Diagnosis of gastric syphilis by direct immunofluorescence staining and real-time PCR testing

Abstract

We report on a case of gastric syphilis in a patient with chronic dyspepsia. The diagnosis was established by serology and the demonstration of spirochetes in diffusely inflammed gastric mucosa by staining with a fluorescent monoclonal antibody specific for pathogenic treponemes and by the detection of specific treponemal DNA sequences by a real-time PCR.

FIG. 1.

Gastric syphilis: histopathology of the stomach antrum. The mucosal glandular architecture is erased by a dense and diffuse lymphoplasmacytic infiltrate. Only residual glands with luminal neutrophilic infiltrates are seen. Inflammatory spillover is present in the submucosa. (Hematoxylin and eosin stain was used. Magnification, ×400.)

FIG. 2.

Specific immunofluorescence staining of pathogenic treponemes with monoclonal antibody. The FITC-labeled mouse antitreponemal 37-kDa monoclonal antibody stain demonstrates numerous spirochetes in thin-section specimens by the use of a ×100 oil objective and a ×10 ocular. Filter cubes B-2A and B-2C/E were used in photographs A and B, respectively.

FIG. 3.

Detection of pathogenic treponeme-specific DNA from paraffin-embedded thin sections by the real-time PCR. Amplification results of real-time simplex PCR specific for T. pallidum DNA detection are shown. (A) FAM-labeled TaqMan probed targeting polA; (B) ROX-labeled TaqMan probed targeting the 47-kDa lipoprotein gene.