[Diagnostic image (372). A neonate with undetermined sex]. / Diagnose in beeld (372). Een neonatus met dubieus geslacht.

A neonate born small for gestational age presented with female genitalia and a large genital tubercle, due to a large preputium, a not uncommon condition in dysmature female infants.

[Prevention and treatment of congenital syphilis]. / Preventie en behandeling van congenitale syfilis.

Due to uncertainties about the treatment of their mothers' syphilis infections, in three neonates congenital syphilis was suspected. The mother of the first newborn, a girl, had treated herself for a syphilis infection. The second mother, who gave birth to a son, was treated adequately for her infection, but there was no record of this available at the time of birth. The third mother, who gave birth to a girl, had also been treated for syphilis, but within the month before delivery. None of the neonates had any clinical manifestations of congenital syphilis. These obscurities resulted in serological examination of all three neonates and in treatment in the first and third cases. The reported increase in the incidence of syphilis infections in The Netherlands poses a risk of more cases of congenital syphilis infection in newborns. It is crucial to be aware of the consequences of syphilis infection in the neonate and fetus, and also of the various measures available for its prevention and treatment. In The Netherlands, screening for syphilis is routinely carried out during pregnancy. If a pregnant woman is found to be infected, the therapy of choice is penicillin. The Treponema pallidum agglutination test (TPA) and the venereal disease research laboratory (VDRL) test should be performed on the mother and the newborn after birth. All infants born to seropositive but insufficiently treated mothers require careful physical examinations. Infants with proven infection or with a high index of suspicion should be treated with aqueous crystalline penicillin G for a total of 10 days. After discharge, all infants should be followed up with physical and serological examinations up to the first year of life.

[Diagnostic image (249). An infant with a swollen red toe]. / Diagnose in beeld (249). Een zuigeling met een gezwollen, rode teen.

A 4-month-old male infant had a red and swollen left fourth toe due to strangulation by a hair.

[Diagnosis image (250). A tachypnoeic neonate with rightsided prominence of heart sounds]. / Diagnose in beeld (250). een tachypnoïsche zuigeling met rechts duidelijker harttonen dan links.

In a male neonate pneumonia and situs inversus were diagnosed: Kartagener's syndrome (primary ciliary dyskinesia).

[Diagnostic image (136). A boy with coughing fits and subconjunctival hemorrhage. Subconjunctival hemorrhage secondary to whooping cough]. / Diagnose in beeld (136). Een jongen met hoestbuien en subconjunctivale bloedingen. Subconjunctivale bloedingen bij kinkhoest.

An 8-year-old boy suffered from persisting coughing fits for two weeks and subconjunctival haemorrhage since one week. In paired sera serological proof of infection with Bordetella pertussis was found.

[An unusual cause of fever: chronic meningococcemia]. / Een ongewone oorzaak van koorts: chronische meningokokkemie.

In a 14-year old boy admitted because of fever of unknown origin chronic meningococcaemia was diagnosed. He had suffered for the last four months from periods of high fever accompanied by skin rash and arthralgia. Blood culture showed the presence of Neisseria meningitidis. Cerebrospinal fluid culture remained negative. Following the administration of high-dose intravenous benzylpenicillin a prompt resolution of all signs and symptoms was observed. No immunological abnormalities were found. Chronic meningococcaemia can be a--nowadays uncommon--cause of fever of unknown origin.