Serological for syphilis screenIng of cordblood by mikeholy


									  528         SAMT     VOL 73      7 MEI1988

 Serological screenIng of cord blood
 for syphilis

                                                                                            test and the FTA-ABS IgM test. The VDRL card test results
                                                                                            obt~ined at the local laboratory were compared for sensitivity and
      Summary                                                                               specificity with the VDRL card results of the reference laboratory.

      Meticulous antenatal screening for maternal syphilis
      can prevent congenital syphilis. In the event of in-                                  Results
      adequate antenatal screening, determination of reagin
      reactivity on cord blood becomes mandatory. A card                                    A cord blood sample was obtained and screened at the reference
      test utilising the VDR carbon antigen (Wellcome)                                      laboratory in I 979 of a total of 2358 deliveries; of these samples
      was used to screen cord blood samples for reagin                                      1390 were also screened at the local laboratory, utilising only the
      reactivity. The same blood was also screened by a                                     VDRL card test. Reagin reactivity (titre:;' I ; 8) was found in 2,2%
                                                                                            of samples. The majority of these patients (65?9%) had reagin
      reference laboratory, where the VDRL card test was
                                                                                            titres of I : 8 (Fig. 1). The sensitivity and specifiClty of the VDRL
    . repeated and every result was substantiated by                                        card tesr done ar rhe local laboratory were 83,3% and 99,8%
      treponemal tests. The VDRL card test done at the                                      respecrively. The negative predictive value of rhe local resuIrs was
      local laboratory had a sensitivity of 83,3% and a                                     99,6% (Table I).
      specificity of 99,8% when compared with the results
      of the reference laboratory.
                                                                                                   30    29
     S Atr Med J 1988; 73: 528-529.

Early congenital syphilis is a preventable disease. l However,                              V1          ~
10,5% of neonatal deaths over an 8-month period (April 1986                                 l-
                                                                                            z           ~
-December 1986) at Kalafong Hospital resulted from congenital                               l-
                                                                                            «      IS
syphilis. This figure reflects inadequate antenatal care. 2 In a                            "-
population with a high prevalence of syphilis,. many cases of                               w..

which may not be identified antenataIly, detection of reagin                                '"
                                                                                            w      10   ~
reactivity in cord blood is the backbone of screening for                                   '"          ~
congenital syphilis. 3 Detection of reagin reactivity is simple,
                                                                                                        ~              5
quick and inexpensive, and sophisticated laboratory facilities                                          ~                                    5
are not required. In addition results can be available on the                                           ~        ~
                                                                                                                                           ~       3
                                                                                                        ~        ~                  1
                                                                                                                                           ~       ~          1
first postnatal day,4 before mother and baby are discharged,                                            ~
                                                                                                        ~        ~                §§§;     ~       ~        §§§;
thereby eliminating the need to contact patients at a later date.                                       1 :8         1: 16        1: 32    1:64    1: 512   1:1024
   The main objectives of the screening programme were to
                                                                                                                                   REAGIN TITRES
evaluate the sensitivity, specificity and negative predictive
value of the VDRL card test performed without facilities to                                 Fig. 1. Distribution of reagin titres in 1 979 cord blood samples at
substantiate results.                                                                       Kalafong Hospital, 1986.

Methods                                                                                            TABLE I. VDRL RESULTS FROM TWO LABORATORIES
After every delivery cord blood was collected by the nursing staff                                Local laboratory         VDRL +         VDRL -    Total
in two separate specimen tubes. One tube was sent to the local                                    Reference
laboratory where the card test utilising VDRL carbon antigen                                      laboratory
(Wellcome) was performed. The second tube was sent to the                                           VDRL+                    30               6        36
reference laboratory where the VDRL card test was repeated. In
                                                                                                    VDRL-                     3            1351     1354
the event of a negative VDRL card test, a Treponema pallidum
haemagglutination (TPHA) test was carried out. If the VDRL                                            Total                  33            1357     1390
card test was positive (a titre of 1 :8 or more) the TPHA test was
performed together with the fluorescent treponemal. antibody
absorption (FTA-ABS) test, the FTA-ABS immunoglobulin G                                       The reagin ritres reported by rhe rwo laborarories revealed
                                                                                            considerable interobserver variation. Any reagin titre reported by
                                                                                            the local laboratory had ro be substantiared by TPHA and FTA-
                                                                                            ABS rests at the reference laboratory.
Department of Paediatrics, University of Pretoria and
Kalafong Hospital, Pretoria
Accepted 2 July 1987.
Based on a paper presented at the 6th Conference on Priorities in Perinatal Care in South   In view of its high specificity, sensitivity and negative predictive
Africa, Golden Gate, 17 - 20 March 1987.                                                    value, the VDRL card test appears to be eminently suitable
                                                                                                                                      SAMJ   VOL 73   7 MAY 1988         529

for screening for congenital syphilis in populations at risk.                                      The author gratefully acknowledges the work done by Mrs
Since simple technology is involved, large numbers of patients                                  Heidi Fickl of the Department of Microbiology, University of
can be screened without the immediate availability of sophisti-                                 Pretoria, and Mr Thomas Mashao of the Kalafong Hospital
cated laboratory facilities.                                                                    laborarory. Permission to publish from Dr C. G. Joubert, Super-
   A negative VDRL result practically rules out congenital                                      intendent of Kalafong Hospital, is appreciated.
syphilis. s A positive VDRL result must be substantiated by
treponemal tests.
   The absolute yield of such screening may be low. This could                                  REFERENCES
tempt some clinicians to discontinue it. However, if testing is                                 1. Stray-Pederson B. Economic evaluation of maternal screening to prevent
adequate, the potential for the prevention of morbidity and                                        congenital syphilis. Sex Transm Dis 1983; 10: 167-172.
mortality is great. 1,6 Some cases of congenital syphilis can                                   2. Hira SK, Ramam AV, Sehgal D, Bhat Gj, Chintu C, Lulenga RC.
                                                                                                   Congenital syphilis in Lusaka - incidence in a general nursery ward. East
occur despite ostensibly adequate maternal penicillin treatment                                    AIr Med] 1982; 59: 241-245.
during pregnancy.6                                                                              3. Rathbun KC. Congenital syphilis: a proposal for improved surveillance,
                                                                                                   diagnosis and treatment. Sex Transm Dis 1983; 10: 102-107.
   By inference, the VDRL card test should be implemented                                       4. Goodhan G L. Use and interpretation of serologic tests for the diagnosis of
in the clinic situation to screen for maternal syphilis during                                     syphilis. South Med] 1983; 73: 373-379.
                                                                                                5. Alpert G, Plotkin SA. A practical guide to the diagnosis of congenital
pregnancy. This practice remains the most important measure                                        syphilis in the newborn infant. Pediatr Clin North Am 1986; 33: 465-480.
for the prevention of congenital syphilis. 6                                                    6. Editorial. Prevention of congenital syphilis.]AMA 1984; 252: 1750-1751.

Physiological characteristics of rugby
players including muscle glycogen
                                  • •
content and muscle fibre composItIon
MARY ANN JARDINE,                                 TONI M. WIGGINS,                             KATHRYN H. MYBURGH,                           T. D. NOAKES

    Summary                                                                                        content but was unnecessary since severe muscle
                                                                                                   glycogen depletion did not occur during a match
    There are few studies of the anthropomorphic and                                               even in players on a normal mixed diet before
    physiological characteristics of South African rugby"                                          competition. It is concluded that for forwards, a high
    players.' Twenty-nine club rugby players were                                                  absolute V0 2 ma., and for both backs and forwards a
    evaluated for body composition, maximal treadmill                                              predominance of fast-twitch muscle fibres are pre-
    performance, muscle fibre composition and the                                                  requisites for success in this sport. Pre-match
    muscle glycogen content, including the effects of                                              carbohydrate-loading would appear to be necessary
    carbohydrate-loading and playing a rugby match.                                                only when more than one match is to be played
    The body composition and physiological charac-                                                 within 48 hours.
    teristics of the players were similar to that previously
    reported for international players. Very high absolute                                         S Air Med J   1988; 73: 529-532.
    values for maximum oxygen consumption (V0 2 m••)
    were measured in the forwards. Both backs and
    forwards had a preponderance of fast-twitch muscle
                                                                                                There are few studies of the anthropomorphic and physiological
    fibres (57% and 53% respectively). Carbohydrate-
                                                                                                characteristics of rugby players. 1- Despite the popularity of
    loading increased pre-match muscle glycogen
                                                                                                the sport in this country, none of these studies is South
                                                                                                African. Three South African studies have determined physio-
                                                                                                logical responses during rugby matches. 9 - 11
                                                                                                   To correct this deficit, members of the University of Cape
Sport Science Centre, Department of Physiology, University                                      Town Rugby Club were studied in order to determine the
of Cape Town                                                                                    anthropomorphic and physiological characteristics, induding
MARY ANN JARD1NE, B.SC.(MED.) HONS (SPORT SCI.)                                                 muscle fibre composition, of a group of South African rugby
TO 11 M. W1GG1NS, DIP. MED. TECH. (SA)                                                          players. Tests were also carried out to determine whether the
                                                                                                players were adequately trained for the demands of the sport
                                                                                                and whether muscle glycogen depletion 12 might explain fatigue
Accepted 26 Feb 1987.                                                                           at the end of a rugby match.
Reprint requests to: Professor T. D. Noakes, Sport Science Centre, Department of Physiology.       Since it is known that a high carbohydrate diet in the last 48
University of CapiTown Medic.1 School, Observatory, 7925 RSA.                                   - 72 hours before strenuous exercise (carbohydrate-loading)

To top