Signs Of Congenital Syphilis Research Articles

Factors associated with signs of congenital syphilis in newborns

ObjectiveTo analyze risk factors (maternal, obstetric and demographic) associated with congenital syphilis and the clinical characteristics of the newborns. MethodA cross-sectional study carried out in ten public maternity hospitals in Fortaleza, Ceará, Brazil that included cases of live births reported with congenital syphilis in 2015. Results469 cases were analyzed; 199 (42.4 %) showed some sign or symptom suggestive of congenital syphilis; of these, 65 (32.7 %) were preterm, 87 (43.7 %) had low birth weight, 116 (58.3 %) had jaundice that required phototherapy, 13 (6.5 %) had hepatomegaly, 10 (5 %) had skin lesions, eight (4.0 %) had splenomegaly and one (0.5 %) had limb pseudoparalysis. Records of other clinical changes were identified in 36 (7.7 %) children. Children whose mothers were not treated or who received a drug other than penicillin and those whose mothers had a VDRL titer ≥ 1:16 at birth were 3.7 and 3.2 times more likely to be born with signs of congenital syphilis (p < 0.001- 95 % CI 2.41–5.58; p < 0.001 – 95 % CI 2.41–5.58) respectively. ConclusionsThe findings of this study draw attention to the importance of improving the quality of prenatal care and the development of studies aimed at finding alternative drugs for the treatment of syphilis in pregnant women and the prevention of congenital syphilis.

Syphilis - a disease that still occurs

Introduction: Syphilis is a systemic disease caused by Treponema pallidum. Humans are the only hosts, and the incubation period lasts from 9-90 days. Currently it can be divided into congenital or acquired. This division is due to the moment in which the infection occurred. Congenital Syphilis- when the infection happens during the prenatal period, whereas acquired, when the infection took place in the period after birth. In early acquired syphilis the I and II stages can be distinguished as well as early latent syphilis. As defined, early latent syphilis includes an acquired infection up to 1 or 2 years back, depending on the guidelines. Late syphilis however includes: late latent syphilis, tertiary syphilis, late cardiovascular syphilis, late neurosyphilis. Congenital syphilis has also been divided into early (which includes the first 2 years) as well as late, which is characterised by signs of congenital syphilis, the so-called stigmata of congenital syphilis constituting the untreated infection during the fetal stage or the infancy stage. Aim of the Study: The aim of our study is to divert the attention to one of the sexually transmitted diseases, which despite the downward trend at the end of the 20th century, rebounded at the beginning of the 21st century, especially among men who have sexual contact with other men. We paid attention to the symptoms accompanying this disease, also in the context of congenital syphilis, as well as the different methods of pharmacological treatment according to European guidelines. Materials and methods: Reviewed literature available at scientific articles , Google Scholar using keywords: “syphilis – epidemiology”, “syphilis treatment”, “symptoms of syphilis”, as well as European guidelines regarding the treatment of syphilis.

Complete Resolution of Nonimmune Hydrops Fetalis Secondary to Maternal Syphilis Infection

Maternal syphilis infection is a common infectious cause of nonimmune hydrops fetalis. Generally, hydrops fetalis is equated with poor prognoses in affected pregnancies. A 38-year-old G5P2114 presented at 28 5/7 weeks' gestation with newly diagnosed primary syphilis infection, sonographic findings of hydrops fetalis, and elevated middle cerebral artery Dopplers concerning for fetal anemia. Following treatment with intramuscular penicillin, the symptoms of hydrops fetalis were resolved and our patient delivered a healthy male neonate with no signs of congenital syphilis at the time of delivery. Routine and early testing for syphilis is an important component of prenatal care. Though not previously documented, the secondary findings of suspected fetal syphilis may be able to completely resolve in utero with penicillin treatment.

Laws and signs of congenital syphilis

Laws and signs of congenital syphilis

Screening for Syphilis During Pregnancy in Turkey

OBJECTIVE: To assess the prevalence of syphilis among patients at a tertiary referral center in Turkey and determine the need for antenatal syphilis screening based on the results. STUDY DESIGN: A retrospective cohort study based on patient data obtained from a tertiary referral center in Turkey. Serological syphilis screening using the Venereal Disease Research Laboratory (VDRL) was performed on all pregnant women as a part of routine antenatal care at their first hospital visit during pregnancy. Treponema pallidum hemagglutination assay (TPHA) was used to confirm positive screening results for syphilis. RESULTS: Patients’ mean age was 27.4 years. The incidence of positive syphilis serology was 0.013% (one patient), which was supported by a positive confirmatory test (0.013%).The TPHA-positive pregnant woman diagnosed with syphilis was treated with benzathine penicillin, and she gave birth to normal infants without any signs of congenital syphilis. CONCLUSION: Syphilis prevalence should be determined in each developing country with population-based studies. According to the prevalence of syphilis, each country should determine its own syphilis antenatal screening policies.

Dental stigmata and enamel thickness in a probable case of congenital syphilis from XVI century Croatia

ObjectiveTo analyse the dental remains of an individual with signs of congenital syphilis by using macroscopic observation, CBCT and micro-CT images, and the analysis of the enamel thickness. DesignAnthropological analysis of human skeletal remains from the 16th century archaeological site Park Grič in Zagreb, Croatia discovered a female, 17–20 years old at the time of death, with dental signs supportive of congenital syphilis: mulberry molars and canine defects, as well as non-specific hypoplastic changes on incisors. The focus of the analysis was on three aspects: gross morphology, hypoplastic defects of the molars, canines and incisors, as well as enamel thickness of the upper first and second molars. ResultsThe observed morphology of the first molars corresponds to the typical aspect of mulberry molars, while that of the canines is characterised by hypomineralisation. Hypoplastic grooves were observed on the incisal edges of all incisors. The enamel of the first molars is underdeveloped while in the second molars a thick-enamelled condition is observed. ConclusionsOur observations for the dental and skeletal evidence are supportive to a diagnosis of congenital syphilis for this specimen from XVI century Croatia. The use of CT imaging helped documenting the diagnostic features and quantifying the effect of the dental stigmata on first molars.

Congenital Syphilis Like Many Years Ago

This case concerns a premature infant with typical signs of congenital syphilis born to an untreated foreign mother. Syphilis prevalence in pregnant women has been rising in Italy since the beginning of the 21st century, mainly due to immigration. A correct antenatal syphilis screening and consequent adequate therapy of pregnant woman are fundamental to prevent the neonatal infection.

Knochenschmerzen im Erwachsenenalter als Erstsymptom einer Syphilis connata tarda

A 20-year-old woman developed multifocal bone pain. Diagnostic radiology revealed thickened periosteum, and syphilis serology was positive (T. pallidum haemagglutination test 1:5120). She also had discrete signs of congenital syphilis, with retinitis pigmentosa and Hutchinson's incisors. Skeletal scintigraphy demonstrated increased uptake even in radiologically unremarkable bones. The bone pain decreased after four-week administration of 1 M units of penicillin G daily. Scintigraphy one year later showed regression of the increased uptake, skeletal radiology did not reveal significant changes. This case shows that late manifestations of congenital syphilis still occur today. The stigmata of such an infection can be minute and easily missed. Skeletal scintigraphy is better for demonstrating active bone involvement than conventional radiology.

Fetal Syphilis

In Brief Objective To examine the pathophysiology of fetal syphilis and correlate hematologic, immunologic, and sonographic findings. Methods Twenty-four women with untreated syphilis during pregnancy were prospectively identified. Sonography with amniocentesis and percutaneous umbilical blood sampling were performed. Darkfield examination, rabbit infectivity testing, and polymerase chain reaction for detection of Treponema pallidum were performed on amniotic fluid. Hematologic and chemical testing of fetal blood was performed using standard techniques. Fetal antitreponemal IgM was detected by Western blot assay. Maternal syphilis was treated with 2.4 to 4.8 million units of benzathine penicillin G intramuscularly. Neonatal outcomes and signs of congenital syphilis were recorded. Results Six women had primary, 12 had secondary, and six had early latent syphilis. Sixty-six percent of fetuses (95% confidence interval [CI] 47%, 82%) had either congenital syphilis or detection of Treponema pallidum in amniotic fluid. Sixty-six percent had hepatomegaly, including three fetuses (12.5%, 95% CI 4%, 31%) with ascites. Fetal antitreponemal IgM was detected in three cases. Abnormal liver transaminases were found in 88% (CI 69%, 96%), anemia in 26% (CI 13%, 47%), and thrombocytopenia in 35% (CI 19%, 55%). Maternal treatment was successful in 83% (CI 64%, 93%). Risk of treatment failure was significantly increased when hepatomegaly and ascites were present (P = .01). Conclusion Findings with fetal syphilis are similar to those of neonatal syphilis. We hypothesize that fetal transaminase elevation occurs early in the course of infection; hematologic abnormalities and hydrops occur later. Severity of disease may be associated with risk of treatment failure. The fetus infected with syphilis may manifest hepatomegaly, abnormal liver function tests, anemia, and thrombocytopenia similar to the infected neonate.

Fetal syphilis: clinical and laboratory characteristics

Objective: To examine the pathophysiology of fetal syphilis and correlate hematologic, immunologic, and sonographic findings. Methods: Twenty-four women with untreated syphilis during pregnancy were prospectively identified. Sonography with amniocentesis and percutaneous umbilical blood sampling were performed. Darkfield examination, rabbit infectivity testing, and polymerase chain reaction for detection of Treponema pallidum were performed on amniotic fluid. Hematologic and chemical testing of fetal blood was performed using standard techniques. Fetal antitreponemal IgM was detected by Western blot assay. Maternal syphilis was treated with 2.4 to 4.8 million units of benzathine penicillin G intramuscularly. Neonatal outcomes and signs of congenital syphilis were recorded. Results: Six women had primary, 12 had secondary, and six had early latent syphilis. Sixty-six percent of fetuses (95% confidence interval [CI] 47%, 82%) had either congenital syphilis or detection of Treponema pallidum in amniotic fluid. Sixty-six percent had hepatomegaly, including three fetuses (12.5%, 95% CI 4%, 31%) with ascites. Fetal antitreponemal IgM was detected in three cases. Abnormal liver transaminases were found in 88% (CI 69%, 96%), anemia in 26% (CI 13%, 47%), and thrombocytopenia in 35% (CI 19%, 55%). Maternal treatment was successful in 83% (CI 64%, 93%). Risk of treatment failure was significantly increased when hepatomegaly and ascites were present ( P = .01). Conclusion: Findings with fetal syphilis are similar to those of neonatal syphilis. We hypothesize that fetal transaminase elevation occurs early in the course of infection; hematologic abnormalities and hydrops occur later. Severity of disease may be associated with risk of treatment failure.

In Utero Infection with Treponema Pallidum in Early Pregnancy

Amniocentesis was performed under sonographic guidance in gravidas (< 20 weeks' gestation) with untreated syphilis. Five to ten millilitres of amniotic fluid from each patient was used for rabbit infectivity testing (RIT) and polymerase chain reaction (PCR) to detect amniotic fluid infection with Treponema pallidum. Gravidas were treated with benzathine penicillin G. Newborns were examined for clinical and laboratory signs of congenital syphilis including immunoglobulin M (IgM) antibody to T. pallidum by Western blotting (immunoblotting). Eleven patients were enrolled at a mean gestational age of 16.8 weeks. T. pallidum was recovered from amniotic fluid by RIT in four cases (36 per cent), and PCR was positive in three of the amniotic fluid specimens (27 per cent). There were no false-positive PCR results. None of the newborns had clinical evidence of congenital syphilis and their sera lacked IgM reactivity to T. pallidum antigens by immunoblotting. These findings confirm in utero infection with T. pallidum in continuing early pregnancy and indicate that in utero treponemal infection can be eradicated by maternal treatment.

Enzyme-linked immunosorbent assays for detection of immunoglobulin M to nontreponemal and treponemal antigens for the diagnosis of congenital syphilis.

Sera from newborn infants born of mothers with a high risk of syphilis were examined for immunoglobulin M (IgM) antibodies in two different enzyme-linked immunosorbent assays (ELISAs), using either purified flagella from Treponema phagedenis biotype Reiter or the Venereal Disease Research Laboratory (VDRL) antigen as the antigen. All sera were also examined by the fluorescent treponemal antibody absorption (FTA-ABS) test for IgM. Three different groups of patients were studied. Group 1 consisted of 84 women and their newborn infants from a high-risk population for syphilis. Congenital syphilis was diagnosed in one child who had an IgM-positive cord blood specimen in both the ELISA and the FTA-ABS test. Group 2 consisted of 10 mothers and their newborn children. All mothers had positive syphilis-screening tests, and all children had signs of congenital syphilis. All but one child had positive IgM tests. Group 3 consisted of 15 mothers and their newborn children. These mothers had been treated for syphilis late in pregnancy, and all had a positive screening test at delivery. Two of the children had positive IgM tests, probably caused by reactivity after late intrauterine treatment of congenital syphilis. The specificities of the IgM tests were high when evaluated with sera from newborn children without signs of congenital syphilis. Even though IgM rheumatoid factor was found in all of the children tested with definite congenital syphilis, the rheumatoid factor did not cause false-positive results in either the VDRL ELISA or the flagellum ELISA. No significant IgG-IgM competition was noticed in the ELISAs. This study also confirmed that IgA antibodies do not cross the placenta; most newborn children with congenital syphilis were positive in the VDRL ELISA for IgA. Both the VDRL ELISA and the flagellum ELISA are very useful in the diagnosis of congenital syphilis and may be substitute for the FTA-ABS test. The VDRL ELISA for IgM will be especially useful in developing countries with a high incidence of congenital syphilis.

Syphilis in pregnant women in Zambia.

Because of the high incidence of congenital syphilis at the University Teaching Hospital, Lusaka, Zambia, the potential risks of congenital infection and fetal loss due to syphilis were assessed by screening 202 antenatal patients, 340 pregnant women admitted to the hospital whose pregnancies ended in either spontaneous abortion or stillbirth, and 469 consecutive babies delivered at the hospital. Primary serological screening was performed with the rapid plasma reagin test, and reactive sera were confirmed by the Treponema pallidum haemagglutination test. In all cases detailed histories were obtained and patients were examined for clinical signs of syphilis. The TPHA test result was reactive in 12.5% of antenatal patients and in 42% of women who aborted in the later half of pregnancy. Among 469 consecutive babies delivered at the hospital, 30 had reactive results to the TPHA test; of these two were stillborn and four had signs of congenital syphilis at birth. Thus, syphilis appears to affect adversely an appreciably high number of pregnant women in Zambia. For this reason a special campaign to screen adequately and treat pregnant women and neonates is needed.

先天梅毒に対する形態異常歯の診断的価値に関する研究

It is commonly acknowledged that occurrence in children of certain morphological abnormities of teeth is closely associated with the presence of congenital syphilis in them. Although a great many reports are hitherto available on this problem, most of these were very divergent in either the classification or representation of the abnormities of tooth anatomy, and failed to provide any exact criterion with which one is able to make successful diagnosis. In the present study, a series of oral examination programs was undertaken on a total of 5324 pupils of primary schools, and, based on the eleven dental stigmata hitherto proposed to be involved with congenital syphilis, a group of 29 subjects bearing any one or two such stigmata was gathered out. These subjects were examined for other possible signs of congenital syphilis besides above 11 stigmata to serve for further aid of diagnosis and, based on the serology test as final evidence, diagnostic value of the above 11 stigmata was respectively evaluated. The results were summarized as follows. 1. It was concluded that Fournier's and Hutchinson's teeth proved most reliable for diagnosis of congenital syphilis. 2. Nineteen subjects had Hutchinson's teeth and 18 had Fournier's teeth and when both groups were combined, these members accounted for 29 out of the total children or 0.54% of the total. 3. Eight (31%) out of 29 subjects had both Hutchinson's and Fournier's signs combined. 4. Although no typical instance of Hutchinson's teeth was encountered in the examination of deciduous teeth, similar atypical signs of Hutchinson's stigmata were observed in both permanent and deciduous dentitions, particularly in the lower anterior and upper lateral incisor teeth of the same individuals in whom the manifestation was exceptionally strong. 5. Syphilitic eye disturbances were detected in 11 subjects (0.2%) out of the total children and these subjects accounted for about two third of 29 subjects who had either Hutchinson's or Fournier's teeth or both. 6. A lesser diagnostic value should be assigned to the dwarf teeth as compared to the above two stigmata. 7. About 10% of the teeth with constricted cusps was supposed to be involved in congenital syphilis. 8. Although occurrence of the teeth with a lava-like appearance was very few, results of the serology test administered strongly suggested that such teeth were sure evidence of congenital syphilis. 9. Those manifestations such as Kraupa's symptom (abnormal form of upper lateral incisors), the spiral teeth, mottled teeth, erosion, Carabelli's tubercle and diastema ; these proved of no value for true diagnosis of congenital syphilis.

Epileptic Seizures. Clinical and Electrographic Features, Diagnosis and Treatment.

Physicians examining newborn infants should no longer dread the discovery of unusual skin problems. Practical dermatologic help is now available in this highly readable text, the first in English dealing exclusively with neonatal skin. It particularly encourages pediatricians to carefully examine the skin of newborns for signs of prematurity, infection, inherited disease, and birth trauma. Detection of premature skin with its poor vasomotor tone, inability to sweat, and reduced fat pad insulation signals danger of thermal instability and the need for controlled environmental temperature. Increased percutaneous absorption in such skin adds additional risk from bathing with toxic substances such as hexachlorophene or boric acid. Increased desquamation occurs with prolonged gestation of 40 to 42 weeks and with dysmaturity from prenatal anoxia. Dysmature skin also demonstrates meconium staining and long hair and nails. Nursery personnel should readily recognize the common, transient, benign skin lesions described in this book, as concerned mothers will appreciate intelligible explanations for milia, miliaria, salmon patches, mongolian spots, erythema toxicum neonatorum, cutis marmorata, and neonatal acne. Detailed information is also given for many severe skin dis¬ eases, which are organized by chap¬ ters into morphologically similar groups such as vesiculobullous erup¬ tions, scaling disorders, and vascular malformations. Special attention is given to pigmentary disorders indica¬ tive of genetic diseases like neurofibromatosis and tuberous sclerosis. The dermatologie novice will bene¬ fit greatly from chapters on basic ter¬ minology, diagnostic technique, and topical therapy. Also helpful are the plentiful references, current to 1972, and numerous tables which consoli¬ date key facts, such as causes of pur¬ pura, signs of congenital syphilis, and types of ichthyosis. Photographs are abundant, with 62 in color, but are of

CLAVICLE SIGN OF LATE CONGENITAL SYPHILIS

In 1927 Higoumenakis presented before the Medical Society of Athens, Greece, a patient with congenital syphilis who showed tumefaction of the inner third of the right clavicle and a roentgenogram of the clavicle of another patient who, besides other stigmas of congenital syphilis, showed enlargement of the sternal extremity of the right clavicle. The author expressed his opinion, based on these observations, that the clavicle sign may be another stigma of congenital syphilis. He was able to verify this assumption by subsequent examination of all patients coming under his observation. The result of the investigation showed that: (1) the clavicle sign has a diagnostic value equal to other definite signs of congenital syphilis; (2) it occurs in greater frequency than the other stigmas of congenital syphilis and consequently is of greater diagnostic value, and (3) it is never encountered in persons with acquired syphilis or in healthy persons. Since then,

Signs of congenital syphilis during delivery

Signs of congenital syphilis during childbirth were studied by Commandeur and Rhenter and they concluded that they could be found only in a relatively small number of syphilitic children.