매독특이항체 검출을 위한 Centaur Syphilis, Immulite Syphilis와 Mediace TPLA 시약의 비교 평가

서동희,황동희,주신영,최현희 대한진단검사의학회 2015 Laboratory Medicine Online Vol.5 No.2

Background: We evaluated the efficacy of two chemiluminescence immunoassays that detect treponemal antibodies, Centaur Syphilis and Immulite Syphilis, in comparison with Mediace Treponema pallidum latex agglutination (TPLA). Methods: The study was conducted in two phases. In the first phase, we tested 1,147 serum samples that were sequentially submitted for routine syphilis serology. In the second phase, we tested a panel of 119 frozen serum samples that had previously tested positive by Mediace RPR. The kappa value, total agreement percentage, and sensitivity and specificity were analyzed. Results: Of the 1,147 random samples, 24 (2.09%) tested positive with Centaur Syphilis, 16 (1.39%) with Immulite Syphilis, and 19 (1.66%) with Mediace TPLA. Of the 119 Mediace RPR-positive samples, 103 (86.6%) tested positive with Centaur Syphilis, 101 (84.9%) with Immulite Syphilis, and 105 (88.2%) with Mediace TPLA. The percent agreements (kappa values) were 98.8% (0.934) between Centaur Syphilis and Mediace TPLA, 99.0% (0.94) between Immulite Syphilis and Mediace TPLA, and 99.2% (0.955) between Centaur Syphilis and Immulite Syphilis. To measure the sensitivity and specificity of each treponemal test, samples showing agreement in three or four of the tests (three treponemal tests and Mediace-RPR) were regarded as true positive (n=117) or true negative (n=1,142). The respective values for sensitivity and specificity were 100% and 99.6% for Centaur Syphilis, 98.3% and 100% for Immulite Syphilis, and 99.2% and 99.7% for Mediace TPLA. Conclusions: Results from the three treponemal assays were in good agreement. Greater sensitivity of Centaur Syphilis and greater specificity of Immulite Syphilis were suggested. 배경: 본 연구에서는 트레포네마항체 검출을 위한 화학발광면역측정시약인 ADVIA Centaur Syphilis와 Immulite 2000 Syphilis screen을 Mediace Treponema pallidum latex agglutination (TPLA)과의 비교를 통하여 평가하였다. 방법: 본 연구는 두 단계로 진행되었다. 첫 번째는 2012년 11월에 랩지노믹스 의학연구소에 Mediace RPR 정밀검사가 의뢰된 1,147개의 연속적인 검체에 대해서 검사를 시행하였고, 두 번째는 Mediace RPR 정밀검사에서 양성으로 나왔던 119개의 동결된 검체를 검사하였다. 모든 혈청 검체에 대해서 Centaur Syphilis, Mediace TPLA, 그리고 Immulite Syphilis 검사를 시행하였다. 검사 간 일치율, kappa값, 각 검사의 민감도 및 특이도를 분석하였다. 결과: 무작위 1,147 검체에 대해 Centaur Syphilis는 24개(2.09%)가 양성을, Mediace TPLA로는 19개(1.66%)가 양성을, Immulite Syphilis로는 16개(1.39%)가 트레포네마항체 양성반응을 보였다. RPR정밀 양성 119개 검체에 대해 Centaur Syphilis로는 103개(86.6%)가 양성을 보였고, Immulite Syphilis로는 101개(84.9%)가, Mediace TPLA로는 105개(88.2%)가 양성을 보였다. 검사결과 간 일치율(kappa값)은 Centaur syphilis와 Mediace TPLA는 98.8% (0.934), Immulite Syphilis와 Mediace TPLA는 99.0% (0.94), Centaur Syphilis와 Immulite Syphilis는 99.2% (0.955)를 보였다. 세 가지 트레포네마검사와 RPR 검사 중 3개 이상이 일치한 검체를 진양성(n= 117) 또는 진음성(n=1,142)으로 간주하여 평가한 트레포네마검사의 민감도와 특이도는 각각 Centaur Syphilis 100%, 99.6%, Immulite Syphilis 98.3%, 100%, Mediace TPLA 99.2%, 99.7%였다. 결론: 세 가지 트레포네마검사, Centaur Syphilis, Mediace TPLA, Immulite Syphilis는 높은 검사 결과 간 일치율을 보였다. 다른 검사보다 Centaur syphilis가 조금 더 높은 민감도를, Immulite syphilis가 조금 더 높은 특이도를 보이는 것으로 생각되었지만 정확한 평가를 위해서는 혈청학적으로 확진된 대규모 검체를 대상으로 한 추가적인 연구가 필요할 것으로 생각된다.

Conjugal Syphilis

Lee, Jung Bock,Lee, Yung Jae,Chung, Kee-Yang,Lee, Min Geol Korean Dermatological Association 1994 Annals of Dermatology Vol.6 No.1

화류병과 문명병으로 표상된 일본과 조선의 근대 - 한일근대소설의 매독담론 -

안영희 ( An¸ Young-hee ) 한국외국어대학교 일본연구소 2020 日本硏究 Vol.0 No.86

韓日近代小説に表れた梅毒言説は帝国と植民地でそれぞれ異なる方式として表象される。梅毒モチーフの日本近代小説の特徴は次のようである。梅毒が使われた日本近代小説は私小説で多く現れた。日本近代小説では梅毒にかかった登場人物は作家、芸者、混血児が多く、遊郭と刑務所、拘置所が背景としてよく表れる。日本近代小説で梅毒は、主に遊郭で公娼と芸者を通して下流階層の男性たちがかかる病気として描かれる。日本で梅毒は花柳界に努めている人やそこを利用する人がかかる花柳病という認識がある。従って、梅毒にかかる男性は性欲管理が出来ず、野蛮的で不潔であるというイメージが強い。 梅毒モチーフの韓国近代小説の特徴は次のようである。韓国近代小説で梅毒が登場する小説は主に主流作家が書いている。李光洙、金東仁、朴泰遠、蔡萬植のように有名な作家の作品で梅毒がよく扱われている。韓国近代小説で梅毒にかかった登場人物はお金持ちの息子、新しい女、キーセンであり、背景は遊郭のみならず、一般家庭も含まれる。従って、朝鮮で梅毒は産業化と近代化の過程で文明の発達のために必然的に生じる文明病であり、上流階層にかかる認識が強い。特に知識人男性には、お金持ちがかかる文明病、新知識を受け入れた新しい女には放蕩な性生活のためにかかる花柳病という批判的な視線を適用している。このように韓日近代小説に表れた梅毒言説は帝国と植民地でそれぞれ異なる方式として表象されている。これは即ち、帝国の統治言説の差別的な適用と関連している。 The syphilis discourse in modern Korean and Japanese novels is represented in different ways in the empire and the colony. The characteristics of syphilis discourse in modern Japanese novels are as follows. Among the 56 works of modern Japanese novels that deal with syphilis, 29 fall into the so-called I-novel category. Syphilis is depicted as being predominantly contracted by men in the lower class through licensed prostitutes or geisha in the demimonde quarters. In Japan, syphilis was considered a social disease caused by people working in or visiting the red-light districts. Therefore, it was used to indicate that men suffering from syphilis could not properly manage their sexual desire and were unmodern, barbaric, and unsanitary. The characteristics of syphilis discourse in modern Korean novels are as follows. Most of the modern Korean novels featuring syphilis are those by mainstream writers. It is heavily featured in the works of famous writers such as Lee Kwangsoo, Kim Dongin, Park Taewon, and Chae Mansik. In modern Korean novels, there were many new women and sons of affluent families who had syphilis. Therefore, in Chosun, syphilis was recognized as a civilizational disease caused by the development of civilization in the process of industrialization and modernization. In particular, society took a biased view of syphilis, depending on the gender difference. In the case of rich intellectual men, syphilis was considered a civilizational disease. In contrast, in the case of modern new women who accepted new knowledge, it was regarded as a social disease caused by their sexual promiscuity.

매독의 임상적, 혈청학적 양상과 치료 전후의 혈청학적 변

이정우 ( Jung Woo Lee ),박경태 ( Kyoung Tae Park ),김정수 ( Joung Soo Kim ),유희준 ( Hee-joon Yu ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.2

Background: Recently, there has been an increase in the prevalence of syphilis in Korea and in case reports of treatment failures of syphilis. Objective: This study was designed to explicate the clinical and laboratory features of syphilis, underlying diseases of the VDRL false-positive group, and responses to treatment of patients with syphilis. Methods: Between January 2001 and June 2010, we selected 115 patients with reactive results on the VDRL test. We evaluated several characteristics including their age, gender, clinical stage, skin lesion, serologic result, the rate and the underlying diseases of the VDRL false-positive group, and their serologic responses to syphilis treatment. Results: There was no significant difference in the incidence of syphilis by gender except in the case of primary syphilis. The annual incidence of syphilis has shown a significant upward trend, especially in the younger age group (10~39 years). Using a serum VDRL titer of 8 as a cut-off value, we found a significant difference between early and latent syphilis. The rate for the VDRL false-positive group was 24.3%. Treatment failures were not reported and the median time to a successful serological response for patients with early syphilis treated with penicillin was 106 days. The Jarish-Herxheimer reaction occurred in 13.7%, and these symptoms were self-limited without any treatment. Conclusion: The annual incidence of syphilis in Korea has shown a significantly upward trend, especially in the younger age group. All responses evaluated were reported for those treated successfully without having any significant adverse effects. Thus, continued surveillance and adequate treatment of syphilis is important not only to enhance disease control but also to improve public health. (Korean J Dermatol 2011; 49(2):111~118)

자동화 매독 검사법인 Architect Syphilis TP assay와 Mediace TPLA의 일치율 및 위양성 평가

허희진,채석래 동국대학교 의학연구소 2009 東國醫學 Vol.16 No.1

자동화장비로 검사 가능한 Mediace Treponema pallidum latex agglutination (Sekisui, Japan; 이하 Mediace TPLA)와 Architect Syphilis TP assay (Abbott, Germany; 이하 Syphilis TP)의 결과치를 비교하여 일치율을 조사하였다. 트레포네마검사에서 위양성의 가능성이 높은 환자 검체를 대상으로 두 검사법의 위양성률을 구하여 두 자동화검사법의 유용성을 평가하고자 하였다. Mediace TPLA 양성이었던 161 예를 대상으로 Syphilis TP 검사를 시행하였다. 위양성률을 평가하기 위해 항핵항체 양성이거나 B형간염표면항원 양성, 항-C형간염바이러스항체 양성, rheumatoid factor 양성, CRP 양성 또는 70세 이상의 고령 환자 검체 234예를 연구 대상으로 Mediace TPLA와 Syphilis TP 검사를 시행하였다. 두 검사 결과의 차이를 보이는 예는 line-blot immunoassay (Innolia Syphilis score, Innogenetics, Belgium)로 확인하였다. Mediace TPLA 양성이었던 161예중 4예 (2.5%)는 Syphilis TP 음성이었고, 이 중 2예는 line-blot immunoassay 양성, 2에는 음성이었다. 중화후 Mediace TPLA, 중화전 Mediace TPLA와 Syphilis TP의 위양성률은 각각 0%(0/234), 1.7%(4/234), 1.7%(4/234)였다. 두 검사의 일치율은 98%(387/395) 였다. 자통화 매독검사인 Mediace TPLA와 Syphilis TP는 양성으로 나온 검체에서의 일치율이 높고 기존의 트레포네마검사 보다 낮은 위양성률을 보이므로, 수기법을 대체할 수 있는 유용한 검사로 생각된다. We compared the results of Mediace Treponema pallidum latex agglutination (TPLA) (Sekisui Chemical Co., Ltd, Japan) with Architect Syphilis TP assay (Syphilis TP) (Abbott, Germany), automated treponemal tests for the diagnosis of syphilis. To establish false positive rates, two methods were tested with patients' sera with laboratory results reported to be related with false positivity of treponemal test. One hundred sixty one patients' sera with Mediace TPLA positivity underwent Syphilis TP. Two hundred thirty four patients' sera with positivity for anti-nuclear antibody, HBs Ag, Anti-HCV, rheumatoid factor or CRP, or old age (≥70) were included in the evaluation of false positive rates. Discrepancies between Mediace TPLA and Syphilis TP results were confirmed by line-blot immunoassay (Innolia Syphilis score, Innogenetics, Belgium). Among 161 patients' sera with Mediace TPLA positivity, 4 cases (2.5%) showed discrepancy between Mediace TPLA and Syphilis TP results: Among 4 cases, 2 cases showed positive line-blot immunoassay results and 2 showed negative results. False positive rate of Mediace TPLA after neutralization, Mediace TPLA before neutralization and Syphilis TP was 0.0% (0/234), 1.7% (4/234) and 1.7% (4/234), respectively. The concordance rate of Mediace TPLA and Syphilis TP was 98% (387/395). The results of comparison data demonstrated that Mediace TPLA and Syphilis TP had high concordance. False positivity of Mediace TPLA and Syphilis TP were low compared with previously reported that of treponemal test. Therefore, automated treponemal tests would be considered to be a valid alternative to traditional treponemal test for confirmation of syphilis.

Comparative Performance of the Reverse Algorithm Using Architect Syphilis TP Versus the Traditional Algorithm Using Rapid Plasma Reagin in Florida’s Public Health Testing Population

Yolanda R. Totten,Bonnie M. Hardy,Berry Bennett,Marie-Claire Rowlinson,,Susanne Crowe, 대한진단검사의학회 2019 Annals of Laboratory Medicine Vol.39 No.4

In Florida, where syphilis is a reportable disease, the number of primary and secondary (P&S) syphilis cases has increased from 3,266 in 2008–2010 to 5,340 in 2013–2015, a 63% increase. The objective of this study was to compare the performance and sensitivity of the syphilis reverse algorithm with the traditional algorithm for detecting P&S (infectious) syphilis cases. Clinical specimens from individuals who self-referred for syphilis testing at public health clinics were processed using the traditional algorithm (non-treponemal rapid plasma reagin (RPR) test followed by a confirmatory treponemal (EIA) test) and then further tested with the Architect Syphilis TP (ASTP) immunoassay (Abbott Diagnostics, Chicago, IL, USA) or by RPR confirmation, if needed (reverse algorithm). Of 1,079 specimens, 59 were positive for syphilis. The sensitivity of the reverse algorithm was 98.3% (58/59) and of the traditional algorithm was 72.9% (43/59). Based on clinical evidence, of the 16 traditional algorithm-negative but reverse algorithm-positive cases, 68.8% (11/16) were classified as missed P&S infections (treatment naïve) and 31.2% (5/16) were classified as missed past syphilis (latent or infections with documented linkage to care). The reverse algorithm enables the detection of additional P&S syphilis cases missed by our current traditional algorithm.

최근 일반 건강인에 대한 매독 혈청 검사 양성율 - 1995년

김희성,이한승,이민걸,이정복 ( Hee Sung Kim,Han Sung Lee,Min Geol Lee,Jung Bock Lee ) 대한피부과학회 1997 大韓皮膚科學會誌 Vol.35 No.3

Background: The VDRL is used as a screening test for syphilis worldwide. In addition, reactive rates of the VDRL test are used to estimate the incidence of syphilis. The prevalence of syphilis reported in Korea varies according to the study population, district and time. Reports on prevalence of syphilis indicate that reactive rates of the serologic test for syphilis showed an increasing tendency in the 1960s and has steadily decreased in the 1990s. We have already reported VDRL positive rates periodically since the late 1970s in similar areas with similar population groups and methods in order to standardize the results for accurate analysis of the prevalence of syphilis in Korea. Objective : This study was performed utilizing the VDRL test in order to find out if the decreasing trend of syphilis prevalence is still continuing. Methods : The ser ologic tests for syphilis were carried out on 13,426 apparently normal adults aged twenty-years-old or over(8,250 blood donors in the Seoul area, 2,461 physical examinees examined at Severance Hospital, Yonsei University and 2,715 pregnant women at delivery at Severance Hospital, Yonsei University ) from January to December 1995. We hve performed the VDRL quantitative test in VDRL-reactive persons among blood donors and pregnant women. Results : The reactive rate of the serum VDRL test was 0.2% in 13,426 healthy adults(blood donors.0.2%, physical examinees:0,2%, pregnant women:0.3%). There was a statistically decreasing tendency compared to 0.4% in 1990(p<0.001). The VDRL quantitative test resulted in levels below the 1:2 titer in 92% of the VDRL-reactive physical exarninees and pregnant women. Conclusion . From the comparison of VDRL reactive rates for syphilis in an apparently normal Korean population obtained by the present author group since 1977, i.e., 2.5% in 1977, 1.1% in 1981, 0.6% in 1986, 0.4% in 1990 and 0.2% in 1995, it is clear that the prevalence of syphilis has been rapidly decreasing since the mid 1970s in Korea. (Kor J Dermatol 1997;35(3): 514-519)

1기, 2기 매독환자에서 Treponema pallidum 항체를 이용한 면역조직화학염색 연구

최세림 ( Se Rim Choi ),김동현 ( Dong Hyun Kim ),이희정 ( Hee Jung Lee ),김태헌 ( Tae Heon Kim ),윤문수 ( Moon Soo Yoon ) 대한피부과학회 2010 대한피부과학회지 Vol.48 No.10

Background: Syphilis is an infection caused by Treponema pallidum (T. pallidum), and this disease is increasing in incidence. However, making the diagnosis of syphilis is sometimes still challenging because of the variable clinical and histopathologic findings and there are cases with negative serologic findings, and especially in the setting of HIV infection and immunosuppressive therapy. Objective: In this study, we specifically evaluated the number and distribution patterns of T. pallidum in the skin lesions from patients with primary or secondary syphilis. Methods: Forty eight skin biopsy specimens with the clinical and/or serological diagnosis of syphilis were evaluated by immunohistochemistry (IHC) using primary polyclonal antibodies against T. pallidum. Results: Overall, T. pallidum was identified in 45 specimens (94%). The IHC of the 22 specimens from the patients with primary syphilis were all positive (100%). Twenty three (88%) out of 26 specimens from the patients with secondary syphilis showed positive results. T. pallidum was also identified in three patients with negative VDRL. Although the density of T. pallidum was higher in the specimens from the patients with primary syphilis than in those from the patients with secondary syphilis, the differences were not statistically significant (p=0.32). An epitheliotropic pattern was more frequently observed in the specimens from the patients with secondary syphilis (81%) than in those from the patients with primary syphilis (50%) (p=0.01). The density and distribution patterns of T. pallidum didn`t show any correlation with the duration of skin lesions or the VDRL titer. Conclusion: IHC using a polyclonal antibody against T. pallidum could be an effective method for making the diagnosis of primary and secondary syphilis. (Korean J Dermatol 2010;48(10):844~852)

A Case of Successful Treatment of Congenital Syphilis in an Extremely Preterm Baby With Severe Respiratory Distress

( Yoon Kyung Cho ),( Yeon Kyung Lee ),( Sun Young Ko ) 대한소아감염학회 2022 Pediatric Infection and Vaccine Vol.29 No.3

본 증례는 극소미숙아에서 선천매독을 성공적으로 치료한 것에 대한 내용이다. 재태주수 29주 3일, 1,395 g의 여아가 응급 제왕절개 분만으로 태어났으며, 당시 1분 아프가 점수는 2점, 5분 아프가 점수는 4점이었다. 산모는 산전진찰을 전혀 받지 않았던 불법 체류자로, 분만 직전에 매독으로 진단받았다. 환아는 심각한 호흡곤란 증후군, 신생아 폐 고혈압 지속증, 파종성 혈관 내 응고증, 피부의 낙설, 긴 뼈 끝 부위에 골용해성 변화 등을 보였었다. 2주간 Penicillin G 치료를 받았으며, 퇴원 시에는 다른 합병증 없이 건강한 상태로 퇴원할 수 있었다. 최근 한국뿐만 아니라 전 세계적으로 선천 매독의 발생률이 늘어나고 있다. 신생아 진료의들은 선천 매독의 임상 양상을 충분히 알고 미리 대처하여 장기적 합병증 및 사회적, 경제적 부담을 줄일 수 있도록 해야 할 것이다. We report a case of successful treatment of congenital syphilis in an extremely preterm baby. A 1,395 g female infant was born by emergency Caesarean section due to preterm labor and breech presentation at gestational age at 29 weeks and 3 days with an Apgar score of 2 and 4 at 1 minute and 5 minutes, respectively. The mother of the newborn, an illegal immigrant who did not receive any antenatal care, was diagnosed as active syphilis infection by reactive rapid plasma regain (RPR) (titer 1:128) just before the delivery. Upon birth, the newborn presented with various clinical manifestations, including severe respiratory distress syndrome, persistent pulmonary hypertension of the newborn, disseminated intravascular coagulopathy, desquamation and scaling of the whole body, and osteolytic changes of long bone ends. Results of laboratory tests showed signs of early congenital syphilis, including positive syphilis reagin test (12.7 R.U.), reactive with RPR titer of 1:64, and positive for immunoglobulin (Ig) M and IgG fluorescent treponemal antibody absorption test. However, after completion of penicillin G treatment for two weeks, laboratory results dramatically improved, showing a negative syphilis reagin test (0.5 R.U.) and non-reactive in RPR. In conclusion, the incidence of congenital syphilis is prone to be resurgent in South Korea, neonatologists should be fully aware of the clinical features of congenital syphilis because early diagnosis and prompt treatment are essential in order to reduce the social and economic burden due to congenital syphilis.

위장, 간 침범과 함께 막성 신병증이 합병된 제2기 매독

권현희 ( Kwon Hyeon Hui ),우창민 ( U Chang Min ),오효진 ( O Hyo Jin ),안기성 ( An Gi Seong ),조창호 ( Jo Chang Ho ),김용진 ( Kim Yong Jin ),이인희 ( Lee In Hui ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.1

Syphilis, caused by the spirochete Treponema pallidum, is a chronic systemic infectious disease. Nephrotic syndrome, hepatitis, or gastric involvement resulting from secondary syphilis are well-documented complications, but very rare. Moreover, the simultaneous occurrence of these complications in the same patient is extremely rare. This report describes 43-year old male patient with syphilis presented with features of nephrotic syndrome, acute hepatitis, and gastric involvement. A diagnosis of secondary syphilis was nade by skin lesions and serologic tests for syphilis. After a diagnosis of syphilis, we supposed that nephrotic syndrome and hepatitis were the complications of sccondary syphilis and performed kidney and liver biopsies. A kidney biopsy revealed membranous nephropathy characterized by subepithelial hump-like electron-dense deposits and effacement of epithelial foot-processes on electron microscopy. A liver biopsy showed a feature of lobular hepatitis with a few granulomas. Esophagogastroduodenoscopy (EGD) showed multiple shallow ulcers with varying degrees of nodular mucosa at gastric antrum. The patient was treated with intramuscular benzathine penicillin G, 2.4 million units. Proteinuria, skin lesion, hepatitis, and EGD finding were resolved rapidly after penicillin therapy. In conclusion, syphilis should be considered in the differential diagnosis of the nephrotic syndrome, hepatitis, and gastric involvement occurring separately or simultaneously. (Korean J Nephrol 2004;23(1):152-157)