Immunohistochemical detection of Treponema pallidum in skin samples with clinical and histopathological correlations and Warthin-Starry staining critical analysis
Abstract Background: Syphilis in its different phases may be a difficult diagnosis in clinical and histopathological grounds. Objectives: The present study objectives were to evaluate the detection and tissue distribution of Treponema pallidum in skin lesions of syphilis. Methods: A blinded diagn...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Dermatologia
2023-08-01
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| Series: | Anais Brasileiros de Dermatologia |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0365-05962023000400480&tlng=en |
| _version_ | 1827865744116809728 |
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| author | Mariana Freitas de Assis Pereira Rosa Leonardo Pereira Quintella Luiz Claudio Ferreira Tullia Cuzzi |
| author_facet | Mariana Freitas de Assis Pereira Rosa Leonardo Pereira Quintella Luiz Claudio Ferreira Tullia Cuzzi |
| author_sort | Mariana Freitas de Assis Pereira Rosa |
| collection | DOAJ |
| description | Abstract Background: Syphilis in its different phases may be a difficult diagnosis in clinical and histopathological grounds. Objectives: The present study objectives were to evaluate the detection and tissue distribution of Treponema pallidum in skin lesions of syphilis. Methods: A blinded diagnostic accuracy study was performed with immunohistochemistry and Warthin-Starry silver staining in skin samples from patients with syphilis and other diseases. Patients attended two tertiary hospitals between 2000 and 2019. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were calculated for the association between immunohistochemistry positivity and clinical-histopathological variables. Results: Thirty-eight patients with syphilis and their 40 biopsy specimens were included in the study. Thirty-six skin samples were used as non-syphilis controls. The Warthin-Starry technique was unable to accurately demonstrate bacteria in all samples. Immunohistochemistry showed spirochetes only in skin samples from patients with syphilis (24/40) with 60% sensitivity (95% CI 44.8-75.2). Specificity was 100% and accuracy, 78.9% (95% CI 69.8-88.1). Most cases had spirochetes in both dermis and epidermis and there was a high bacterial load. Study limitations: Correlation between immunohistochemistry and clinical or histopathological characteristics was observed but was limited statistically due to the small sample size. Conclusions: Spirochetes were promptly seen in an immunohistochemistry protocol, which can contribute to the diagnosis of syphilis in skin biopsy samples. On the other hand, the Warthin-Starry technique showed to be of no practical value. |
| first_indexed | 2024-03-12T14:53:37Z |
| format | Article |
| id | doaj.art-605f0e8d336a470cbcf0af32d86f1e9a |
| institution | Directory Open Access Journal |
| issn | 0365-0596 |
| language | English |
| last_indexed | 2024-03-12T14:53:37Z |
| publishDate | 2023-08-01 |
| publisher | Sociedade Brasileira de Dermatologia |
| record_format | Article |
| series | Anais Brasileiros de Dermatologia |
| spelling | doaj.art-605f0e8d336a470cbcf0af32d86f1e9a2023-08-15T07:40:47ZengSociedade Brasileira de DermatologiaAnais Brasileiros de Dermatologia0365-05962023-08-0198448048610.1016/j.abd.2022.02.008Immunohistochemical detection of Treponema pallidum in skin samples with clinical and histopathological correlations and Warthin-Starry staining critical analysisMariana Freitas de Assis Pereira Rosahttps://orcid.org/0000-0002-8422-5332Leonardo Pereira Quintellahttps://orcid.org/0000-0002-2076-8776Luiz Claudio Ferreirahttps://orcid.org/0000-0002-9312-4656Tullia Cuzzihttps://orcid.org/0000-0002-3331-5290Abstract Background: Syphilis in its different phases may be a difficult diagnosis in clinical and histopathological grounds. Objectives: The present study objectives were to evaluate the detection and tissue distribution of Treponema pallidum in skin lesions of syphilis. Methods: A blinded diagnostic accuracy study was performed with immunohistochemistry and Warthin-Starry silver staining in skin samples from patients with syphilis and other diseases. Patients attended two tertiary hospitals between 2000 and 2019. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were calculated for the association between immunohistochemistry positivity and clinical-histopathological variables. Results: Thirty-eight patients with syphilis and their 40 biopsy specimens were included in the study. Thirty-six skin samples were used as non-syphilis controls. The Warthin-Starry technique was unable to accurately demonstrate bacteria in all samples. Immunohistochemistry showed spirochetes only in skin samples from patients with syphilis (24/40) with 60% sensitivity (95% CI 44.8-75.2). Specificity was 100% and accuracy, 78.9% (95% CI 69.8-88.1). Most cases had spirochetes in both dermis and epidermis and there was a high bacterial load. Study limitations: Correlation between immunohistochemistry and clinical or histopathological characteristics was observed but was limited statistically due to the small sample size. Conclusions: Spirochetes were promptly seen in an immunohistochemistry protocol, which can contribute to the diagnosis of syphilis in skin biopsy samples. On the other hand, the Warthin-Starry technique showed to be of no practical value.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0365-05962023000400480&tlng=enDiagnosisHistologyImmunohistochemistrySyphilisTreponema pallidum |
| spellingShingle | Mariana Freitas de Assis Pereira Rosa Leonardo Pereira Quintella Luiz Claudio Ferreira Tullia Cuzzi Immunohistochemical detection of Treponema pallidum in skin samples with clinical and histopathological correlations and Warthin-Starry staining critical analysis Anais Brasileiros de Dermatologia Diagnosis Histology Immunohistochemistry Syphilis Treponema pallidum |
| title | Immunohistochemical detection of Treponema pallidum in skin samples with clinical and histopathological correlations and Warthin-Starry staining critical analysis |
| title_full | Immunohistochemical detection of Treponema pallidum in skin samples with clinical and histopathological correlations and Warthin-Starry staining critical analysis |
| title_fullStr | Immunohistochemical detection of Treponema pallidum in skin samples with clinical and histopathological correlations and Warthin-Starry staining critical analysis |
| title_full_unstemmed | Immunohistochemical detection of Treponema pallidum in skin samples with clinical and histopathological correlations and Warthin-Starry staining critical analysis |
| title_short | Immunohistochemical detection of Treponema pallidum in skin samples with clinical and histopathological correlations and Warthin-Starry staining critical analysis |
| title_sort | immunohistochemical detection of treponema pallidum in skin samples with clinical and histopathological correlations and warthin starry staining critical analysis |
| topic | Diagnosis Histology Immunohistochemistry Syphilis Treponema pallidum |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0365-05962023000400480&tlng=en |
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