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BMJ Case Rep ; 14(2)2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547108


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.

Debilidad Muscular/diagnóstico , Sífilis Congénita/diagnóstico , Terapia Combinada , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Debilidad Muscular/etiología , Debilidad Muscular/terapia , Sífilis Congénita/complicaciones , Sífilis Congénita/terapia
BMC Infect Dis ; 21(1): 64, 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33435889


BACKGROUND: Congenital syphilis is completely preventable through screening and treatment, but rates have been rising in the United States. Certain areas are at particularly high risk. We aimed to assess attitudes, knowledge, and barriers around effective prevention of congenital syphilis among health care providers and community women potentially at risk. METHODS: Two parallel studies were conducted: in-depth interviews with health care providers and focus groups with community women in the area of Baton Rouge, Louisiana. Each group was questioned about their experience in providing or seeking prenatal care, knowledge and attitudes about congenital syphilis, sources of information on testing and treatment, perceptions of risk, standards of and barriers to treatment. Results were transcribed into QSR NVivo V10, codes developed, and common themes identified and organized. RESULTS: Providers identified delays in testing and care, lack of follow-through with partner testing, and need for community connection for prevention, as major contributors to higher rates of congenital syphilis. Women identified difficulties in accessing Medicaid contributing to delayed start of prenatal care, lack of transportation for prenatal care, and lack of knowledge about testing and prevention for congenital syphilis. CONCLUSIONS: Providers and community members were in broad agreement about factors contributing to higher rates of congenital syphilis, although some aspects were emphasized more by one group or another. Evidence-based interventions, likely at multiple levels, need to be tested and implemented to eliminate congenital syphilis.

Concienciación , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Complicaciones Infecciosas del Embarazo/psicología , Sífilis Congénita/psicología , Treponema pallidum , Adolescente , Adulto , Femenino , Grupos Focales , Disparidades en Atención de Salud , Humanos , Louisiana/epidemiología , Tamizaje Masivo , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Atención Prenatal , Diagnóstico Prenatal , Investigación Cualitativa , Sífilis Congénita/diagnóstico , Sífilis Congénita/epidemiología , Sífilis Congénita/microbiología , Adulto Joven
Medicine (Baltimore) ; 99(40): e22321, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019408


RATIONALE: Congenital syphilis (CS) can manifest as a variety of clinical presentations according to the severity in symptomatic infants during neonatal period. Preterm neonates with CS may have more clinical evidences of infection and be more severely affected by CS compared with term ones. With increasing survival of markedly premature infants for recent decades, CS may be a challenging problem in those with severe manifestations associated with combined pathophysiologies of CS and prematurity. PATIENT CONCERNS: A very low birth weight infant at 32 weeks gestation presented with an unusual CS presentation consisting of prematurity-associated severe neonatal morbidities including meconium obstruction, prolonged cholestatic jaundice with elevated liver enzymes, and disseminated intravascular coagulation with a bleeding diathesis, in addition to common or typical manifestations of CS. DIAGNOSES: Congenital syphilis. INTERVENTIONS: Therapy consisting of a complete course of parenteral penicillin, blood component therapy, proximal ileotomy with inspissated meconium evacuation and distal loop ileostomy, and other conservative treatments. OUTCOMES: Resolution with normal gastrointestinal function and improved liver function was observed. LESSONS: This case suggests that in premature infants CS may manifest as unusual severe neonatal morbidities that may result from combination of syphilitic pathologies and contributors or conditions associated with prematurity including multisystem immaturity.

Recien Nacido Prematuro/fisiología , Recién Nacido de muy Bajo Peso/fisiología , Sífilis Congénita/fisiopatología , Sífilis Congénita/terapia , Transfusión de Componentes Sanguíneos/métodos , Femenino , Humanos , Recién Nacido , Íleo Meconial/cirugía , Penicilinas/uso terapéutico , Índice de Severidad de la Enfermedad , Sífilis Congénita/diagnóstico
Lancet Infect Dis ; 20(7): e173-e179, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32502432


Syphilis is caused by a spirochaete bacterium called Treponema pallidum. Vertical transmission of spirochaetes can lead to congenital infection of the fetus in pregnant women who are inadequately treated or not treated at all, causing various clinical manifestations including stillbirth and neonatal death, cutaneous and visceral manifestations, or asymptomatic infection. We present a severe case of syphilis in a 3-month-old boy with skin lesions, portal hypertension, and anaemia. Because the mother was tested negative for syphilis antibodies at 16 weeks of gestation, a diagnosis of congenital syphilis was initially not considered. This case shows that transmission of T pallidum can still occur in high-income countries with a high rate of antenatal screening. Early recognition might be hampered if physicians do not consider congenital syphilis as a possible diagnosis. Congenital syphilis should be considered in any severe and diagnostically challenging infectious disease case, even in the context of negative antenatal screening.

Sífilis Congénita/diagnóstico , Sífilis Congénita/terapia , Adulto , Femenino , Humanos , Lactante , Masculino , Sífilis Congénita/patología
Obstet Gynecol ; 135(5): 1121-1135, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32282589


Despite a national plan to eliminate syphilis by 2005, recent trends have reversed previously achieved progress in the United States. After a nadir between 2000 and 2013, rates of primary and secondary syphilis among women and congenital syphilis rose by 172% and 185% between 2014 and 2018, respectively. Screening early in pregnancy, repeat screening in the third trimester and at delivery among women at high risk, adherence to recommended treatment regimens, and prompt reporting of newly diagnosed syphilis cases to local public health authorities are strategies that obstetrician-gynecologists can employ to fight the current epidemic. In this report, clinical manifestations and management of syphilis in pregnancy are reviewed, and both traditional and reverse sequence screening algorithms are reviewed in detail in the context of clinical obstetrics.

Obstetricia/normas , Complicaciones Infecciosas del Embarazo/diagnóstico , Diagnóstico Prenatal/normas , Sífilis Congénita/epidemiología , Sífilis/epidemiología , Adulto , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/microbiología , Tercer Trimestre del Embarazo , Sífilis/diagnóstico , Sífilis Congénita/diagnóstico , Treponema pallidum , Estados Unidos/epidemiología
J Glob Health ; 10(1): 010504, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32280458


Background: Countdown to 2030 (CD2030) tracks progress in the 81 countries that account for more than 90% of under-five child deaths and 95% of maternal deaths in the world. In 2017, CD2030 identified syphilis screening and treatment during antenatal care (ANC) as priority indicators for monitoring. Methods: Country-reported data in the UNAIDS Global AIDS Monitoring System (GAM) system were used to evaluate four key syphilis indicators from CD2030 countries: (1) maternal syphilis screening and (2) treatment coverage during ANC, (3) syphilis seroprevalence among ANC attendees, and (4) national congenital syphilis (CS) case rates. A cascade analysis for CD2030 countries with coverage data for the number of women attending at least 4 antenatal care visits (ANC4), syphilis testing, seroprevalence and treatment was performed to estimate the number of CS cases that were attributable to missed opportunities for syphilis screening and treatment during antenatal care. Results: Of 81 countries, 52 (64%) reported one or more values for CS indicators into the GAM system during 2016-2017; only 53 (65%) had maternal syphilis testing coverage, 41 (51%) had screening positivity, and 40 (49%) had treatment coverage. CS case rates were reported by 13 (16%) countries. During 2016-2017, four countries reported syphilis screening and treatment coverage of ≥95% consistent with World Health Organization (WHO) targets. Sufficient data were available for 40 (49%) of countries to construct a cascade for data years 2016 and 2017. Syphilis screening and treatment service gaps within ANC4 resulted in an estimated total of 103 648 adverse birth outcomes with 41 858 of these occurring as stillbirths among women attending ANC4 (n = 31 914 408). Women not in ANC4 (n = 25 619 784) contributed an additional 67 348 estimated adverse birth outcomes with 27 198 of these occurring as stillbirths for a total of 69 056 preventable stillbirths attributable to syphilis in these 40 countries. Conclusion: These data and findings can serve as an initial baseline evaluation of antenatal syphilis surveillance and service coverage and can be used to guide improvement of delivery and monitoring of syphilis screening and treatment in ANC for these priority countries.

Complicaciones Infecciosas del Embarazo/diagnóstico , Sífilis/diagnóstico , Femenino , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Tamizaje Masivo , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Atención Prenatal , Sífilis/epidemiología , Sífilis/prevención & control , Sífilis Congénita/diagnóstico , Sífilis Congénita/epidemiología , Sífilis Congénita/prevención & control , Organización Mundial de la Salud
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(3): 337-342, 2020 Mar 10.
Artículo en Chino | MEDLINE | ID: mdl-32294831


Objective: To assess the health status and health service utilization of children born to syphilis infected mothers during pregnancy, in order to prevent mother-to-child transmission of syphilis to the newborns. Methods: Women with maternal syphilis were studied by trained researchers via phone calls, in Shanghai during 2014-2015. Data related to demographics, status of infection and health care, utilization by both mothers and their children were collected through specifically designed questionnaires. Non-parametric tests including chi-square were used to assess the health status and health service utilization of children born to mothers with different demographic and socioeconomic characteristics. Results: A total of 495 children born to mothers with maternal syphilis were recruited from 1 000 syphilis infected parturient women. A total of 61 out of the 495 children were diagnosed as having congenital syphilis (57 children were diagnosed at birth and another 4 were diagnosed during the follow-up period). Children born to women who received syphilis treatment during pregnancy were at lower risk on congenital syphilis (χ(2)=7.214, P=0.027). 37.8% of the children were reported to have had different illnesses in the past three months, mainly involving upper respiratory infections (32.3%) or diarrhea (3.6%). Children diagnosed with congenital syphilis showed a higher prevalence of different kinds of diseases, compared to those without congenital syphilis (47.5% vs. 36.6%). 81.6% of the children had received regular child health care services. Subjects with the following factors as: being immigrant, with lower education, unemployed, unmarried and multipara, were related to the less use of regular child healthcare services. Only 39.7% of the parents would inform the care-takers about the risk of congenital syphilis infection of their own children at the child health care centers. Mothers with residency of Shanghai, having higher education level and employed, were less willing to inform doctors about the risk of congenital syphilis infection of their children. Conclusions: Loss to follow-up among children born to syphilis infected pregnant women remained a serious problem. Few parents would be willing to inform the healthcare takers that their children are at risk of syphilis, when receiving child health care services at the centers. It was necessary to integrate the congenital syphilis follow-up programs into the routine child care services so as to timely diagnose and treat the patients with congenital syphilis.

Servicios de Salud del Niño/estadística & datos numéricos , Salud del Niño/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/epidemiología , Sífilis/epidemiología , Niño , China/epidemiología , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Embarazo , Complicaciones Infecciosas del Embarazo/terapia , Sífilis/terapia , Sífilis/transmisión , Sífilis Congénita/diagnóstico
Rev. enferm. UERJ ; 27: e41031, jan.-dez. 2019.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1024417


Objetivo: conhecer as repercussões do diagnóstico da Sífilis Congênita no recém-nascido para a mãe. Método: pesquisa qualitativa desenvolvida com 15 mães de recém-nascidos com Sífilis Congênita e internados em um hospital público do sul do Brasil. Os dados foram coletados por entrevistas semiestruturadas, submetidos à análise de conteúdo e aprovados pelo Comitê de Ética em Pesquisa. Resultados: as mães manifestaram sentimentos de culpa, desespero, tristeza e horror. Havia esperança de não passar a infecção para o recém-nascido. Verificou-se a reincidência da doença em mais de uma gestação. Referiram medo do estigma social e buscaram informações acerca da doença na internet, como também com médicos e enfermeiros. Conclusão: há desinformação das mães quanto à infecção da sífilis, principalmente sobre como evitar a transmissão vertical e a reinfecção. Cabe ao enfermeiro, instrumentalizar a mãe para o cuidado ao recém-nascido com Sífilis Congênita, por meio de um processo educativo que qualifique o cuidado da criança e da mãe

Objective: to learn how a diagnosis of congenital syphilis in newborns affects the mothers. Method: in this qualitative study of 15 mothers of newborns with congenital syphilis admitted to a public hospital in southern Brazil, data were collected by semistructured interview, and treated by content analysis. The study was approved by the research ethics committee. Results: the mothers expressed feelings of guilt, despair, sadness and horror. They hoped not to transmit the infection to the newborn. The disease was found to have recurred in more than one pregnancy. They reported fear of social stigma, and looked for information about the disease on the Internet, as well as from doctors and nurses. Conclusion: mothers are misinformed regarding infection by syphilis, especially on how to prevent vertical transmission and reinfection. It is up to nurses to instruct mothers on how to care for newborns with congenital syphilis, through an educational process to improve care for the child and the mother.

Objetivo: conocer las repercusiones, para la madre, del diagnóstico de sífilis congénita en el neonato. Método: investigación cualitativa desarrollada junto a 15 madres de neonatos con sífilis congénita e ingresados en un hospital público en el sur de Brasil. Se recolectaron los datos a través de entrevistas semiestructuradas y se sometieron al análisis de contenido; después fueron aprobados por el Comité de Ética en Investigación. Resultados: las madres expresaron sentimientos de culpa, desesperación, tristeza y horror. Había esperanza de no transmitir la infección al neonato. Se verificó la reincidencia de la enfermedad en más de un embarazo. Declararon el temor al estigma social y buscaron información sobre la enfermedad en internet, así como junto a médicos y enfermeros. Conclusión: las madres están desinformadas en cuanto a la infección por Sífilis, especialmente sobre cómo prevenir la transmisión vertical y la reinfección. Le toca al enfermero darle a la madre herramientas para que cuide bien al neonato con Sífilis Congénita, a través de un proceso educativo que califique el cuidado del niño y la madre

Humanos , Femenino , Recién Nacido , Adulto , Persona de Mediana Edad , Sífilis Congénita , Sífilis Congénita/diagnóstico , Sífilis Congénita/psicología , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Atención de Enfermería , Brasil , Familia , Investigación Cualitativa , Relaciones Madre-Hijo
Gac Med Mex ; 155(5): 464-472, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31695231


Introduction: Congenital syphilis continues to be a public health problem in Mexico. Objective: To assess the similarities and differences between national standards, guidelines and international documents related to the detection of syphilis in pregnant women and congenital syphilis. Method: Two algorithms were developed based on the standard of female care during pregnancy and on the standard for prevention and control of sexually transmitted infections. Based on the Centers for Disease Control (CDC) guidelines, algorithms were developed for syphilis during pregnancy, syphilis in the newborn and sexual contacts. Results: The standard for pregnancy mentions that syphilis testing should be carried out in every pregnant woman on her first contact or at delivery, without diagnostic tests being specified. The Official Mexican Standard (NOM) on sexually transmitted infections mentions the traditional algorithm for syphilis detection, treatment follow-up, coinfection with human immunodeficiency virus and congenital syphilis criteria. The CDC recommend reverse algorithm, antibody titer, treatment and follow-up as part of diagnosis. Conclusions: The elimination of mother-to-child transmission of syphilis requires NOMs updating and homogenizing, as well as the study of stillbirths and neonates born to mothers with syphilis.

Algoritmos , Guías de Práctica Clínica como Asunto , Complicaciones Infecciosas del Embarazo/diagnóstico , Serodiagnóstico de la Sífilis , Sífilis Congénita/diagnóstico , Femenino , Regulación Gubernamental , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , México , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Sífilis Congénita/prevención & control
Medicine (Baltimore) ; 98(44): e17744, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689826


Congenital syphilis (CS) can cause serious impact on the fetus. However, congenital syphilis presenting as sepsis is a critical condition but hardly identified by the clinic for the first time. In this study, we aimed to identify the benefit of earlier and accurate diagnosis for the infants who suffer congenital syphilis presenting as sepsis.A retrospective study was performed with patients diagnosed of congenital syphilis presenting as sepsis who were the inpatients in the West China Second Hospital between 2011 and 2018. The control group was collected in the neonatal sepsis patients whose blood culture are positive.Fifty-eight patients were included in the study. In the congenital syphilis group, one patient died and 12 (41.3%) patients get worse to MODS (multiple organ dysfunction syndrome). Symptoms, signs, and lab examinations are found to be significantly different (P < .05) between two groups as below, including rash, palmoplantar desquamation, abdominal distension, splenomegaly, hepatomegaly, etc. And, at the aspect of Hb, PLT, WBC, CRP, ALT, AST, these differences occurred in the different groups. It is obvious that the prognosis of children with syphilis is worse. According to a comparison between the different outcomes in the CS, the worse outcome subgroup of patients is significantly younger and have more severely impaired liver function.Because of the high mortality of these infants, pediatricians should improve awareness of CS. Syphilis screening is recommended for pregnant women.

Sepsis Neonatal/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Sepsis/diagnóstico , Sífilis Congénita/diagnóstico , Sífilis/diagnóstico , Estudios de Casos y Controles , China , Diagnóstico Diferencial , Diagnóstico Precoz , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/microbiología , Insuficiencia Multiorgánica/mortalidad , Sepsis Neonatal/microbiología , Sepsis Neonatal/mortalidad , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Complicaciones Infecciosas del Embarazo/mortalidad , Estudios Retrospectivos , Sepsis/microbiología , Sepsis/mortalidad , Sífilis/microbiología , Sífilis/mortalidad , Serodiagnóstico de la Sífilis , Sífilis Congénita/mortalidad
Afr Health Sci ; 19(2): 1858-1865, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31656468


Background: A significant proportion of newborns in the developing countries are born with congenital anomalies. Objective: This study investigated congenital infections due to Rubella virus, Toxoplasma gondii, Treponema pallidum among presumed normal neonates from full term pregnant women in Mwanza, Tanzania. Methods: Sera from mothers were tested for Treponema pallidum and Toxoplasma gondii infection while newborns from mothers with acute infections were tested for T. pallidum and T. gondii, and all newborns were tested for Rubella IgM antibodies. Results: A total of 13/300 (4.3 %) mothers had T. pallidum antibodies with 3 of them having acute infection. Two (0.7 %) of the newborns from mothers with acute infection were confirmed to have congenital syphilis. Regarding toxoplasmosis, 92/300 (30.7 %) mothers were IgG seropositive and 7 had borderline positivity, with only 1/99 (1%) being IgM seropositive who delivered IgM seronegative neonate. Only 1/300 (0.3 %) newborn had rubella IgM antibodies indicating congenital rubella infection. Conclusion: Based on these results, it is estimated that in Mwanza city in every 100,000 live births about 300 and 600 newborns have congenital rubella and syphilis infections, respectively. Rubella virus and T. pallidum are likely to be among common causes of congenital infections in developing countries.

Complicaciones Infecciosas del Embarazo/epidemiología , Virus de la Rubéola/inmunología , Rubéola (Sarampión Alemán)/congénito , Rubéola (Sarampión Alemán)/epidemiología , Sífilis Congénita/epidemiología , Toxoplasma/inmunología , Toxoplasmosis Congénita/epidemiología , Treponema pallidum/inmunología , Adolescente , Adulto , Anticuerpos Antivirales/sangre , Estudios Transversales , Femenino , Sangre Fetal/inmunología , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/inmunología , Atención Prenatal , Prevalencia , Rubéola (Sarampión Alemán)/diagnóstico , Virus de la Rubéola/aislamiento & purificación , Estudios Seroepidemiológicos , Sífilis/complicaciones , Sífilis/epidemiología , Sífilis Congénita/diagnóstico , Tanzanía/epidemiología , Toxoplasma/aislamiento & purificación , Toxoplasmosis/complicaciones , Toxoplasmosis/epidemiología , Toxoplasmosis Congénita/diagnóstico , Treponema pallidum/aislamiento & purificación , Población Urbana
Rev Saude Publica ; 53: 76, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31553379


OBJECTIVE: To evaluate the factors associated with HIV and syphilis testing during pregnancy in Brazil. METHODS: This was an ecological study covering all Brazilian municipalities evaluated by the second cycle of the National Program for Access and Quality Improvement in Primary Care, 2013-2014. The dependent variables were based on prenatal care access: prenatal care appointments, and HIV and syphilis tests during prenatal care. The independent variables were compared with demographic and social characteristics. Bivariate analysis was performed assessing the three outcomes with the independent variables. Variables with significant associations in this bivariate analysis were fit in a Poisson multiple regression analysis with robust variance to obtain adjusted estimates. RESULT: Poisson regression analysis showed a statistically significant association with the variables "less than eight years of study" [prevalence ratio (PR) = 1.31; 95%CI 1.19-1.45; p < 0.001] and "participants of the cash transfer program" (PR = 0.80; 95%CI 0.72-0.88; p < 0.001) for the outcome of "having less than six prenatal care appointments" and individual variables. A statistically significant association was found for "participants of the cash transfer program" (PR = 1.43; 95%CI 1.19-1.72; p < 0.001) regarding the outcome from the comparison between HIV testing absence during prenatal care and demographic and social characteristics. The absence of syphilis testing during prenatal care, and demographic and social characteristics presented a statistically significant association for the education level variable "less than eight years of study" (PR =1.75; 95%CI 1.56-1.96; p < 0.001) and "participants of the cash transfer program" (PR = 1.21, 95%CI 1.07-1.36; p < 0.001). CONCLUSIONS: The individual factors were associated with prenatal care appointments and HIV and syphilis tests in Brazilian pregnant women. They show missed opportunities for diagnosing HIV and syphilis infection during prenatal care and indicate weaknesses in the quality of maternal health care services to eliminate mother-to-child transmission.

Infecciones por VIH/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Atención Prenatal/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Sífilis Congénita/diagnóstico , Distribución por Edad , Brasil/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Humanos , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Distribución de Poisson , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Atención Prenatal/métodos , Prevalencia , Atención Primaria de Salud/métodos , Calidad de la Atención de Salud , Análisis de Regresión , Factores Socioeconómicos , Sífilis Congénita/epidemiología
Ann Dermatol Venereol ; 146(11): 696-703, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31558291


Congenital syphilis (CS) is caused by Treponema pallidum infection in utero. There is a need to develop new tools to diagnose CS: the diagnostic value of PCR is difficult to assess. The aim of this study was to describe the clinical and laboratory characteristics of mothers and infants with CS as diagnosed by PCR tests on various maternal and neonatal samples. PATIENTS AND METHODS: We included all infants epidemiologically linked to a mother diagnosed with syphilis whose samples were referred to the Syphilis Reference Center, and for whom at least one positive PCR result was obtained. RESULTS: Twenty-two mother-infant pairs (8.3%) with assay performed on samples from one to four different anatomic sites were included between February 2011 and April 2018. Seven mothers (31.8%) were born abroad, fifteen (68.2%) presented psychological and/or social problems, eight (36.4%) had not been screened for syphilis prior to delivery, and eleven (50%) were referred from French overseas departments or territories, or from the Paris region. Six infants (27.3%) were stillborn and six were born preterm, while fifteen infants (68.2%) presented clinical features of CS. All infants born preterm were symptomatic. Infant VDRL/RPR titer was no greater than four times that in the mother's serum, except in two cases. DISCUSSION: Lack of antenatal care, social disadvantage and psychological issues were common. There is a need for enhanced surveillance both in the French overseas departments/territories and in the Paris region. A larger study is required to assess the sensitivity and specificity of PCR. The best site for sampling has yet to be established. We recommend the collection of as many samples as possible to avoid underdiagnosis of CS.

ADN Bacteriano , Reacción en Cadena de la Polimerasa , Sífilis Congénita/diagnóstico , Treponema pallidum/genética , Adolescente , Adulto , Femenino , Francia , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Embarazo , Estudios Prospectivos , Mortinato , Adulto Joven
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31537633


Congenital syphilis (CS) is a preventable infection, yet the incidence has surged to the highest rates in 20 years. Because 50% of live-born infants with CS are asymptomatic at birth, there is an increasing likelihood that pediatric providers will encounter older infants whose diagnoses were missed at birth, emphasizing the importance of timely prenatal screening and treatment. We present one such case of an infant admitted twice at 3 and 4 months of age with long bone fractures and suspected nonaccidental trauma. On her second presentation, several additional symptoms prompted evaluation for and eventual diagnosis of CS. In this case, it is demonstrated that an isolated long bone fracture can be a first presentation of CS, with other classic findings possibly appearing later. Pediatric providers should be familiar with the varied presentations of CS in older children, including the radiographic findings that we describe. The rising rates of CS reveal deficiencies in our current strategy to prevent CS and, thus, we recommend reconsideration of universal syphilis screening in the third trimester and at delivery, with timely treatment to prevent CS during pregnancy.

Sífilis Congénita/diagnóstico , Antibacterianos/uso terapéutico , Maltrato a los Niños/diagnóstico , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Fracturas Espontáneas/etiología , Humanos , Fracturas del Húmero/etiología , Lactante , Penicilina G/uso terapéutico , Periostitis/microbiología , Úlcera Cutánea/microbiología , Sífilis Congénita/tratamiento farmacológico , Transaminasas/sangre
Acta bioquím. clín. latinoam ; 53(3): 337-341, set. 2019. tab
Artículo en Español | LILACS | ID: biblio-1038104


La sangre de cordón es una alternativa no invasiva que ha sido empleada para el tamizaje de sífilis congénita. Los objetivos del trabajo fueron evaluar la validez del uso de sangre de cordón como muestra para tamizaje de casos presuntivos de sífilis congénita, determinar la prevalencia de sífilis materna, estudiar la tasa de casos presuntivos de sífilis congénita y establecer el porcentaje de madres no estudiadas para sífilis en el periparto. Se realizó un análisis retrospectivo y observacional entre junio de 2017 y mayo de 2018. Se relevaron datos de serología de sangre de cordón y sangre de la madre. Se utilizó Unheated Serum Reagin como prueba de tamizaje y FTA-Abs y/o quimioluminiscencia como confirmatorias. Se excluyeron los binomios madre-hijo sin estudio de sangre de cordón. Binomios madre-hijo estudiados: 2.487. Sensibilidad y especificidad: 82,29% IC 95% (73,17- 89,33) y 99,96% IC 95% (99,76-100,00), respectivamente. Prevalencia de sífilis materna: 4,04%. Tasa de caso presuntivo de sífilis congénita: 26/1.000 RNV. Madres sin registros de serología para sífilis en el periparto: 70 (2,86%). La sangre de cordón no sería una muestra válida para el tamizaje debido a la baja sensibilidad encontrada, aunque en muchos casos es la única oportunidad de evaluar el binomio madre-hijo.

Cord blood is a non-invasive alternative which has been used for screening of congenital syphilis. The aims of the present study were to evaluate the validity of the use of cord blood as a sample for the screening of a probable congenital syphilis case, to study the prevalence of maternal syphilis, to analyse the rate of probable congenital syphilis case and to determine the percentage of non-studied mothers for syphilis in the peripartum. A retrospective and observational analysis was conducted between June 2017 and May 2018. Cord blood and maternal blood serology results were taken from the Laboratory Information System. Unheated Serum Reagin was used as a screening test and FTA-Abs and/or quimioluminiscense as confirmatory studies. Infant-mother binomies without cord blood studies were excluded. Infant-mother binomies studied: 2487. Sensibility and specificity 82.29% [95% CI: 73.17 to 89.33] and 99.96% [95% CI: 99.76 to 100.00], respectively. MSP prevalence: 4.04%. Probable congenital syphilis case rate: 26/1000 NB. Non-studied mothers for syphilis in the peripartum: 70 (2.86%). Cord blood would not be a valid sample for screening due to the low sensibility found, although in many cases it is the only opportunity to evaluate the infant-mother binomies.

O sangue do cordão é uma alternativa não invasiva que tem sido usada para triagem da sífilis congênita. Os objetivos do trabalho foram avaliar a validade do uso do sangue do cordão como amostra para o rastreio de um caso presumível de sífilis congénita, determinar a prevalência da sífilis materna, estudar a taxa de caso presumível de sífilis congénita e estabelecer a percentagem de mães em que não se analisa a sífilis no periparto. Foi realizada entre junho de 2017 e maio de 2018 uma análise retrospectiva e observacional, onde foram colectados os dados do Sistema de Computação Laboratorial de sorologia sangue do cordão e sangue da mãe. Foi utilizado um Unheated Serum Reagin como teste de triagem e FTA-Abs e/ou quimiluminescência como confirmatórias. Os binomios mãe-filho foram excluídos sem o estudo do sangue do cordão. Binomios mãe-filho estudado: 2.487. Sensibilidade e especificidade: 82,29% IC 95% (73,17-89,33) y 99,96% IC 95% (99,76-100,00), respectivamente. Prevalência de SFM: 4,04%. Taxa CPSC: 26/1.000 RNV. Mães sem registros sorológicos para sífilis no periparto: 70 (2,86%). O sangue do cordão não seria uma amostra válida para triagem devido à baixa sensibilidade encontrada, no entanto em muitos casos é a única oportunidade do avaliar o binomios mãe-filho.

Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Sífilis Congénita/diagnóstico , Sífilis Congénita/sangre , Sangre Fetal , Sífilis Congénita/líquido cefalorraquídeo , Prevalencia , Estudios Retrospectivos , Estudio Observacional
Mikrobiyol Bul ; 53(3): 336-342, 2019 Jul.
Artículo en Turco | MEDLINE | ID: mdl-31414635


The screening for syphilis during pregnancy is important to prevent intrauterine transmission and complications. Prozone phenomenon may cause a false negative result in non-treponemal syphilis tests, which complicates an accurate diagnosis. In this case report a newborn syphilis case was presented to emphasize the importance of reverse algorithm in diagnosis and the prozone phenomenon which can cause problems in rapid plasma reagin (RPR) test. The 2920 g infant patient was born from a 24-year-old mother with no known diseases, at the 35th week of gestation by cesarean section due to premature rupture of membranes. The initial physical examination of the newborn revealed erythema and exfoliation of the bilateral hands and feet. Laboratory results revealed CRP: 90 mg/L, WBC: 19.2 x 103/µl, hemoglobin: 9.5 g/dl, platelet count: 214 x 103/µl, HIV-Ag/Ab: non-reactive, anti-Toxoplasma gondii IgM and IgG: negative, anti-cytomegalovirus IgM: negative, anti-cytomegalovirus IgG: positive (128.7 AU/ml), anti-Rubella IgM: negative, anti-Rubella IgG: positive (26 IU/ml), anti-Treponema pallidum (anti-T.pallidum) antibody [IgM and IgG by the chemiluminescence microparticle enzyme immunoassay (Architect Syphilis TP; Abbott Japan Co, Japan)]: positive (Signal Cut Off value (S/CO): 28.35), and RPR (Omega Diagnostics, UK): negative. All of the above ELISA tests were performed by using Architect (Abbott Diagnostics, Wiesbaden, Germany) kits. When the RPR test was repeated with serial dilutions of the serum in order to detect prozone phenomenon, positive reaction was detected starting from 1:2 and ending at 1:64 dilution. It was determined that the mother was not tested for syphilis during her pregnancy. When both the mother and the father were tested for syphilis, the mother's anti-T.pallidum total antibody test result was reactive (S/CO: 30.52) and the RPR was positive at 1:32 dilution, while the father's anti-T.pallidum total antibody test result was reactive (S/CO: 16.05) and the RPR was negative. A four-fold difference between the maternal and infant RPR dilutions is required by the guidelines for a laboratory diagnosis of congenital syphilis. Although this criterion was not met in the newborn, the case was accepted as congenital syphilis due to clinical findings. Congenital syphilis must be considered in the differential diagnosis in the presence of skin manifestations at the birth and early neonatal period. Accurate and early diagnosis of the disease is important to start appropriate treatment and prevent complications. As described in the presented case, the use of reverse syphilis test algorithm will enable to reach the correct diagnosis of the infection. If the result of the treponemal test is positive and the RPR test is negative, prozone phenomenon should be considered and the RPR test should be repeated with serial serum dilutions.

Serodiagnóstico de la Sífilis , Sífilis Congénita , Adulto , Algoritmos , Anticuerpos Antibacterianos/sangre , Cesárea , Femenino , Alemania , Humanos , Recién Nacido , Embarazo , Serodiagnóstico de la Sífilis/métodos , Serodiagnóstico de la Sífilis/normas , Sífilis Congénita/diagnóstico , Treponema pallidum , Adulto Joven
Neonatal Netw ; 38(3): 170-177, 2019 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-31470384


Congenital syphilis (CS) has been consistently on the rise in the United States since 2012, despite long-standing recommendations for routine testing and treatment of pregnant women. CS is associated with miscarriage, stillbirth, early infant death, and organ dysfunction in the newborn. Prevention is the optimal goal; however, early identification of infected infants is imperative to reduce the risk of serious, long-term complications. Clinicians must possess adequate knowledge of CS and the potentially life-threatening conditions that can arise to provide immediate and effective care. This case study portrays the clinical presentation of an infant with CS and the management of the multisystem effects of the disease.

Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Unidades de Cuidado Intensivo Neonatal/normas , Guías de Práctica Clínica como Asunto , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/enfermería , Sífilis Congénita/diagnóstico , Sífilis Congénita/enfermería , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Resultado del Tratamiento , Estados Unidos
Arch. argent. pediatr ; 117(4): 399-402, ago. 2019. ilus
Artículo en Español | LILACS, BINACIS | ID: biblio-1054944


La sífilis presenta un marcado aumento de su prevalencia en Argentina y en el mundo. La Organización Mundial de la Salud estima que, por año, hay 12 millones de personas infectadas mundialmente, y 270 000 corresponden a recién nacidos con sífilis congènita. Se presenta a una niña de 8 años de edad con mononucleosis por virus de Epstein-Barr, que mostró como hallazgo diagnóstico sífilis confirmada por dos pruebas treponémicas positivas; se interpretó el cuadro como compatible con sífilis congènita latente tardía asintomática.

Syphilis shows marked increase in its prevalence in Argentina and the world. The World Health Organization estimates that annually there are 12 million people infected in the world, 270,000 corresponding to newborns with congenital syphilis. We describe an 8-year-old girl who was undergoing mononucleosis due to Epstein-Barr virus and presented syphilis as a diagnostic finding, confirmed by two different positive treponemal tests, assuming a compatible picture of late latent congenital asymptomatic syphilis.

Humanos , Femenino , Niño , Sífilis Congénita/diagnóstico , Treponema pallidum , Serodiagnóstico de la Sífilis , Sífilis Congénita/tratamiento farmacológico