Clinical characteristics of infants hospitalized with early congenital syphilitic nephropathy: a single-center retrospective cross-sectional study in China.

BACKGROUND: Early studies claimed that early congenital syphilitic (CS) nephropathy was rare, and systematic studies about this disease are absent, which may lead to poor awareness of early CS nephropathy in clinicians and result in misdiagnosis and poor patient prognosis. The present study systematically and comprehensively analyzes the clinical characteristics of infants with early CS nephropathy hospitalized in Beijing Ditan Hospital, an infectious disease hospital in China in order to improve the understanding and management of this disorder. METHODS: Data of the children with early CS from July 1, 2008, to December 31, 2021, were collected from the electronic medical record system of the hospital. Each patient's demographic characteristics, clinical history, mother's history of syphilitic infection, and laboratory values were extracted. The patients were enrolled to either the nephropathy group or the non-nephropathy group depending on diagnosis. Descriptive statistics was used to report basic demographics, clinical and laboratory test values, and variables were compared between the two groups by nonparametric tests, t test or χ2 tests. RESULTS: Of the 122 children with early CS enrolled, 24(19.7%) were diagnosed with early CS nephropathy. All of the children with CS nephropathy were young infants < 6 months old. A majority of them showed typical congenital syphilitic skin lesions, but a quarter of them did not have skin lesions. Compared with non-nephropathic children with early CS, those with nephropathy had higher frequency of hepatosplenomegaly, fever, edema, gastrointestinal (GI) symptoms, and anemia, as well as decreased C3 levels. Urinalysis results showed hematuria in all patients with early CS nephropathy, with proteinuria and renal function impairment in 91.7% and 12.5% of the patients, respectively. Nephritic-type nephrotic syndrome and glomerulonephritis were diagnosed in 45.8% and 54.2% of these patients, respectively. All infants with CS nephropathy were cured or improved after appropriate treatments. CONCLUSION: Infants with early CS nephropathy often presented with nephritic-type nephrotic syndrome or glomerulonephritis, and the typical skin lesions, fever, hepatosplenomegaly, and edema, etc., were its common clinical presentations, and these characteristics could help with the diagnosis. But for infants with nephropathy who did not have typical clinical presentations, CS should also be screened as an important etiology to avoid misdiagnosis.

Gestational and congenital syphilis: gaps to be elucidated

ABSTRACT Congenital and gestational syphilis are increasingly prevalent multisystemic infections in Brazil. This study aimed to present a case series of three children diagnosed with congenital syphilis even though their mother had unreactive treponemal tests. The VDRL (Venereal Disease Research Laboratory) titers of a 22-year-old mother with three pregnancies decreased after treatment. The mother did not have a reactive treponemal test, but all the three children were diagnosed with early congenital syphilis. This case series highlights the difficulty in diagnosing gestational and congenital syphilis in Brazil.

An analysis of the clinical features of children with early congenital Syphilis and Syphilitic Hepatitis.

BACKGROUND: The infection rate of congenital syphilis is gradually increasing, the clinical manifestations of some children with congenital syphilis are abnormal liver function, which is given the clinical diagnosis of syphilitic hepatitis. At present, there are few studies on the clinical features of children with early congenital syphilis combined with syphilitic hepatitis, so we set out to do such a study. We compared the liver function indicators before and after the treatment of syphilis to find the clinical features that can provide guidance for clinical diagnosis and treatment. METHODS: This study collected clinical data on 51 children with early congenital syphilis combined with syphilitic hepatitis in Beijing Ditan Hospital, affiliated with Capital Medical University, between April 2014 and October 2019. We observed their age, gender, clinical symptoms, and physical symptoms, as well as the pregnancy and childbirth history of their mothers. We also compared the liver function indicators before and after the treatment of the syphilis and analyzed the children's clinical features. RESULTS: The results of this study showed that the clinical manifestations in children with early congenital syphilis combined with syphilitic hepatitis were diverse. The most common clinical manifestation was anemia (56.9 %), followed by syphilitic rash (54.9 %), hands, feet, and whole-body peeling (35.3 %), and splenomegaly (29.4 %). Liver damage caused by a syphilis infection tends to result in elevated alanine aminotransferase, aspartate aminotransferase, and bilirubin, while albumin decreases. After the syphilis treatment, the liver function indexes were significantly improved compared with before treatment, and the difference was statistically significant (all p < 0.05). CONCLUSIONS: A child with abnormal liver function, especially with anemia, skin rash, peeling, abdominal distension, and hepatosplenomegaly should be highly suspected of having a syphilis infection. Once the diagnosis is made, the appropriate standard penicillin treatment should be started as soon as possible to improve the condition and prognosis of the child.

Incidência de sífilis congênita no estado de Santa Catarina no ano de 2012 / Congenital syphilis incidence in the state of Santa Catarina in 2012

Introdução ­ A sífilis congênita, apesar de prevenível, vem se mantendo como um problema de saúde pública desafiador até os dias atuais. Objetivos ­ Descrever a incidência da sífilis congênita no estado de Santa Catarina no ano de 2012. Métodos ­ Estudo ecológico onde a população estudada foram os casos notificados nas macrorregiões de Santa Catarina, de acordo com os dados obtidos do SINAN acessados em base de dados de acesso público por sífilis congênita no ano de 2012. Os dados foram apresentados na forma de taxas de incidência e também por números absolutos e porcentagens. Resultados ­ No ano de 2012 a maior taxa de incidência por 100000 nascidos vivos foi na macrorregião Grande Florianópolis (3,64), seguida das macrorregiões Foz do rio Itajaí (3,62) e Sul (1,62). A macrorregião Nordeste também apresentou um alto índice (1,45), seguido das macrorregiões Extremo Oeste (1,34) e Meio Oeste (1,16). O número de parceiros não tratados foi maior (60,9%) e 85,5% das mães realizaram o pré-natal. A taxa de incidência total de casos no estado de Santa Catarina no ano de 2012 foi de 1,72. Discussão ­ As falhas na assistência do pré-natal, a realização do diagnóstico tardio ou tratamento inadequado são fatores importantes que poderiam explicar que ainda exista um elevado número de casos de sífilis congênita. Apesar de possuir diagnóstico e tratamento de fácil acesso, verificou-se que o processo não acontece como previsto, provavelmente pela falta real da implementação das orientações do Ministério da Saúde.

Background - Congenital syphilis, although preventable, has remained as a challenging public health problem until today. Objectives - To describe the incidence of congenital syphilis in the state of Santa Catarina, South Brazil, in 2012. Methods - Ecological study where the population studied were the cases reported in the macro-regions of Santa Catarina, according to data obtained from SINAN accessed database public access due to congenital syphilis in 2012. The data were presented as incidence rates and also by absolute numbers and percentages. Results - In the year 2012 the highest incidence rate per 100,000 newborns was in the macro-region Florianópolis (3.64), followed by macro-regions Foz do Itajaí (3.62) and South (1.62). The Northeast macro-region also had a high rate (1.45), followed by macro-Far West (1.34) and Midwest (1.16). The number of untreated partners was higher (60.9%) and 85.5% of the mothers had prenatal care. The total incidence rate in the state of Santa Catarina in 2012 was 1.72. Discussion - The flaws in prenatal care, the delayed diagnosis or inadequate treatment are important factors that could explain that there is still a high number of cases of congenital syphilis. Despite having the diagnosis and treatment of easily accessible, it was found that the process does not happen as expected, probably due to lack of real implementation of the Health Ministry guidelines.

Incidência de sífilis congênita nos estados do Brasil no período de 2007 a 2009 / Congenital Syphilis incidence in Brazilian States between 2007 and 2009

Introdução ? A sífilis congênita comporta-se comouma doença de amplo espectro clínico. De maneira geral,dividimos a doença em precoce ou tardia conformea manifestação clínica tenha aparecido antes ou depoisdos dois primeiros anos de vida. Objetivos ? Descrevera incidência da sífilis congênita nos estados do Brasil noperíodo de 2007 a 2009. Métodos ? Estudo ecológicoonde a população em risco estudada foi considerada ade nascidos vivos de acordo com os dados obtidos doSINASC acessados nos indicadores de saúde do DATASUS.Foram considerados os casos notificados de sífiliscongênita no período, disponíveis também no DATASUS.Os dados foram apresentados na forma de taxasde incidência e também por números absolutos e porcentagens.Resultados ? No período de 2009 a maiortaxa de incidência foi no estado do Amapá (7,14), seguidode Ceara (4,99) e posteriormente Rio Grande do Norte(4,27), Sergipe também apresentou um alto índice(3,42), seguido de Alagoas (3,35). Segundo a faixa etáriaa predominância foi observada em recém nascidos ate6 dias (94,57%). O numero de parceiros não tratadosfoi o maior (57,41%). No período compreendido entre2007 e 2009, o ano que apresentou uma maior taxade incidência foi 2008 (70,91). Discussão ? As falhasna assistência do pré-natal, a realização do pré-natal deforma incompleta ou inadequada, seja pelo início tardioou por falta de comparecimento às consultas sãofatores importantes que poderiam explicar que aindaexista um numero alto de casos de sífilis congênita, jáque trata-se de uma doença de fácil diagnóstico e comum tratamento acessível e provavelmente pela falta deinformação da doença e pela baixa escolaridade da populaçãobrasileira adulta ainda se observa um alto índicede parceiros não tratados.

Introduction - Vertical transmission of syphilis remainsa major public health problem in Brazil. Congenital syphilisbehaves as a broad spectrum of clinical disease. In general,we divide the disease in early or late depending onthe clinical manifestation has appeared before or afterthe first two years of life. Objective ? To describe the incidenceof congenital syphilis in the states of Brazil from2007 to 2009. Methods ? An ecological study where thepopulation at risk was considered the study of live birthsaccording to data from the SINASC accessed in health indicatorsDATASUS. We considered the reported cases of congenitalsyphilis in the period, also available in DATASUS.Data were presented as incidence rates and also by absolutenumbers and percentages. Results ? During 2009the highest incidence was in the state of Amapá (7.14),followed by Ceará (4.99) and subsequently Rio Grandedo Norte (4.27), Sergipe also had a high incidence (3.42), followed by Alagoas (3.35). According to age the prevalencewas observed in newborns up to 6 days (94.57%).The number of partners that was not treated was the highest(57.41%). In the period between 2007 and 2009,the year that presented a higher incidence rate was 2008(70.91). Discussion - The flaws in pre-natal care, completionof pre-natal incomplete or inadequate, either by lateonset or lack of attendance at appointments are importantfactors that could explain that there is still a high numberof cases of congenital syphilis, since it is a disease easilydiagnosed and treatment accessible and probably the lackof disease information and the low education of the Brazilianpopulation still show a high rate of untreated partners.