Neonatal Congenital Syphilis Research Articles

Congenital syphilis in neonates: a case report

Background: Congenital syphilis (CS) in neonates is diagnosed when Treponema pallidum was identified in a laboratory test of neonates infected by mothers with syphilis. Recently, CS is still a significant and growing health problem worldwide despite being preventable. This case report will provide an overview of CS management conducted at our center, Sanjiwani Hospital, Gianyar, Bali-Indonesia. Case presentation: We report a case of CS in a newborn female neonate with the positive result of TPHA and VDRL titer 1/128 from a mother diagnosed with the latent phase of syphilis infection. On physical examination found subcostal retraction of the chest, grunting on auscultation, and jaundice. The treatments given include oxygen via cannula nasal with 2 liters per minute, intravenous access with dextrose 10%, the antibiotic combination of cefotaxime 125 mg every 12 hours and gentamicin 12.5 mg every 24 hours. For the management of CS, the patient was given Benzathine Penicillin G at a dose of 125,000 IU single dose intramuscularly. Phototherapy was assisted the patient for 48 hours to manage the hyperbilirubinemia. The patient was discharged on the eight days of treatment with oral antibiotic cefixime 12.5 mg every twelve hours for three days. Conclusion: The entity of CS is a disease suffered by infants with clinical manifestations or examination supporting the diagnosis of syphilis. The mother should do a screening during her pregnancy to prevent untreated syphilis and its complications for her babies.

An old disease on the rise: new approaches to syphilis in pregnancy.

Maternal and congenital syphilis infection is on the rise in the United States and worldwide. Without adequate testing or provider recognition of infection, treatment can be neglected resulting in significant perinatal morbidity and mortality. This review article discusses the epidemiology of T. pallidum, describes novel diagnostic tests, and considers the need to expand therapeutic options. A new chemiluminescence immunoassay for use in the reverse-sequence algorithm is more sensitive and specific in pregnant women than previously noted and is helpful for identifying pregnant women at highest risk for neonatal congenital syphilis. Point-of-care testing may be used to detect early syphilitic disease and provide same-day testing and treatment. Randomized control trials of oral cefixime for treatment of syphilis are paving the way for potential use in pregnant women. Penicillin skin testing, challenge, and desensitization in pregnancy can be done safely. Congenital syphilis is a preventable disease and treatable infection in the modern world, but we are still met with challenges in its eradication. We should proceed with advancing efficient laboratory testing, expanding medical therapy, and implementing public health measures to curb the rise of the disease.

Hospitalizations due to Congenital Syphilis in Neonates: Associated Factors from the Prenatal Care Process

Objective: To identify the factors associated with hospitalizations due to congenital syphilis in neonates, based on the characteristics of prenatal care. Materials and method: A quantitative case-control study, conducted by applying a questionnaire to 65 puerperal women with their babies hospitalized from July to November 2017. The data were analyzed using logistic regression, according to the plan proposed in the hierarchical approach. Results: 20% of the hospitalizations were due to syphilis (cases) and 80% to other causes (control). The vulnerability risk (p = 0.036), previous history of sexually transmitted infection (p = 0,006), use of oral contraceptives (p = 0.011) and parity (p = 0.043) variables were statistically significant. The absence of the partner during the consultation (p = 0.028), failure to perform a rapid test for syphilis (p = 0.035) and educational activity for the partner (p = 0.033) were also associated with the occurrence of the outcome, in addition to the variables of the newborn: low birth weight (p = 0.025), not being on exclusive breastfeeding (p = 0.036) and not having had skin-to-skin contact (p = 0.043). Conclusions: Congenital syphilis has several risk factors for its occurrence. It was possible to observe that the assistance inequalities existing in care during the prenatal consultations directly reflect on the occurrence of this condition.

Importance of Serological Tests in the Diagnosis of Asymptomatic Congenital Syphilis in Neonates: A Case Report

Introduction: Congenital Syphilis (CS) is caused by the vertical transmission of Treponema pallidum during pregnancy. Here, we describe a case of CS, diagnosed solely by serological tests. Case Presentation: The patient was a newborn with CS, whose mother was infected with Treponema pallidum at the gestational age of 16 - 20 weeks. However, the patient had no signs of early CS, such as low birth weight, nasal congestion, maculopapular rash, or hepatosplenomegaly. The histopathological features in both mother and neonate suggested syphilitic placentitis. Regarding the serological tests, a non-reactive Venereal Disease Research Laboratory (VDRL) test result and a reactive Treponema pallidum haemagglutination (TPHA) test result were reported. After establishing the diagnosis of CS, we initiated treatment with procaine penicillin G (50,000 U/kg body weight), which was injected intramuscularly once a day for 10 days. Six months after discharge, physical examinations showed normal findings and non-reactive results of VDRL and TPHA tests. Conclusions: It can be concluded that detailed history-taking and serological tests play a vital role in establishing the diagnosis of CS, particularly in patients with asymptomatic congenital syphilis. An early diagnosis of CS can guide clinicians to initiate a standardized treatment and improve patient outcomes.

Sentimentos e conhecimentos de puérperas em face da sífilis congênita neonatal

Surveying feelings and awareness of neonatal congenital syphilis among mothers

Congenital syphilis in neonates with nonreactive nontreponemal test results

Infants whose mothers had syphilis during pregnancy were studied to determine how often exposed newborns with normal physical examinations and nonreactive nontreponemal serologic tests had abnormal laboratory or radiographic studies. Retrospective analysis of prospectively collected data from infants born to mothers with syphilis and had a normal examination and a nonreactive nontreponemal test. Some infants had IgM immunoblotting, PCR testing or rabbit infectivity testing (RIT) performed. From 1984 to 2002, 115 infants had a nonreactive serum Venereal Disease Research Laboratory (VDRL)/rapid plasma reagin (RPR) test and a normal physical examination at birth. Among 87 infants born to mothers who had untreated syphilis, 4 had a positive serum IgM immunoblot or PCR test, but none had spirochetes recovered by RIT. Two infants had anemia, one had an elevated serum alanine aminotransferase concentration and one with Down's syndrome had direct hyperbilirubinemia. Among 14 infants born to mothers treated <4 weeks before delivery, none had abnormal laboratory or radiographic tests, although 1 of 11 had a reactive serum IgM immunoblot. Among 14 infants born to mothers treated ⩾4 weeks before delivery, none had abnormal laboratory or radiographic tests. Newborns with normal physical examination and nonreactive nontreponemal test results are unlikely to have abnormalities detected on conventional laboratory and radiographic testing.

Influence of mother's treatment for syphilis on the incidence of congenital syphilis in newborn babies

Objective To explore the influence of mother's treatment for syphilis on the incidence of congenital syphilis in newborn babies.Methods 40 cases of neonatal congenital syphilis,according to mother different treatment methods,were divided into regular treatment group (20 cases),mother without regular treatment group (10 cases),mother with no treatment group (10 cases).The incidence of neonatal congenital syphilis was compare.Results The neonatal congenital syphilis could affect multiple systems,manifested as skin damage,pathological jaundice,hepatosplenomegaly,edema,anemia,thrombocy to penia,bone injury,cerebrospinal fluid abnormalities et al.The incidence rate of neonatal congenital syphilis in regular treatment group was 10％,which was significantly lower than normal treatment 40％ and untreatment 50％ (x2 =11.2,P ＜ 0.05 ; x2 =20.4,P ＜ 0.01).The neonatal congenital syphilis incidence rate was not statistically significant between the informal group and untreatment group (x2 =0.68,P ＞ 0.05) ;30 cases were cured (75 ％),improved in 7 cases (17％) ;3 cases died (7 ％).Conclusion The prevention and treatment of syphilis infection in mothers are the key point to prevent neonatal congenital syphilis. Key words: Syphilis, congenital; Infant, newborn

Disseminated Intravascular Coagulation with Intracranial Haematoma in Neonatal Congenital Syphilis

Disseminated intravascular coagulation (DIC) although a well known complication in neonatal sepsis is extremely rare in congenital syphilis and there are scanty reports of this entity in the literature. Intracranial bleeding following DIC in neonatal congenital syphilis is even rarer, and has been reported only once earlier. We are reporting the second case of neonatal DIC with intracranial haematoma due to congenital syphilis in a newborn. Our patient also had clinical and biochemical evidence of hepatitis which predisposes to DIC. Extensive investigations and emergent use of imaging modalities including ultrasound and CT scan led to early diagnosis and treatment in our patient, who could therefore be salvaged from an otherwise life threatening disease.

Congenital syphilis: still a serious, under-diagnosed threat for children in resource-poor countries

With 700,000 to 1.5 million new cases annually, congenital syphilis remains a major infectious cause of morbidity and mortality in neonates, infants and children in resource-poor countries. We therefore analyzed the extent of congenital syphilis in the pediatric patient population at our rural hospital in Tanzania. For this retrospective analysis, from January 1, 1998 to August 31, 2000, all cases of congenital syphilis were collected from the medical records of the neonatal and pediatric department at Haydom Lutheran Hospital in rural northern Tanzania. Age, sex, weight, clinical signs and symptoms, venereal disease research laboratory (VDRL) results of mother and/or child, hemoglobin concentration, treatment, and outcome were recorded and analyzed. Fourteen neonates and infants were included. The earlier the diagnosis, the more it rested on maternal data because the presentation of neonatal congenital syphilis resembled neonatal sepsis. Syphilitic skin lesions were only seen in the post-neonatal age group. VDRL results were positive in 11 of the 14 mothers, and in 4 of the infants. Anemia was common in older infants. No patient showed signs of central nervous system involvement. Two patients died, and the remaining were cured after standard treatment with procaine penicillin. Highlighting the variable picture of congenital syphilis, this report demonstrates how difficult it is to make a correct diagnosis by solely history and clinical presentation in a resource-poor setting. Hence false-positive and false-negative diagnoses are common, and clinicians have to maintain a high index of suspicion in diagnosing congenital syphilis. Therefore, an important approach to control and finally eliminate congenital syphilis as a major public health problem will be universal on-site syphilis screening of all pregnant women at their first antenatal visit and immediate treatment for those who test positive.

Screening for Syphilis Infection in Pregnant Women: Evidence for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

In 2004, the U.S. Preventive Services Task Force strongly recommended that clinicians screen all pregnant women for syphilis infection. To update the evidence on screening pregnant women for syphilis infection. MEDLINE searches from 1 January 2003 through 31 July 2008, recent systematic reviews, reference lists of retrieved articles, and expert suggestions. English-language studies were selected to answer the following 2 questions: Does screening for syphilis in pregnancy reduce the prevalence of congenital syphilis in neonates? Are there harms of screening for syphilis or harms of treatment with penicillin in pregnancy to women or neonates? Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; and ecologic studies were selected for the potential benefits question. Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; case-control studies; and large case series were selected for the potential harms question. Information on the study design, selection criteria, demographic characteristics, and clinical outcomes was extracted from each study. One study on benefits evaluated the effect before and after the implementation of a universal syphilis screening program for pregnant women and found reductions in rates of congenital syphilis. Two studies on screening accuracy for syphilis reported false-positive rates of less than 1%. One study that used a large insurance claims database reported an incidence of anaphylaxis after oral penicillin of 0.1 per 10,000 dispensings. In a study from Hungary, oral penicillin in pregnancy was not associated with orofacial clefts. This was a targeted literature search and could have missed small studies on the benefits and harms of screening for syphilis in pregnancy. We did not review evidence on interventions to improve rates of prenatal screening. New evidence from a study of universal screening supports previous evidence on the effectiveness of screening for syphilis in pregnancy to prevent congenital syphilis. Harms include testing and follow-up for false-positive test results and adverse effects from penicillin treatment.

Clinical analysis on organs dysfunction induced by neonatal congenital syphilis

目的 探讨新生儿先天性梅毒脏器功能损害的特点.方法 回顾性总结2002年3月～2003年4月收入我院新生儿病房的15例先天性梅毒患儿的临床资料.结果 该病临床表现以多脏器功能损害为主,其中皮肤损害居首位,肝脏损害居第2位,同时伴有心、肺、胃肠道及血液系统损害.15例患儿中并发3个以上脏器功能损害的有14例.结论 新生儿先天性梅毒感染引起脏器功能损害的严重性,应引起重视.对有出生后无原因发热、皮疹、肝脾大、水肿及心肺功能改变者应全部进行筛查,有利于早期诊断和治疗。

Analysis on clinical characteristics of early congenital syphilis in neonates

先天性梅毒(congenital syphilis)又称胎传梅毒,是梅毒孕妇通过胎盘将梅毒螺旋体传给胎儿所致[1,2].过去对该病缺乏认识,近几年来该病发病有增高趋势.我科2004年5月～2005年2月共收治新生儿早期先天性梅毒7例,这7例患儿临床表现各异,现报告如下。

Congenital syphilis: β2-microglobulin in cerebrospinal fluid and diagnosis of neurosyphilis in an affected newborn

Meningoencephalitis in neonatal congenital syphilis (CS) is a difficult diagnosis because of the limitation of standard cerebrospinal fluid (CSF) tests. This limitation means that new markers in CSF tests are needed to establish whether meningitis is present in presumptive cases of CS. beta2-Microglobulin (beta2-m) is raised in CSF recovered from neonates with central nervous system (CNS) infections, but it does not correlate with cellular count or proteins in the CSF. We present a preterm newborn with symptomatic CS. First-day CSF showed 50 cells/mm3, protein of 220 mg/dL and a beta2-m concentration of 16.9 mg/dL (normal <2.25 mg/dL). Serial determinations of beta2-m showed a marked reduction (76%) after 10 days of appropriate treatment. At 30 days of life, beta2-m was already within the normal range (1.8 mg/dL). Cerebral ultrasonography showed ventricular dilatation, moderate periventricular echogenicity, subependimal hemorrhages, and linear hyperechoic areas in the thalamus and basal ganglia. We suggest that beta2-microglobulin is very useful in the diagnosis of CNS involvement and in monitoring the response to treatment. In addition, infants with CS may exhibit CNS imaging findings similar to those observed in other intrauterine CNS infections.

Lumbar puncture in the evaluation of possible asymptomatic congenital syphilis in neonates

OBJECTIVE: To evaluate the usefulness of lumbar puncture (LP) in the initial evaluation of symptom-free infants for congenital syphilis. STUDY DESIGN: We retrospectively studied infants who had successful LPs and were born to untreated or inadequately treated seropositive women between 1990 and 1993 in two hospitals in Washington, D.C. We identified 329 such symptom-free infants (syphilis group). The cerebrospinal fluid (CSF) VDRL was reactive in two (0.6%) infants. The CSF leukocyte and protein concentrations of these infants were compared with those in 84 symptom-free control infants who were born to seronegative women and who had LPs performed in 1993 to rule out sepsis because of associated risk factors. Control infants had negative results for bacterial cultures (CSF and blood) and bacterial antigen tests (CSF and urine). RESULTS: Thirty control subjects and 67 infants in the syphilis group had traumatic taps (CSF erythrocytes >500 × 10 6/L), and hence were excluded from the analysis of cell count and proteins. Birth weights and gestational ages were similar in both groups. The CSF leukocyte and protein values were similar in the syphilis group and in control infants: mean CSF leukocytes 7.7 × 10 6/L (mean 7.7/mm 3, range 0 to 57/mm 3, SD 8.8) versus 6.9 × 10 6/L (mean 6.9/mm> 3, range 0 to 31/mm 3, SD 7), p = 0.5, and mean protein concentration 981 mg/L (range 270 to 2280 mg/L, SD 376) versus 936 mg/L (range 360 to 1750 mg/L, SD 368), p = 0.96, respectively. The combination of CSF leukocyte values >5 × 10 6/L (>5/mm 3) or protein values >400 mg/L (>40 mg/dl) was found in 97.8% of the infants in the syphilis group, compared with 95.3% of the control group. CONCLUSION: Because of the low yield of reactive CSF VDRL and the similar CSF leukocyte and protein values in the syphilis group and the control infants, the role of routine LP in the initial evaluation of symptom-free infants for congenital syphilis should be reconsidered. (J P EDIATR 1996;128:125-9)

Neonatal congenital syphilis. Diagnosis by the absorbed fluorescent treponemal antibody (IgM) test.

Neonatal congenital syphilis. Diagnosis by the absorbed fluorescent treponemal antibody (IgM) test.

Fluorescent antibody test for neonatal congenital syphilis: A progress report

Sera from newborn infants with reactive VDRL and FTA-ABS tests were examined in an indirect IgM fluorescent antibody procedure. This experimental test was reactive in all 18 cases of neonatal syphilis and nonreactive in all clinically normal infants studied. Although the γM-FTA-ABS test appeared to be at least as specific as the VDRL and FTA-ABS tests, further study is necessary in order to definitely establish its sensitivity. The test appears to be specific for neonatal congenital syphilis and sometimes reverts to normal after adequate treatment.