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1.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31537633

RESUMO

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.


Assuntos
Sífilis Congênita/diagnóstico , Antibacterianos/uso terapêutico , Maus-Tratos Infantis/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Fraturas Espontâneas/etiologia , Humanos , Fraturas do Úmero/etiologia , Lactente , Penicilina G/uso terapêutico , Periostite/microbiologia , Úlcera Cutânea/microbiologia , Sífilis Congênita/tratamento farmacológico , Transaminases/sangue
3.
Infect Dis Obstet Gynecol ; 2019: 2613962, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30894787

RESUMO

Objective: The aim of this retrospective review is to evaluate trends in the management of maternal and congenital syphilis (CS) in a tertiary care center in New Orleans, LA. Study Design: All cases of maternal and neonatal syphilis over a five year period at Touro Infirmary, New Orleans, LA, were identified using ICD-9/10 codes. Charts were reviewed for demographic and obstetrical variables, stage of syphilis at diagnosis, lab values, and treatment regimen. Newborn treatment and other outcomes were recorded. Results: During the study period 106 infected mother-baby pairs were identified. Of these, 73 charts are available for review. 41% (n = 30) of women received inadequate therapy according to their stage of disease. 9% of newborns (n = 6) were found to be symptomatic for CS; however, only 83.3% of these were admitted to the neonatal intensive care unit. Only 20% (n = 6) of infants were adequately treated with an extended penicillin regimen if the mother was not adequately treated. Furthermore, only 63.0% of newborns had a nontreponemal titer performed. Conclusion: With rising rates of CS, strict adherence to the 2015 CDC guidelines for treatment of syphilis must be maintained.


Assuntos
Antibacterianos/uso terapêutico , Penicilinas/uso terapêutico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Sífilis Congênita/tratamento farmacológico , Sífilis/tratamento farmacológico , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Nova Orleans/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Retrospectivos , Sífilis/epidemiologia , Sífilis Congênita/epidemiologia , Adulto Jovem
4.
Rev Bras Ginecol Obstet ; 41(2): 90-96, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30786305

RESUMO

OBJECTIVE: The present study assessed epidemiological and obstetrical data from pregnant women with syphilis at the Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (UFTM, in the Portuguese acronym), describing this disease during pregnancy and its vertical transmission for future healthcare actions. METHODS: Records from pregnant women who had been admitted to the Obstetrics Department of the Hospital de Clínicas of the UFTM and were diagnosed with syphilis between 2007 and 2016 were reviewed. A standardized form was used to collect epidemiological, obstetric data and outcomes of congenital infection. The present research has been authorized by the Ethics Committee of the institution. RESULTS: There were 268 women diagnosed with syphilis, with an average age of 23.6 years old. The majority of the patients were from Uberaba. Inadequate prenatal care was observed in 37.9% of the pregnant women. Only 34.2% of the patients completed the treatment according to the guidelines issued by the Ministry of Health of Brazil, and 19.8% of the partners of the patients underwent adequate syphilis treatment; 37 (13.8%) couples (patients and partners) underwent correct treatment. Regarding the obstetric outcomes, 4 (1.5%) patients had a miscarriage and 8 (3.4%) had fetal losses (from the fetal loss group, 7 had no adequate treatment); 61 (25.9%) patients had premature births - this prematurity has been significantly correlated to inadequate or incomplete treatment in 49 (27.9%) patients, compared with 12 (13.0%) patients with premature births and adequate treatment (p = 0.006). The average live newborn weight was 2,840 g; 25.3% had a birth weight < 2,500 g; 74.2% had congenital syphilis, a data with heavy correlation to inadequate or incomplete prenatal care, prematurity, and low birth weight. CONCLUSION: Public awareness policies on adequate prenatal care, intensification of serological screening, and early treatment of syphilis are needed, considering the rise of cases diagnosed during gestation and its potentially preventable deleterious consequences related to congenital transmission.


Assuntos
Complicações Infecciosas na Gravidez/epidemiologia , Sífilis/epidemiologia , Antibacterianos/administração & dosagem , Brasil/epidemiologia , Ceftriaxona/administração & dosagem , Esquema de Medicação , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Penicilina G Benzatina/administração & dosagem , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Diagnóstico Pré-Natal , Prognóstico , Estudos Retrospectivos , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sífilis Congênita/tratamento farmacológico , Sífilis Congênita/epidemiologia , Resultado do Tratamento , Adulto Jovem
5.
Cochrane Database Syst Rev ; 2: CD012071, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30776081

RESUMO

BACKGROUND: Congenital syphilis continues to be a substantial public health problem in many parts of the world. Since the first use of penicillin for the treatment of syphilis in 1943, which was a notable early success, it has remained the preferred and standard treatment including for congenital syphilis. However, the treatment of congenital syphilis is largely based on clinical experience and there is extremely limited evidence on the optimal dose or duration of administration of penicillin or the use of other antibiotics. OBJECTIVES: To assess the effectiveness and safety of antibiotic treatment for newborns with confirmed, highly probable and possible congenital syphilis. SEARCH METHODS: We searched the Cochrane STI Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, WHO ICTRP, ClinicalTrials.gov and Web of Science to 23 May 2018. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing antibiotic treatment (any concentration, frequency, duration and route) with no intervention or any other antibiotic treatment for neonates with confirmed, highly probable or possible congenital syphilis. DATA COLLECTION AND ANALYSIS: All review authors independently assessed trials for inclusion, extracted data and assessed the risk of bias in the included studies. We resolved any disagreements through consensus. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: Two RCTs (191 participants) met our inclusion criteria and none of these trials was funded by the industry. One trial (22 participants) compared benzathine penicillin with no intervention for infants with possible congenital syphilis. Low-quality evidence suggested that benzathine penicillin administration may not have decreased the rate of neonatal death due to any cause (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.06 to 11.70), and showed a possible reduction into the proportion of neonates with clinical manifestations of congenital syphilis (RR 0.12, 95% CI 0.01 to 2.09). Penicillin administration increased the serological cure at the third month (RR 2.13, 95% CI 1.06 to 4.27). These results should be taken with caution, because the trial was stopped early because there were four cases with clinical congenital syphilis in the no treatment group and none in the treatment group. Interim analysis suggested this difference was significant. This study did not report neonatal death due to congenital syphilis or the frequency of serious or minor adverse events after therapy. We downgraded the quality of evidence because of imprecision and risk of bias.One trial (169 participants) compared benzathine penicillin versus procaine benzylpenicillin. High- and moderate-quality evidence suggested that there were probably no differences between benzathine penicillin and procaine benzylpenicillin for the outcomes: absence of clinical manifestations of congenital syphilis (RR 1.00, 95% CI 0.97 to 1.03) and serological cure (RR 1.00, 95% CI 0.97 to 1.03). There were no cases of neonatal death due congenital syphilis; all 152 babies who followed up survived. This study did not report on the frequency of serious or minor adverse events after therapy. We downgraded the quality of evidence because of serious risk of bias. AUTHORS' CONCLUSIONS: At present, the evidence on the effectiveness and safety of antibiotic treatment for newborns with confirmed, highly probable or possible congenital syphilis is sparse, implying that we are uncertain about the estimated effect. One trial compared benzathine penicillin with no intervention for infants with possible congenital syphilis. Low-quality evidence suggested penicillin administration possibly reduce the proportion of neonates with clinical manifestations of congenital syphilis, penicillin administration increased the serological cure at the third month. These findings support the clinical use of penicillin in neonates with confirmed, highly probable or possible congenital syphilis. High- and moderate-quality evidence suggests that there are probably no differences between benzathine penicillin and procaine benzylpenicillin administration for the outcomes of absence of clinical manifestations of syphilis or serological cure.


Assuntos
Antibacterianos/uso terapêutico , Penicilina G Benzatina/uso terapêutico , Penicilina G Procaína/uso terapêutico , Sífilis Congênita/tratamento farmacológico , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Int J STD AIDS ; 30(1): 82-85, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30114994

RESUMO

Congenital syphilis is a prevalent infection in much of the world but rare in contexts where antenatal screening and treatment are available. In the UK in 2016, three cases of congenital syphilis were reported in babies born to women who were seronegative at the time of booking and hence a high degree of clinical vigilance is required in the unwell infant. We present the case of a seven-week-old baby girl with congenital syphilis with the unusual finding of discrete liver lesions. This baby was successfully treated with intravenous ceftriaxone.


Assuntos
Ossos da Extremidade Inferior/diagnóstico por imagem , Fígado/diagnóstico por imagem , Complicações Infecciosas na Gravidez/diagnóstico , Sífilis Congênita/diagnóstico , Treponema pallidum/isolamento & purificação , Administração Intravenosa , Administração Oral , Biópsia , Ceftriaxona/uso terapêutico , Feminino , Humanos , Recém-Nascido , Imagem por Ressonância Magnética , Penicilina V/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Sífilis Congênita/sangue , Sífilis Congênita/tratamento farmacológico , Resultado do Tratamento , Treponema pallidum/genética , Ultrassonografia
7.
Adv Neonatal Care ; 18(6): 446-450, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30499825

RESUMO

BACKGROUND: There is a global rise in maternal syphilis and infants born with congenital syphilis. CLINICAL FINDINGS: This case report presents a 32-week gestation premature male infant with initial clinical findings significant for respiratory failure as well as blueberry muffin spot rash and hepatosplenomegaly, which are consistent with congenital syphilis. PRIMARY DIAGNOSIS: This case study is unique in that the diagnosis of congenital neurosyphilis was demonstrated despite negative maternal serology because of the prozone phenomenon. This phenomenon refers to an overwhelming acute infection that interferes with testing by antibody flocculation or clumping of antibodies, causing a false-negative result and allows an infection such as syphilis to go undetected during pregnancy when Venereal Disease Research Laboratory test is performed. INTERVENTIONS: The infant received a 10-day course of aqueous penicillin G 150,000 U/kg every 8 hours per Centers for Disease Control and Prevention and Redbook recommendations for congenital neurosyphilis. OUTCOMES: The infant was discharged home on day of life 38 and was followed as an outpatient with serial rapid plasma reagin titers confirming adequate treatment of congenital neurosyphilis. He was also referred to the high-risk infant clinic to monitor for developmental milestones secondary to prematurity and central nervous system infection. PRACTICE RECOMMENDATIONS: Providers within the neonatal setting should consider early congenital syphilis testing on infants with similar clinical presentation regardless of negative maternal testing.


Assuntos
Reações Falso-Negativas , Neurossífilis/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Sorodiagnóstico da Sífilis , Sífilis Congênita/diagnóstico , Sífilis/diagnóstico , Vesícula/etiologia , Cardiolipinas/imunologia , Colesterol/imunologia , Exantema/etiologia , Feminino , Fêmur/diagnóstico por imagem , Hepatomegalia/etiologia , Humanos , Úmero/diagnóstico por imagem , Hipóxia/etiologia , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Neurossífilis/complicações , Neurossífilis/congênito , Neurossífilis/tratamento farmacológico , Fosfatidilcolinas/imunologia , Gravidez , Complicações Infecciosas na Gravidez/imunologia , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Insuficiência Respiratória/etiologia , Esplenomegalia/etiologia , Sífilis/imunologia , Sífilis Congênita/complicações , Sífilis Congênita/tratamento farmacológico , Tíbia/diagnóstico por imagem , Ulna/diagnóstico por imagem
8.
Adv Neonatal Care ; 18(6): 438-445, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30020089

RESUMO

BACKGROUND: Syphilis is caused by the spirochete bacterium Treponema pallidum. Syphilis left untreated, or inadequately treated during pregnancy, can result in congenital syphilis (CS). Congenital syphilis can lead to severe sequelae or fetal, neonatal, or infant death. PURPOSE: To discuss the epidemiological trends, pathophysiology, diagnosis, and management of CS; the implications of CS upon the infant; as well as the importance of the nurse's role in the prompt identification of CS and the timely interventions needed to minimize sequelae. METHODS: A literature search was completed using ProQuest, CINAHL, Google Scholar, and PubMed. Articles published within the past 10 years were included. FINDINGS: Epidemiological trends of CS in the United States indicate that maternal syphilis infection and CS are on the rise. Risk factors include ethnicity, socioeconomic status, access to prenatal care, and sexual behaviors, as well as compliance with prenatal syphilis screening by prenatal providers. Risks of CS to the developing fetus begin at approximately 14 weeks. Timely treatment is necessary to minimize or eliminate mortality and morbidity. IMPLICATIONS FOR PRACTICE: Evidence-based, interprofessional strategies, which promote a collaborative perinatal/neonatal preventative approach to care of the pregnant female, are indicated to reverse the increasing incidence of CS within the United States. Strategies prioritizing early identification and treatment of at-risk neonates are necessary to reduce/eliminate the devastating long-term consequences of CS upon this vulnerable population. IMPLICATIONS FOR RESEARCH: The paucity of research, which focuses on CS, is most likely due to ethical concerns related to infants as research participants and provides an opportunity for future research. Future research could focus on factors that focus on maternal-fetal/maternal-child transmission of CS.


Assuntos
Papel do Profissional de Enfermagem , Complicações Infecciosas na Gravidez/epidemiologia , Sífilis Congênita/epidemiologia , Antibacterianos/uso terapêutico , Diagnóstico Precoce , Intervenção Médica Precoce , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Penicilina G/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Diagnóstico Pré-Natal , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sífilis/epidemiologia , Sorodiagnóstico da Sífilis , Sífilis Congênita/diagnóstico , Sífilis Congênita/tratamento farmacológico , Estados Unidos/epidemiologia
10.
Sex Transm Dis ; 45(9S Suppl 1): S29-S37, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29624562

RESUMO

BACKGROUND: Congenital syphilis (CS)-the preventable transmission of Treponema pallidum from infected mother to fetus-remains a significant problem worldwide. METHODS: From July through November 2017, 239 articles relevant to CS prevention were identified via keyword searches in PubMed and Google Scholar, ancestry searches, and expert recommendation. Articles were then assessed for (1) measurement of a specified CS or adverse pregnancy outcomes (APOs) and (2) geographic setting in high/upper middle income countries according to United Nations criteria. In total, 119 articles met inclusion criteria. These were then vetted for 1 of 3 arms of CS prevention, after which additional ancestral searches were conducted within each arm to arrive at the final collection of articles per CS prevention strategy-maternal prenatal treatment (n = 33), prenatal screening (n = 24), and public health interventions that support screening and treatment (n = 15). RESULTS: Of the 7 studies that evaluated treatment with benzathine penicillin G (BPG) use within the context of a modern health care system, all showed BPG to be highly effective in CS prevention; 3 additional studies demonstrated BPG effectiveness in preventing APOs. Ten studies revealed early disease detection through prenatal screening significantly reduces CS and APOs when paired with BPG. There was limited literature evaluating public health interventions, such as partner notification, surveillance, and prenatal screening laws. CONCLUSIONS: Congenital syphilis is a preventable disease, effectively avoided with appropriate prenatal screening and BPG therapy. Increasing syphilis rates among all adults, accompanied by gaps in the provision of prenatal care to women at high risk of infection, are major contributors to CS persistence.


Assuntos
Antibacterianos/uso terapêutico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Penicilina G Benzatina/uso terapêutico , Complicações Infecciosas na Gravidez/prevenção & controle , Sífilis Congênita/prevenção & controle , Treponema pallidum/fisiologia , Diagnóstico Precoce , Feminino , Humanos , Programas de Rastreamento , Mães , Gravidez , Cuidado Pré-Natal , Diagnóstico Pré-Natal , Saúde Pública , Sífilis Congênita/tratamento farmacológico , Sífilis Congênita/transmissão
11.
Pediatr Dermatol ; 35(2): e110-e113, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29314211

RESUMO

Congenital syphilis is an infection transmitted from mother to fetus and can present with early but variable cutaneous manifestations. In rare situations, a bullous eruption known as pemphigus syphiliticus may develop. We present an unusual case of broad desquamation of the extremities in a newborn infant who was found to have congenital syphilis. Pemphigus syphiliticus should be considered in the differential diagnosis of neonatal bullous eruptions and erosions.


Assuntos
Pênfigo/etiologia , Sífilis Congênita/diagnóstico , Sífilis Cutânea/diagnóstico , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Humanos , Recém-Nascido , Pênfigo/diagnóstico , Penicilinas/uso terapêutico , Pele/patologia , Sífilis Congênita/tratamento farmacológico
12.
Sex Transm Infect ; 94(8): 562-564, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-28942420

RESUMO

OBJECTIVES: The objective of this retrospective study was to summarise the clinical manifestations of, and to analyse the incidence and risk factors of, Jarisch-Herxheimer reaction (JHR) during the treatment of children with symptomatic congenital syphilis. METHODS: Clinical data of 60 children with clinically and laboratory diagnosed congenital syphilis, hospitalised in Beijing Ditan Hospital between January 2010 and November 2015, were collected and analysed. RESULTS: A total of 11 patients with congenital syphilis (11/60, 18.3%) developed JHR. JHR occurred in 1-6 hour after the first dose of penicillin. Common clinical manifestations included fever (11/11, 100%), irritability (11/11, 100%), rapid pulse and breathing (11/11, 100%), exacerbation of existing rash (5/11, 45.6%) and chills (3/11, 27.3%). Of the 11 patients who developed JHR, 9 patients (9/11, 81.8%) had bone syphilis, 10 (10/11, 90.9%) had more than three organs affected by syphilis and 10 (10/11, 90.9%) had a high plasma concentration of rapid plasma reagin (RPR) (≥1:256); these percentages were significantly higher than in patients who had not developed JHR (p<0.05), suggesting that the occurrence of JHR was related to bone syphilis, having more than three organs affected by syphilis and a high plasma concentration of RPR. CONCLUSIONS: Clinicians should be familiar with the risk factors for this reaction and its common clinical manifestations.


Assuntos
Antibacterianos/efeitos adversos , Penicilinas/efeitos adversos , Sífilis Congênita/complicações , Antibacterianos/uso terapêutico , Pré-Escolar , Calafrios/induzido quimicamente , Feminino , Febre/induzido quimicamente , Humanos , Lactente , Recém-Nascido , Masculino , Penicilinas/uso terapêutico , Reaginas/sangue , Estudos Retrospectivos , Fatores de Risco , Sífilis Congênita/tratamento farmacológico
13.
J Cutan Med Surg ; 22(1): 97-99, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28821219

RESUMO

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.


Assuntos
Doenças do Recém-Nascido , Sífilis Congênita , Antibacterianos/uso terapêutico , Feminino , Pé/microbiologia , Pé/patologia , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/tratamento farmacológico , Doenças do Recém-Nascido/imunologia , Doenças do Recém-Nascido/patologia , Penicilinas/uso terapêutico , Sífilis Congênita/diagnóstico , Sífilis Congênita/tratamento farmacológico , Sífilis Congênita/imunologia , Sífilis Congênita/patologia , Treponema pallidum
15.
Pediatr Infect Dis J ; 37(6): 576-579, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29189610

RESUMO

BACKGROUND: There are minimal neurodevelopmental follow-up data for infants exposed to syphilis in utero. METHODS: This is an inception cohort study of infants exposed to syphilis in utero. We reviewed women with reactive syphilis serology in pregnancy or at delivery in Edmonton (Canada), 2002 through 2010 and describe the neurodevelopmental outcomes of children with and without congenital syphilis. RESULTS: There were 39 births to women with reactive syphilis serology, 9 of whom had late latent syphilis (n = 4), stillbirths (n = 2) or early neonatal deaths (n = 3), leaving 30 survivors of which 11 with and 7 without congenital syphilis had neurodevelopmental assessment. Those with congenital syphilis were all born to women with inadequate syphilis treatment before delivery. Neurodevelopmental impairment was documented in 3 of 11 (27%) infants with congenital syphilis and one of 7 (14%) without congenital syphilis with speech language delays in 4 of 11 (36%) with congenital syphilis and 3 of 7 (42%) without congenital syphilis. CONCLUSIONS: Infants born to mothers with reactive syphilis serology during pregnancy are at high risk for neurodevelopmental impairment, whether or not they have congenital syphilis, so should all be offered neurodevelopmental assessments and early referral for services as required.


Assuntos
Transtornos do Neurodesenvolvimento/etiologia , Complicações Infecciosas na Gravidez/microbiologia , Sífilis Congênita/complicações , Adolescente , Adulto , Antibacterianos/uso terapêutico , Canadá , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Mães , Transtornos do Neurodesenvolvimento/microbiologia , Parto , Gravidez , Fatores de Risco , Sorodiagnóstico da Sífilis , Sífilis Congênita/tratamento farmacológico , Sífilis Congênita/mortalidade , Treponema pallidum , Adulto Jovem
17.
Sex Transm Dis ; 44(8): 498-502, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28703731

RESUMO

BACKGROUND: From 2012 to 2014, rates of congenital syphilis increased in Louisiana and Florida. We evaluated the effectiveness of early (first or second) and third trimester syphilis screening for the prevention of congenital syphilis in these high-morbidity states. METHODS: Reported syphilis cases among pregnant women in Louisiana and Florida during January 1, 2013, to December 31, 2014, were reviewed for documented screening for syphilis in the first 2 trimesters and third trimester. Pregnant women with syphilis were linked to congenital syphilis records and stratified by whether the pregnancy led to a reported congenital syphilis case. RESULTS: Seven hundred ten pregnant women with syphilis in Louisiana and Florida were linked to 155 congenital syphilis cases. Three hundred seventy (52%) pregnant women with syphilis were staged as early syphilis (n = 270) or high-titer late or unknown duration-latent syphilis (n = 100), and 109 (70% of the total) were linked to congenital syphilis cases. Screening in the first 2 trimesters identified 513 pregnant women who tested positive for syphilis, and 470 (92%) potential congenital syphilis were averted. One hundred nine pregnant women tested positive for syphilis in the third trimester, and 85 (78%) had babies without congenital syphilis. During their pregnancy, 85 (12%) women tested negative at least once, and 55 (65%) had babies with congenital syphilis. Thirty-nine women had no reported syphilis screening 30 days or longer before delivery. CONCLUSIONS: Screening for syphilis both early and in the third trimester prevented many pregnant women with syphilis from having a baby with congenital syphilis. Preventing all congenital syphilis would likely require preventing all syphilis among women.


Assuntos
Diagnóstico Pré-Natal , Sífilis Congênita/prevenção & controle , Afro-Americanos , Grupo com Ancestrais do Continente Europeu , Feminino , Florida , Hispano-Americanos , Humanos , Louisiana , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Sífilis Congênita/diagnóstico , Sífilis Congênita/tratamento farmacológico , Sífilis Congênita/etnologia
18.
J Korean Med Sci ; 32(8): 1374-1376, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28665076

RESUMO

Syphilis infection has re-emerged after years of declining incidence. The prevalence of congenital syphilis (CS) has increased in Korea and other countries during the last few decades. Untreated infants develop symptoms such as rhinorrhea, anemia, jaundice, cutaneous lesions, hepatosplenomegaly, and pseudoparalysis within weeks or months. Significant renal disease is uncommon in CS, and clinical renal involvement varies from mild transient proteinuria to frank nephrosis. We report a 2-month-old infant with CS who presented with only nephrotic syndrome (NS). The previously healthy infant presented with NS and showed no other syphilitic manifestations. Remission of the NS was achieved with adequate penicillin treatment. No recurrence of proteinuria was observed during the 1 year of follow-up. Although rare, this long forgotten disease continues to affect pregnant women, resulting in prenatal or postnatal mortality. We still consider the possibility of syphilitic nephropathy and therefore serologic testing for congenital NS.


Assuntos
Síndrome Nefrótica/diagnóstico , Sífilis Congênita/diagnóstico , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Humanos , Lactente , Masculino , Síndrome Nefrótica/etiologia , Penicilinas/uso terapêutico , Proteinúria/etiologia , Sífilis Congênita/complicações , Sífilis Congênita/tratamento farmacológico
19.
J Perinatol ; 37(2): 116-121, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27711044

RESUMO

OBJECTIVE: To evaluate the maternal-fetal management and follow-up of infants at risk for congenital syphilis. STUDY DESIGN: Monocentric retrospective cohort study at the Félix Guyon Hospital, Saint-Denis, La Réunion between January 2008 and December 2014. Management of 38 pregnancies (35 women, 39 fetuses) with a positive syphilis serology was evaluated according to the Centers for Disease Control and Prevention (CDC) guidelines. RESULTS: A total of 68% (n=26) of pregnancies were screened before 16 weeks of gestation, and 26% (n=10) had appropriate treatment. Adverse outcomes were noted in 45% of pregnancies. Neonatal serology was not performed in 7 live-born neonates (19%) and 33 infants were classifiable according to the four CDC scenarios. In the infants, adequate complementary evaluation and appropriate treatment were noted in 42% (n=13) and 55% (n=17) of cases, respectively. Rate of infant follow-up was 76% (n=16). No treatment failure was observed in infants. CONCLUSION: Reinforcement of public health policies and a better sensitization, training and collaboration among perinatal caregivers are warranted given the gaps revealed in our study.


Assuntos
Penicilina G/uso terapêutico , Complicações Infecciosas na Gravidez/epidemiologia , Sífilis Congênita/diagnóstico , Sífilis Congênita/tratamento farmacológico , Adolescente , Adulto , Feminino , França , Humanos , Recém-Nascido , Masculino , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Sífilis Congênita/prevenção & controle , Resultado do Tratamento , Adulto Jovem
20.
MedicalExpress (São Paulo, Online) ; 3(6)Nov.-Dec. 2016. tab
Artigo em Inglês | LILACS | ID: biblio-841464

RESUMO

OBJECTIVE: Treponema pallidum is the etiological agent of congenital syphilis, which results from fetal contamination by the infected mothers, who were not treated or were inadequately treated during pregnancy. METHODS: An observational, prospective and longitudinal study, was performed (2010-2014), through the evaluation of 428 newborns during 18 months in a syphilis clinic from a Philanthropic Maternity Hospital in Aracaju, capital city of the Northeastern state of Sergipe, Brazil. The findings were statistically expressed as descriptive data and the statistical program used was SPSS (Statistical Package for Social Sciences). RESULTS AND CONCLUSIONS: The prevalence of congenital syphilis was 10.02/1,000 live births. A total of 120 (28%) of newborns did not attend the first appointment. During the observational period, at 18 months, the rate of abandonment was 75%. The average interval of healing of the newborns was 4.25 months. A high prevalence of congenital syphilis was found with low adhesion to the first consultation and monitoring period; 67.1% of newborns were treated with Crystalline Penicillin (Penicillin G) and only 3% of them required a repeat treatment.


OBJETIVO: A sífilis congênita tem como agente etiológico o Treponema pallidum e resulta da contaminação do feto pela gestante infectada sem tratamento ou com tratamento inadequado. MÉTODO: Foi realizado um estudo observacional, prospectivo, longitudinal, com a participação de 428 recém-nascidos que foram acompanhados durante 18 meses em um ambulatório de sífilis de uma Maternidade Filantrópica em Aracaju. Os achados foram estatisticamente expressos de maneira descritiva e o programa estatístico utilizado foi o SPSS. RESULTADOS E CONCLUSÕES: A prevalência de sífilis congênita para 1000 nascidos vivos foi de 10,02 casos. Não compareceram à primeira consulta 28,2% dos recém-nascidos. Durante o acompanhamento, aos 18 meses, o percentual de abandono foi de 75%. O intervalo médio de cura dos recém-nascidos foi de 4,25 meses. Foi encontrada uma alta prevalência de sífilis congênita com baixas adesões à primeira consulta e ao acompanhamento; 67,1% foram tratados com penicilina cristalina e apenas 3% necessitaram repetir o tratamento.


Assuntos
Humanos , Recém-Nascido , Penicilinas/uso terapêutico , Cuidado Pré-Natal/estatística & dados numéricos , Sífilis Congênita/tratamento farmacológico , Sífilis Congênita/transmissão , Sífilis Congênita/epidemiologia , Transmissão Vertical de Doença Infecciosa , Prevalência , Estudos Prospectivos , Estudos Longitudinais
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