case report.Nonimmune hydrops fetalis occurred secondary to a syphilitic infection. Ultrasonographic evaluation and cordocentesis were used to confirm the antenatal infection. An IgM antibody specific for treponema pallidum wall antigen (anti-47-kDa) was used to document the fetal infection. High-dose intravenous penicillin was administered in an attempt to achieve adequate fetal levels.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/6. Identification of treponema pallidum in amniotic fluid and fetal blood from pregnancies complicated by congenital syphilis.Two pregnant women with secondary syphilis underwent amniocentesis and evaluation for fetal syphilis. In both cases, motile spirochetes, typical of treponema pallidum, were observed during dark-field microscopic examination of the amniotic fluid. The presence of T pallidum was confirmed by antitreponemal monoclonal antibody immunofluorescence assays and by rabbit infectivity tests using the amniotic fluid. In the first case, an infant at 35 weeks' gestation delivered within 24 hours of amniocentesis had hepatosplenomegaly, osteochondritis, and neurosyphilis. In the second case, a fetus at 24 weeks' gestation was hydropic and a fetal blood sample showed anemia, thrombocytopenia, and elevated liver enzymes. Fetal syphilis was confirmed by rabbit infectivity testing using fetal blood obtained by funipuncture. This is the first report of the diagnosis of fetal syphilis by funipuncture and confirmation of the presence of virulent T pallidum in the blood of a human fetus. The mother was treated for secondary syphilis, but the infant had residual signs of congenital infection at birth 14 weeks later. Neonatal serum from the first case and fetal serum from the second case showed specific immunoglobulin m reactivity with the 47-kd antigen of T pallidum by Western blot assays. A new wild-type strain of T pallidum, designated DAL-1, was isolated from the amniotic fluid of the first case and is available for future studies. We conclude that the presence of T pallidum in amniotic fluid or fetal blood indicates fetal-placental infection. Further investigation is necessary to determine the pathogenesis of amniotic fluid infection and its role in the prenatal diagnosis of congenital syphilis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/6. Persistent histological and immunological abnormalities in congenital syphilitic glomerulonephritis after disappearance of proteinuria.A 40-day-old male infant suffered from generalized anasarca, proteinuria and hematuria. Serologic study revealed marked elevation of antibody titer against treponema pallidum, the same serologic finding was also noted in both his parents. Two weeks of treatment with penicillin was given. The edema subsided 7 days later, and proteinuria and hematuria disappeared 20 days after the initiation of penicillin treatment. At the age of 60 days, all the clinical symptoms and signs vanished; urinalysis and renal function were all within normal limits and renal biopsy was performed. Pathologic study revealed membranous glomerulonephritis with deposition of IgG, IgM and complement c3, C1q, C4 and treponema antigen in the subepithelial area of the glomerular basement membrane. These phenomena suggest that treponemal antigen-antibody complexes were deposited in the glomeruli and activated the classic pathway of complements, leading to an immune complex nephritis. Immunologic study revealed that the patient had high circulating helper T cells (CD4 cells), low level of suppressor T cells (Leu2 15 cells) with high CD4/CD8 ratio. It was accompanied by detectable circulating immune complex and high titer of T. pallidum hemagglutinin antibody titer. This change suggests that abnormal immune regulation may play an important role in the development of syphilitic glomerulonephritis.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
4/6. Membranous glomerulonephritis in congenital syphilis.The glomerulonephritis of congenital syphilis is thought to be immune-complex mediated. We describe a case of C. S. in whom the only manifestation was a glomerulonephritis. Immunopathogenic studies allowed the identification of treponemal antigen in glomeruli. The elution of immunoglobulins from renal tissue showed that glomerular deposits contained antitreponemal antibodies. cryoglobulins with antitreponemal activity were also isolated from the patient's serum.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
5/6. Treponemal antigens in congenital and acquired syphilitic nephritis: demonstration by immunofluorescence studies.Two patients, a 4-month-old infant girl with congenital syphilis and a 45-year-old man with secondary syphilis, had the nephrotic syndrome with glomerulonephritis. immunoglobulins and treponemal antigenic material were seen in the glomeruli of both patients by immunofluorescence microscopic studies of renal tissue. Electron micrographs showed subepithelial electron dense deposits along the glomerular basement membrane. This confirms earlier suggestions that the renal injury is of an immune-complex type.- - - - - - - - - - ranking = 5keywords = antigen (Clic here for more details about this article) |
6/6. Congenital syphilis in a newborn: an immunopathologic study.A 3-week-old girl presented to the emergency room with respiratory distress and generalized maculopapular rash. The newborn was hospitalized with a presumptive diagnosis of congenital syphilis, but she died after 2 days of therapy. Tissue from the gastrointestinal tract, brain, liver, spleen, and lung was studied by using direct fluorescent antibody and immunohistochemical analysis (IHC) for treponema pallidum. The inflammatory infiltrate was characterized by using IHC against CD3, CD20, CD68, and smooth muscle actin. The diagnosis of congenital syphilis was confirmed by demonstrating spirochetes in tissues with IHC and direct fluorescent antibody examination. IHC showed abundant treponemes in the small intestine and liver and occasional spirochetes in the meninges. bacteria were seen as intact spirochetes, granular staining, or large extracellular collections of antigen. A constant pathologic feature throughout the tissues was concentric macrophage (CD68-positive) infiltrate around vessels, giving an onion-skin appearance. IHC identified the macrophages as the prime immune response in congenital syphilis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |