Sánchez P J, Wendel G D, Grimprel E, Goldberg M, Hall M, Arencibia-Mireles O, Radolf J D, Norgard M V
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235.
J Infect Dis. 1993 Jan;167(1):148-57. doi: 10.1093/infdis/167.1.148.
IgM immunoblotting and polymerase chain reaction (PCR) were evaluated for use in diagnosing congenital syphilis, and the prevalence of central nervous system (CNS) invasion by Treponema pallidum during congenital infection was examined. The results of rabbit infectivity testing (RIT) on serum and cerebrospinal fluid (CSF) of 19 infants born to mothers with untreated early syphilis were compared with results of PCR and IgM immunoblotting. Seven infants had clinical evidence of congenital syphilis supported by positive serum IgM immunoblot (7/7), PCR (6/7), and RIT (3/3). Six symptomatic infants (86%) had T. pallidum isolated from CSF by RIT; 5 of 6 RIT-positive CSF samples were positive by PCR, and 2 also were reactive by IgM immunoblot. In 12 asymptomatic infants, 5 (42%) had a reactive serum IgM immunoblot and in 4 of these IgM reactivity was the only evidence of congenital infection. CNS invasion by T. pallidum was uncommon among asymptomatic infants; only 1 (8%) was positive by CSF RIT. The excellent agreement between RIT and PCR further substantiates the use of PCR as a surrogate for RIT. Our data indicate that the diagnosis of asymptomatically infected neonates will require a comprehensive approach using assays for both specific neonatal IgM and T. pallidum DNA in serum and CSF.
对免疫球蛋白M（IgM）免疫印迹法和聚合酶链反应（PCR）用于诊断先天性梅毒进行了评估，并研究了先天性感染期间梅毒螺旋体侵犯中枢神经系统（CNS）的患病率。将19名母亲患有未经治疗的早期梅毒的婴儿的血清和脑脊液（CSF）的兔感染性试验（RIT）结果与PCR和IgM免疫印迹结果进行了比较。7名婴儿有先天性梅毒的临床证据，血清IgM免疫印迹（7/7）、PCR（6/7）和RIT（3/3）均呈阳性。6名有症状的婴儿（86%）通过RIT从脑脊液中分离出梅毒螺旋体；6份RIT阳性脑脊液样本中有5份PCR呈阳性，2份IgM免疫印迹也呈阳性。在12名无症状婴儿中，5名（42%）血清IgM免疫印迹呈阳性，其中4名婴儿IgM反应性是先天性感染的唯一证据。无症状婴儿中梅毒螺旋体侵犯中枢神经系统的情况并不常见；只有1名（8%）脑脊液RIT呈阳性。RIT和PCR之间的高度一致性进一步证实了使用PCR替代RIT的可行性。我们的数据表明，对无症状感染新生儿的诊断需要采用综合方法，同时检测血清和脑脊液中的特异性新生儿IgM和梅毒螺旋体DNA。
