Нейросифилис: эпидемиология, патогенез, клиника, лабораторная диагностика

The article describes the key achievements and problems related to studying neurosyphilis. It also shows the dynamics of neurosyphilis incidence in Russia and abroad from the early twentieth century and up to present. The article also describes issues related to the pathogenesis, clinical course and pathomorphism of the disease. The authors present current approaches to the laboratory diagnostics of neurosyphilis.Освещены основные достижения и проблемы, связанные с изучением сифилиса нервной системы. Показана динамика заболеваемости нейросифилисом в России и за рубежом с начала ХХ века по настоящее время. Рассмотрены вопросы, касающиеся патогенеза, клинического течения и патоморфоза заболевания. Представлены современные подходы к лабораторной диагностике нейросифилиса

Современные иммунологические методыисследования цереброспинальной жидкостиу больных нейросифилисом

The authors conducted a comparative study of the diagnostic value (sensitivity, specificity, efficiency and predictive value of positive and negative results) of immunology methods (microprecipitation test, RPR, complement-fixation test, immunofluorescence test with whole spinal fluid, ELISA, passive hemagglutination test, Treponema pallidum immobilization test, immunoblotting) for studying the cerebrospinal fluid in 37 neurosyphilitic patients and 31 patients with syphilis in the anamnesis but without any clinical and laboratory data confirming the syphilitic affection of the nervous system. The highest diagnostic efficiency indices for neurosyphilis were noted for such methods as microprecipitation test (80.9%), passive hemagglutination test (98.5%) and immunoblotting (97.0%), which enables the authors to recommend the methods as standard neurosyphilis diagnostics methods in the territory of the Russian Federation. It was revealed that antibodies for pale treponema antigens Tr17 and Tr47 were detected in the course of immunoblotting most often regardless of any clinical manifestations and duration of the syphilitic infection. The authors set the priorities for individual examination methods when diagnosing asymptomatic, early and late meningovascular neurosyphilis. They also developed a diagnostic algorithm for detecting neurosyphilis based on the sequential application of ELISA/immunoblotting, microprecipitation test and passive hemagglutination test

Анализ заболеваемости и качества лабораторной диагностикинейросифилиса в Российской Федерации

According to the analysis of the state statistical reporting, the rate of new neurosyphilis cases was growing in the Russian Federation in 1999-2009. Substantial differences in the number of detected neurosyphilis cases by different federal districts were established. Low-quality laboratory diagnostics was proved to be one of the factors promoting the neurosyphilis incidence rate. The quality of the neurosyphilis laboratory diagnostics was studied by means of questionnaires distributed among dedicated dermatovenerological medical institutions. Substantial shortcomings in the neurosyphilis laboratory diagnostics were established including absence of spinal fluid diagnostics in 17%-33% of the institutions and inadequate compliance with the regulatory study methods (immunofluorescence test with whole spinal fluid, microprecipitation test, cytosis and protein determination in the spinal fluid). For the purposes of optimizing the neurosyphilis diagnostics in the Russian Federation, we suggest to provide for all-round and complex examination of patients with suspected neurosyphilis based on the regulatory laboratory and functional diagnostics methods; it is also required to make the spinal fluid examination based on the passive hemagglutination test being highly sensitive and specific as well as having a high diagnostic efficacy for neurosyphilis a part of the standards aimed at rendering medical aid to neurosyphilis patients.Анализ данных государственной статистической отчетности показал рост числа вновь зарегистрированных случаев заболевания нейросифилисом в Российской Федерации за период с 1999 по 2009 г. Установлены существенные различия в количестве выявляемых случаев заболевания нейросифилисом по различным федеральным округам. Отмечено, что одним из факторов роста заболеваемости нейросифилисом может являться низкое качество лабораторной диагностики. Путем анкетирования специализированных медицинских учреждений дерматовенерологического профиля Российской Федерации осуществлена оценка качества лабораторной диагностики нейросифилиса. Установлены существенные недостатки лабораторной диагностики нейросифилиса, заключающиеся в отсутствии ликвородиагностики в 17-33% учреждений и недостаточном использовании регламентированных методов исследования (РИФц, РМП, определения цитоза и белка в ликворе). В целях оптимизации диагностики нейросифилиса в Российской Федерации предлагается обеспечить всестороннее комплексное обследование больных с подозрением на нейросифилис с использованием регламентированных методов лабораторной и функциональной диагностики; включить в проект Стандарта оказания медицинской помощи больным нейросифилисом исследование ликвора высокочувствительным и специфичным методом РПГА, обладающим высокой диагностической эффективностью при выявлении нейросифилиса

Специфическое поражение коленного суставау больного сифилисом

The article presents a case of a rare form of late syphilitic arthritis. It also describes the potential of using the polymerase chain reaction method in the diagnostics of late forms of the syphilitic infection.Представлено наблюдение редкой формы позднего сифилиса - сифилитического артрита. Показаны возможности при- менения метода полимеразной цепной реакции в диагностике поздних форм сифилитической инфекции

Prevalence of the A2058G mutation in 23S rRNA gene, which determines Treponema pallidum macrolide resistance in Russian population

Objective. To investigate prevalence of the A2058G mutation in the Russian population of T. pallidum and its association with molecular subtypes. Materials and Methods. We analyzed DNA isolated from 325 samples of clinical material obtained from patients of dermatovenereological treatment and prophylactic institutions in 6 federal districts of the Russia in the period from 2014 to 2021. Patients were diagnosed with primary syphilis of the genital organs, primary syphilis of other sites, or secondary syphilis of the skin and mucous membranes. DNA was isolated using the Proba-NK reagent kit (DNA-technology, Russia) according to the manufacturer's instructions. The presence of T. pallidum genetic material was confirmed by PCR with primers for the species-specific polA gene. Molecular typing was performed based on the analysis of polymorphic regions of species-specific T. pallidum genes. The primary decoding of the nucleotide sequences of the 23S rRNA gene fragment was carried out using the Sequencing Analysis 5.3.1 program. The analyzed fragments were aligned using the Mega 5 program. Results. Eight molecular subtypes of T. pallidum – 14d/f, 14d/g, 14b/f, 14c/f, 14i/f, 9d/f, 14b/g and 14e/f with stable dominance of subtype 14d/f – were identified in the Russian Federation in the interval 2014–2021. Three subtypes, 14d/g, 14b/g and 14b/f, carrying the A2058G mutation associated with azithromycin resistance, were identified. Conclusions. Studies on molecular typing of T. pallidum strains in the Russia have shown significant population heterogeneity. Three sublines containing the A2058G mutation were shown to exist, one of which – 14b/f – is described as rare. The obtained data confirm the relevance of continuous monitoring of the emergence of resistant strains and the development of new mutations