title: Molecular detection of Treponema pallidum sp. pallidum in blood samples of VDRL-seroreactive women with lethal pregnancy outcomes: a retrospective observational study in northern Brazil.
abstract: BACKGROUND
  Although control measures of maternal and congenital syphilis are available in Brazil, difficulties exist within the healthcare network in providing a laboratory diagnosis of the infection during the prenatal period. The objective of this study was to confirm the presence of Treponema pallidum by PCR in women with positive VDRL serology and lethal pregnancy outcomes, i.e., abortion, stillbirth and neonatal death.
  
  
  METHODS
  A retrospective study was conducted on VDRLseroreactive women with lethal pregnancy outcomes admitted to the Fundação Santa Casa de Misericórdia do Pará (FSCM-PA) between January and July 2004. Serum samples and DNA from whole blood were obtained at the time of screening by the VDRL test. These samples were analyzed by IgG ELISA, IgM FTA-Abs and simple PCR (polA).
  
  
  RESULTS
  During the study period, 0.7% (36/4,912) of women with lethal pregnancy outcomes presented a positive VDRL test. The polAgene was amplified in 72.7% (24/33) of these women, with 55.6% (20/36) and 94.4% (34/36) presenting IgM and IgG antibodies against T. pallidum, respectively. Comparison of these results showed a significant difference, with agreement between the PCR and IgM FTA-Abs results, suggesting that maternal syphilis was an active infection. No basic cause of death of the conceptus was reported in 97.2% (35/36) of cases. Among women who were submitted to the VDRL test during the prenatal period, only four of the nine seroreactive patients underwent treatment.
  
  
  CONCLUSIONS
  The high frequency of syphilis in the group studied indicates the fragility of the service of infection diagnosis, treatment and monitoring, compromising epidemiological control.
authors.affiliation: Laboratório de Imunogenética, Universidade Federal do Pará, Belém, PA, Brasil. charliana@gmail.com
authors.forename: Charliana Aragão Damasceno
authors.initials: CA
authors.lastname: Casal
authors.forename: Mayra Oliveira da
authors.initials: MO
authors.lastname: Silva
authors.forename: Igor Brasil
authors.initials: IB
authors.lastname: Costa
authors.forename: Eliete da Cunha
authors.initials: Eda C
authors.lastname: Araújo
authors.forename: Tereza Cristina de Oliveira
authors.initials: TC
authors.lastname: Corvelo
mesh_terms: D000907:Antibodies, Bacterial / Q000097:blood*; D002308:Cardiolipins / Q000097:blood*; D002784:Cholesterol / Q000097:blood*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D010713:Phosphatidylcholines / Q000097:blood*; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013587:Syphilis / Q000175:diagnosis*; D013588:Syphilis Serodiagnosis / Q000379:methods; D014210:Treponema pallidum / Q000235:genetics* / Q000276:immunology
chemical_list: D000907:Antibodies, Bacterial; D002308:Cardiolipins; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D010713:Phosphatidylcholines; C054448:VDRL antigen; D002784:Cholesterol