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Araujo ACB, de Souza OF, Kersanach BB, Mozzer JSC, Feitosa VL, Brandão VA, de Alencar FEC, Oliveira NS, da Silva AVB, de Abreu LC. Trends in Congenital Syphilis Incidence and Mortality in Brazil's Southeast Region: A Time-Series Analysis (2008-2022). EPIDEMIOLOGIA 2025; 6:22. [PMID: 40407563 PMCID: PMC12101142 DOI: 10.3390/epidemiologia6020022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2025] [Revised: 04/24/2025] [Accepted: 04/29/2025] [Indexed: 05/26/2025] Open
Abstract
Congenital syphilis (CS) is an important infectious cause of miscarriage, stillbirth, and neonatal morbidity and mortality. Despite the advances in diagnosis and treatment, CS continues to challenge health systems with increasing incidence and mortality rates in recent years worldwide. Given this, the present study aims to comparatively analyze the temporal trends in CS incidence and mortality in Brazil's Southeast Region from 2008 to 2022. This is an ecological time-series study using secondary data on congenital syphilis from the states of Espírito Santo, Minas Gerais, Rio de Janeiro, and São Paulo. The data was extracted from the Brazilian Health System Informatics Department. Incidence and mortality rates were calculated per 100,000 live births. Joinpoint regression models were employed to identify trends in annual percentage change and average annual percentage change with 95% confidence intervals. The temporal trend of CS incidence in Brazil's Southeast Region increased 12.8% between 2008 and 2022. Minas Gerais, São Paulo, Espírito Santo, and Rio de Janeiro showed increasing temporal trends of 21.4%, 14.1%, 14.0%, and 10.9%, respectively. The temporal trend of CS mortality in Brazil's Southeast Region rose 11.9% between 2008 and 2022. Minas Gerais, São Paulo, and Rio de Janeiro exhibited increasing mortality temporal trends of 21.9%, 20.8%, and 10.1%, respectively. In contrast, Espírito Santo showed reduced mortality, with no deaths in 2021 and 2022. The temporal trend of CS incidence increased in all states of Brazil's Southeast Region between 2008 and 2022, highlighting the need to reassess control measures. The temporal trend of CS mortality also increased during the same period, except in Espírito Santo. Considering that CS is preventable with adequate prenatal care and low-cost measures, these findings can serve as instruments to support strengthening public health policies.
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Affiliation(s)
- Alexandre Castelo Branco Araujo
- Study Design and Scientific Writing Laboratory, Health Sciences Center, Federal University of Espírito Santo, Vitoria CEP29043-900, Brazil;
| | | | - Betina Bolina Kersanach
- Health Sciences Center, Federal University of Espírito Santo, Vitoria CEP29043-900, Brazil; (B.B.K.); (J.S.C.M.); (V.L.F.); (V.A.B.); (F.E.C.d.A.); (N.S.O.); (A.V.B.d.S.)
| | - Julia Silva Cesar Mozzer
- Health Sciences Center, Federal University of Espírito Santo, Vitoria CEP29043-900, Brazil; (B.B.K.); (J.S.C.M.); (V.L.F.); (V.A.B.); (F.E.C.d.A.); (N.S.O.); (A.V.B.d.S.)
| | - Victor Lopes Feitosa
- Health Sciences Center, Federal University of Espírito Santo, Vitoria CEP29043-900, Brazil; (B.B.K.); (J.S.C.M.); (V.L.F.); (V.A.B.); (F.E.C.d.A.); (N.S.O.); (A.V.B.d.S.)
| | - Vinicius Andreata Brandão
- Health Sciences Center, Federal University of Espírito Santo, Vitoria CEP29043-900, Brazil; (B.B.K.); (J.S.C.M.); (V.L.F.); (V.A.B.); (F.E.C.d.A.); (N.S.O.); (A.V.B.d.S.)
| | - Filomena Euridice Carvalho de Alencar
- Health Sciences Center, Federal University of Espírito Santo, Vitoria CEP29043-900, Brazil; (B.B.K.); (J.S.C.M.); (V.L.F.); (V.A.B.); (F.E.C.d.A.); (N.S.O.); (A.V.B.d.S.)
| | - Norma Suely Oliveira
- Health Sciences Center, Federal University of Espírito Santo, Vitoria CEP29043-900, Brazil; (B.B.K.); (J.S.C.M.); (V.L.F.); (V.A.B.); (F.E.C.d.A.); (N.S.O.); (A.V.B.d.S.)
| | - Andrea Vasconcellos Batista da Silva
- Health Sciences Center, Federal University of Espírito Santo, Vitoria CEP29043-900, Brazil; (B.B.K.); (J.S.C.M.); (V.L.F.); (V.A.B.); (F.E.C.d.A.); (N.S.O.); (A.V.B.d.S.)
| | - Luiz Carlos de Abreu
- Study Design and Scientific Writing Laboratory, Health Sciences Center, Federal University of Espírito Santo, Vitoria CEP29043-900, Brazil;
- Postgraduate Program in Medical Sciences, University of São Paulo, São Paulo CEP01246-903, Brazil
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Feng S, Zhu Q, Ren M, Miao G, Zhang G. A case of acquired syphilis in an infant through mouth-to-mouth transmission of prechewed food. Int J STD AIDS 2025; 36:334-336. [PMID: 39777408 DOI: 10.1177/09564624241312950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
BACKGROUND Patients with syphilis are the only source of infection, which can be transmitted through sexual contact and mother-to-child and blood transmission, and rarely through contaminants. The clinical manifestations of syphilis are complex and variable, and can be easily misdiagnosed. This article reports a case of syphilis in a child with "psoriasis"-like lesions who was fed pre-chewed food. CASE PRESENTATION An 18-month-old girl presented with mung bean to peanut-sized erythema and papules scattered on both lower limbs and perianal area; some of the erythema was covered with scales, with clear boundaries and no fusion. The case was misdiagnosed as "psoriasis" in the local hospital until the child and her mother tested positive for syphilis in the outpatient clinic of our hospital. The girl's mother had a habit of chewing food in her mouth before feeding it to her child. CONCLUSIONS Consumption of food chewed by a person with syphilis can lead to infection, and attention should be paid to the possible ways and means of being infected.
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Affiliation(s)
- Sen Feng
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
- Subcenter of National Clinical Research Center for Skin and Immune Diseases, Shijiazhuang, Hebei Province, China
- Hebei Provincial Innovation Center of Dermatology and Medical Cosmetology Technology, Shijiazhuang, China
| | - Qing Zhu
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
- Subcenter of National Clinical Research Center for Skin and Immune Diseases, Shijiazhuang, Hebei Province, China
- Hebei Provincial Innovation Center of Dermatology and Medical Cosmetology Technology, Shijiazhuang, China
| | - Mingyuan Ren
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
- Subcenter of National Clinical Research Center for Skin and Immune Diseases, Shijiazhuang, Hebei Province, China
- Hebei Provincial Innovation Center of Dermatology and Medical Cosmetology Technology, Shijiazhuang, China
| | - Guoying Miao
- Department of Dermatology, Affiliated Hospital of Hebei University of Engineering, Handan, China
| | - Guoqiang Zhang
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
- Subcenter of National Clinical Research Center for Skin and Immune Diseases, Shijiazhuang, Hebei Province, China
- Hebei Provincial Innovation Center of Dermatology and Medical Cosmetology Technology, Shijiazhuang, China
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Ge J, Trinh K, Peters SM. White ventral-lateral tongue lesions in a 58-year-old man. J Am Dent Assoc 2025:S0002-8177(25)00054-6. [PMID: 40019410 DOI: 10.1016/j.adaj.2025.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 12/10/2024] [Accepted: 01/23/2025] [Indexed: 03/01/2025]
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Fanella S, Bitnun A, Barton M, Sauvé L. Diagnosis and management of congenital syphilis: Avoiding missed opportunities. Paediatr Child Health 2024; 29:463-479. [PMID: 39677391 PMCID: PMC11638085 DOI: 10.1093/pch/pxae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/01/2023] [Indexed: 12/17/2024] Open
Abstract
Congenital syphilis can result in pregnancy loss and substantial morbidity in newborns. The current epidemic of congenital syphilis in Canada (especially Western Canada) is a preventable public health emergency. Rates indicate a lack of control of syphilis within the community and insufficient public health resources to prevent spread that predate the COVID-19 pandemic. Risk factors include lack of prenatal care, methamphetamine and other substance use, and unstable housing. The cornerstone of prevention is identification, treatment, and follow-up during pregnancy, including of partners. Clinicians caring for newborns need to consider aspects of maternal treatment, reinfection risk, the results of paired maternal and infant syphilis serology, and infant clinical assessment. A complete risk assessment will guide effective management and follow-up of infants exposed in utero to syphilis.
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Affiliation(s)
- Sergio Fanella
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Ari Bitnun
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Michelle Barton
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
| | - Laura Sauvé
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario, Canada
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Fanella S, Bitnun A, Barton M, Sauvé L. Le diagnostic et la prise en charge de la syphilis congénitale : ne laisser passer aucune occasion. Paediatr Child Health 2024; 29:463-479. [PMID: 39677392 PMCID: PMC11638101 DOI: 10.1093/pch/pxae040] [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: 12/17/2024] Open
Abstract
La syphilis congénitale peut provoquer un arrêt de grossesse et une morbidité importante chez les nouveau-nés. L'épidémie actuelle de syphilis congénitale au Canada (particulièrement dans l'Ouest canadien) est une urgence sanitaire évitable. Les taux font foi d'un manque de contrôle de la syphilis dans la communauté et d'un manque de ressources de santé publique pour éviter une propagation qui s'est amorcée avant la pandémie de COVID-19. Les facteurs de risque incluent l'absence de soins prénatals, l'utilisation de méthamphétamines et d'autres substances psychoactives et l'instabilité du logement. Le dépistage, le traitement et le suivi pendant la grossesse, y compris chez les partenaires, constituent la pierre angulaire de la prévention. Les cliniciens qui s'occupent de nouveau-nés ont besoin d'examiner les aspects du traitement de la mère, le risque de réinfection, les résultats de la sérologie appariée de la syphilis chez la mère et le nouveau-né, de même que l'évaluation clinique du nouveau-né. Une évaluation complète du risque orientera la prise en charge et le suivi efficaces des nouveau-nés exposés à la syphilis in utero.
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Affiliation(s)
- Sergio Fanella
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)
| | - Ari Bitnun
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)
| | - Michelle Barton
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)
| | - Laura Sauvé
- Société canadienne de pédiatrie, comité des maladies infectieuses et d'immunisation, Ottawa (Ontario)
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Guo W, Zhang Z. A case of early-onset congenital syphilitic osteomyelitis of the calcaneus and literature review. BMC Pediatr 2024; 24:639. [PMID: 39385133 PMCID: PMC11462753 DOI: 10.1186/s12887-024-05105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 09/24/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND Congenital syphilis (CS) is a sexually transmitted disease caused by Treponema pallidum (TP). When the skeletal system is involved, it often results in multiple, symmetrical bone destruction at the epiphyses of long tubular bones such as the humerus and radius, rarely involving the calcaneus. This article reports a case of calcaneal osteomyelitis caused by TP in a child with no other bone damage and subtle clinical manifestations, No similar cases have been reported. CASE PRESENTATION A 4-month-old male infant presented with right foot swelling without any obvious cause and no history of trauma. X-ray and CT scans showed bone loss in the calcaneus and surrounding soft tissue swelling. Review of past medical records revealed that the infant had been diagnosed with CS infection during a hospital stay for "pneumonia" at one month old. The parents refused surgery, opting for conservative treatment at an external hospital for three weeks, during which the symptoms of the affected foot showed no significant improvement. Subsequently, the child was treated at our hospital with surgery, including lesion removal and cast fixation, followed by oral antibiotic treatment. The last follow-up showed no swelling or tenderness in the affected foot, with good mobility, and X-rays indicated that the bone had essentially returned to normal. CONCLUSIONS Early CS rarely involves the calcaneus. When diagnosing unexplained calcaneal osteomyelitis in infants, this rare cause should be considered. A thorough medical history should be taken and a careful physical examination conducted. Once diagnosed, timely surgical debridement and appropriate antibiotic therapy targeting TP infection are required. Early identification and intervention can result in a good prognosis without related complications.
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Affiliation(s)
- Wang Guo
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Zhiqun Zhang
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
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Yu W, You X, Luo W. Global, regional, and national burden of syphilis, 1990-2021 and predictions by Bayesian age-period-cohort analysis: a systematic analysis for the global burden of disease study 2021. Front Med (Lausanne) 2024; 11:1448841. [PMID: 39211337 PMCID: PMC11357943 DOI: 10.3389/fmed.2024.1448841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Objective To comprehensively assess the global burden of syphilis and related risk factors over 1990-2021, forecast future disease trends, and understand the impact of syphilis on global health. Methods Global Burden of Disease Study 2021 (GBD 2021) data were used for age-, sex-, and region-stratified analysis of the numbers and age-standardized rates (per 100,000 population) of syphilis incidence, prevalence, deaths, and disability-adjusted life years (DALYs). Next, a differential analysis of syphilis risk factors was performed. Finally, trends for years after 2021 were predicted using Bayesian age-period-cohort (BAPC) prediction models. Results In 2021, the total number of syphilis prevalence globally was 70,541,482.80 (95% uncertainty interval: 54,910,897.66-88,207,651.97), with the highest numbers noted in Central Sub-Saharan Africa [4,622.60 (95% uncertainty interval: 3,591.97-5,753.45)]. Over 1990-2021, the global age-standardized prevalence and incidence rates increased, whereas the age-standardized death and DALY rates decreased. Among all groups, infants aged <5 years demonstrated the highest age-standardized DALY rates. Moreover, the lower the sociodemographic index (SDI), the higher was the age-standardized rate. The primary factor contributing to syphilis disease burden was identified to be unsafe sex. BAPC analysis revealed an overall increase in age-standardized prevalence rate in the <5-year age group over 1990-2035, and the highest age-standardized prevalence rate occurred in the 25-34-year age group. Conclusion Between 1990 and 2021, syphilis occurrence and prevalence increased consistently. Projections indicated a continual increase in syphilis incidence in children aged <5 years, and age-standardized prevalence rates were the highest in adults aged 25-34 years. Our results regarding the epidemiological trends of syphilis and its variations across regions, age groups, and sexes may aid policymakers in addressing the global impact of the disease effectively.
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Affiliation(s)
| | | | - Wei Luo
- Department of Clinical Laboratory, Qingdao Municipal Hospital, Qingdao, China
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Costa IB, Pimenta IDSF, Aiquoc KM, Oliveira ÂGRDC. Congenital syphilis, syphilis in pregnancy and prenatal care in Brazil: An ecological study. PLoS One 2024; 19:e0306120. [PMID: 38917233 PMCID: PMC11198837 DOI: 10.1371/journal.pone.0306120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/11/2024] [Indexed: 06/27/2024] Open
Abstract
The aim of this research was to evaluate the incidence of congenital syphilis and the ratio between congenital syphilis and syphilis in pregnant women in Brazil according to socioeconomic indicators (inadequate water supply and sanitation; illiteracy at 15 years of age or older; household income per capita; proportion of poor people; Gini index; human development index; and average health expenditure per inhabitant by the health system) and prenatal quality-of-care indicators. We conducted an ecological study using a sample composed of 257 municipalities, each with ≥ 100,000 inhabitants. Data was collected from four public databases: the Brazilian Institute of Geography and Statistics, comprising socioeconomical data from the 2010 census; and the data of 2019 available in the databases of the Department of Informatics of the Brazilian Health System, Information and Management of Primary Care, and the Electronic Citizen Information System. Descriptive analysis of dependent and independent variables and bivariate analysis by Negative Binomial regression were carried out. The mean incidence of congenital syphilis was 38% higher in municipalities with a Human Development Index up to 0.785 (ratio of means [RM] = 1.38; p = 0.049) and 57% higher among populations where less than 50% of primary healthcare services provided a rapid test for syphilis (RM = 1.57; p < 0.001). The ratio between congenital syphilis and syphilis in pregnant women was 29% higher in municipalities with a low household income per capita (RM = 1.29; p < 0.001) and 28% higher in locations where less than 50% of the primary healthcare services provided a rapid test for syphilis (RM = 1.28; p < 0.001). There was no statistical significance of the quality of prenatal care compared to the outcomes. This result underscores the challenges in detecting syphilis infections among pregnant women during prenatal care, consequently increasing the risk of vertical transmission of the disease to the fetus. Traits of inequality in the occurrence of congenital syphilis also draw attention to strategies to reduce health inequities and improve prenatal care.
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Affiliation(s)
- Izabelle Bezerra Costa
- Post-Graduation Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Kezauyn Miranda Aiquoc
- Post-Graduation Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ângelo Giuseppe Roncalli da Costa Oliveira
- Post-Graduation Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Odontology, Federal University of Rio Grande do Norte, Natal, Brazil
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Salomè S, Cambriglia MD, Montesano G, Capasso L, Raimondi F. Congenital Syphilis: A Re-Emerging but Preventable Infection. Pathogens 2024; 13:481. [PMID: 38921779 PMCID: PMC11206692 DOI: 10.3390/pathogens13060481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
Congenital syphilis presents a significant global burden, contributing to fetal loss, stillbirth, neonatal mortality, and congenital infection. Despite the target established in 2007 by the World Health Organization (WHO) of fewer than 50 cases per 100,000 live births, the global incidence is on the rise, particularly in low- and middle-income regions. Recent data indicate a rate of 473 cases per 100,000 live births, resulting in 661,000 total cases of congenital syphilis, including 355,000 adverse birth outcomes such as early fetal deaths, stillbirths, neonatal deaths, preterm or low-birth-weight births, and infants with clinical congenital syphilis. Alarmingly, only 6% of these adverse outcomes occurred in mothers who were enrolled, screened, and treated. Unlike many neonatal infections, congenital syphilis is preventable through effective antenatal screening and treatment of infected pregnant women. However, despite available screening tools, affordable treatment options, and the integration of prevention programs into antenatal care in various countries, congenital syphilis remains a pressing public health concern worldwide. This review aims to summarize the current epidemiology, transmission, and treatment of syphilis in pregnancy, as well as to explore global efforts to reduce vertical transmission and address the reasons for falling short of the WHO elimination target.
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Affiliation(s)
- Serena Salomè
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (M.D.C.); (G.M.); (L.C.); (F.R.)
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Muzi G, Ferrara D, Mamone R, D'Auria D, Ranucci G, Quitadamo P, Zeccolini M, Parisi P, Esposito F. Ultrasound findings in early congenital syphilis: Two case reports and literature review. Radiol Case Rep 2024; 19:1859-1865. [PMID: 38425775 PMCID: PMC10901694 DOI: 10.1016/j.radcr.2024.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 03/02/2024] Open
Abstract
Syphilis is caused by treponema pallidum. If untreated, or inadequately treated, during pregnancy, it can result in congenital syphilis (CS), which is classified as early and late. Early CS displays before 2 years of age. We herein describe 2 cases of early CS, whose clinical onset included liver failure, edema, organomegaly, and respiratory distress. We focus on liver, intestinal, and brain ultrasound (US) and other peculiar radiological findings. To date, there are no scientific data on intestinal and brain US findings in patients with early CS whereas data on abdominal US are scarce. Increasing knowledge about US findings in early CS could be useful to improve the diagnostic and therapeutic approach to these patients.
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Affiliation(s)
- Giulia Muzi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Dolores Ferrara
- U.O. Radiology, “A.O.R.N. Santobono-Pausilipon” Children's Hospital, Naples, Italy
| | - Rosanna Mamone
- U.O. Radiology, “A.O.R.N. Santobono-Pausilipon” Children's Hospital, Naples, Italy
| | - Divina D'Auria
- Department of Advanced Biomedical Sciences, “Università degli Studi di Napoli Federico II”, Naples, Italy
| | - Giusy Ranucci
- Department of Pediatrics, AORN Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Paolo Quitadamo
- Pediatric Gastroenterology and Hepatology Unit, Santobono-Pausilipon, Children's Hospital, Naples, Italy
| | - Massimo Zeccolini
- U.O. Radiology, “A.O.R.N. Santobono-Pausilipon” Children's Hospital, Naples, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Esposito
- UOSD Diagnostica per Immagini in Emergenza Urgenza, “AORN Santobono-Pausilipon”, Children Hospital, Naples, Italy
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Ngathaweesuk Y, Hendrikse J, Groot-Mijnes JDFD, de Boer JH, Hettinga YM. Causes of infectious pediatric uveitis: A review. Surv Ophthalmol 2024; 69:483-494. [PMID: 38182040 DOI: 10.1016/j.survophthal.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/11/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
Infectious pediatric uveitis is a rare disease that can cause severe ocular damage if not detected rapidly and treated properly. Additionally, early identification of an infection can protect the child from life-threatening systemic infection. Infectious uveitis can be congenital or acquired and may manifest as a primary ocular infection or as a reactivation. Nevertheless, publications on infectious paediatric uveitis are usually limited to a small number of patients or a case report. So far, most studies on uveitis in children have focused primarily on noninfectious uveitis, and a systematic study on infectious uveitis is lacking. In this review, we summarize the literature on infectious uveitis in pediatric populations and report on the epidemiology, pathophysiology, clinical signs, diagnostic tests, and treatment. We will describe the different possible pathogens causing uveitis in childhood by microbiological group (i.e. parasites, viruses, bacteria, and fungi). We aim to contribute to early diagnosis and management of infectious pediatric uveitis, which in turn might improve not only visual outcome, but also the general health outcome.
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Affiliation(s)
- Yaninsiri Ngathaweesuk
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Jytte Hendrikse
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - Jolanda Dorothea Francisca de Groot-Mijnes
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joke Helena de Boer
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands
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Fortin O, DeBiasi RL, Mulkey SB. Congenital infectious encephalopathies from the intrapartum period to postnatal life. Semin Fetal Neonatal Med 2024:101526. [PMID: 38677956 DOI: 10.1016/j.siny.2024.101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Congenital infections are a common but often underrecognized cause of fetal brain abnormalities, as well as fetal-neonatal morbidity and mortality, that should be considered by all healthcare professionals providing neurological care to fetuses and newborns. Maternal infection with various pathogens (cytomegalovirus, Toxoplasmosis, Rubella virus, Parvovirus B19, lymphocytic choriomeningitis virus, syphilis, Zika virus, varicella zoster virus) during pregnancy can be transmitted to the developing fetus, which can cause multisystem dysfunction and destructive or malformative central nervous system lesions. These can be recognized on fetal and neonatal imaging, including ultrasound and MRI. Imaging and clinical features often overlap, but some distinguishing features can help identify specific pathogens and guide subsequent testing strategies. Some pathogens can be specifically treated, and others can be managed with targeted interventions or symptomatic therapy based on expected complications. Neurological and neurodevelopmental complications related to congenital infections vary widely and are likely driven by a combination of pathophysiologic factors, alone or in combination. These include direct invasion of the fetal central nervous system by pathogens, inflammation of the maternal-placental-fetal triad in response to infection, and long-term effects of immunogenic and epigenetic changes in the fetus in response to maternal-fetal infection. Congenital infections and their neurodevelopmental impacts should be seen as an issue of public health policy, given that infection and the associated complications disproportionately affect woman and children from low- and middle-income countries and those with lower socio-economic status in high-income countries. Congenital infections may be preventable and treatable, which can improve long-term neurodevelopmental outcomes in children.
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Affiliation(s)
- Olivier Fortin
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington DC, USA
| | - Roberta L DeBiasi
- Division of Pediatric Infectious Disease, Children's National Hospital, Washington DC, USA; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA; Department of Tropical Medicine, Microbiology and Infectious Diseases, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Sarah B Mulkey
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington DC, USA; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA; Department of Neurology and Rehabilitation Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
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Affiliation(s)
- Irene A Stafford
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at UT Health, Houston (I.A.S.); and the Department of Medicine, Division of Infectious Diseases, Emory University (K.A.W.), and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention - both in Atlanta (K.A.W., L.H.B.)
| | - Kimberly A Workowski
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at UT Health, Houston (I.A.S.); and the Department of Medicine, Division of Infectious Diseases, Emory University (K.A.W.), and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention - both in Atlanta (K.A.W., L.H.B.)
| | - Laura H Bachmann
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at UT Health, Houston (I.A.S.); and the Department of Medicine, Division of Infectious Diseases, Emory University (K.A.W.), and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention - both in Atlanta (K.A.W., L.H.B.)
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14
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Sanchez-Holgado M, Bravo MC, Alvarez-Garcia P, Lopez-Ortego P, Criado Camargo S, Pellicer A. Severe pulmonary hypertension and circulatory failure associated with Congenital syphilis. Case report. J Neonatal Perinatal Med 2024; 17:255-260. [PMID: 38640174 DOI: 10.3233/npm-230133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
BACKGROUND Congenital syphilis is a vertical infection caused by Treponema pallidum. Despite the implementation of preventive strategies during pregnancy, its incidence is increasing, and it constitutes an important public health problem. Most patients with congenital syphilis are asymptomatic; however, a small group may develop severe disease at birth with the need of advanced resuscitation in the delivery room, acute hypoxemic respiratory failure, and hemodynamic instability. Therefore, awareness is needed. METHODS AND RESULTS This series describes the clinical course of two late preterm infants with congenital syphilis who developed acute hypoxemic respiratory failure, pulmonary hypertension, and circulatory collapse early after birth. Integrated hemodynamic evaluation with neonatologist-performed echocardiography (NPE) and therapeutic management is provided. CONCLUSIONS A comprehensive hemodynamic evaluation including early and serial functional echocardiography in these patients is needed to address the underlying complex pathophysiology and to help to establish accurate treatment.
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Affiliation(s)
- M Sanchez-Holgado
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - M C Bravo
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - P Alvarez-Garcia
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - P Lopez-Ortego
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - S Criado Camargo
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - A Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
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Abstract
PURPOSE OF REVIEW Congenital infections are a major cause of childhood multidomain neurodevelopmental disabilities. They contribute to a range of structural brain abnormalities that can cause severe neurodevelopmental impairment, cerebral palsy, epilepsy, and neurosensory impairments. New congenital infections and global viral pandemics have emerged, with some affecting the developing brain and causing neurodevelopmental concerns. This review aims to provide current understanding of fetal infections and their impact on neurodevelopment. RECENT FINDINGS There are a growing list of congenital infections causing neurodevelopmental issues, including cytomegalovirus, Zika virus, syphilis, rubella, lymphocytic choriomeningitis virus, and toxoplasmosis. Fetal exposure to maternal SARS-CoV-2 may also pose risk to the developing brain and impact neurodevelopmental outcomes, although studies have conflicting results. As Zika virus was a recently identified congenital infection, there are several new reports on child neurodevelopment in the Caribbean and Central and South America. For many congenital infections, children with in-utero exposure, even if asymptomatic at birth, may have neurodevelopmental concerns manifest over time. SUMMARY Congenital infections should be considered in the differential diagnosis of a child with neurodevelopmental impairments. Detailed pregnancy history, exposure risk, and testing should guide diagnosis and multidisciplinary evaluation. Children with congenital infections should have long-term follow-up to assess for neurodevelopmental delays and other neurosensory impairments. Children with confirmed delays or high-risk should be referred for rehabilitation therapies.
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Affiliation(s)
- Olivier Fortin
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC
| | - Sarah B. Mulkey
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
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16
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George EA, Nwankwo C, Castelo-Soccio L, Oboite M. Disorders in Children. Dermatol Clin 2023; 41:491-507. [PMID: 37236717 DOI: 10.1016/j.det.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Pediatric dermatoses can present at birth or develop over time. When managing dermatology conditions in children, caregiver involvement is important. Patients may have lesions that need to be monitored or need assistance with therapeutic administration. The following section provides a subset of pediatric dermatoses and notable points for presentation in skin of color patients. Providers need to be able to recognize dermatology conditions in patients of varying skin tones and provide therapies that address the condition and any associated pigmentary alterations.
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Affiliation(s)
| | - Christy Nwankwo
- University of Missouri, Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Leslie Castelo-Soccio
- National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Michelle Oboite
- University of Pennsylvania, Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Newton J, Silence C, Boetes J, Cohen BA. Mucocutaneous manifestations of congenital syphilis in the neonate: A review of a surging disease. Pediatr Dermatol 2022; 40:238-241. [PMID: 36583308 DOI: 10.1111/pde.15228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/03/2022] [Indexed: 12/31/2022]
Abstract
Syphilis is an infection caused by Treponema pallidum. It is most commonly acquired through sexual transmission, although it can also be transmitted vertically across the placenta, resulting in congenital syphilis. Even with improved public health measures, testing, and treatment capabilities, primary, secondary, and congenital syphilis have all surged since 2012. Given this marked increase in both incidence and prevalence, here we present a comprehensive review of the clinical presentation, treatment, and management of congenital syphilis, with particular consideration given to the mucocutaneous manifestations of the disease in neonates.
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Affiliation(s)
- Jazmin Newton
- University of South Dakota Sanford School of Medicine, Vermillion, South Dakota, USA
| | - Channi Silence
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jared Boetes
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bernard A Cohen
- Dermatology and Pediatrics, John Hopkins School of Medicine, Baltimore, Maryland, USA
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Auriti C, Bucci S, De Rose DU, Coltella L, Santisi A, Martini L, Maddaloni C, Bersani I, Lozzi S, Campi F, Pacifico C, Balestri M, Longo D, Grimaldi T. Maternal-Fetal Infections (Cytomegalovirus, Toxoplasma, Syphilis): Short-Term and Long-Term Neurodevelopmental Outcomes in Children Infected and Uninfected at Birth. Pathogens 2022; 11:pathogens11111278. [PMID: 36365029 PMCID: PMC9692284 DOI: 10.3390/pathogens11111278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
(1) Background: Infections in pregnancy can lead to miscarriage, premature birth, infections in newborns, and developmental disabilities in babies. Infected infants, symptomatic at birth, can have long-term sequelae, and asymptomatic babies are also at increased risk of developing long-term sensorineural outcomes. Targeted therapy of the pregnant mother can reduce fetal and neonatal harm. (2) Aim of the study: To explore the association between symptoms and time of onset of long-term sequelae in infected children born from mothers who contracted an infection during pregnancy, by a long-term multidisciplinary follow-up. (3) Methods: For up to 2−4 years, we evaluated cognitive, motor, audiological, visual, and language outcomes in infants with symptomatic and asymptomatic congenital infections and in uninfected infants. (4) Results: 186 infants born from women who acquired Cytomegalovirus infection (n = 103), Toxoplasma infection (n = 50), and Syphilis (n = 33) during pregnancy were observed. Among them, 119 infants acquired the infection in utero. Infected infants, symptomatic at birth, obtained lower scores on the Cognitive and Motor Scale on Bayley-III compared to asymptomatic and uninfected infants (p = 0.026; p = 0.049). Many severe or moderate sequelae rose up within the first year of life. At 24 months, we observed sequelae in 24.6% (14/57) of infected children classified as asymptomatic at birth, compared to 68.6% (24/35) of symptomatic ones (χ2 = 15.56; p < 0.001); (5) Conclusions: Infected babies symptomatic at birth have a worse prognosis than asymptomatic ones. Long-term sequelae may occur in infected children asymptomatic at birth after the first year of life. Multidisciplinary follow-up until 4−6 years of age should be performed in all infected children, regardless of the presence of symptoms at birth.
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Affiliation(s)
- Cinzia Auriti
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
- Correspondence: ; Tel.: +39-0668592427
| | - Silvia Bucci
- Department of Neurosciences, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Domenico Umberto De Rose
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Luana Coltella
- Department of Microbiology and Virology, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Alessandra Santisi
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Ludovica Martini
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Chiara Maddaloni
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Iliana Bersani
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Simona Lozzi
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Francesca Campi
- Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Concettina Pacifico
- Audiology and Otosurgery Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Martina Balestri
- Department of Neurosciences, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Daniela Longo
- Department of Imaging, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Teresa Grimaldi
- Department of Neurosciences, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
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19
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Williams JEP, Graf RJ, Miller CA, Michelow IC, Sánchez PJ. Maternal and Congenital Syphilis: A Call for Improved Diagnostics and Education. Pediatrics 2022; 150:188941. [PMID: 36000327 DOI: 10.1542/peds.2022-057927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jessica E P Williams
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.,The Ohio State University College of Medicine, Columbus, Ohio
| | - Rachel J Graf
- The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Ian C Michelow
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut
| | - Pablo J Sánchez
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.,Divisions of Neonatology and Pediatric Infectious Diseases, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,The Ohio State University College of Medicine, Columbus, Ohio
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20
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Tonni G, Grisolia G, Pisello M, Zampriolo P, Fasolato V, Sindico P, Araújo Junior E, Bonasoni MP. Congenital Syphilis Presenting with Brain Abnormalities at Neuroscan: A Case Report and a Brief Literature Review. Microorganisms 2022; 10:microorganisms10081497. [PMID: 35893555 PMCID: PMC9330733 DOI: 10.3390/microorganisms10081497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
A case of vertical transmission in a 35-year-old pregnant woman, gravida 4, para 2 with an unknown medical history of carrying primary syphilis is described. A routine 3rd trimester scan was performed at 30 + 5 weeks of pregnancy, which revealed fetal growth restriction (FGR) associated with absent fetal movement, a pathologic neuroscan characterized by cortical calcifications and ominous Doppler waveform analysis of the umbilical artery and ductus venosus. Computerized electronic fetal monitoring (EFM) showed a Class III tracing, according to the American College of Obstetricians and Gynecologists (ACOG) guidelines. An emergency C-section was performed and a female newborn weighing 1470 g was delivered. The Apgar scores were 5 and 8 at the first and fifth min, respectively. Besides the prompted obstetrical and neonatal interventions, the neonate died after 7 days. A histologic examination of the placenta revealed a chorioamnionitis at stage 1/2 and grade 2/3. The parenchyma showed diffuse delayed villous maturation, focal infarcts, and intraparenchymal hemorrhages. The decidua presented with chronic deciduitis with plasma cells. The parents declined the autopsy. Congenital syphilis is an emerging worldwide phenomenon and the multidisciplinary management of the mother and the fetus should be mandatory.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology and Researcher, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42122 Reggio Emilia, Italy
- Correspondence:
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, ASST Mantova, 46100 Mantova, Italy; (G.G.); (M.P.); (P.Z.)
| | - Marlene Pisello
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, ASST Mantova, 46100 Mantova, Italy; (G.G.); (M.P.); (P.Z.)
| | - Paolo Zampriolo
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, ASST Mantova, 46100 Mantova, Italy; (G.G.); (M.P.); (P.Z.)
| | - Valeria Fasolato
- Neonatal Intensive Care Unit (NICU), Carlo Poma Hospital, ASST Mantova, 46100 Mantova, Italy; (V.F.); (P.S.)
| | - Paola Sindico
- Neonatal Intensive Care Unit (NICU), Carlo Poma Hospital, ASST Mantova, 46100 Mantova, Italy; (V.F.); (P.S.)
| | - Edward Araújo Junior
- Department of Obstetrics, Universitade Federal de Sao Paulo, Sao Paulo 04021-001, Brazil;
| | - Maria Paola Bonasoni
- Pathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42122 Reggio Emilia, Italy;
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