Research progress on the mechanism of Treponema pallidum breaking through placental barrier.

Congenital syphilis, a significant cause of fetal mortality worldwide, is a congenital infectious disease instigated by the vertical transmission of Treponema pallidum during pregnancy. Clinical manifestations include preterm delivery, stillbirth, neonatal skin lesions, skeletal abnormalities, and central nervous system aberrations. The ongoing increase in the incidence of congenital syphilis, coupled with complexities in diagnosis, necessitates a detailed understanding of its pathogenesis for the development of improved diagnostic approaches, and to interrupt the route of vertical transmission. Drawing from the broader body of research associated with vertical transmission pathogens, we aim to clarify the potential mechanisms by which Treponema pallidum breaches the placental barrier to infect the fetus.

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.

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

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 is 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.

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.

Perfil dos casos de sífilis congênita no rio grande do norte: estudo de série temporal / Profile of Congenital Syphilis cases in Rio Grande do Norte State: a Temporal Series Study / El perfil de los casos de sífilis congénita en Rio Grande do Norte: Estudiode Serie Temporal

Objetivo:Analisar a incidência, a mortalidade e o perfil dos casos de sífilis congênita no Rio Grande do Norte entre 2014 e 2018. Metodologia:Trata-se de um estudo epidemiológico, quantitativo, ecológico, realizado com dados de sífilis congênita registrados no Sinan. Resultados:A taxa de incidência e mortalidade por sífilis congênita duplicaram no Estado no período analisado. A maioria das crianças foi diagnosticada com menos de 7 dias após o nascimento, sendo mais predominante em filhos de mães com idade entre 20 e 29 anos, com baixa escolaridade e pardas, que foram diagnosticadas com sífilis recente e que tiveram acesso ao pré-natal. A maioria teve o diagnóstico da sífilis materna durante o pré-natal, mas não realizou tratamento adequado e o parceiro não recebeu tratamento. Conclusões:Os achados apontam para necessidade de estratégias para qualificação da atenção pré-natal com intuito de evitar a transmissão vertical, especialmente nesses grupos mais susceptíveis e vulneráveis (AU).

Objective:To analyze the incidence, mortality, and profile of cases of congenital syphilis at the Rio Grande do Norte between 2014 and 2018. Methodology:This is an epidemiological, quantitative, ecological study conducted with data on congenital syphilis registered at Sinan. Results:The incidence and mortality from congenital syphilis doubled in Rio Grande do Norte State during the analyzed period. Most children were diagnosed less than seven days after birth, being more prevalent in children of mothers aged 20 to 29 years, with low education and mixed-race, diagnosed with recent syphilis, and who had access to prenatal care. Most were diagnosed with maternal syphilis during prenatal care but did not receive adequate treatment, and the partner did not receive treatment. Conclusions:The findings show the need for strategies for quality prenatal care to avoid vertical transmission, especially in these most susceptible and vulnerable groups (AU).

Objetivo: Analizar la incidencia, la mortalidad y el perfil de los casos de sífilis congénita en el Río Grande del Norte entre 2014 y 2018.Metodología: Se trata de un estudio epidemiológico, cuantitativo y ecológico realizado con los datos de sífilis congénita registrados en el Sinan.Resultados: La incidencia y mortalidad por sífilis congénita se duplicó en el estado de Río Grande do Norte durante el período analizado. La mayoría de los niños fueron diagnosticados en menos de siete días después del nacimiento, siendo más prevalente en los hijos de madres de 20 a 29 años, con baja educación y mestizos, diagnosticados con sífilis reciente y que tuvieron acceso a la atención prenatal. La mayoría fueron diagnosticados de sífilis materna durante la atención prenatal pero no recibieron el tratamiento adecuado, y la pareja no recibió tratamiento.Conclusiones: Los hallazgos muestran la necesidad de estrategias de atención prenatal de calidad para evitar la transmisión vertical, especialmente en estos grupos más susceptibles y vulnerables (AU).

Massive Perivillous Fibrin Deposition Associated With Placental Syphilis: A Case Report.

Massive perivillous fibrin deposition (MPFD) and the related entity of maternal floor infarction (MFI) are uncommon placental disorders of unknown etiology, associated with adverse obstetric outcome and a significant risk of recurrence. We describe a 19-year-old mother with untreated syphilis who delivered a male neonate with low birth weight, skin desquamation, and pneumonia. Placenta examination showed the expected changes for syphilis but unexpectedly, also showed MPFD. To our knowledge, this is the first report of MPFD associated with placental syphilis, thus expanding the list of etiologies that may be related to MPFD/MFI. It is postulated that the syphilis infection in our case led to a hypercoaguable state, eventually resulting in MPFD. In the right clinical setting, syphilis might be considered in the differential diagnosis when MPFD/MFI is observed on placental examination. The recurrence risk of MFPD/MFI associated with infections is believed to be lower than idiopathic cases and, by extrapolation, this lower risk should apply to syphilis as well.

Congenital syphilis, the great imitator-case report and review.

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.

Anatomical and biochemical evidence for Treponema pallidum in a 19th to early twentieth century skeletal cadaver.

This report summarizes findings relating to the biochemical and skeletal evidence for Treponema pallidum in an unusually old case of congenital syphilis. In 1951, the Milwaukee Public Museum acquired skeletal remains from the Surgical School of Marquette University. The male was identified as a 60-65-year-old, that was suffering from congenital syphilis. His remains are now part of the anthropological collections of Wisconsin Lutheran College (Milwaukee, Wisconsin). Venereal Disease Research Laboratory (VDRL) and Rapid Plasma Reagin (RPR) tests were used to verify the presence of the bacteria-generated antibodies, while mass spectrometry testing provided indirect evidence for the historical treatment of the disease. Notably, antibody detection in human remains of this age is rare. These initial results support what is known of syphilis and its treatment prior to the wide scale, clinical use of penicillin therapy, and describe evidence for long-term skeletal symptoms of congenital syphilis in century-old human remains.

An unusual presentation of early congenital syphilis with annular configuration of blisters resembling "string-of-pearls".

Skin lesions in early congenital syphilis can show considerable variability. A 35-day-old infant presented with rhinitis, desquamation of palms and soles, pseudoparalysis of the right upper limb, and annular lesions with peripheral blistering over the chest and abdomen, resembling a "string-of-pearls." A diagnosis of congenital syphilis was made on the basis of radiologic evaluation and reactive Venereal Disease Research Laboratory (VDRL) in both mother and child. We report this case to highlight the unusual presentation of congenital syphilis with annular configuration of blisters, mimicking a "string-of-pearls."

Fetal and Placental Pathology in Congenital Syphilis: A Comprehensive Study in Perinatal Autopsy.

INTRODUCTION: At autopsy, without available serologic information, diagnosing congenital syphilis (CS) relies on identification of Treponema pallidum in tissues. Recognition of clues leading to detection of the organism is important. MATERIALS AND METHODS: Autopsy cases with CS were studied for fetal and placental abnormalities. RESULTS: Twenty-one cases were recruited: 12/21 with identifiable T. pallidum and 9/21 with positive serology and characteristics of CS. 20/21 (95%) demonstrated ≥1 fetal abnormalities. Chronic stress involution of thymus was most common. Hydrops and hepatosplenomegaly were found in >50%. Metaphyseal abnormalities and organ inflammation were found in <30%. Mucocutaneous lesions were lacking. Placental abnormalities were identified in 20/21 (95%). Placentomegaly was most common. Amniotic fluid infection (AFI) was noted in >50%. CONCLUSION: Common findings in CS at autopsy include chronic stress involution of thymus, hydrops, and hepatosplenomegaly. Mucocutaneous lesions are uncommon. Common placental findings in fetal deaths due to CS include placentomegaly and AFI.

Early Congenital Syphilis: Recognising Symptoms of an Increasingly Prevalent Disease.

BACKGROUND: Congenital syphilis (CS) is an infectious disease resulting from transplacental transmission of Treponema pallidum spirochetes from an infected mother to fetus during pregnancy. While uncommon, CS has shown an increased incidence in Canada and the United States since 2001 and 2012, respectively. CASE REPORT: We present the case of a 5-week-old female infant with blistering rash on the palms and soles. The infant displayed decreased movement of the left upper extremity, clinically consistent with Parrot pseudoparalysis. Cutaneous involvement was limited to few tan crusted papules on the palms and soles. Mother reported a "false-positive" result of rapid plasma reagin (RPR) testing at 31 weeks. Cerebrospinal fluid studies of the infant resulted with positive Venereal Disease Research Laboratory (VRDL) test and positive microhemagglutination assay (MHA-TP). Histopathology of a crusted papule revealed a lichenoid infiltrate composed of lymphocytes, histiocytes, and plasma cells. Immunohistochemical staining for T pallidum was negative. The patient completed treatment with a 10-day course of intravenous penicillin. DISCUSSION: While CS is largely considered a historic entity, it has been increasing in incidence in the United States since 2012 and in Canada since the early 2000s. Diagnosis of CS can be difficult as infants may be asymptomatic or present with nonspecific signs. This case highlights the presentation of minimal cutaneous involvement as well as skeletal involvement after birth. RPR testing may result in false negatives or indeterminate results, further complicating diagnosis. Given these difficulties in screening and the increasing incidence of CS, clinicians may need to refamiliarise themselves with its clinical findings.

Signos dentales de la sífilis congénita / Dental signs of congenital syphilis

La sífilis congénita es causada por una bacteria en forma de espiroqueta denominada Treponema pallidum; se transmite de la madre infectadaaal feto. Esta enfermedad causa distintas alteraciones sistémicas, dependiendoen qué fase de la sífilis se infecta el producto. El incremento de casos a nivel mundial hace necesario el estudio de su epidemiología y que se implementen programas de salud que atiendan a la población embarazada, con seguimiento por medio del control prenatal. Se estima que 1.5 por ciento de las mujeres embarazadas a nivel mundial la padecen. Las alteraciones dentales tienen su etiología en la infl amación provocada por la espiroqueta al momento de la amelogénesis; los signos dentales característicos de la sífi lis congénita son los incisivos de Hutchinson, molares de mora y, en menor medida, los caninos de Fournier. El propósito de este trabajo es hacer una revisión de la literatura, enfatizando en las características clínicas de la enfermedad que nos permitan realizar el diagnóstico de la sífilis congénita.

Congenital syphilis is caused by a spirochete bacterium called Treponema pallidum; it is transmitted from the infected mother to the fetus. This disease causes diff erent systemic alterations, dependingon which phase of syphilis the product is infected. The increase incases worldwide makes it necessary to study its epidemiology andto implement health programs that serve the pregnant population, with follow-up through prenatal control. It is estimated that 1.5% of pregnant women world wide suff er from it. Dental alterations have theiretiology in the infl ammation caused by the spirochete at the momentof amelogenesis; the characteristic dental signs of congenital syphilisare Hutchinson incisors, blackberry molars, and, to a lesser extent, Fournier’s canines. The purpose of this paper is to review the literature, emphasizing the clinical characteristics of the disease that may allowus to diagnose congenital syphilis.

[Necrotizing funisitis : Histopathological indicator of occult congenital syphilis]. / Nekrotisierende Funikulitis : Histopathologischer Indikator für eine okkulte konnatale Syphilis.

Congenital syphilis is a rare disease in central Europe. Placental changes may be non-specific but a typical finding is necrotizing funisitis of the umbilical cord. In a case report we describe how the histopathological incidental finding of B lymphocyte-rich, necrotizing funisitis led to the diagnosis of a previously unknown Treponema pallidum infection in parents and their newborn child. The pathological suspicion of congenital syphilis, although rare, has implications for the clinical management (serological evaluation of parents and child as well as the social environment, evaluation of viral coinfection and treatment decision) and is a notifiable disease.

Dental Stigmata of Congenital Syphilis: A Historic Review With Present Day Relevance.

Syphilis was the first sexually transmitted disease to be diagnosed in childhood. Most developed countries controlled syphilis effectively after the 1950s and congenital syphilis became rare. Since the late 1990s there has been a resurgence of syphilis in developed and developing countries and the WHO estimates that at least half a million infants die of congenital syphilis every year. The earliest reference to the dental manifestations of congenital syphilis was by Sir Jonathan Hutchinson, Assistant Surgeon at The London Hospital in 1861. Three main dental defects are described in congenital syphilis; Hutchinson's incisors, Moon's molars or bud molars, and Fournier's molars or mulberry molars. Although many physicians, dentists, and pathologists in developed countries will be aware of the dental features of syphilis, most will never have seen a case or made the diagnosis. The purpose of this article is to review some of the history of congenital syphilis, remind healthcare professionals of the features, and bring to their attention that the changes are still prevalent and that milder cases can be mistaken for other causes of hypoplasia.

Diagnosing congenital syphilis using Hutchinson's method: Differentiating between syphilitic, mercurial, and syphilitic-mercurial dental defects.

OBJECTIVES: This study focuses on the dental abnormalities observed by Sir Jonathan Hutchinson, Henry Moon and Alfred Fournier in patients with congenital syphilis and in those treated with mercury, in order to define alterations in dental morphology attributable to each of these causes. These definitions are applied to reported paleopathological cases, exploring various etiologies behind the defects, in order to aid in the diagnosis of congenital syphilis. METHODS: Original works were examined for descriptions of dental abnormalities in congenital syphilis and in mercurial treatments. These descriptions were compared with dentitions of paleopathological cases (n = 4) demonstrating abnormalities attributed to congenital syphilis. RESULTS: Distinct morphological differences were recognized between congenital syphilitic teeth and teeth affected by mercury. Mercury produces a pronounced deficiency in enamel of incisors, canines and first permanent molars that become rugged and pitted, and of dirty grey honeycombed appearance. Mercury-induced dental changes are evident in three out of four cases studied here. In one case, only syphilitic changes were present. DISCUSSION: Dental changes in congenital syphilis range from no visible signs to those beyond the classical models of Hutchinson, Moon and Fournier. Treatment of neonates and infants with mercury produces additional changes. Signs of disease and treatment with mercury on teeth may occur together; permanent incisors, first molars and canines, are typically affected, premolars and second/third molars are usually spared. Signs of treatment with mercury might be the only evidence of the occurrence of the disease as mercury was rarely used to treat other diseases.

A probable case of congenital syphilis from pre-Columbian Austria.

This study examines the skeletal remains of a subadult from an archeological site in Austria. Radiocarbon dating and archeological attribution indicate that this individual is of pre-Columbian origin. Most of the skeleton was recovered, and only the teeth and the orbital roofs show changes. Dental defects such as the mulberry molar and a tapered, fang-like canine suggest a diagnosis of congenital syphilis. This is the first probable case of congenital syphilis from pre-Columbian Central Europe. Our findings contribute to the pre-Columbian theory, offering counter evidence to the assumption that syphilis was carried from Columbus' crew from the New to the Old World.