Sífilis congénita e infarto hepático, una asociación no reportada. Descripción de un caso pediátrico / Congenital syphilis and hepatic infarction, a not previously reported association. A pediatric case report

La sífilis congénita es causada por la infección del feto con Treponema pallidum durante el embarazo. Los síntomas son variables. Si bien es común el daño endotelial, no suele estar presente en los casos congénitos. Reportamos el caso de un lactante de 42 días de vida hospitalizado por masa abdominal. Las imágenes confirmaban la presencia de una lesión en el lóbulo hepático izquierdo sin efecto de masa. Las biopsias mostraron cambios compatibles con infarto y hepatitis neonatal. Las serologías del paciente y de su madre confirmaron el diagnóstico de sífilis congénita, y recibió tratamiento con penicilina intravenosa. El hígado se encuentra protegido de los daños isquémicos gracias a su doble irrigación, pero la acumulación de noxas puede haber provocado dicha presentación inusual. Tres meses más tarde, el paciente se encontraba libre de síntomas y la resonancia de control mostró atrofia del lóbulo izquierdo, mientras el resto del parénquima no presentaba alteraciones.

Congenital syphilis is caused by Treponema pallidum infection of the fetus during pregnancy. Symptoms are variable. While endothelial damage is common, it is not usually present in congenital cases. Here we report the case of a 42-day-old infant hospitalized due to an abdominal mass. Imaging studies confirmed the presence of an injury in the left lobe of the liver without mass effect. Biopsies showed changes compatible with infarction and neonatal hepatitis. The patient's and his mother's serologies confirmed the diagnosis of congenital syphilis, and he was treated with intravenous penicillin. The liver protected from ischemic injury by its double irrigation, but the accumulation of harmful agents may have caused this unusual presentation. Three months later, the patient was symptom-free, and the control MRI showed atrophy of the left lobe, while the rest of the parenchyma was unchanged.

A case report of interstitial keratitis and secondary glaucoma after cataract surgery that may be related to late congenital syphilis.

BACKGROUND: The destruction of blood eye barrier and the administration of corticosteroid eyedrops after phacoemulsification surgery can lead to the replication of the local potential pathogens. With the rapid increase and popularization of cataract surgery, all kinds of rare postoperative complications have appeared. Here, we report a case of interstitial keratitis and secondary glaucoma after cataract surgery, which may be related to late congenital syphilis, which eventually led to blindness in the right eye. We hope that the timely report of this case will enable doctors to pay more attention to the possibility of potential pathogen replication after cataract surgery, and enable more patients to receive reasonable and effective treatment. CASE PRESENTATION: A 63-year-old female was referred to our clinic for investigation with a 1-week history of moderate pain in the right eye and ipsilateral headache in January 2020. She had cataract surgery on her right eye two years ago and on her left eye one year ago. The intraocular pressure (IOP) in the right eye was 43.2 mmHg and that in the left eye was 28.5 mmHg. Her right eye underwent medication, trabeculectomy and finally was subjected to ciliary body photocoagulation to control the IOP. The IOP of the left eye was well controlled by regular use of eye drops. In addition to the elevated IOP, the inflammation of the anterior segment and corneal stroma was found. Before cataract surgery, bilateral corneal opacities was revealed, but after cataract surgery, interstitial keratitis in both eyes was gradually aggravated, during the follow-up period from 2019 to 2021. She informed us that she had suffered from decreased vision in both eyes and was diagnosed with bilateral keratitis and congenital syphilis at the age of 20. In 2018, the serologic test for syphilis was positive in blood (Chemiluminescence analysis (CLIA): + ; Toluidine red unheated serum test (TRUST): + , titer was 1:1). However, four tests for TRUST were negative in 2019 and 2020, so she was not treated for syphilis. CONCLUSION: This case of glaucoma and interstitial keratitis might be secondary to ocular inflammation caused by late congenital syphilis. The ocular inflammation and the activation of syphilis may be related to cataract surgery.

Congenital syphilis: a rare presentation of a forgotten infection.

Congenital syphilis (CS), a common but forgotten disease has a broad spectrum of clinical presentation. Vertical transmission of this spirochaetal infection from the pregnant mother to the foetus can result in varied manifestations ranging from asymptomatic infection to life- threatening conditions in the form of stillbirth and neonatal death. The haematological and visceral manifestations of this disease can closely mimic various conditions including haemolytic anaemia and malignancies. Congenital syphilis should be considered as a differential in any infant presenting with hepatosplenomegaly and haematological abnormalities even if the antenatal screen was negative. We report a 6-month-old infant with congenital syphilis presenting with organomegaly, bicytopenia and monocytosis. A strong index of suspicion and early diagnosis is the key to the good outcome as treatment is simple and cost- effective.

Clinical manifestations of syphilis in the oral cavity: a review / Manifestações clínicas da sífilis na cavidade oral: uma revisão bibliográfica

Introduction: Syphilis is a sexually transmitted infection caused by Treponema pallidum bacterium, which impact on a significant increase in contagions reported worldwide, bringing up the need of urgent actions to ensure the control, treatment, and diagnosis of the disease. Objective: Given this context, this work presents a bibliographical review on syphilis, aiming to describe the most common oral manifestations that occur on the four stages of this infection. Methods: For the literature review, the searches were carried out in the PubMed, Science Direct, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature and databases of Virtual Health Library. Results: Regarding the primary syphilis, the main clinical manifestations in the oral cavity include chancres in the palate, buccal mucosa, tongue, and lips. In the secondary stage, the presence of diffuse and nonspecific oral lesions was identified. In tertiary syphilis, stomatitis and glossitis are present, being the hard palate and the tongue the main affected regions. In congenital syphilis, the patients are affected with dental and jaw malformations. Conclusion: The clinical manifestations of syphilis in the oral cavity can appear at any stage of the infection, being the oral cavity the second most affected region by this sexually transmitted infection. Therefore, the knowledge regarding this subject is extremely important for health professionals, as well as for the population, being essential to carry out the correct diagnosis and adequate treatment for the rapid cure of this infection (AU)

Introdução: A sífilis é uma infecção sexualmente transmissível oriunda da bactéria Treponema Pallidum, com transmissão através de relações sexuais sem o uso de preservativos ou por contato com lesões contaminadas. Nos últimos anos, diversos novos casos estão sendo reportados de forma alarmante, mostrando uma realidade dura sobre as dificuldades do diagnóstico da doença. Objetivo: Diante desse contexto, este trabalho apresenta uma revisão bibliográfica sobre a sífilis, com o objetivo de descrever as manifestações orais mais comuns nos quatros estágios possíveis da doença. Métodos: Para a revisão de literatura, realizou-se a busca dos artigos nas bases de pesquisas PubMed, Science Direct, Scientific Electronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde e Biblioteca Virtual em Saúde. Resultados: Observou-se que, na sífilis primária, as principais manifestações clínicas na cavidade oral ocorrem com a presença de cancros no palato, na mucosa jugal, na língua e nos lábios. No estágio secundário, identificou-se a presença de lesões orais difusas e inespecíficas. Na sífilis terciária, podem ocorrer estomatites e glossites, sendo o palato duro e a língua as principais regiões acometidas. Na sífilis congênita, os possíveis sinais clínicos na cavidade oral são malformações dentárias e nos maxilares. Conclusões: As manifestações clínicas da sífilis na cavidade oral podem surgir em qualquer estágio da infecção, sendo a cavidade oral a segunda região com maior acometimento da infecção. Portanto, é de extrema importância o conhecimento das manifestações orais da sífilis pelos profissionais da área da saúde, bem como pela população, sendo fundamental o correto diagnóstico e tratamento rápido para a cura precoce da doença. (AU)

Left Ventricular Giant Aneurysm Caused by Congenital Syphilis Causing Severe Outflow Tract Obstruction.

We present the exceedingly rare case of an 18-year-old boy with recurrent syncope attacks and dyspnea at rest for 3 weeks. Transthoracic echocardiography showed a giant aneurysm dilatation occupying the left ventricular outflow tract. The intraoperative finding was a giant thick-walled unruptured aneurysm of the sinus of Valsalva from the right coronary cusp. The roof of the aneurysm was excised and the defect was repaired, sparing the aortic valve. Histopathology analysis from the roof of the wall of the aneurysm revealed features of endarteritis obliterans of the vasa vasora in keeping with syphilitic infection with aneurysmal dilation. A rapid plasma reagin test was reactive.

Adverse pregnancy outcomes associated with maternal syphilis infection.

BACKGROUND: Syphilis infections affect many pregnant women worldwide every year. The increasing rates of maternal and congenital syphilis infections in recent years in the United States necessitates further investigation into the adverse effects of syphilis infection on maternal and neonatal health. OBJECTIVE: We sought to examine the association of maternal syphilis infection with adverse pregnancy and perinatal outcomes. METHODS: We performed a retrospective cohort study of women with singleton pregnancies who delivered between 23 and 42 weeks in California between 2007 and 2011. We compared demographic characteristics and pregnancy outcomes between pregnant women with syphilis and without syphilis. Maternal outcomes of interest included gestational hypertension, pre-eclampsia, gestational diabetes, preterm delivery, cesarean delivery, induction of labor, and severe maternal morbidity. Neonatal outcomes included neonatal intensive care unit admission, congenital anomaly, congenital syphilis, small for gestational age, stillbirth, neonatal death, infant death. Descriptive statistics were assessed using chi-square/Fisher's Exact tests. Multivariable logistic regression was used to estimate the association between syphilis and adverse pregnancy and perinatal outcomes. Statistical comparisons with a p-value of less than .05 and 95% CI that did not cross the null were considered statistically significant. RESULTS: Among a cohort of 2,566,246 women, there were 991 pregnancies complicated by maternal infection with syphilis (0.04%). We found during multivariable logistic regression that syphilis infection was significantly associated with preterm delivery (aOR: 1.27, 95% CI: 1.05-1.54), NICU admission >24 h (aOR: 2.54, 95% CI: 2.13-3.04) and stillbirth (aOR: 5.01, 95% CI: 3.16-7.92) after adjusting for a number of potential confounders including maternal age, race/ethnicity, education, parity, prenatal visits, body mass index, smoking and insurance status. CONCLUSION: Maternal syphilis infection in pregnancy is associated with specific adverse pregnancy outcomes, even after adjusting for potential confounders. These data can be used to counsel patients with syphilis in pregnancy, and in developing approaches to clinical care. Due to the increased risk of stillbirth, perhaps such patients should receive antenatal testing. Further research is necessary to investigate the mechanisms of morbidity.

Spinal arteriovenous malformation in a pediatric patient with a history of congenital syphilis: a case report.

BACKGROUND: Spinal arteriovenous malformations in children are extremely rare and pose great risk for intraoperative hemorrhage. Congenital syphilis sometimes presents with vascular symptoms, however, there is little published on patients with a history of congenital syphilis presenting with spinal arteriovenous malformations. CASE PRESENTATION: A 15-month-old female with a history of congenital syphilis presented with urinary retention, fever, and subacute onset of paraplegia. MRI showed a lesion at T8-L1, angiogram was performed which confirmed the presence of a complex type IVc arteriovenous malformation and fistula from Artery of Adamkiewicz at L1-L2. It also showed peri medullary dilated veins and a pseudoaneurysm that compressed the spinal cord at T8-T10. Somatosensory evoked potentials and motor-evoked potentials were not recordable on the bilateral lower extremities prior to surgery. Once the patient was optimized for surgery, osteoplastic laminotomies from T6-T12 were performed. The dura was opened and the intradural, intramesenchymal hematoma was evacuated. There were two episodes of brisk arterial bleeding with hypotension during resection of the hematoma. The patient was taken to the angiography suite from the OR to successfully coil the large aneurysm. Intraoperative spinal cord monitoring remained undetectable in the bilateral lower extremities. The patient's paraplegia remained unchanged from preoperative presentation. CONCLUSION: Congenital syphilis may present with vascular changes that might impact surgical approaches and treatment outcomes in patients with spinal arteriovenous malformations. Preparation for massive transfusion and intraoperative monitoring are imperative in ensuring a safe perioperative experience.

Congenital syphilis in a 4-month-old infant with limb weakness.

We describe a rare case of a 4-month-old girl presenting with a several month history of reduced movement to the left arm accompanied by a maculopapular rash to the limbs. X-ray findings included inflammatory periosteal changes to the radius and ulna. Treponema pallidum IgM was detected in both baby and mother, and a diagnosis of congenital syphilis was made. This case is an interesting clinical picture with a variety of important differential diagnoses, including non-accidental injury, malignancy, autoimmune disease and other congenital infections. With an increasing rate of congenital syphilis infection in the developed world, it is vital that clinicians are able to recognise symptoms to ensure prompt diagnosis and treatment. In this respect, we can attempt to avoid the chronic and potentially life-threatening complications of untreated infection.

Epidemiological characterization of congenital syphilis in a health region of the northern zone in the state of Ceará, Brazil

The study sought to investigate the epidemiological profile of congenital syphilis in a health region in the State of Ceará, in the period from 2015 to 2019. This is a descriptive epidemiological study, with a quantitative approach, with secondary data collected through the Health System. Information on Notifiable Diseases and Live Birth Information System. There were a total of 248 cases:65cases in 2015, 50 in 2016, 45 in 2017, 51 in 2018 and 37 in 2019. The incidence of congenital syphilis was: 8.1(2015), 6.1(2016), 5.1 (2017), 5.3(2018) and 3.9(2019). In 62.9% of cases from all the years, women were between 20 and 34 years old and in 45.5% of cases they had less than eight years of educational instruction. 57.2% never had a miscarriage, 63.3% had vaginal deliveries and 59.2% had full-term deliveries. Most women received prenatal care (95.9%). In 49.5% of cases, the diagnosis of maternal syphilis occurred during prenatal care. Only 67 (27%) of the pregnant women were treated properly and only 52 (29%) had their partners treated. The study shows aflaw in prenatal care with low effectiveness of the prevention actions, determining factors in the control of congenital syphilis.

Exposição à sífilis na gestação e suas consequências perinatais e no neurodesenvolvimento infantil / Exposure to syphilis during pregnancy and its perinatal and neurodevelopmental consequences for children

Objetivo: Descrever os possíveis acometimentos perinatais e no neurodesenvolvimento infantil entre crianças expostas à sífilis durante a gestação comparadas com crianças que não foram expostas à sífilis. Métodos: Trata-se de um estudo retrospectivo de caso controle. Houve aprovação do comitê de ética da instituição. Foram incluídas crianças nascidas de mulheres que tiveram resultado positivo para sífilis durante a gestação, sem outra infecção congênita associada. Para cada caso, foram selecionados dois controles pareados pelo mês de nascimento e sexo, e que não apresentavam nenhuma doença tipo TORCH ou arboviroses. Dados sociodemográficos, socioeconômicos e de saúde maternos e dados de saúde do recém-nascido foram coletados por análise de prontuário. Foi utilizado o teste estatístico de qui-quadrado, e valor de p < 0,05 foi considerado significante, sendo calculada a razão de chances (OR) bruta e seus respectivos intervalos de 95% de confiança. Resultados: Após a aplicação de critérios de inclusão e exclusão, foram analisados 29 casos de exposição fetal de sífilis durante gravidez pareados com 58 controles. O estudo observou que no grupo do caso havia mulheres mais jovens e com menor escolaridade. Em relação às alterações fetais, não encontramos mudanças estruturais. Foram encontradas alterações motoras em quatro crianças do grupo exposto à sífilis na gravidez, mas que não persistiram. Até 1 ano de vida, as crianças estavam sem qualquer tipo de alteração. Conclusões: A população de mulheres mais vulnerável a adquirir infecções sexualmente transmissíveis parece ainda ser a mais jovem e com menos escolaridade. Ser exposto à sífilis durante a gravidez não aumentou o risco para atrasos de desenvolvimento provavelmente pelo tratamento adequado.

Objective: To describe the possible perinatal and child neurodevelopmental involvement among children exposed to syphilis during pregnancy compared with children who were not exposed to syphilis. Methods: This is a retrospective case-control study. It was previously approved by the institution's ethics committee research. Children born to women who tested positive for syphilis during pregnancy, without another associated congenital infection, were included. For each case, two controls were selected, matched by month of birth and sex, and who did not present TORCH syndrome or arboviruses. Sociodemographic, socioeconomic, and maternal and newborn health data were collected in the medical record. The chi-square statistical test was used, a p-value of < 0.05 was considered significant and crude odds ratio (OR) and their respective 95% confidence intervals were calculated. Results: After applying the inclusion and exclusion criteria, 29 cases of fetal syphilis exposure during pregnancy were analyzed and matched with 58 controls. The study found that in the case group the women were younger with less education. Regarding fetal alterations, we did not find structural changes. The study encountered motor changes in four children from the group exposed to syphilis during pregnancy, which did not persist. Up to 1 year of life, the children were without any type of alterations. Conclusions: The population of women most vulnerable to acquire sexually transmitted infections still seems to be the youngest and less educated. Being exposed to syphilis during pregnancy did not increase the risk for developmental delays, probably due to adequate treatment.

Increase of incidence of congenital syphilis in santa catarina state between 2007-2017: temporal trend analysis / Aumento da incidência de sífilis congênita no estado de santa catarina no período de 2007 a 2017: análise da tendência temporal

ABSTRACT Objective: To estimate the incidence of congenital syphilis and temporal trends of the reported cases of the disease in the state of Santa Catarina between 2007 and 2017. Methods: Observational study with retrospective cohort design, with secondary data from the Injury of Notification Information System (SINAN). Linear trend test and geoprocessing were performed to verify the behavior of the cases in the period. Results: There were 2,898 reported cases of congenital syphilis in the period, with an average of 2.9 per 1,000 live births in the period. There was an exponential increase of 0.9 percentage points per year, considered statistically significant (p<0.001). There was no difference between the incidences of cases in the different regions of the State. The fatality rate was 8.5%, considering deaths from syphilis, miscarriages and stillbirths. The profile was predominant of white mothers, with low schooling and 11.8% did not perform prenatal care. For this reason, 26.9% of them had a diagnosis of syphilis at the time of delivery. Most of the pregnant women (51.9%) had inadequate pharmacological treatment and 65.1% of the partners were not treated. Conclusions: There was an exponential increase tendency in cases of congenital syphilis in the State of Santa Catarina in the period studied in all regions of the State, which reveals the failure of prenatal care, late diagnosis and inadequate treatment of the pregnant woman and her partner.

RESUMO Objetivo: Estimar a incidência de sífilis congênita e a tendência temporal dos casos notificados da doença no estado de Santa Catarina no período entre 2007 e 2017. Métodos: Estudo observacional com desenho de coorte retrospectiva, com dados secundários coletados no Sistema de Informação de Agravos de Notificação (SINAN). Foi realizado o teste de tendência linear e o geoprocessamento para verificar o comportamento dos casos no período. Resultados: No período, foram notificados 2.898 casos de sífilis congênita, com média de 2,9 a cada mil nascidos vivos. Houve crescimento exponencial de 0,9 ponto percentual ao ano, sendo estatisticamente significante (p<0,001). Não houve diferença entre a incidência de casos nas diferentes regiões do Estado. A taxa de letalidade foi de 8,5%, considerando os óbitos por sífilis, os abortos e os natimortos. O perfil predominante foi de mães da raça branca e com baixa escolaridade. Do total de mães analisadas, 11,8% não realizaram pré-natal - por esse motivo, 26,9% delas tiveram o diagnóstico de sífilis no momento do parto. A maioria das gestantes (51,9%) teve tratamento farmacológico inadequado e 65,1% dos parceiros não foram tratados. Conclusões: No período estudado, houve tendência de aumento exponencial dos casos de sífilis congênita em todas as regiões do Estado de Santa Catarina, o que revela a falha no pré-natal, o diagnóstico tardio e o tratamento inadequado da gestante e do seu parceiro.

Factors associated with unfavorable outcomes caused by Syphilis infection in pregnancy / Fatores associados aos desfechos desfavoráveis provocados pela Sífilis na gestação

Abstract Objective: to analyze factors associated with unfavorable outcomes caused by syphilis infection in pregnancy. Methods: descriptive study carried out from May to August 2014, in public maternity hospitals. A questionnaire was administered to all women with a reactive Venereal Disease Research Laboratory (VDRL) test result and the data were supplemented with information from medical records and prenatal files. The bivariate analysis was performed using Pearson's chi-square or Fisher's exact test. For the multivariate analysis, was used through the logistic regression model. Results: a total of 137 puerperal women participated in the study, of which 14.3% had an unfavorable outcome, namely: stillbirth (2.9%), preterm birth (8.8%) and low birth weight (2.9%). In the multivariate analysis the odds ratio for the prevalence of an unfavorable outcome was three-fold higher in women who did not undergo a second VDRL test (OR=3,54; IC95% 1,04-15,33) and two-fold higher in women with a VDRL titer >1:8 (OR=2,15; IC95% 1,11-11,2). Conclusions: The unfavorable outcomes occurred in women who did not undergo the second VDRL test and those whose VDRL titer was >1:8 performed in the maternity hospital.

Resumo Objetivos: analisar os fatores associados aos desfechos desfavoráveis provocados pela sífilis na gestação. Métodos: estudo descritivo realizado entre maio a agosto de 2014, em maternidades públicas. Foi aplicado um questionário a todas as mulheres que apresentaram exame de Venereal Disease Research Laboratory (VDRL) reagente e os dados foram complementados com informações dos prontuários e cartões de pré-natal. Para análise bivariada utilizou-se o teste do qui-quadrado de Pearson ou exato de Fisher. Para análise multivariada utilizou-se a regressão logística. Resultados: participaram do estudo 137 puérperas e, destas, 14,3% apresentaram algum desfecho desfavorável, a saber: natimortalidade (2,9%), prematuridade (8,8%) e baixo peso ao nascer (2,9%). Na análise multivariada, a razão de chance de prevalência do desfecho desfavorável foi três vezes maior em mulheres que não realizaram um segundo VDRL (OR=3,54; IC95% 1,04-15,33) e duas vezes maior em mulheres cuja titulação do VDRL foi maior que 1:8 (OR=2,15; IC95% 1,11-11,2). Conclusões: os desfechos desfavoráveis ocorreram em mulheres que não realizaram o segundo VDRL e cuja titulação desse exame realizado na maternidade foi superior a 1:8.

Presence of dental signs of congenital syphilis in pre-modern specimens.

OBJECTIVE: Tooth morphology can vary due to genetic factors, infectious diseases and other environmental stresses. Congenital syphilis is known to interrupt tooth formation i.e. odontogenesis and amelogenesis, producing specific dental characteristics. Variation of those characteristics can occur, resulting in dental signs "not typical" of the disease, however, they are described in the 19th century literature. Past treatments of congenital syphilis with mercury also interrupted dental processes resulting in significantly different dental signs. The aim of this study is to examine the dentition of the oldest (pre 15th century) cases attributed to congenital syphilis to determine whether their dental processes have been affected by either congenital syphilis itself, its treatments (mercury) or a combination of both (syphilitic-mercurial). DESIGN: Comparisons of dental signs of congenital syphilis and its mercuric treatments as described by Hutchinson, Moon and Fournier in the 1800s and in standardised methods as established by modern studies, are made with the dentition of specimens found in archaeological sites in Mexico, Italy, Turkey and Austria dating back to the Terminal Formative Period, Classical Antiquity, Byzantine times and Middle Ages. RESULTS: The dentitions of a child from Oaxaca, Mexico, St. Pölten, Austria, and two juveniles from Classical Antiquity site Metaponto, Italy, show signs attributed to syphilis only. One adolescent from Byzantine site Nicaea, Turkey, shows dental signs characterised as syphilitic-mercurial. CONCLUSIONS: Dental abnormalities observed in Mediterranean individuals match a range of signs attributable to congenital syphilis and its treatments, more so than the New World case. Therefore, it is likely that these individuals suffered from congenital syphilis.

Serología reactiva en la embarazada. A propósito de tres casos / Reactive serology in pregnant women. Apropos of three cases

La sífilis gestacional se transmite de madre a hijo, por vía placentaria y por canal del parto. Es diagnosticada en el niño en el momento del nacimiento, esta transmisión hematógena del treponema pallidum de la gestante no tratada o tratada inadecuadamente a su recién nacido, se denomina sífilis congénita. Entre las estrategias del Ministerio de Salud Pública está prevenir la transmisión materna de la sífilis al feto, o al menos, tratarla en útero. Para lograr este propósito debe garantizarse la realización de serologías a la gestante y al esposo. Múltiples pueden ser las causas de una serología reactiva pero siempre se debe pensar en la sífilis. Se presentan tres casos de sífilis en gestantes y su seguimiento en área de salud (AU).

Gestational syphilis is transmitted from mother to child via the placenta and the birth canal. It is diagnosed in the child at the moment of birth. This hematogenous transmission of the treponema pallidum from the non-treated or inadequately treated pregnant woman to her new born child is called congenital syphilis. Preventing the maternal transmission of the syphilis to the fetus, or at least treating it in the uterus, is among the strategies of the Ministry of Public Health. To achieve this purpose serology should be carried out to the pregnant woman and her husband. The causes of a reactive serology might be different, but it is always necessary to thing of syphilis. Three cases of syphilis in pregnant women are presented and also their follow-up in a health area (AU).

Update on syphilis and pregnancy.

While the origins of syphilis remain unknown, it has long been recognized as an infectious entity with complex pathophysiology. In this review, we highlighted the epidemiology and risk factors associated with syphilis. The incidence of syphilis in most populations showed a consistent upward trend until the 1940s with the introduction of penicillin as the preferred treatment. The emergence of congenital syphilis and vertical transmission has been a direct result of heterosexual syphilis transmission. We also explore the microbiology and pathogenesis of Treponema pallidum as it directly correlates with its route of transmission and infectivity. The clinical features are best categorized into stages (primary, secondary, early, and late latent and tertiary). The primary stage presents as a characteristic chancre and inguinal adenopathy, while the secondary "bacteremia" stage has a predilection to dermatologic manifestations and constitutional symptoms. The latent phase of syphilis witnesses a quiescent period with variable relapse of symptoms and finally, one-third of untreated patients undergo tertiary syphilis years after the initial infection characterized by severe neurologic or cardiovascular symptomatology. We will also review the data collected for congenital syphilis from the CDC as this can manifest with stillbirth, neonatal death, and nonimmune hydrops. The diagnosis of syphilis focuses on a combination of nontreponemal and treponemal antibody tests with the CDC recommending a traditional algorithm from screening to confirmation. However, other agencies have recently adopted the reverse testing algorithm which has outperformed the traditional algorithm in certain populations. We finally focus on syphilotherapy and monitoring response to treatment with a specific emphasis on pregnancy. Birth Defects Research 109:347-352, 2017. © 2017 Wiley Periodicals, Inc.

Hipoacusia neurosensorial secundaria a infecciones perinatales / Sensorioneural hearing loss secondary to perinatal infections / A perda auditiva neurossensoral secundária a infecções perinatais

Introducción: 1 a 2 de cada 1.000 recién nacidos tienen una pérdida auditiva neurosensorial significativa. De las deficiencias auditivas congénitas, el 50% resultan de infecciones en el embarazo y/o parto; como las provocadas por: Toxoplasmosis, rubéola, citomegalovirus, herpes y sífilis. Métodos: Se realizó una búsqueda bibliográfica sistemática de artículos utilizando bibliotecas virtuales y libros de texto de relevancia dentro de la especialidad. Resultados: La rubéola en mujeres susceptibles puede producir el síndrome de rubéola congénita. La sordera es la manifestación más frecuente de la enfermedad y es la secuela más importante. El 15% de los niños infectados por Citomegalovirus padecen una pérdida auditiva por daño coclear y alteraciones en el sistema nervioso central al nacer. Otro 15% pueden desarrollar luego del nacimiento hipoacusia, retardo mental o dificultades en el desarrollo del lenguaje y del aprendizaje. Aproximadamente el 80% de los recién nacidos infectados por toxoplasmosis son asintomáticos; el resto presentará manifestaciones clínicas de afectación sistémica incluyendo compromiso auditivo como parte del cuadro. La infección por Herpes simple suele ser devastadora en el recién nacido. Se ha descrito hipoacusia en más del 50% de los casos. La sordera se asocia frecuentemente con la sífilis congénita. Junto con la queratitis intersticial y las malformaciones dentarias, forma parte de la tríada de Hutchinson. Conclusiones: La hipoacusia es un problema de gran importancia en la infancia. Las infecciones agrupadas en el término TORCHS causan hipoacusia neurosensorial adquirida en forma prenatal, dando lugar a sorderas presentes al nacer o de desarrollo diferido o progresivo.

Introduction: 1 to 2 of every 1,000 newborns have significant sensorineural hearing loss. From all the congenital hearing empairments, 50% take place during pregnancy and/or childbirth; such as those caused by: toxoplasmosis, rubella, cytomegalovirus, herpes and syphilis. Methods: A systematic literature research was performed using virtual libraries and relevant specialty textbooks. Results: Rubella in susceptible women may cause congenital rubella syndrome. Deafness is the most common manifestation of the disease and is the most important sequel. 15% of those children infected with Cytomegalovirus children suffer hearing loss from cochlear damage and alterations in the central nervous system at birth. Another 15% can then develop birth hearing loss, mental retardation or difficulties in language development and learning. Approximately 80% of newborns infected with toxoplasmosis are asymptomatic; the rest will present clinical manifestations of systemic disease including hearing impairment as part of the picture. Herpes simplex infection is devastating in the new born. Hearing loss has been described in over 50% of cases. Deafness is often associated with congenital syphilis. Along with interstitial keratitis and dental malformations, it is part of the Hutchinson triad. Conclusions: Hearing loss is a major problem in childhood. Gathered as TORCHS acquired infections cause sensorineural hearing loss prenatally, resulting in hearing loss present at birth or deferred or progressive development.

Introdução: 1 a 2 em cada 1.000 recém-nascidos têm perda auditiva neurossensorial significativo. Das deficiências auditivas congênitas, 50% das infecções resultar em gravidez e / ou parto; tais como aquelas causadas por: toxoplasmose, rubéola, citomegalovírus, herpes e sífilis. Métodos: Uma busca sistemática da literatura foi realizada utilizando bibliotecas virtuais e livros relevantes no art. Resultados: A rubéola em mulheres suscetíveis pode causar a síndrome da rubéola congênita. A surdez é a manifestação mais comum da doença e é a sequela mais importante. 15% das crianças infectadas com Citomegalovírus sofrer perda de audição de danos e alterações coclear no sistema nervoso central no nascimento. Outros 15% podem desenvolver perda auditiva nascimento, retardo mental ou dificuldades no desenvolvimento da linguagem e aprendizagem. Cerca de 80% dos recém-nascidos infectados com toxoplasmose é assintomática; o resto vai apresentar manifestações clínicas da doença sistêmica, incluindo a deficiência auditiva como parte da imagem. Infecção Herpes simplex geralmente devastadores no recém-nascido. A perda de audição tem sido descrita em mais de 50% dos casos. A surdez é frequentemente associada a sífilis congênita. Junto com ceratite intersticial e malformações dentárias, faz parte da tríade Hutchinson. Conclusões: A perda auditiva é um problema grave na infância. Agrupados nas infecções TORCHS causam perda auditiva neurossensorial pré-natal, resultando em perda auditiva presente no nascimento ou em diferido ou desenvolvimento progressivo.

Cerebral microcalcifications in a newborn with congenital tuberculosis.

Tuberculosis is a serious public health problem worldwide. In 2012, the World Health Organization estimated 8.6 million new cases and 1.3 million deaths due to the disease. In 2011, the incidence in Colombia was 24 cases per 100,000 inhabitants. There is little information about tuberculosis in pregnant women, and congenital infection is considered a rare disease that is difficult to diagnose, leads to high mortality, and may be confused with tuberculosis acquired after birth. In addition, it has been associated with HIV infection in mothers and infants. Moreover, there is increasing incidence of congenital syphilis in the world. In Colombia, the prevalence is 2.5 cases per 1,000 births and its frequency in the Instituto Materno Infantil-Hospital La Victoria is one case per 57 births. We report the case of a newborn under treatment for congenital syphilis and in whom microcalcifications were found in a transfontanelar ultrasound. This finding warned about the existence of another infectious agent. PCR was negative for cytomegalovirus, and IgM titers for toxoplasma, rubella and herpes I and II were also negative. After learning about a history of incomplete treatment for tuberculosis in the mother, we suspected the presence of an infection by the tubercle bacillus in the newborn. No acid-fast bacilli were demonstrated in three gastric juice samples. The IS6110 PCR assay was found positive in cerebrospinal fluid and urine, but not in blood. The newborn was treated with crystalline penicillin for 10 days along with isoniazid, rifampicin, pyrazinamide and streptomycin. The patient is currently under clinical monitoring.

Microcalcificaciones cerebrales en un recién nacido con tuberculosis congénita / Cerebral microcalcifications in a newborn with congenital tuberculosis

La tuberculosis es un problema grave de salud pública a nivel mundial. La Organización Mundial de la Salud estimaba que en el 2012 se habían presentado 8,6 millones de casos nuevos y 1,3 millones de muertes a causa de la enfermedad. En Colombia, la incidencia en 2011 fue de 24 casos por 100.000 habitantes. No hay información sobre la tuberculosis en las mujeres gestantes y la infección congénita se considera una enfermedad rara, de difícil diagnóstico, que genera alta mortalidad y puede confundirse con la adquirida después del nacimiento. La tuberculosis se ha relacionado con la infección por el virus de la inmunodeficiencia humana en madres y neonatos. Por otra parte, los casos de sífilis congénita han aumentado en el mundo y, en Colombia, la prevalencia es de 2,5 casos por 1.000 nacimientos, en tanto que, en el Instituto Materno Infantil-Hospital La Victoria, la frecuencia es de un caso por 57 nacimientos. Se presenta el caso de un recién nacido en tratamiento para sífilis congénita que presentó microcalcificaciones detectadas en una ecografía transfontanelar, lo que alertó sobre la existencia de otro agente infeccioso. La prueba de PCR fue negativa para citomegalovirus, así como los títulos de IgM para toxoplasma, rubéola y herpes I y II. Dado el antecedente de un tratamiento incompleto para tuberculosis en la mujer gestante, se sospechó la presencia de infección por el bacilo de la tuberculosis. No se encontraron bacilos ácido-alcohol resistentes en tres muestras de jugo gástrico, y la prueba de PCR-IS 6110 fue positiva en líquido cefalorraquídeo y en orina, pero no en sangre. El recién nacido recibió tratamiento con penicilina cristalina durante 10 días, así como con isoniacida, rifampicina, pirazinamida y estreptomicina. Actualmente se le hace seguimiento clínico.

Tuberculosis is a serious public health problem worldwide. In 2012, the World Health Organization estimated 8.6 million new cases and 1.3 million deaths due to the disease. In 2011, the incidence in Colombia was 24 cases per 100,000 inhabitants. There is little information about tuberculosis in pregnant women, and congenital infection is considered a rare disease that is difficult to diagnose, leads to high mortality, and may be confused with tuberculosis acquired after birth. In addition, it has been associated with HIV infection in mothers and infants. Moreover, there is increasing incidence of congenital syphilis in the world. In Colombia, the prevalence is 2.5 cases per 1,000 births and its frequency in the Instituto Materno Infantil-Hospital La Victoria is one case per 57 births. We report the case of a newborn under treatment for congenital syphilis and in whom microcalcifications were found in a transfontanelar ultrasound. This finding warned about the existence of another infectious agent. PCR was negative for cytomegalovirus, and IgM titers for toxoplasma, rubella and herpes I and II were also negative. After learning about a history of incomplete treatment for tuberculosis in the mother, we suspected the presence of an infection by the tubercle bacillus in the newborn. No acid-fast bacilli were demonstrated in three gastric juice samples. The IS 6110 PCR assay was found positive in cerebrospinal fluid and urine, but not in blood. The newborn was treated with crystalline penicillin for 10 days along with isoniazid, rifampicin, pyrazinamide and streptomycin. The patient is currently under clinical monitoring.