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Koliou M, Chatzicharalampous E, Charalambous M, Aristeidou K. Congenital syphilis as the cause of multiple bone fractures in a young infant case report. BMC Pediatr 2022; 22:728. [PMID: 36539748 PMCID: PMC9768959 DOI: 10.1186/s12887-022-03789-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The differential diagnosis of multiple unexplained bone fractures in a young infant usually includes child abuse or bone disease such as osteogenesis imperfecta. Bone abnormalities can occur in 60-80% of cases with congenital syphilis and may be the sole manifestation. However, this frequent manifestation of this rare disease such as congenital syphilis is frequently disregarded. We describe a case of a young infant with multiple long bone fractures diagnosed with congenital syphilis. CASE PRESENTATION This 2-month-old male patient was referred to our hospital because of fractures of the ulna and distal radius bilaterally and noisy breathing with the suspicion of osteogenesis imperfecta. After thorough examination, the infant had anemia and a palpable spleen. We performed a screen for congenital infections among other investigations, which revealed positive non-treponemal and treponemal antibodies for syphilis. Hence the diagnosis for Congenital Syphilis was made. We performed a lumbar puncture (LP) which showed mild pleocytosis. The patient was treated with intravenous aqueous penicillin G 200 000 UI/KG per day for 10 days. In addition, a single dose of intramuscular penicillin G benzathine 50 000 UI/KG was given due to the abnormal result of CSF. On follow up admission 6 months later, the new syphilis serology had much improved and the new LP revealed no abnormal findings. CONCLUSIONS We present this case report in order to remind of a common manifestation of congenital syphilis, a rare disease which needs to be included in the differential diagnosis of multiple unexplained fractures in early infancy. In our case the fractures were symmetric and bilateral and they were accompanied by anemia and mild hepatosplenomegaly which led to the investigation of congenital syphilis as a possible cause. However, two thirds of infants with congenital syphilis are asymptomatic at birth. All women should have a proper syphilis screening during pregnancy.
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Affiliation(s)
- Maria Koliou
- grid.6603.30000000121167908Medical School, University of Cyprus, Palaios Dromos Lefkosias- Lemesou, 5 Agiou Symeon Street, Strovolos, Nicosia, 2037 Cyprus ,grid.416318.90000 0004 4684 9173Department of Paediatrics, Archbishop Makarios III Hospital, 6 Korytsas Str, 2012 Nicosia, Cyprus
| | - Elpida Chatzicharalampous
- grid.416318.90000 0004 4684 9173Department of Paediatrics, Archbishop Makarios III Hospital, 6 Korytsas Str, 2012 Nicosia, Cyprus
| | - Myria Charalambous
- grid.416318.90000 0004 4684 9173Department of Paediatrics, Archbishop Makarios III Hospital, 6 Korytsas Str, 2012 Nicosia, Cyprus
| | - Kyriakos Aristeidou
- grid.416318.90000 0004 4684 9173Department of Radiology, Archbishop Makarios III Hospital, 6 Korytsas Str, 2012 Nicosia, Cyprus
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Hariharan AR, Schindelar L, Nichols LRB, Kruse RW. A Metaphyseal Corner Fracture that Wasn't: A Case Report of Osteitis from Congenital Syphilis. JBJS Case Connect 2020; 10:e0557. [PMID: 32224647 DOI: 10.2106/jbjs.cc.19.00557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE Congenital syphilis (CS) is an infrequently seen condition in the United States; however, rates of CS have been on the rise. We present a case of an infant with a lesion of the radius that was initially diagnosed as a metaphyseal corner fracture and treated as such until maternal syphilis testing was noted to be positive. Ultimately, the child was diagnosed with CS. She is now undergoing treatment with penicillin and recovering well. CONCLUSION Although CS is rare, the incidence is on the rise and should remain on the differential of lytic lesions of bone in young children.
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Affiliation(s)
| | - Lili Schindelar
- Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware
| | | | - Richard W Kruse
- Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware
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Abstract
Syphilis, caused by Treponema pallidum, is transmitted both sexually and transplacentally. Untreated syphilis is a progressive disease that may result in death or disability in children and adults. Syphilis diagnosis requires 2-stage serologic testing for nontreponemal and treponemal antibodies. Congenital syphilis diagnosis requires careful review of maternal testing and treatment, comparison of maternal and neonatal nontreponemal antibody titers, and clinical evaluation of the neonate. In this review, we present the current epidemiology of syphilis, and the clinical manifestations, diagnosis, and management of syphilis as they relate to pediatric practice, specifically, congenital syphilis and acquired syphilis in adolescents and pregnant women.
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Affiliation(s)
- Sarah Heston
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Faculty Office Building, 49 North Dunlap Street, Room 293, Memphis, TN 38105, USA
| | - Sandra Arnold
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Faculty Office Building, 49 North Dunlap Street, Room 293, Memphis, TN 38105, USA.
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Neuberger I, Garcia J, Meyers ML, Feygin T, Bulas DI, Mirsky DM. Imaging of congenital central nervous system infections. Pediatr Radiol 2018; 48:513-523. [PMID: 29550865 DOI: 10.1007/s00247-018-4092-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/08/2018] [Accepted: 01/19/2018] [Indexed: 10/17/2022]
Abstract
Congenital central nervous system (CNS) infections are a cause of significant morbidity and mortality. The recent Zika virus outbreak raised awareness of congenital CNS infections. Imaging can be effective in diagnosing the presence and severity of infection. In this paper we review the clinical presentations and imaging characteristics of several common and less common congenital CNS infections.
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Affiliation(s)
- Ilana Neuberger
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Box B125, Aurora, CO, 80045, USA
| | - Jacquelyn Garcia
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Box B125, Aurora, CO, 80045, USA
| | - Mariana L Meyers
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Box B125, Aurora, CO, 80045, USA
| | - Tamara Feygin
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dorothy I Bulas
- Department of Radiology, Children's National Health System, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - David M Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Box B125, Aurora, CO, 80045, USA.
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Abstract
Congenital syphilis (CS) is a disease that continues to persist in the United States despite its preventable nature. Mother-to-child transmission of CS can be avoided with appropriate maternal diagnosis and treatment during the pregnancy. Diagnosing CS and determining the therapeutic course can be challenging. This review covers the recent guidelines for the diagnosis and treatment of CS and the various factors that affect management decisions. These factors include the mother's antenatal management, the infant's clinical presentation and results, laboratory and serologic testing, and more.
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Singh AE, Levett PN, Fonseca K, Jayaraman GC, Lee BE. Canadian Public Health Laboratory Network laboratory guidelines for congenital syphilis and syphilis screening in pregnant women in Canada. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2015; 26 Suppl A:23A-8A. [PMID: 25798162 PMCID: PMC4353984 DOI: 10.1155/2015/589085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Despite universal access to screening for syphilis in all pregnant women in Canada, cases of congenital syphilis have been reported in recent years in areas experiencing a resurgence of infectious syphilis in heterosexual partnerships. Antenatal screening in the first trimester continues to be important and should be repeated at 28 to 32 weeks and again at delivery in women at high risk of acquiring syphilis. The diagnosis of congenital syphilis is complex and is based on a combination of maternal history and clinical and laboratory criteria in both mother and infant. Serologic tests for syphilis remain important in the diagnosis of congenital syphilis and are complicated by the passive transfer of maternal antibodies which can affect the interpretation of reactive serologic tests in the infant. All infants born to mothers with reactive syphilis tests should have nontreponemal tests (NTT) and treponemal tests (TT) performed in parallel with the mother's tests. A fourfold or higher titre in the NTT in the infant at delivery is strongly suggestive of congenital infection but the absence of a fourfold or greater NTT titre does not exclude congenital infection. IgM tests for syphilis are not currently available in Canada and are not recommended due to poor performance. Other evaluation in the newborn infant may include long bone radiographs and cerebrospinal fluid tests but all suspect cases should be managed in conjunction with sexually transmitted infection and/or pediatric experts.
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Affiliation(s)
- Ameeta E Singh
- Division of Infectious Diseases, University of Alberta, Edmonton, Alberta
| | - Paul N Levett
- Saskatchewan Disease Control Laboratory, Regina, Saskatchewan
| | - Kevin Fonseca
- Alberta Provincial Laboratory for Public Health, Calgary, Alberta
| | - Gayatri C Jayaraman
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario
| | - Bonita E Lee
- Division of Pediatric Infectious Diseases, University of Alberta, Edmonton, Alberta
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Arnold SR, Ford-Jones EL. Congenital syphilis: A guide to diagnosis and management. Paediatr Child Health 2011; 5:463-9. [PMID: 20177559 DOI: 10.1093/pch/5.8.463] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although congenital syphilis is a rare disease in Canada, infected infants may experience severe sequelae, including cerebral palsy, hydrocephalus, sensorineural hearing loss and musculoskeletal deformity. Timely treatment of congenital syphilis during pregnancy may prevent all of the above sequelae. However, the diagnosis of suspected cases and management of congenital syphilis may be confusing, and the potential for severe disability is high when cases are missed. The present review provides assistance to practitioners in the diagnosis of suspected cases and management of children with presumed or confirmed infection.
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Affiliation(s)
- S R Arnold
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
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Krüger C, Malleyeck I. Congenital syphilis: still a serious, under-diagnosed threat for children in resource-poor countries. World J Pediatr 2010; 6:125-31. [PMID: 20490768 DOI: 10.1007/s12519-010-0028-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 10/08/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND With 700,000 to 1.5 million new cases annually, congenital syphilis remains a major infectious cause of morbidity and mortality in neonates, infants and children in resource-poor countries. We therefore analyzed the extent of congenital syphilis in the pediatric patient population at our rural hospital in Tanzania. METHODS For this retrospective analysis, from January 1, 1998 to August 31, 2000, all cases of congenital syphilis were collected from the medical records of the neonatal and pediatric department at Haydom Lutheran Hospital in rural northern Tanzania. Age, sex, weight, clinical signs and symptoms, venereal disease research laboratory (VDRL) results of mother and/or child, hemoglobin concentration, treatment, and outcome were recorded and analyzed. RESULTS Fourteen neonates and infants were included. The earlier the diagnosis, the more it rested on maternal data because the presentation of neonatal congenital syphilis resembled neonatal sepsis. Syphilitic skin lesions were only seen in the post-neonatal age group. VDRL results were positive in 11 of the 14 mothers, and in 4 of the infants. Anemia was common in older infants. No patient showed signs of central nervous system involvement. Two patients died, and the remaining were cured after standard treatment with procaine penicillin. CONCLUSIONS Highlighting the variable picture of congenital syphilis, this report demonstrates how difficult it is to make a correct diagnosis by solely history and clinical presentation in a resource-poor setting. Hence false-positive and false-negative diagnoses are common, and clinicians have to maintain a high index of suspicion in diagnosing congenital syphilis. Therefore, an important approach to control and finally eliminate congenital syphilis as a major public health problem will be universal on-site syphilis screening of all pregnant women at their first antenatal visit and immediate treatment for those who test positive.
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Affiliation(s)
- Carsten Krüger
- Department of Pediatrics, St. Franziskus Hospital, Ahlen, Germany.
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Abstract
Syphilis rates in women and congenital syphilis rates have declined steadily in the United States in recent years. However, syphilis remains a worldwide public health problem, with more than 12 million cases in adults and more than half a million pregnancies affected yearly. Prenatal screening and treatment programs are limited or nonexistent in many developing countries. The genome of Treponema pallidum, one of the smallest among prokaryotes, has been sequenced, but methods for continuous in vitro cultivation of the microbe remain elusive. There are no promising candidates for future vaccines at this time. Serologic testing, for both specific treponemal and nontreponemal antibodies, continues to be a primary means of diagnosis. Penicillin remains the drug of choice for congenital and acquired syphilis in childhood. The diagnosis of syphilis beyond early infancy raises concerns for possible child sexual abuse, although progression of congenital syphilis may account for some cases. Syphilis is a potentially eradicable disease, but this can be achieved only with sustained international will and cooperation to fund the necessary screening and treatment programs.
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Affiliation(s)
- Charles R Woods
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Alvares BR, Mezzacappa MAM, Poterio CB. Sífilis congênita simulando a síndrome da criança espancada: relato de caso. Radiol Bras 2002. [DOI: 10.1590/s0100-39842002000400015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As autoras descrevem os achados radiológicos dos ossos longos de um recém-nascido com diagnóstico confirmado de sífilis congênita, enfatizando o diagnóstico diferencial com a síndrome da criança espancada. É apresentada a evolução radiológica das lesões nos ossos longos, do nascimento até o quarto mês de vida. Os dados clínicos e laboratoriais do recém-nascido, as radiografias anteriores e os achados radiológicos característicos da doença de base foram essenciais para o diagnóstico desta doença.
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Affiliation(s)
- J Peihong
- Institute of Dermatology, Xinghua Hospital, Shanghai, China.
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Simmank KC, Pettifor JM. Unusual presentation of congenital syphilis. ANNALS OF TROPICAL PAEDIATRICS 2000; 20:105-7. [PMID: 10945059 DOI: 10.1080/02724936.2000.11748117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Congenital syphilis (CS) usually presents in the neonatal period and may involve any organ system. The signs are diverse and a high index of suspicion must be maintained to make the diagnosis. Early congenital syphilis can present at any time before 2 years of age, but a review of the literature over the last 30 years indicates that it usually presents in the neonatal period and seldom later than 3-4 months of life. We report an 8-month-old boy who presented an unusual combination of signs of congenital syphilis, which led to delay in establishing the diagnosis. This case emphasises the importance of maintaining a high index of suspicion for CS throughout early childhood.
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Affiliation(s)
- K C Simmank
- Department of Paediatrics, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
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