Department of Mycology-Bacteriology, Institute of Tropical Medicine 'Pedro Kourí', Havana, Cuba.
Department of Biology, Masaryk University, Brno, 625 00, Czech Republic.
Clin Microbiol Infect. 2018 Nov;24(11):1210.e1-1210.e5. doi: 10.1016/j.cmi.2018.02.006. Epub 2018 Feb 16.
Bejel, caused by Treponema pallidum subsp. endemicum (TEN), was until now considered as a non-venereal disease endemic in areas with hot and dry climates. This study has identified TEN in clinical samples from Cuban patients previously diagnosed with syphilis.
We performed sequencing-based molecular typing on 92 samples from Cuban individuals diagnosed with syphilis. Moreover, to differentiate T. pallidum subspecies, multi-locus sequence analysis (MLSA) was designed and was applied to suspicious samples.
Nine samples, from six patients, had a nucleotide sequence similarity (at all typing loci) to the Bosnia A genome, which is the infectious agent of bejel. Additionally, MLSA clearly supported a TEN classification for the treponemal samples. Clinical and epidemiological data from the six patients also suggested sexual transmission of bejel as well as the endemicity of this rare treponematosis in Cuba.
Molecular identification of Treponema pallidum subsp. endemicum, the agent of bejel, in Cuban patients diagnosed with syphilis indicates the clear limitations of a diagnosis based exclusively on serology, geographical occurrence, clinical symptoms and anamnestic data. This finding has important implications for Global Public Health Systems, including paradigm changes regarding the location of endemic outbreaks, clinical aspects and transmission of this neglected disease.
由梅毒密螺旋体亚种地方性亚种（TEN）引起的贝杰尔病，直到现在仍被认为是在炎热干燥气候地区流行的非性传播疾病。本研究在先前被诊断为梅毒的古巴患者的临床样本中发现了 TEN。
我们对 92 名被诊断患有梅毒的古巴个体的样本进行了基于测序的分子分型。此外，为了区分梅毒亚种，设计了多位点序列分析（MLSA）并应用于可疑样本。
九个样本（来自六个患者）与波斯尼亚 A 基因组（贝杰尔的病原体）具有核苷酸序列相似性（在所有分型基因座上）。此外，MLSA 清楚地支持将这些梅毒螺旋体样本归类为 TEN。来自六个患者的临床和流行病学数据也表明了贝杰尔的性传播以及这种罕见的螺旋体病在古巴的流行。
在被诊断患有梅毒的古巴患者中，梅毒密螺旋体亚种地方性亚种（TEN）的分子鉴定表明，仅基于血清学、地理位置、临床症状和病史数据进行诊断存在明显的局限性。这一发现对全球公共卫生系统具有重要意义，包括关于地方性暴发的位置、临床方面和这种被忽视的疾病传播的范式转变。
