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What is dark field microscopy syphilis?

What is dark field microscopy?

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All of us are quite familiar with the appearance and visibility of stars on a dark night, this despite their enormous distances from the Earth. Stars can be readily observed at night primarily because of the stark contrast between their faint light and the black sky.

Yet stars are shining both night and day, but they are invisible during the day because the overwhelming brightness of the sun “blots out” the faint light from the stars, rendering them invisible. During a total solar eclipse, the moon moves between the Earth and the sun blocking out the light of the sun and the stars can now be seen even though it is daytime. In short, the visibility of the faint star light is enormously enhanced against a dark background.

This principle is applied in darkfield (also called darkground) microscopy, a simple and popular method for making unstained transparent specimens clearly visible. Such objects often have refractive indices very close in value to that of their surroundings and are difficult to image in conventional brightfield microscopy. For instance, many small aquatic organisms have a refractive index ranging from 1.2 to 1.4, resulting in a negligible optical difference from the surrounding aqueous medium. These are ideal candidates for dark field microscopy.

dark field microscopy requires blocking out of the central light which ordinarily passes through and around (surrounding) the specimen, allowing only oblique rays from every azimuth to “strike” the specimen mounted on the microscope slide. The top lens of a simple Abbe darkfield condenser is spherically concave, allowing light rays emerging from the surface in all azimuths to form an inverted hollow cone of light with an apex centered in the specimen plane. If no specimen is present and the numerical aperture of the condenser is greater than that of the objective, the oblique rays cross and all such rays will miss entering the objective because of their obliquity. The field of view will appear dark.

The darkfield condenser/objective pair illustrated in Figure 1 is a high-numerical aperture arrangement that represents darkfield microscopy in its most sophisticated configuration, which will be discussed in detail below. The objective contains an internal iris diaphragm that serves to reduce the numerical aperture of the objective to a value below that of the inverted hollow light cone emitted by the condenser. The cardioid condenser is a reflecting darkfield design that relies on internal mirrors to project an aberration-free cone of light onto the specimen plane.

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When a specimen is placed on the slide, especially an unstained, non-light absorbing specimen, the oblique rays cross the specimen and are diffracted, reflected, and/or refracted by optical discontinuities (such as the cell membrane, nucleus, and internal organelles) allowing these faint rays to enter the objective. The specimen can then be seen bright on an otherwise black background. In terms of Fourier optics, dark field microscopy removes the zeroth order (unscattered light) from the diffraction pattern formed at the rear focal plane of the objective. This results in an image formed exclusively from higher order diffraction intensities scattered by the specimen.

The photomicrographs in Figure 2 illustrate the effects of darkfield and brightfield illumination on silica skeletons from a small marine protozoan (radiolarian) in a whole mount specimen. In ordinary brightfield, skeletal features of the radiolarian are not well defined and tend to be washed out in photomicrographs recorded either with traditional film or digitally captured. was taken in brightfield illumination with the condenser aperture diaphragm closed to a point where diffraction artifacts obscure some of the sample detail. This enhances specimen contrast at the expense of image distortion. Under dark field microscopy, more detail is present, especially in the upper portion of the organism, and the image acquires an apparent three-dimensional appearance. When a red filter is used in conjunction with a darkfield stop , the radiolarian takes on a colorful appearance that is more pleasing, although no additional detail is produced and there is even some reduction in image quality.

Specimens that have smooth reflective surfaces produce images due, in part, to reflection of light into the objective. In situations where the refractive index is different from the surrounding medium or where refractive index gradients occur (as in the edge of a membrane), light is refracted by the specimen. Both instances of reflection and refraction produce relatively small angular changes in the direction of light, allowing some to enter the objective. In contrast, some light striking the specimen is also diffracted, producing a 180-degree arc of light that passes through the entire numerical aperture range of the objective. The resolving power of the

What is dark field microscopy syphilis?

RPR/VDRL/MHA-TP (Serologic Tests for Syphilis)
Darkfield/FTA-ABS Microscopy

A variety of serologic tests for syphilis are available, including:

  • VDRL (Venereal Disease Research Laboratory)
  • RPR (Rapid Plasma Reagin)
  • FTA-ABS (Fluorescent Treponemal Antibody Absorption)
  • TP-MHA (Treponema Pallidum Microhemagglutination Assay)

Each differs the others in the precise substance being measured, complexity, and specificity. All are satisfactory for use in managing syphilis. Abnormals may be:

  • Reactive,
  • Weakly reactive, or
  • Bordeline

Whenever a screening test (RPR, VDRL) is positive, a more specific test (FTA-ABS, TP-MHA) should be used to confirm the test and rule out a “biologic false positive.”

A negative or “nonreactive” test may indicate:

  • The patient doesn’t have syphilis
  • The patient has syphilis, but is so early in the course of the disease that the test has not yet turned positive. In these cases, the test may never turn positive if the patient is effectively treated.
  • The patient had primary syphilis, had a positive test, was effectively treated, 6 months have passed and the test has now reverted back to negative.
  • The patient had secondary syphilis, had a positive test, was effectively treated, 12-18 months have passed and the test has now reverted back to negative.
  • The patient has syphilis, but his/her immune system is impaired.

A positive or “reactive” test may indicate:

  • The patient has syphilis.
  • The patient had syphilis, was effectively treated, but the test has not yet returned to negative:
    • With primarily syphilis, it typically takes about 6 months for the test to turn negative.
    • With secondary syphilis, it typically takes 12-18 months for the test to turn negative.
    • The longer syphilis remains untreated, the longer it will take for the test to return to normal, and the less likely it is to ever return to normal.
  • The patient has a biologic false positive (BFP)

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Darkfield microscopy for point-of-care syphilis diagnosis

syphilis is a sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum subspecies pallidum. Globally, an estimated 12 million cases of syphilis occur annually. In the United States, 13,997 cases of primary and secondary (infectious) syphilis were reported to the Centers for Disease Control and Prevention (CDC) in 2009, a 3.7% increase from 2008 and a 134% increase from 2000, when a post-war low of 5,979 primary and secondary syphilis cases was reported. Men who have sex with men (MSM) — especially those who are HIV infected — and blacks are disproportionately affected by syphilis. Geographically, urban areas and the Southeastern region of the United States have the highest rates.

Syphilis is most commonly transmitted by skin-to-skin (or mucous membrane) contact. Following exposure, the infection passes through the following stages:

Primary syphilis, characterized by a painless ulcer, called a chancre, usually develops three weeks after exposure (range 10 days to 90 days) at the site of inoculation. The chancre heals spontaneously after several weeks.

Secondary syphilis is most often characterized by a generalized rash that also resolves without treatment. Rash on the palms and soles can also occur, as can systemic manifestations such as fever, malaise, and lymphadenopathy. Given the widely variable nature of the rash and other manifestations of the disease, syphilis has acquired the moniker “The Great Imitator.”

Early (one year) latent syphilis, defined by the absence of signs or symptoms of disease and diagnosed by serologic evidence of infection.

Tertiary syphilis, which affects about a third of untreated patients and manifests with cutaneous, cardiovascular, or neurologic disease.

Syphilis can also be acquired in utero at any stage of pregnancy and lead to congenital syphilis. Routine syphilis screening and treatment in pregnant women has made congenital syphilis rare in the United States.

Approaches to syphilis diagnosis

Because T pallidum is too fragile an organism to be cultured in the clinical setting, diagnostic testing relies on two approaches: direct detection of the organism and indirect evidence of infection.
Syphilis – Treponema pallidum on darkfield.

Direct methods include darkfield microscopy, molecular assays to detect T pallidum DNA, and histopathologic examination of biopsies of skin or mucous membranes (which can also provide indirect evidence of infection, on the basis of patterns of inflammation in the tissue). Direct methods have the advantage, in some cases, of detecting infection before a patient has mounted a measurable antibody response that results in a reactive serologic test result.

Darkfield microscopy allows visualization of live treponemes obtained from a variety of cutaneous or mucous membrane lesions, as follows.

In primary syphilis, the chancre teems with treponemes that can be seen with darkfield microscopy. The sensitivity of darkfield microscopy for the diagnosis of primary syphilis is approximately 80%. Darkfield sensitivity declines over time and can also decrease if the patient has applied topical antibiotics to the lesion(s). Of note, the mouth harbors normal non-pathogenic treponemes that are indistinguishable microscopically from T pallidum. Therefore, oral specimens cannot be used for darkfield microscopy because of the possibility of false-positive test results.

In secondary syphilis, mucous patches (as long as not oral) and condyloma lata (found in moist areas between body folds) are appropriate specimens for darkfield microscopy. Dry skin lesions usually do not contain sufficient organisms for darkfield testing.

In congenital syphilis, moist discharge from the nose (snuffles) and vesiculobullous lesions of the skin are high-yield specimen sources for darkfield testing.

Indirect methods of diagnosis include serologic testing of blood or cerebrospinal fluid (CSF) and detection of CSF abnormalities (elevated white blood cell count or protein) consistent with neurosyphilis. Serologic testing of blood involves demonstration of host antibody to either endogenous antigens (non-treponemal tests) or to antigens of T pallidum (treponemal tests). Non-treponemal tests, including the rapid plasma reagin test and the venereal disease research laboratory test, have historically been used as the initial screening tests for the serologic diagnosis of syphilis. If a patient’s non-treponemal test is reactive, confirmatory testing with a treponemal test is performed, using either the T pallidum particle agglutination test, the fluorescent treponemal antibody-absorbed test, or another treponemal test. A reactive treponemal test confirms the diagnosis of a new or previously treated case of syphilis. If the treponemal test is non-reactive, the positive non-treponemal test result is considered a biologic false-positive that is not diagnostic of syphilis. A newer algorithm that is gaini

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