Letters.indd

Olivier Barraud, Edgar Badell,
8. Barraud O, Baclet MC, Denis F, Ploy MC. François Denis, Nicole Guiso,
Quantitative multiplex real-time PCR for and Marie-Cécile Ploy
Antimicrob Chemother. 2010;65:1642–5. The purpose of this study was to la Santé et de la Recherche Médicale, 9. Naas T, Mikami Y, Imai T, Poirel L, Nord- Limoges, France (O. Barraud, F. Denis, M.- mann P. Characterization of In53, a class 1 plasmid- and composite transposon–locat- C. Ploy); University of Limoges, Limoges ed integron of Escherichia coli which car- ries an unusual array of gene cassettes. J Institut Pasteur, Paris, France (E. Badell, Bacteriol. 2001;183:235–49. doi:10.1128/ 10. Hegstad K, Langsrud S, Lunestad BT, from 200 conscious transfusion DOI: http://dx.doi.org/10.3201/eid1711.110282 Scheie AA, Sunde M, Yazdankhah SP. Does the wide use of quaternary ammo- nium compounds enhance the selection obstetric inpatient departments and References
and spread of antimicrobial resistance and laboratory diagnosis of diphtheria. J In-fect Dis. 2000;181(Suppl 1):S138–45. Address for correspondence: Marie-Cécile Barcelona, Spain) was confi rmed by doi:10.1086/315552 Ploy, Institut National de la Santé et de la using a T. pallidum hemagglutination 2. Bolt F, Cassiday P, Tondella ML, Dezoysa Recherche Médicale, Equipe Avenir, 2 Rue du A, Efstratiou A, Sing A, et al. Multilocus Dr Marcland, 87025 Limoges Cedex, France; A rapid plasma reagin (RPR) assay sequence typing identifi es evidence for re-combination and two distinct lineages of Corynebacterium diphtheriae. J Clin Mi- 3. Maple PA, Efstratiou A, Tseneva G, Ri- The in-vitro susceptibilities of toxigenic strains of Corynebacterium diphtheriae rounding areas to ten antibiotics. J An-timicrob Chemother. 1994;34:1037–40. in accordance with national guidelines.
2010;44:141–66. doi:10.1146/annurev-genet-102209-163504 5. Jové T, Da Re S, Denis F, Mazel D, Ploy To the Editor: Transfusion-
transmitted syphilis, which is caused interval [CI] 4.3%–11.7%) were er strength and excision activity in class 1 by Treponema pallidum subspecies seropositive for syphilis by EIA and pallidum, is one of the oldest recognized 6. Nesvera J, Hochmannova J, Patek M. infectious risks of blood transfusion (1). An integron of class 1 is present on the Routine screening of blood donors and prevalence of recent infections of 3.5% refrigeration of donated blood before (95% CI 1.0%–6.0%) (Table). Twenty- terium Corynebacterium glutamicum. cases of transfusion-transmitted CI 8.3%–17.7%) were seropositive by 7. Tauch A, Gotker S, Puhler A, Kalinowski syphilis over the past 4 decades (2–6).
The World Health Organization blood samples from 9 (35%) were pTET3 from Corynebacterium glutami- cum encodes the aminoglycoside adenyl- transferase gene cassette aadA9 and the blood for syphilis (7), but doing so of recent infection of 4.5%.
regulated tetracycline effl ux system Tet 33 fl anked by active copies of the widespread insertion sequence IS6100. Plasmid. income countries, including Komfo Anokye Teaching Hospital in Kumasi, receiving an RPR-reactive unit of Ghana, do not screen donated blood blood that had been refrigerated for Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 11, November 2011 Table. Characteristics of 16 recipients of syphilis-positive blood transfusions, Kumasi, Ghana* *ID, identification; RPR, rapid plasma reagin; EIA, enzyme immunoassay; TPHA, Treponema pallidum hemagglutination assay; R, reactive; –, negative; ND, not done; NA, not available; NR, not reactive; +, positive. All results for transfused blood tested by EIA and TPHA were positive. use. Posttransfusion fever developed banks in sub-Saharan Africa where, Transfusion Medicine Unit for assistance; in this recipient, who responded because of inadequate supply and high staff of the Departments of Paediatrics, to treatment with cefuroxime and demand, blood is used as soon as it Obstetrics and Gynaecology; Medicine; gentamicin, although results of blood becomes available. Such short periods and Oncology at Komfo Anokye Teaching culture for bacteremia and peripheral of blood storage do not provide an Hospital for cooperation; and the patients blood fi lm for malaria parasites adequate margin of safety against for participating in the study. This study was were negative. She had no relevant transfusion-transmitted syphilis. part of the PhD requirement for A.K.O.-O.
sexual history, had been febrile Findings from this study have been after the transfusion, and showed no discussed with the hospital transfusion Commonwealth Scholarship Commission, evidence of mucocutaneous lesions committee, and new syphilis screening UK.
or lymphadenopathy at her follow-up guidelines and testing algorithms are visit 1 month after the transfusion. being developed.
Alex K. Owusu-Ofori,
Christopher M. Parry,
and Imelda Bates
This recipient who showed seroconversion of a transfusion Author affi liations: Komfo Anokye Teaching seroconversion most likely had a case recipient shows that in centers where Hospital, Kumasi, Ghana (A.K. Owusu- of transfusion-transmitted syphilis. screening is not conducted, recipients Ofori); Liverpool School of Tropical Other treponemal infections such of blood transfusions are at risk for Medicine, Liverpool, UK (A.K. Owusu-Ofori, as yaws cannot be differentiated contracting transfusion-transmitted I. Bates); and University of Oxford, Oxford, serologically from syphilis, and a syphilis. This fi nding is likely in blood UK (C.M. Parry) epidemiologic features (8); however, blood and where blood is stored only DOI: http://dx.doi.org/10.3201/eid1711.110985yaws is not endemic to Kumasi, and for a few days. This study highlights because this child had no clinical transfusion-transmitted syphilis References
evidence of yaws, this disease as a serious public health issue in 1. Gardella C, Marfi n AA, Kahn RH, Swint is unlikely to be the cause of the developing countries and demonstrates Refrigeration of units of blood for syphilis should be conducted.
≥5 days kills T. pallidum, but 57% of States. J Infect Dis. 2002;185:545–9. doi:10.1086/338829 the donated blood in this study was Acknowledgments
2. De Schryver A, Meheus A. Syphilis and blood transfusion: a global perspective. situation prevails across many blood Francis Sarkodie, and staff of the Transfusion. 1990;30:844–7. doi:10.1046/j.1537-2995.1990.30991048793.x Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 11, November 2011 were screened for T. pallidum–specifi c Transfusion syphilis: a case report. seas territory with 810,000 inhabitants, IgM by using fl uorescent treponemal Sex Transm Dis. 1983;10:200–1. doi:10.1097/00007435-198311000-00009 has a health care system similar to antibody absorption or IgM capture that in continental France. Neither ELISA from immediately after birth associated infections: 50 years of relent- syphilis infection, CS, nor other to 15 days old. Two case-patients had trepanomatosis (yaws) is notifi able. positive results; 1 was symptomatic. ress. Transfusion. 2010;50:2080–99. doi:10.1111/j.1537-2995.2010.02851.x Since 2006, an increase in early Six of the 7 children who had probable 5. Soendjojo A, Boedisantoso M, Ilias MI, syphilis was documented, fi rst in CS received appropriate penicillin G Rahardjo D. Syphilis d’emblee due to men who have sex with men infected treatment, except for 1 asymptomatic blood transfusion: case report. Br J Vener with HIV and second in the general baby for whom long-term medical 6. Chambers RW, Foley HT, Schmidt PJ. population.
components. Transfusion. 1969;9:32–4. spective study by using data from months of age reached 100%.
of CS on the island. Data from all public was 22 years. All mothers were natives can region: report of the 2004 survey. (n = 4) and private (n = 2) hospitals of Réunion Island except 1 who was Brazzaville (Republic of the Congo): on the island with neonatology born in Madagascar and received no and obstetrical departments were antenatal follow-up. Medical history 8. Asiedu K. The return of yaws. Bull World investigated. Birth deliveries at indicated previous genital herpes for 3 home were not included. Inclusion women. Social diffi culties or alcohol Address for correspondence: Alex K. Owusu- criteria were positive specifi c (T. consumption were reported for 3 Ofori, Department of Microbiology, Komfo pallidum hemagglutination assay) women. The mean age of gestation at Anokye Teaching Hospital, PO Box 1934, and nonspecifi c (Venereal Disease which the fi rst syphilis screening was Kumasi, Ghana; email: alex.owusu-ofori@liv.
Research Laboratory [VDRL]) test conducted was 23 weeks (5–33 weeks). results for Treponema spp. among Two mothers were symptomatic. children <2 years of age during Syphilis was diagnosed after delivery 2004–2009. Additionally, hospitalized for 3 mothers; seroconversion occurred children coded as having congenital during the pregnancy. Except for syphilis (International Classifi cation missing data on 1 mother, all mothers of Diseases [ICD] 10 codes A50.0 were HIV negative.
Syphilis, Réunion hospital database were included. After retrospective review, we found 7 CS reviewing medical fi les of mothers and cases during 2008–2009 but none their children, cases were classifi ed as during 2004–2007. The incidence rate confi rmed or probable CS according of probable CS cases was estimated To the Editor: Syphilis, caused to the case defi nition of the Centers for
by the bacterium Treponema pallidum, Disease Control and Prevention (2).
Eighteen children had positive have been underestimated because infection, but T. pallidum can also syphilis serologic results by T. not all parturients with a positive be transmitted by infected pregnant pallidum hemagglutination assay and syphilis test result and fetal deaths women to their children. Every year, VDRL tests, according to the selection were investigated. Meanwhile, a at least 500,000 children are born with criteria. Among these 18 test results, fetal death at 30 weeks was reported congenital syphilis (CS); maternal 7 were classifi ed as probable CS (late during the investigation but not syphilis causes another half million treatment for mother or symptoms included in the selection criteria. stillbirths and abortions, usually in linked to CS), 3 in 2008 and 4 in 2009 The Centers for Disease Control and countries with limited resources (1). (Table). The male:female sex ratio was Prevention defi nition of CS based However, CS has been recently found 0.75. Five case-patients were preterm on maternal status can also lead to in industrialized countries such as newborns; 3 of the most premature an overestimation. Late screening of the United States, where the CS rate babies had signs linked to CS, such syphilis in mothers, lack of antenatal increased by 23% during 2005–2008, as hepatosplenomegaly, cutaneous follow-up, higher VDRL titer, or after a 38% increase in the syphilis rate mucosal signs, neurologic signs, unknown stage of the disease at among US women and girls during an radiographic signs of CS in long bones, time of diagnosis have already been earlier period (2004–2007) (2). edema, and biologic anomalies. All described in other studies (3–5).
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 11, November 2011

Source: http://archive.lstmliverpool.ac.uk/2394/2/EID_11-0985.pdf