{"id":1262,"date":"2017-09-27T14:48:36","date_gmt":"2017-09-27T12:48:36","guid":{"rendered":"http:\/\/www.newslab.sk\/2017\/09\/27\/laboratorna-diagnostika-syfilisu\/"},"modified":"2017-09-28T07:20:31","modified_gmt":"2017-09-28T05:20:31","slug":"laboratory-diagnosis-of-syphilis","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/laboratory-diagnosis-of-syphilis\/","title":{"rendered":"Laboratory diagnosis of syphilis"},"content":{"rendered":"
*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf \r\nattachment at the end of the paper.<\/span> <\/strong><\/pre>\n
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\u00davod<\/strong><\/p>\n
Syfilis (lues) je historicky zn\u00e1me chronick\u00e9 multisyst\u00e9mov\u00e9 pohlavne prenosn\u00e9 infek\u010dn\u00e9 ochorenie sp\u00f4soben\u00e9 bakt\u00e9riou Treponema pallidum. Uva\u017euje sa o mo\u017enosti, \u017ee do Eur\u00f3py sa dostal s n\u00e1morn\u00edkmi Christophera Columba po n\u00e1vrate z Nov\u00e9ho\u00a0 sveta. Pomerne r\u00fdchlo\u00a0 zachv\u00e1til mnoho eur\u00f3pskych kraj\u00edn a prepukol\u00a0 do rozsiahlej epid\u00e9mie. Predpoklad\u00e1 sa, \u017ee mnoho v\u00fdznamn\u00fdch osobnost\u00ed trpelo\u00a0 t\u00fdmto\u00a0 ochoren\u00edm, napr\u00edklad Beethoven, Karol VIII., Ivan Hrozn\u00fd, Shakespeare, Vincent Van Gogh, Oscar\u00a0 Wilde, Adolf Hitler a Abraham Lincoln. Napriek\u00a0 s\u00fa\u010dasn\u00fdm mo\u017enostiam diagnostiky a lie\u010dby je to st\u00e1le aktu\u00e1lny\u00a0 probl\u00e9m zdravotn\u00edctva na celom\u00a0 svete. V SR m\u00e1 od roku 1990 alarmuj\u00faco st\u00fapaj\u00faci trend. S ochoren\u00edm sa stret\u00e1vame hlavne u sexu\u00e1lne akt\u00edvnych dospel\u00fdch, ke\u010f sa infekcia\u00a0 akviruje\u00a0 sexu\u00e1lnym kontaktom s infek\u010dn\u00fdmi l\u00e9ziami. Pod\u013ea\u00a0 \u00fadajov\u00a0 Eur\u00f3pskeho centra pre\u00a0 kontrolu chor\u00f4b (ECDC) takmer dve\u00a0 tretiny\u00a0 novodiagnostikovan\u00fdch pr\u00edpadov tvoria\u00a0 mu\u017ei\u00a0 maj\u00faci\u00a0 sex\u00a0 s mu\u017emi.\u00a0 Ve\u013ek\u00e9 nebezpe\u010denstvo spo\u010d\u00edva v prieniku T. pallidum cez placentu na novorodencov u nelie\u010den\u00fdch alebo\u00a0 nedostato\u010dne lie\u010den\u00fdch s\u00e9ropozit\u00edvnych\u00a0 matiek, \u010do je, \u017eia\u013e, u n\u00e1s aktu\u00e1lny probl\u00e9m najm\u00e4 v soci\u00e1lne slab\u0161\u00edch vrstv\u00e1ch. Mo\u017en\u00fd je aj prenos transf\u00faziou krvn\u00fdch deriv\u00e1tov. Ve\u013emi pr\u00edle\u017eitostne sa stret\u00e1vame so z\u00edskan\u00edm infekcie cez poru\u0161en\u00fd ko\u017en\u00fd kryt. Jedin\u00fd\u00a0 zn\u00e1my\u00a0 prirodzen\u00fd hostite\u013e\u00a0 je \u010dlovek.<\/p>\n
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P\u00f4vodca<\/strong><\/p>\n
Treponema pallidum subs. pallidum (obr\u00e1zok 1) z \u010de\u013eade\u00a0 Spirochetaceae je fragiln\u00fd\u00a0 \u0161pir\u00e1lovit\u00fd mikroorganizmus 0,18\u2008\u03bcm\u00a0 \u0161irok\u00fd, 20\u2008\u03bcm\u00a0 dlh\u00fd so 4 a\u017e 14 pravideln\u00fdmi\u00a0 z\u00e1vitmi. Z oboch koncov\u00a0 vy\u010dnievaj\u00face axi\u00e1lne fibrily, podobn\u00e9 bakteri\u00e1lnym bi\u010d\u00edkom, umo\u017e\u0148uj\u00fa rot\u00e1ciu\u00a0 v priestore. Protoplazmatick\u00fd valec je obalen\u00fd\u00a0 3-vrstvovou stenou, ktor\u00e1 obsahuje kyselinu muramov\u00fa, a udr\u017eiava vl\u00e1knit\u00fd tvar. Cel\u00e9 telo je obalen\u00e9 tenkou fragilnou membr\u00e1nou. Virulentn\u00e9 kmene maj\u00fa na svojom povrchu\u00a0 slizov\u00fa vrstvu. Trepon\u00e9my maj\u00fa n\u00edzku odolnos\u0165 a s\u00fa citliv\u00e9 na vplyvy vonkaj\u0161ieho prostredia, ni\u010dia ich aj zrieden\u00e9\u00a0 roztoky\u00a0 be\u017en\u00fdch dezinfek\u010dn\u00fdch prostriedkov a kysl\u00edk. Pri teplote nad 39,5\u2008\u00b0C hyn\u00fa za 4 hodiny a v krvn\u00fdch konzerv\u00e1ch nepre\u017eij\u00fa\u00a0 4 dni. Inkuba\u010dn\u00fd\u00a0 \u010das\u00a0 je od 10 do 90 dn\u00ed, priemerne asi 3 t\u00fd\u017edne. Trepon\u00e9my s\u00fa ve\u013emi invaz\u00edvne, prenikaj\u00fa ko\u017eou\u00a0 alebo\u00a0 sliznicami a \u0161pecificky sa via\u017eu na r\u00f4zne\u00a0 druhy\u00a0buniek. K disemin\u00e1cii doch\u00e1dza relat\u00edvne skoro po inokul\u00e1cii. Rozmno\u017euj\u00fa sa\u00a0 extracelul\u00e1rne.\u00a0 Ich\u00a0 lipoprote\u00edny\u00a0 indukuj\u00fa\u00a0 perivaskul\u00e1rny z\u00e1palov\u00fd\u00a0 proces. M\u00f4\u017eu\u00a0 by\u0165 fagocytovan\u00e9 makrof\u00e1gmi a endoteliami krvn\u00fdch vl\u00e1so\u010dn\u00edc, po\u0161kodzuj\u00fa kapil\u00e1ry a zhor\u0161uj\u00fa ich funkciu. V\u010faka unik\u00e1tnej\u00a0 \u0161trukt\u00fare vonkaj\u0161ej membr\u00e1ny vedia unikn\u00fa\u0165 hostite\u013eskej imunitnej odpovedi.\u00a0 Obsahuj\u00fa enz\u00fdm\u00a0 degraduj\u00faci\u00a0 hyalur\u00f3nov\u00fa kyselinu, \u010do\u00a0 umo\u017e\u0148uje hematog\u00e9nny rozsev napriek\u00a0 vysok\u00e9mu titru cirkuluj\u00facich\u00a0 protil\u00e1tok. N\u00e1sledn\u00e9 imunopatologick\u00e9 procesy s\u00fa sp\u00f4soben\u00e9 komplexmi antig\u00e9nu s protil\u00e1tkou. Slizov\u00e1 vrstva chr\u00e1ni bakt\u00e9rie pred \u00fa\u010dinkom protil\u00e1tok a komplementu. \u0160pecifick\u00e1 protil\u00e1tkov\u00e1 (IgM, IgG) i bunkov\u00e1 obrana m\u00f4\u017ee vies\u0165 k spont\u00e1nnemu uzdraveniu. Imunita\u00a0 sa rozv\u00edja pomaly, asi za 2 roky po infekcii. Napriek komplexnej imunitnej odpovedi v priebehu prvej epiz\u00f3dy syfilisu s\u00fa v\u0161ak mo\u017en\u00e9 reinfekcie. Umo\u017e\u0148uje\u00a0 ich existencia 7 diskr\u00e9tnych variabiln\u00fdch\u00a0 (V) regi\u00f3nov\u00a0 Treponema pallidum repeat protein\u00a0 K (TprK). Protil\u00e1tkov\u00e1 odpove\u010f v priebehu infekcie je namieren\u00e1 pr\u00e1ve proti t\u00fdmto V regi\u00f3nom. Diverzita prote\u00ednu K (TprK) je prek\u00e1\u017ekou rozvoja \u00fa\u010dinnej vakc\u00edny.<\/p>\n
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\u0160t\u00e1dia syfilisu<\/strong><\/p>\n
Prim\u00e1rne po 10 a\u017e 90 d\u0148och\u00a0 od akvirovania infekcie sa vyskytne\u00a0 nebolestiv\u00fd tvrd\u00fd vred (obr\u00e1zok 2) v mieste prenosu. Progreduje od makuly cez papulu do vysokoinfek\u010dn\u00e9ho ulcus durum,\u00a0 z ktor\u00e9ho m\u00f4\u017eu\u00a0 by\u0165 trepon\u00e9my izolovan\u00e9. V infiltr\u00e1te\u00a0nach\u00e1dzame lymfocyty, plazmatick\u00e9 bunky a makrof\u00e1gy, z\u00e1palov\u00e1 reakcia sp\u00f4sobuje obliterat\u00edvnu endoarterit\u00eddu. Po 3 a\u017e 12 t\u00fd\u017ed\u0148och sa i bez lie\u010dby spont\u00e1nne vyhoj\u00ed. Cel\u00e9 prim\u00e1rne \u0161t\u00e1dium je sprev\u00e1dzan\u00e9 region\u00e1lnou lymfadenopatiou. V skorej f\u00e1ze tohto \u0161t\u00e1dia m\u00f4\u017eu by\u0165 s\u00e9rologick\u00e9 testy na syfilis negat\u00edvne. Protil\u00e1tkov\u00e1 odpove\u010f nezabr\u00e1ni rozvoju druh\u00e9ho \u0161t\u00e1dia. Sekund\u00e1rne\u00a0 \u0161t\u00e1dium (obr\u00e1zok 3) sa rozvinie po 4 a\u017e 10 t\u00fd\u017ed\u0148och\u00a0 od objavenia sa prim\u00e1rnej l\u00e9zie. Trepon\u00e9my sa mno\u017eia a zaplavuj\u00fa organizmus. Syst\u00e9mov\u00e1 manifest\u00e1cia zah\u0155\u0148a ne- svrbiv\u00fd generalizovan\u00fd makulopapul\u00f3zny ra\u0161, nevo\u013enos\u0165,\u00a0 hor\u00fa\u010dku, myalgie, artralgie,\u00a0 lymfadenopatiu. Objavuj\u00fa sa condylomata lata a alop\u00e9cia. V\u00fdrazne st\u00fapa koncentr\u00e1cia protil\u00e1tok a tvoria sa komplexy antig\u00e9nu s protil\u00e1tkou.<\/p>\n
Pri prvom i druhom \u0161t\u00e1diu syfilisu m\u00f4\u017eu\u00a0 pr\u00edznaky ust\u00fapi\u0165 a v latentnej podobe m\u00f4\u017ee\u00a0 p\u00f4vodca syfilisu\u00a0 pre\u017e\u00edva\u0165 u infikovan\u00e9ho aj nieko\u013eko rokov alebo\u00a0 a\u017e do konca\u00a0 \u017eivota. Z\u00edskan\u00fd prim\u00e1rny, sekund\u00e1rny a v\u010dasn\u00fd\u00a0 latentn\u00fd syfilis sa pod\u013ea Eur\u00f3pskeho centra pre prevenciu a kontrolu\u00a0 chor\u00f4b (ECDC) a\u00a0 Svetovej\u00a0 zdravotn\u00edckej\u00a0 organiz\u00e1cie\u00a0 (WHO) definuje\u00a0 ako v\u010dasn\u00fd\u00a0 syfilis\u00a0 (infek\u010dn\u00fd\u00a0 syfilis). Pribli\u017ene\u00a0 30 % nelie\u010den\u00fdch pacientov v priebehu 1 a\u017e 20 rokov progreduje do terci\u00e1rneho \u0161t\u00e1dia. Klinicky sa prejavuje ako gumat\u00f3zny syfilis, parenchymat\u00f3zny neurosyfilis a kardiovaskul\u00e1rny syfilis. Nast\u00e1vaj\u00fa org\u00e1nov\u00e9 zmeny, po\u0161kodenie ciev a centr\u00e1lnej nervovej s\u00fastavy (CNS). Trepon\u00e9my sa v tomto \u0161t\u00e1diu dokazuj\u00fa iba v\u00fdnimo\u010dne. V ktoromko\u013evek \u0161t\u00e1diu infekcie\u00a0 m\u00f4\u017ee\u00a0 d\u00f4js\u0165 k rozvoju neurosyfilisu, ke\u010f spiroch\u00e9ty invaduj\u00fa\u00a0 CNS. M\u00f4\u017ee\u00a0 by\u0165 asymptomatick\u00fd, ale\u00a0 aj s ve\u013emi v\u00e1\u017enymi\u00a0 klinick\u00fdmi prejavmi. V\u010dasn\u00fd sa po nieko\u013ek\u00fdch mesiacoch a\u017e rokoch\u00a0 po infekcii prejav\u00ed ako syfilitick\u00e1 meningit\u00edda, meningovaskul\u00e1rny alebo\u00a0 okul\u00e1rny\u00a0 syfilis. Neskor\u00fd\u00a0 sa uk\u00e1\u017ee\u00a0 dek\u00e1dy\u00a0 po infekcii a charakteristick\u00e9 s\u00fa par\u00e9zy a tabes dorsalis. M\u00f4\u017ee sa kon\u010di\u0165 \u00faplnou paral\u00fdzou,\u00a0 stratou reflexov a demenciou s rozpadom osobnosti. Neskor\u00fd\u00a0 latentn\u00fd a terci\u00e1rny\u00a0 (gumat\u00f3zny syfilis, kardiovaskul\u00e1rny a neurosyfilis) sa definuj\u00fa ako neskor\u00fd syfilis (obr\u00e1zok 4). Kongenit\u00e1lny syfilis je d\u00f4sledok penetr\u00e1cie T. pallidum cez\u00a0 placentu alebo\u00a0 k akvirovaniu\u00a0 doch\u00e1dza v infikovanom p\u00f4rodnom kan\u00e1li.\u00a0 Od 70\u00a0 do\u00a0 100\u00a0 % novorodencov matiek\u00a0 s nelie\u010den\u00fdm v\u010dasn\u00fdm syfilisom\u00a0 je infikovan\u00fdch a v jednej tretine\u00a0 pr\u00edpadov\u00a0 sa plod narod\u00ed\u00a0 m\u0155tvy. Av\u0161ak aj primerane lie\u010den\u00fdm\u00a0 matk\u00e1m sa m\u00f4\u017ee\u00a0 narodi\u0165\u00a0 m\u0155tvy alebo infikovan\u00fd novorodenec. Deti s kongenit\u00e1lnym syfilisom sa rodia\u00a0 pred\u010dasne, s\u00fa dehydratovan\u00e9, maj\u00fa\u00a0 n\u00edzku p\u00f4rodn\u00fa\u00a0hmotnos\u0165. Pr\u00edznaky\u00a0 zodpovedaj\u00fa sekund\u00e1rnemu \u0161t\u00e1diu \u2013 exant\u00e9mov\u00e9 ko\u017en\u00e9 prejavy, zv\u00e4\u010d\u0161en\u00e1 pe\u010de\u0148. Potom nast\u00e1va f\u00e1za\u00a0 latencie. Po viac ako\u00a0 dvoch\u00a0 rokoch\u00a0 infekcie\u00a0 hovor\u00edme o neskorom vrodenom syfilise, pri ktorom\u00a0 sa objavuj\u00fa \u0165a\u017ek\u00e9 po\u0161kodenia org\u00e1nov \u2013 hluchota, interstici\u00e1lna keratit\u00edda a\u017e slepota, perfor\u00e1cie podnebia, nosa,\u00a0 s\u00fadkovit\u00fd\u00a0 tvar rez\u00e1kov.<\/p>\n
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Terapia<\/strong><\/p>\n
Ur\u010den\u00e1\u00a0 je v\u00fdhradne dermatovenerol\u00f3gom.\u00a0 Liekom\u00a0 prvej vo\u013eby je G penicil\u00edn,\u00a0 vhodnej\u0161ie je parenter\u00e1lne pod\u00e1vanie a \u00df-lakt\u00e1mov\u00e9 antibiotik\u00e1. Pri alergii na penicil\u00edn\u00a0 je vhodn\u00fd tetracykl\u00edn a doxycykl\u00edn. V pr\u00edpade azitromyc\u00ednu a in\u00fdch makrolidov narast\u00e1 podiel rezistencie sp\u00f4soben\u00fd bodovou mut\u00e1ciou g\u00e9nu\u00a0 pre\u00a0 23S\u00a0 rRNA. Dobr\u00fa penetr\u00e1ciu do mozgovomiechov\u00e9ho moku maj\u00fa tetracykl\u00edn,\u00a0 doxycykl\u00edn a ceftriaxon.<\/p>\n
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Laborat\u00f3rna diagnostika<\/strong><\/p>\n
Na stanovenie diagn\u00f3zy syfilis (Dg. A50 \u2013 A53) s\u00fa nutn\u00e9 tri z\u00e1kladn\u00e9 aspekty: epidemiologick\u00e1 anamn\u00e9za, klinick\u00e9 vy\u0161etrenie a laborat\u00f3rna diagnostika. Mo\u017enosti priamej laborat\u00f3rnej diagnostiky s\u00fa pomerne obmedzen\u00e9. Na umel\u00fdch kultiva\u010dn\u00fdch p\u00f4dach trepon\u00e9my nerast\u00fa, nemno\u017eia sa v kuracom embryu\u00a0 ani v tkanivov\u00fdch kult\u00farach. Met\u00f3dy\u00a0 molekul\u00e1rnej biol\u00f3gie\u00a0 sa rutinne\u00a0 nevyu\u017e\u00edvaj\u00fa\u00a0 pre viac ako 95 % homol\u00f3giu DNA patog\u00e9nnych trepon\u00e9m (T. pallidum subsp. pallidum, T. pallidum subsp. pertenue, T. pallidum subsp. endemicum, T. carateum). U\u017eito\u010dn\u00e9 s\u00fa iba pri diagnostike z prim\u00e1rne steriln\u00fdch tekut\u00edn, ako je mozgovomiechov\u00fd mok, amniotick\u00e1 alebo o\u010dn\u00e1 tekutina. T. pallidum nie je vizualizovate\u013en\u00e1 Gramov\u00fdm farben\u00edm pre jej minim\u00e1lnu hr\u00fabku. Mo\u017en\u00e1 je identifik\u00e1cia \u017eiv\u00fdch trepon\u00e9m v tkanivovom moku z\u00edskanom zo spodiny ulcus durum na z\u00e1klade ich rota\u010dn\u00e9ho a k\u00fdvav\u00e9ho pohybu mikroskopiou v tmavom poli. T\u00e1to metodika patr\u00ed do r\u00fak dermatovenerol\u00f3gov. Je ve\u013emi pr\u00e1cna, za\u0165a\u017een\u00e1 subjekt\u00edvnou chybou pozorovate\u013ea a mo\u017enos\u0165ou z\u00edskania falo\u0161ne pozit\u00edvnych\u00a0 aj negat\u00edvnych v\u00fdsledkov.\u00a0 Striebrenie pod\u013ea Levadetiho je podobne ve\u013emi n\u00e1ro\u010dn\u00e9, priama imunofluorescencia s vyu\u017eit\u00edm polyklon\u00e1lnych\u00a0 protil\u00e1tok identifikuje\u00a0 trepon\u00e9my v l\u00e9zi\u00e1ch.\u00a0 Z\u00e1klad\u00a0 laborat\u00f3rnej diagnostiky tvoria s\u00e9rologick\u00e9 testy.\u00a0 Treba\u00a0 si v\u0161ak uvedomi\u0165, \u017ee \u017eiaden z t\u00fdchto\u00a0 testov nerozl\u00ed\u0161i\u00a0 venerick\u00fd\u00a0 syfilis od nevenerick\u00fdch treponemat\u00f3z (yaws, bejel, endemick\u00fd syfilis a pinta). Tieto patog\u00e9ny s\u00fa morfologicky a antig\u00e9nne podobn\u00e9 a odl\u00ed\u0161i\u0165 ich vieme iba na z\u00e1klade sp\u00f4sobu z\u00edskania, epidemiol\u00f3gie a klinickej manifest\u00e1cie a dnes u\u017e aj DNA sekvenovan\u00edm. V\u0161etky osoby\u00a0 s pozit\u00edvnymi s\u00e9rologick\u00fdmi n\u00e1lezmi by mali by\u0165 lie\u010den\u00e9 na syfilis. Laborat\u00f3rne sa syfilis diagnostikuje kombin\u00e1ciou\u00a0 netrepon\u00e9mov\u00fdch a trepon\u00e9mov\u00fdch testov. V netrepon\u00e9mov\u00fdch\u00a0 (ne\u0161pecifick\u00fdch) reag\u00ednov\u00fdch testoch dokazujeme v s\u00e9re\u00a0 po 10 a\u017e 15 d\u0148och, v likvore po 4 \u2013 8 t\u00fd\u017ed\u0148och po objaven\u00ed sa tvrd\u00e9ho\u00a0 vredu zmes heterofiln\u00fdch IgM a IgG proti kardiolip\u00ednu, lecit\u00ednu a cholesterolu, uvo\u013enen\u00e9ho rozpadom tkan\u00edv hostite\u013ea v priebehu ochorenia a naviazan\u00e9ho ako hapt\u00e9n na prote\u00edny\u00a0 trepon\u00e9m. Titre reag\u00ednov koreluj\u00fa\u00a0 s aktivitou\u00a0 ochorenia, monitoruj\u00fa jeho aktivitu a \u00faspe\u0161nos\u0165 lie\u010dby. Pri absencii terapie kulminuj\u00fa po 1 a\u017e 2 rokoch.\u00a0 V praxi sa stret\u00e1vame s r\u00f4znymi\u00a0 obmenami t\u00fdchto\u00a0 testov: VDRL (Venereal\u00a0 Disease Research Laboratory), BWR (Bordetova-Wassermanova reakcia), RPR (Rapid Plasma Reagin)\u00a0 a RRR (Rapid Reagin\u00a0 Reaction). V na\u0161om laborat\u00f3riu pou\u017e\u00edvan\u00fd\u00a0 RPR test vyu\u017e\u00edva flokul\u00e1ciu kardiolip\u00ednov\u00e9ho antig\u00e9nu naviazan\u00e9ho na uhl\u00edkov\u00e9 \u010dastice protil\u00e1tkami (reag\u00ednmi) v pacientskom s\u00e9re. V trepon\u00e9mov\u00fdch (\u0161pecifick\u00fdch) testoch sa stanovuj\u00fa \u0161pecifick\u00e9 IgM a IgG protil\u00e1tky proti p\u00f4vodcovi ochorenia Treponema pallidum. V\u00e4\u010d\u0161ina z nich vyu\u017e\u00edva rekombinantn\u00e9 antig\u00e9ny trepon\u00e9m. Naj\u010dastej\u0161ie sa po\u017e\u00edvaj\u00fa testy TPPA (Treponema Passive Particle Agglutination Assay), TPHA (Treponema pallidum Haemagglutination As- say), EIA (Enzyme Immunosorbent Assay), CMIA (Chemiluminiscent Microparticle ImmunoAssay) \u2013 IgM, IgG, konfirma\u010dn\u00fd test imunoblot \u2013 IgM, IgG a FTA-abs test (Fluorescent Treponemal Antibody absorption test) v referen\u010dnom laborat\u00f3riu. R\u00fdchly Point of Care test pre jeho suboptim\u00e1lnu senzitivitu odpor\u00fa\u010da ECDC aj WHO iba pre rozvojov\u00e9\u00a0 krajiny. Trepon\u00e9mov\u00e9 testy za\u010d\u00ednaj\u00fa by\u0165 reakt\u00edvne 1 a\u017e 2 t\u00fd\u017edne po objaven\u00ed sa tvrd\u00e9ho vredu, i ke\u010f z praxe vieme, \u017ee je to ve\u013emi individu\u00e1lne\u00a0 a niekedy to m\u00f4\u017ee trva\u0165 a\u017e do troch mesiacov. Stanovenie titrov \u0161pecifick\u00fdch protil\u00e1tok v diagnostike a mana\u017emente syfilisu nie je pr\u00ednosn\u00e9. V\u00fdznam stanovenia titrov je len v diagnostike kongenit\u00e1lneho syfilisu a neurosyfilisu. \u0160pecifick\u00e9 trepon\u00e9mov\u00e9 protil\u00e1tky\u00a0 zost\u00e1vaj\u00fa u v\u00e4\u010d\u0161iny pacientov pozit\u00edvne po cel\u00fd \u017eivot a identifikuj\u00fa osoby\u00a0 \u00faspe\u0161ne lie\u010den\u00e9 aj osoby\u00a0 s nelie\u010den\u00fdm syfilisom. Treba si uvedomi\u0165 mo\u017enos\u0165 biologicky\u00a0 falo\u0161nej reaktivity s\u00e9rologick\u00fdch testov, \u010dasto pri autoimunitn\u00fdch ochoreniach, v gravidite a pri boreli\u00f3ze,\u00a0 preto\u00a0 sa reakt\u00edvne vzorky konfirmuj\u00fa.\u00a0 Optim\u00e1lna je met\u00f3da imunoblot, kde stanovujeme IgM a IgG protil\u00e1tky proti jednotliv\u00fdm\u00a0 membr\u00e1nov\u00fdm prote\u00ednom T. pallidum. Potvrdenie IgM protil\u00e1tok je zvl\u00e1\u0161\u0165 cenn\u00e9 pri diagnostike kongenit\u00e1lneho syfilisu.<\/p>\n
 <\/p>\n
Diagnostika v MEDIREX-e<\/strong><\/p>\n
Pod\u013ea odborn\u00e9ho\u00a0 usmernenia\u00a0 NRC pre syfilis\u00a0 (2005)\u00a0 pre skr\u00edning syfilisu podliehaj\u00fa vyh\u013ead\u00e1vaniu nov\u00fdch pr\u00edpadov (\u0161pecifick\u00fd + ne\u0161pecifick\u00fd test) v\u0161etci\u00a0 dospel\u00ed po 50. roku pri prvej hospitaliz\u00e1cii v roku, do 50. roku pri ka\u017edej\u00a0 hospitaliz\u00e1cii, ka\u017ed\u00fd STD chor\u00fd, ka\u017ed\u00e1 tehotn\u00e1 2x po\u010das gravidity (3.-4.m. a 7.-8.m.), v\u0161etci\u00a0 darcovia krvi, kostnej drene, tkan\u00edv, org\u00e1nov a spermi\u00ed\u00a0 a novorodenci. Ke\u010f\u017ee kombin\u00e1cia testov RRR + TPPA je pr\u00e1cna a \u010dasovo n\u00e1ro\u010dn\u00e1 a v\u00fdsledky s\u00fa a\u017e na\u00a0de\u0148 po doru\u010den\u00ed vzorky do laborat\u00f3ria, zaviedli sme v na\u0161ich laborat\u00f3ri\u00e1ch na skr\u00edning syfilisu\u00a0 \u0161pecifick\u00fd test CMIA IgM + IgG. V\u010faka detekcii\u00a0 IgM protil\u00e1tok je reakt\u00edvny\u00a0 od 2. t\u00fd\u017ed\u0148a\u00a0 ochorenia, plne\u00a0 automatizovan\u00fd a negat\u00edvny v\u00fdsledok je v de\u0148\u00a0 doru\u010denia vzorky do laborat\u00f3ria. Kombin\u00e1ciu testov RRR + TPPA sme ponechali \u0161tandardne pre dermatovenerologick\u00fdch pacientov a novorodencov. Ka\u017ed\u00e9 reakt\u00edvne s\u00e9rum v teste CMIA overujeme testami RRR a TPPA a v\u0161etky novodiagnostikovan\u00e9 n\u00e1lezy\u00a0 konfirmujeme met\u00f3dou imunoblot IgM a IgG. S\u00e9ra nov\u00fdch s\u00e9rologicky diagnostikovan\u00fdch suspektn\u00fdch ochoren\u00ed zasielame na konfirma\u010dn\u00e9 vy\u0161etrenie do R\u00daVZ \u2013 N\u00e1rodn\u00e9ho referen\u010dn\u00e9ho centra pre syfilis v Ko\u0161iciach. \u0160pecifickou s\u00fa\u010das\u0165ou na\u0161ej \u010dinnosti je vy\u0161etrenie z plodovej\u00a0 a o\u010dnej\u00a0 tekutiny\u00a0 a diagnostika neurosyfilisu. Intratek\u00e1lnu produkciu protil\u00e1tok stanovujeme porovnan\u00edm titra TPPA v s\u00e9re\u00a0 a v likvore.<\/span><\/p>\n
Odber biologick\u00e9ho materi\u00e1lu a transport do laborat\u00f3ria Odober\u00e1 sa krv v mno\u017estve 5 \u2013 7\u2008ml do \u0161peci\u00e1lnej odberovej s\u00fapravy\u00a0 ur\u010denej na odber a transport krvi. Do dvoch hod\u00edn sa m\u00f4\u017ee krv transportova\u0165 pri izbovej\u00a0 teplote. Plodov\u00fa vodu, o\u010dn\u00fa\u00a0 tekutinu\u00a0 a likvor je vhodn\u00e9\u00a0 zasiela\u0165\u00a0 v mno\u017estve min. 1\u2008ml. Ak transport vy\u017eaduje\u00a0 dlh\u0161\u00ed \u010das, je potrebn\u00e9 vzorku transportova\u0165 a uchov\u00e1va\u0165 pri 2 \u2013 8\u2008\u00b0C.<\/p>\n
Z\u00e1ver<\/strong><\/p>\n
Z preh\u013eadu klinick\u00fdch prejavov syfilisu vypl\u00fdva, \u017ee nie ka\u017ed\u00fd sympt\u00f3m je typick\u00fd pre toto ochorenie, \u0161t\u00e1dium latencie je bez klinick\u00fdch prejavov, ale pacient m\u00f4\u017ee\u00a0 by\u0165 infek\u010dn\u00fd, preto skr\u00edning\u00a0 a n\u00e1sledn\u00e1 lie\u010dba\u00a0 s\u00fa d\u00f4le\u017eit\u00fdm prevent\u00edvnym opatren\u00edm proti \u0161\u00edreniu syfilisu. V tabu\u013eke 1 a 2 je uveden\u00fd\u00a0 celkov\u00fd po\u010det vy\u0161etren\u00ed \u0161pecifick\u00fdch protil\u00e1tok na na\u0161om oddelen\u00ed v rokoch 2008 a\u017e 2016 a celkov\u00fd po\u010det pozit\u00edvnych vzoriek s\u00e9ra 9\u2009367\u00a0 je alarmuj\u00faci. Na druhej strane je pote\u0161ite\u013en\u00e9, \u017ee sme nezaznamenali ani jedn\u00e9ho novorodenca s reaktivitou \u0161pecifick\u00fdch protil\u00e1tok, ktor\u00fd by mal z\u00e1rove\u0148 pozitivitu netrepon\u00e9mov\u00fdch testov a IgM v konfirma\u010dnom teste imunoblot, tak\u017ee\u00a0 sme nepotvrdili\u00a0 ani jeden\u00a0 kongenit\u00e1lny syfilis, iba prenesen\u00e9 matersk\u00e9 protil\u00e1tky. Potvrdzuje to spr\u00e1vnos\u0165 skr\u00edningu v gravidite. Menej uspokojiv\u00e9 je zistenie 49 pr\u00edpadov\u00a0 neurosyfilisu\u00a0 v sledovanom obdob\u00ed\u00a0 na na\u0161om pracovisku.<\/p>\n
 <\/p>\n
 <\/p>\n
LITERAT\u00daRA<\/p>\n
    \n
  1. Murray PR, Baron EJ, Jorgensen JH, et al. Manual of Clinical Micro- biology. Washington,\u00a0 D.C. 9th edition 20036-2904 USA 2009; 987-1003.<\/li>\n
  2. Brooks GF, Butel JS, Morse SA. Lawetz, Melnick, &Adelberg\u2019s Medical Microbiology. Lange Medical Books\/Mc Graw-Hill 27th\u00a0 edition New York 2001; 285-288.<\/li>\n<\/ol>\n
      \n
    1. Bedn\u00e1\u0159 M, Fra\u0148kov\u00e1 V, Schindler J, et al. L\u00e9ka\u0159sk\u00e1 mikrobiologie, Marvill 1996; 185-188.<\/li>\n
    2. Baro\u0148\u00e1kov\u00e1 A. Syfilis, Via pract 2005; 2 (3): 138-140.<\/li>\n
    3. Martin\u00e1skov\u00e1 K. Syfilis v detskom veku. Dermatol \u00a0Prax\u00a0 2015;\u00a0 9(4): 137-142.<\/li>\n<\/ol>\n
        \n
      1. European guideline on the management of syphilis, European\u00a0 Academy of Dermatology and Venereology 2014.<\/li>\n<\/ol>\n
          \n
        1. EUROPEAN CENTRE FOR DISEASE PREVENTION A\u00a0 CONTROL. 2014\/07\u2008A. Sexually transmitted infections in Europe 2012: surveillance report. \u0160tokholm: ECDC, 2014; 110\u2008s.\u00a0 ISBN 978-92-9193-579-6.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
          *All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper.   \u00davod Syfilis (lues) je historicky zn\u00e1me chronick\u00e9 multisyst\u00e9mov\u00e9 pohlavne prenosn\u00e9 infek\u010dn\u00e9 ochorenie sp\u00f4soben\u00e9 bakt\u00e9riou Treponema pallidum. Uva\u017euje sa o mo\u017enosti, \u017ee do Eur\u00f3py sa dostal s n\u00e1morn\u00edkmi Christophera Columba<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[292],"tags":[528,529,530,525,531],"class_list":["post-1262","post","type-post","status-publish","format-standard","hentry","category-microbiology","tag-acquired-syphilis","tag-congenital-syphilis","tag-non-treponemal-tests","tag-treponema-pallidum-en","tag-treponemal-tests","typ_clanku-original-work"],"acf":{"abstrakt":"
          Syphilis \u00a0is a systemic infectious venereal disease caused by the fragile \u00a0spiral \u00a0bacterium T<\/em>r<\/em>eponema pallidum<\/em>. The route \u00a0of transmission is mostly \u00a0by sexual contact with infectious lesions \u2013 acquired syphilis. According to the European Centre \u00a0for Disease Prevention and Control (ECDC), almost two-thirds of the syphilis \u00a0cases with in- formation on transmission category were reported in men who have sex with men (MSM). Dangerous is the pos- sibility of transmission from mother to foetus in utero <\/strong>\u2013 congenital syphilis \u00a0and by blood products transfusion. There are three \u00a0aspects of syphilis \u00a0diagnosis: clinical history, physical examination and laboratory diagnosis. In our laboratory, we use \u00a0for screening non-treponemal RPR (Rapid Plasma Reagin), and specific treponemal TP- PA (Treponema Passive Particle Agglutination Assay) \u00a0tests or CMIA (Chemiluminescent Microparticle Immuno- Assay). All reactive samples we confirm \u00a0with immunoblot IgM and IgG test.<\/p>\n
          K<\/strong>e<\/strong>ywords: <\/strong>Treponema pallidum, acquired syphilis, congenital syphilis, non-treponemal tests, \u00a0treponemal tests<\/p>\n
           <\/p>\n","casopis":[{"ID":1223,"post_author":"7","post_date":"2017-09-26 14:15:30","post_date_gmt":"2017-09-26 12:15:30","post_content":"
            \r\n \t
          • Fertility disorders: immunological causes and possible curative impact<\/li>\r\n \t
          • The first results of galactose-deficient IgA1 measurement in diagnosis and monitoring of patients with IgA nephropathy<\/li>\r\n \t
          • Application of autovaccines in the treatment of chronic and recurrent colpitises<\/li>\r\n \t
          • Infections of the hip endoprostheses<\/li>\r\n \t
          • Non-invasive markers of liver fibrosis<\/li>\r\n<\/ul>","post_title":"Newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-2017-2","to_ping":"","pinged":"","post_modified":"2017-09-26 14:19:35","post_modified_gmt":"2017-09-26 12:19:35","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab-2017-2\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"90","upload_clanok":{"ID":1259,"id":1259,"title":"NEWSLAB 2-2017_Kopilcov\u00e1","filename":"NEWSLAB-2-2017_Kopilcov\u00e1.pdf","filesize":763231,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2017\/09\/NEWSLAB-2-2017_Kopilcov\u00e1.pdf","link":"https:\/\/www.newslab.sk\/en\/laboratory-diagnosis-of-syphilis\/newslab-2-2017_kopilcova-2\/","alt":"","author":"7","description":"","caption":"","name":"newslab-2-2017_kopilcova-2","status":"inherit","uploaded_to":1262,"date":"2017-09-27 12:08:49","modified":"2017-09-27 12:08:49","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1262","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1262"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1262\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1262"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1262"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1262"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}