Comparison of Traditional and Reverse Syphilis Screening Algorithms in Medical Health Checkups
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: The syphilis diagnostic algorithms applied in different countries vary significantly depending on the local syphilis epidemiology and other considerations, including the expected workload, the need for automation in the laboratory and budget factors. This study was performed to investigate the efficacy of traditional and reverse syphilis diagnostic algorithms during general health checkups. Methods: In total, 1,000 blood specimens were obtained from 908 men and 92 women during their regular health checkups. Traditional screening and reverse screening were applied to the same specimens using automatic rapid plasma regain (RPR) and Treponema pallidum latex agglutination (TPLA) tests, respectively. Specimens that were reverse algorithm (TPLA) reactive, were subjected to a second treponemal test performed by using the chemiluminescent microparticle immunoassay (CMIA). Results: Of the 1,000 specimens tested, 68 (6.8%) were reactive by reverse screening (TPLA) compared with 11 (1.1%) by traditional screening (RPR). The traditional algorithm failed to detect 48 specimens [TPLA(+)/RPR(-)/CMIA(+)]. The median TPLA cutoff index (COI) was higher in CMIA-reactive cases than in CMIA-nonreactive cases (90.5 vs 12.5 U). Conclusions: The reverse screening algorithm could detect the subjects with possible latent syphilis who were not detected by the traditional algorithm. Those individuals could be provided with opportunities for evaluating syphilis during their health checkups. The COI values of the initial TPLA test may be helpful in excluding false-positive TPLA test results in the reverse algorithm
Abstract
Background: The syphilis diagnostic algorithms applied in different countries vary significantly depending on the local syphilis epidemiology and other considerations, including the expected workload, the need for automation in the laboratory and budget factors. This study was performed to investigate the efficacy of traditional and reverse syphilis diagnostic algorithms during general health checkups. Methods: In total, 1,000 blood specimens were obtained from 908 men and 92 women during their regular health checkups. Traditional screening and reverse screening were applied to the same specimens using automatic rapid plasma regain (RPR) and Treponema pallidum latex agglutination (TPLA) tests, respectively. Specimens that were reverse algorithm (TPLA) reactive, were subjected to a second treponemal test performed by using the chemiluminescent microparticle immunoassay (CMIA). Results: Of the 1,000 specimens tested, 68 (6.8%) were reactive by reverse screening (TPLA) compared with 11 (1.1%) by traditional screening (RPR). The traditional algorithm failed to detect 48 specimens [TPLA(+)/RPR(-)/CMIA(+)]. The median TPLA cutoff index (COI) was higher in CMIA-reactive cases than in CMIA-nonreactive cases (90.5 vs 12.5 U). Conclusions: The reverse screening algorithm could detect the subjects with possible latent syphilis who were not detected by the traditional algorithm. Those individuals could be provided with opportunities for evaluating syphilis during their health checkups. The COI values of the initial TPLA test may be helpful in excluding false-positive TPLA test results in the reverse algorithm
참고문헌 (12)
- Greenblatt RM, "Genital ulceration as a risk factor for human immunodeficiency virus infection", AIDS, 2, pp.47~50 (1998)
- Mehta SD, "HIV seroconversion among public sexually transmitted disease clinic patients: analysis of risks to facilitate early identification", J Acquir Immune Defic Syndr, 42, pp.116~122 (2006)
- Morshed MG, "Recent trends in the serologic diagnosis of syphilis", Clin Vaccine Immunol, 22, pp.137~147 (2015)
- Müller I, "Is serological testing a reliable tool in laboratory diagnosis of syphilis? Meta-analysis of eight external quality control surveys performed by the German infection serology proficiency testing program", J Clin Microbiol, 44, pp.1335~1341 (2006)
- Workowski KA, "Sexually transmitted diseases treatment guidelines, 2010", MMWR Recomm Rep, 59, pp.1~110 (2010)
- Loeffelholz MJ, "It is time to use treponema-specific antibody screening tests for diagnosis of syphilis", J Clin Microbiol, 50, pp.2~6 (2012)
- Tong ML, "Analysis of 3 algorithms for syphilis serodiagnosis and implications for clinical management", Clin Infect Dis, 58, pp.1116~1124 (2014)
- Park IU, "Screening for syphilis with the treponemal immunoassay: analysis of discordant serology results and implications for clinical management", J Infect Dis, 204, pp.1297~1304 (2011)
- Binnicker MJ, "Direct comparison of the traditional and reverse syphilis screening algorithms in a population with a low prevalence of syphilis", J Clin Microbiol, 50, pp.148~150 (2012)
- Owusu-Edusei K Jr, "Serologic testing for syphilis in the United States: a cost-effectiveness analysis of two screening algorithms", Sex Transm Dis, 38, pp.1~7 (2011)
- Park BG, "Comparison of six automated Treponema-Specific antibody assays", J Clin Microbiol, 54, pp.163~167 (2016)
- Centers for Disease Control and Prevention, "Discordant results from reverse sequence syphilis screening-five laboratories, United States, 2006-2010", MMWR Morb Mortal Wkly Rep, 60, pp.133~137 (2011)