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Moseley P, Bamford A, Eisen S, Lyall H, Kingston M, Thorne C, Piñera C, Rabie H, Prendergast AJ, Kadambari S. Resurgence of congenital syphilis: new strategies against an old foe. THE LANCET. INFECTIOUS DISEASES 2024; 24:e24-e35. [PMID: 37604180 DOI: 10.1016/s1473-3099(23)00314-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 08/23/2023]
Abstract
Congenital syphilis is a major global cause of fetal loss, stillbirth, neonatal death, and congenital infection. In 2020, the global rate of congenital syphilis was 425 cases per 100 000 livebirths-substantially higher than WHO's elimination target of 50 cases per 100 000 livebirths. Case rates are rising in many high-income countries, but remain low compared with those in low-income and middle-income settings. This Review aims to summarise the current epidemiology and knowledge on transmission and treatment of syphilis in pregnancy, and proposes measures to reduce the rising incidence seen worldwide. We also describe emerging diagnostic and treatment tools to prevent vertical transmission and improve management of congenital syphilis. Finally, we outline a programme of public health priorities, which include research, clinical, and preventive strategies.
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Affiliation(s)
- Philip Moseley
- University of Queensland Frazer Institute, University of Queensland, Brisbane, QLD, Australia
| | - Alasdair Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Sarah Eisen
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Claire Thorne
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Helena Rabie
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa; Tygerberg Academic Hospital, Cape Town, South Africa
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Blizard Institute, Queen Mary University of London, London, UK
| | - Seilesh Kadambari
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK.
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Eallonardo SJ, Freitag NE. Crossing the Barrier: A Comparative Study of Listeria monocytogenes and Treponema pallidum in Placental Invasion. Cells 2023; 13:88. [PMID: 38201292 PMCID: PMC10778170 DOI: 10.3390/cells13010088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/03/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Vertically transmitted infections are a significant cause of fetal morbidity and mortality during pregnancy and pose substantial risks to fetal development. These infections are primarily transmitted to the fetus through two routes: (1) direct invasion and crossing the placenta which separates maternal and fetal circulation, or (2) ascending the maternal genitourinary tact and entering the uterus. Only two bacterial species are commonly found to cross the placenta and infect the fetus: Listeria monocytogenes and Treponema pallidum subsp. pallidum. L. monocytogenes is a Gram-positive, foodborne pathogen found in soil that acutely infects a wide variety of mammalian species. T. pallidum is a sexually transmitted spirochete that causes a chronic infection exclusively in humans. We briefly review the pathogenesis of these two very distinct bacteria that have managed to overcome the placental barrier and the role placental immunity plays in resisting infection. Both organisms share characteristics which contribute to their transplacental transmission. These include the ability to disseminate broadly within the host, evade immune phagocytosis, and the need for a strong T cell response for their elimination.
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Affiliation(s)
- Samuel J. Eallonardo
- Department of Microbiology and Immunology, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Nancy E. Freitag
- Department of Microbiology and Immunology, University of Illinois Chicago, Chicago, IL 60612, USA;
- Department of Pharmaceutical Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
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Garcia LN, Morando N, Otero AV, Moroni S, Moscatelli GF, Gonzalez N, D Slojan A, Lascano F, Ballering G, Pando MA, Altcheh JM. Multilocus sequence typing of Treponema pallidum pallidum in children with acquired syphilis by nonsexual contact. Future Microbiol 2022; 17:1295-1305. [PMID: 36094429 DOI: 10.2217/fmb-2022-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: There are scarce data of Treponema pallidum subsp. pallidum (TPA) characterization in children with syphilis. Nonsexually acquired transmission (NSAT) of TPA is possible in infants through close contact. Methods: A descriptive study in five families with NSAT of syphilis was conducted. Polymerase chain reaction detection of TPA in pediatric index cases (n = 6) and their relatives (n = 44) were conducted followed by multilocus sequence typing (MLST). Results: TPA was detected in swab samples in 16 cases and 12 were characterized by MLST. Nichols lineage was identified in two of five families and SS14-lineage in three of five. In four families, MLST profiles linked index cases to relatives. Conclusion: This is the first report of TPA characterization in children infected by NSAT.
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Affiliation(s)
- Luciana N Garcia
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina.,Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET - GCBA, Buenos Aires, Argentina
| | - Nicolás Morando
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS) CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Adrián V Otero
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina
| | - Samanta Moroni
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina
| | - Guillermo F Moscatelli
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina.,Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET - GCBA, Buenos Aires, Argentina
| | - Nicolás Gonzalez
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina
| | - Alejandra D Slojan
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina
| | - Fernanda Lascano
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina.,Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET - GCBA, Buenos Aires, Argentina
| | - Griselda Ballering
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina
| | - Maria A Pando
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS) CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Jaime M Altcheh
- Servicio Parasitología-Chagas, Hospital de Niños Ricardo Gutierrez, Capital Federal, Buenos Aires, Argentina.,Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET - GCBA, Buenos Aires, Argentina
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David M, Hcini N, Mandelbrot L, Sibiude J, Picone O. Fetal and neonatal abnormalities due to congenital syphilis: a literature review. Prenat Diagn 2022; 42:643-655. [PMID: 35352829 DOI: 10.1002/pd.6135] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The recent recrudescence of syphilis among women of childbearing age is associated with an increasing number of cases of congenital syphilis. We aimed to summarize the fetal and neonatal abnormalities due to congenital syphilis infection, particularly signs amenable to prenatal diagnosis. METHODS Eligible studies were retrieved from the PubMed collection database. Articles focusing on postnatal and antenatal abnormalities covered the periods from 1969 to 2019 and 1975 to 2019, respectively. This review included cohort studies, case series and case reports reporting findings regarding congenital syphilis infections described before and/or after birth. Articles were reviewed by three experts in prenatal diagnosis, and all findings were classified as amenable or not amenable to prenatal diagnosis. RESULTS A total of 432 cases of congenital syphilis infection were reported. Abnormalities were described antenatally in 161 cases, postnatally in 319 cases, and in both the antenatal and postnatal periods in 57 cases. The most frequently reported signs amenable to prenatal diagnosis were abdominal abnormalities (hepatomegaly, splenomegaly, and bowel abnormalities), fetal growth restriction, and elevated middle cerebral artery peak systolic velocity in the context of ascites or atypical hydrops. Brain abnormalities were rare and never isolated. In the neonatal period, the most common abnormalities were hepatosplenomegaly, bone damage and skin lesions. CONCLUSION We found that no individual sonographic sign or pattern of signs is pathognomonic for fetal syphilis. In fetuses with ultrasound abnormalities suggestive of congenital infection, syphilis must be considered as part of the work-up. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marion David
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes Cedex, France
| | - Najeh Hcini
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, French Guyana. CIC Inserm 1424 et DFR Santé Université Guyane, ST Laurent du Maroni, France
| | - Laurent Mandelbrot
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes Cedex, France
- Université de Paris, Paris, France
- Inserm IAME-U1137, Paris, France
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- FHU Prema, Paris, France
| | - Jeanne Sibiude
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes Cedex, France
- Université de Paris, Paris, France
- Inserm IAME-U1137, Paris, France
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- FHU Prema, Paris, France
| | - Olivier Picone
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes Cedex, France
- Université de Paris, Paris, France
- Inserm IAME-U1137, Paris, France
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- FHU Prema, Paris, France
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Moraes BQSD, Feitosa ADO, Wanderley RA, Machado MF. Trend analysis of clinical aspects of congenital syphilis in Brazil, 2009-2018. Rev Assoc Med Bras (1992) 2021; 67:991-996. [PMID: 34817512 DOI: 10.1590/1806-9282.20210432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Congenital syphilis is caused by the vertical transmission of bacteria, Treponema pallidum, from nontreated or inappropriately treated pregnant to the fetus. OBJECTIVE To evaluate the clinical aspects of Congenital syphilis in Brazil, between 2009-2018. METHOD It is an analytical cross-sectional study whose data were collected from the Department of Chronical Conditions and Sexually Transmitted Infections of Brazilian Health Ministry. Clinical variables were analyzed using the software Joinpoint Regression, which makes a segmented linear regression. RESULTS In the study period, 156,969 cases of Congenital syphilis and 1642 deaths by this disease were reported. The trend analysis indicates growing in diagnosis of maternal syphilis during prenatal care, appropriate treatment of pregnant, realization of prenatal care, maternal partner treatment, diagnosis of syphilis in children under seven days, and diagnosis of recent syphilis. CONCLUSIONS Although the trend analysis presents relative improvement in Congenital syphilis panorama in Brazil, the disease still related to high numbers of evitable perinatal morbidity and mortality. Therefore, the prenatal assistance with quality is fundamental to have a possible change in this field in the country.
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Affiliation(s)
| | - Alexya de Oliveira Feitosa
- Universidade Federal de Alagoas, Nucleus of Studies in Social and Preventive Medicine - Arapiraca (AL), Brazil
| | | | - Michael Ferreira Machado
- Universidade Federal de Alagoas, Nucleus of Studies in Social and Preventive Medicine - Arapiraca (AL), Brazil
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Etienne A, Devos S, Thore E, Ndeikoudam Ngrango N, Manaquin R, Koumar Y, Balloy L, Rodet R, Yemadje‐Menudier L, Bertolotti A. Increase in early syphilis diagnoses in the young heterosexual population of Reunion Island: surveillance data, 2010–2018. J Eur Acad Dermatol Venereol 2021; 35:e573-e575. [DOI: 10.1111/jdv.17294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- A. Etienne
- Santé Publique France – La Réunion Saint Denis, La Réunion France
| | - S. Devos
- Santé Publique France – La Réunion Saint Denis, La Réunion France
| | - E. Thore
- CH Ouest Réunion Centre de dépistage Ouest Saint Paul, La Réunion France
| | | | - R. Manaquin
- CHU Réunion Service des Maladies Infectieuses – Dermatologie – Médecine interne Saint Pierre, La Réunion France
| | - Y. Koumar
- CHU Réunion Service des Maladies Infectieuses – Dermatologie – Médecine interne Saint Pierre, La Réunion France
| | - L. Balloy
- CHU Réunion Service des Maladies Infectieuses Saint Denis, La Réunion France
| | - R. Rodet
- CHU Réunion Service des Maladies Infectieuses Saint Denis, La Réunion France
| | | | - A. Bertolotti
- CHU Réunion Service des Maladies Infectieuses – Dermatologie – Médecine interne Saint Pierre, La Réunion France
- Inserm CIC1410 CHU Réunion Saint Pierre, La Réunion France
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