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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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2
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Peters RPH, Nel JS, Sadiq E, Kufa T, Smit DP, Sorour G, Garrett N, Gill K, Makhakhe L, Chandiwana NC, Moran NF, Cohen K, Wattrus C, Moosa MY. Southern African HIV Clinicians Society Guideline for the clinical management of syphilis. South Afr J HIV Med 2024; 25:1577. [PMID: 38725703 PMCID: PMC11079416 DOI: 10.4102/sajhivmed.v25i1.1577] [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: 02/15/2024] [Accepted: 03/24/2024] [Indexed: 05/12/2024] Open
Abstract
Syphilis, 'the great imitator', caused by Treponema pallidum infection, remains a complex and multifaceted disease with a rich history of clinical diversity. This guideline aims to be a comprehensive guide for healthcare workers in Southern Africa, offering practical insights into the epidemiology, pathogenesis, clinical manifestations, diagnostic testing, therapeutic principles, and public health responses to syphilis. Although the syphilis burden has declined over the years, recent data indicate a troubling resurgence, particularly among pregnant women and neonates. This guideline highlights the diagnostic challenges posed by syphilis, stemming from the absence of a single high-sensitivity and -specificity test. While treatment with penicillin remains the cornerstone of treatment, alternative regimens may be used for specific scenarios. We highlight the importance of thorough patient follow-up and management of sex partners to ensure optimal care of syphilis cases. In the context of public health, we emphasise the need for concerted efforts to combat the increasing burden of syphilis, especially within high-risk populations, including people living with HIV.
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Affiliation(s)
- Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jeremy S Nel
- Division of Infectious Diseases, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Helen Joseph Hospital, Johannesburg, South Africa
| | - Eitzaz Sadiq
- Helen Joseph Hospital, Johannesburg, South Africa
- Department of Neurosciences, Division of Neurology, University of the Witwatersrand, Johannesburg, South Africa
| | - Tendesayi Kufa
- Centre for HIV and STIs, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Derrick P Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gillian Sorour
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Lehlohonolo Makhakhe
- Department of Dermatology, University of the Free State, Bloemfontein, South Africa
- The South African Institute of Dermatology, Bloemfontein, South Africa
| | - Nomathemba C Chandiwana
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil F Moran
- KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Karen Cohen
- Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Camilla Wattrus
- Southern African HIV Clinicians Society (SAHCS), Johannesburg, South Africa
| | - Mahomed Yunus Moosa
- Southern African HIV Clinicians Society (SAHCS), Johannesburg, South Africa
- Department of Infectious Disease, Division of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Servos Li MM, Hamersley ERS, Baldassari C. Nasal Disorders. Pediatr Rev 2024; 45:188-200. [PMID: 38556515 DOI: 10.1542/pir.2023-006012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Nasal obstruction, rhinorrhea, and epistaxis are common presenting concerns in primary care clinics. Nasal disorders affect the quality of life for many children and families. Rarely, these complaints may represent a life-threatening condition among infant obligate nasal breathers or cases of unusual pathology. The most common causes of rhinorrhea and nasal obstruction vary by age and include physiologic, infectious, allergic, foreign body, irritant, and traumatic causes. Less commonly, children may have congenital malformations, sinonasal masses, or autoimmune disease. The most common causes of epistaxis are inflammatory, environmental, and traumatic causes and medication misuse, but rarely, children may have predisposing anatomic, hematologic, or vascular abnormalities or even sinonasal tumors. In this article, we provide a thorough review of the common nasal disorders treated every day in primary care clinics and mention briefly some of the rare but serious cases that may be overlooked without considering a full differential diagnosis.
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Affiliation(s)
- Mariah M Servos Li
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Erin R S Hamersley
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, VA
| | - Cristina Baldassari
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
- Department of Pediatric Sleep Medicine, Children's Hospital of the King's Daughters, Norfolk, VA
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4
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Ekselius L, Gerdin B, Vahlquist A. The Syphilis Pandemic Prior to Penicillin: Origin, Health Issues, Cultural Representation and Ethical Challenges. Acta Derm Venereol 2024; 104:adv34879. [PMID: 38436430 PMCID: PMC10926575 DOI: 10.2340/actadv.v104.34879] [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: 12/11/2023] [Accepted: 01/16/2024] [Indexed: 03/05/2024] Open
Abstract
Syphilis is currently a treatable disease, with a low incidence in most developed countries, although the prevalence has increased recently, especially among men-who-have-sex-with-men. In many of the least developed countries, however, syphilis is still a major health problem, although the problem is not comparable to the desperate situation worldwide less than 80 years ago. At that time, and for many centuries previously, syphilis dramatically affected the lives and health of individuals and threatened the well-being of many societies. This review examines the aetiology, transmission, and many manifestations of syphilis from a historical perspective, emphasizing morbidity, treatment, psychosocial and cultural manifestations, as well as ethical issues uncovered in the clinical search for knowledge about the manifestations of the disease.
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Affiliation(s)
- Lisa Ekselius
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Bengt Gerdin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Vahlquist
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
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Supronowicz Ł, Rogalska M. Syphilitic hepatitis. Clin Exp Hepatol 2024; 10:9-13. [PMID: 38765910 PMCID: PMC11100338 DOI: 10.5114/ceh.2024.136235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/16/2023] [Indexed: 05/22/2024] Open
Abstract
Syphilis is a sexually transmitted multisystemic disease known as "the great imitator" due to its variable presentations. Despite being preventable and curable, it still constitutes a major health problem. Hepatic manifestation of syphilis is usually mild cholestatic liver injury but in very rare cases can become fulminant. Moreover, syphilitic hepatitis, known for several decades, is considered rare but is probably under-diagnosed. Given the significant morbidity associated with a missed diagnosis, syphilitic hepatitis should be taken into account as an element of differential diagnosis in patients with unexplained elevation of liver enzymes.
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Affiliation(s)
- Łukasz Supronowicz
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Poland
| | - Magdalena Rogalska
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Poland
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Fowler JA, Warzywoda S, Nourse C, Wu M, Britton S, Rowling D, Griffin P, Lazarou M, Hamilton Z, Dean JA. Barriers to optimal management of syphilis in pregnancy and congenital syphilis in south-east Queensland: a qualitative investigation. Sex Health 2023; 20:506-513. [PMID: 37599092 DOI: 10.1071/sh23119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Australia, like many high-income countries, is experiencing a resurgence of infectious syphilis in pregnancy and congenital syphilis. Evaluations of public health notifications and clinical records suggest that healthcare systems may not be providing optimal care to women and their neonates. This study aims to explore the barriers to optimal management of syphilis in pregnancy and congenital syphilis to identify key areas for improvement. METHODS Between 2021 and 2022, 34 healthcare workers (HCW) practicing in south-east Queensland (SEQ) Australia were recruited to complete semi-structured interviews regarding their perceptions towards management of syphilis in pregnancy and congenital syphilis. Interviews were analysed thematically. RESULTS Thematic analysis identified four themes related to the management of syphilis in pregnancy. These included poor communication between disciplines, services, and teams from delivery through to management and post-delivery, lack of formal internal and external referral pathways, unclear and often complex maternal and congenital syphilis management procedures, and limited HCW knowledge of infectious syphilis in pregnancy and congenital syphilis. CONCLUSION As congenital syphilis numbers continue to rise in SEQ, it is imperative that healthcare systems and HCWs identify and address gaps in the provision of health care.
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Affiliation(s)
- James A Fowler
- The University of Queensland, Faculty of Medicine, School of Public Health, 288 Herston Road, Herston, Qld, 4006, Australia
| | - Sarah Warzywoda
- The University of Queensland, Faculty of Medicine, School of Public Health, 288 Herston Road, Herston, Qld, 4006, Australia
| | - Clare Nourse
- The University of Queensland, Faculty of Medicine, School of Medicine, 288 Herston Road, Herston, Qld 4006, Australia; and Infection Management and Prevention Service, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Qld 4101, Australia
| | - Mandy Wu
- The University of Queensland, Faculty of Medicine, School of Medicine, 288 Herston Road, Herston, Qld 4006, Australia; and Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Qld 4101, Australia
| | - Sumudu Britton
- The University of Queensland, Faculty of Medicine, School of Medicine, 288 Herston Road, Herston, Qld 4006, Australia; and Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, 7 Butterfield Street, Herston, Qld 4029, Australia
| | - Diane Rowling
- Metro North Public Health Unit, Metro North Hospital and Health Service, Bryden Street, Windsor, Qld 4030, Australia
| | - Paul Griffin
- The University of Queensland, Faculty of Medicine, School of Medicine, 288 Herston Road, Herston, Qld 4006, Australia; and Mater Health Brisbane, Raymond Terrace, South Brisbane, Qld 4101, Australia
| | - Mattea Lazarou
- The University of Queensland, Faculty of Medicine, School of Public Health, 288 Herston Road, Herston, Qld, 4006, Australia; and Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Qld 4101, Australia
| | - Zoe Hamilton
- The University of Queensland, Faculty of Medicine, School of Public Health, 288 Herston Road, Herston, Qld, 4006, Australia
| | - Judith A Dean
- The University of Queensland, Faculty of Medicine, School of Public Health, 288 Herston Road, Herston, Qld, 4006, Australia
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Castro-Fonseca E, Rosa B, Silva VR, Andrade CV, Praxedes I, Guastavino AB, Esteves CG, Chalfun G, Prata-Barbosa A, Chimelli L, Garcez PP, Lent R. Pronounced decline of absolute cell numbers in the brain of a newborn with congenital syphilis. J Neuropathol Exp Neurol 2023; 82:887-890. [PMID: 37550256 DOI: 10.1093/jnen/nlad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Affiliation(s)
- Emily Castro-Fonseca
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Barbara Rosa
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Viviane R Silva
- Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cecilia V Andrade
- Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Inês Praxedes
- Department of Pathology, Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andréa B Guastavino
- Department of Neonatology, Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia G Esteves
- Department of Neonatology, Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Georgia Chalfun
- Department of Neonatology, Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arnaldo Prata-Barbosa
- Department of Neonatology, Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Pediatrics, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Leila Chimelli
- Laboratory of Neuropathology, Rio de Janeiro State Brain Institute, Rio de Janeiro, Brazil
| | - Patricia P Garcez
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberto Lent
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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Neurology of Systemic Disease. Neurol Clin 2023; 41:399-413. [PMID: 37030966 DOI: 10.1016/j.ncl.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Sex differences exist within the neurologic complications of systemic disease. To promote new avenues for prevention and develop novel therapeutics, we highlight the role of sex in differential outcomes to infectious disease and cardiac arrest and educate the reader in paraneoplastic presentations that may herald underlying malignancies in women.
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Pugh CP, Baber M, White G. Necrotizing enterocolitis following treatment of congenital syphilis with penicillin in a term newborn. SAGE Open Med Case Rep 2023; 11:2050313X231172672. [PMID: 37205159 PMCID: PMC10186574 DOI: 10.1177/2050313x231172672] [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: 11/29/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
Necrotizing enterocolitis is a disease process of intestinal disruption which has been associated with gastrointestinal microbial alterations after antibiotic exposure. Treatment guidelines and antibiotic exposure for congenital syphilis have historically been based on limited evidence. This case presents a term infant who developed necrotizing enterocolitis after treatment for congenital syphilis.
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Affiliation(s)
- Charles Preston Pugh
- Charles Preston Pugh, Department of Pediatrics,
University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot 512-5B, Little
Rock, AR 72205, USA.
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10
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Genital Tract Infections in Women, Pregnancy and Neonates. Obstet Gynecol Clin North Am 2022; 49:751-769. [DOI: 10.1016/j.ogc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tsang RSW, Shuel M, Hoang W, Hayden K, Hink R, Bullard J, Van Caeseele P, Alexander DC. Characteristics of polymerase chain reaction-positive syphilis cases in Manitoba, Canada, 2017 to 2020: Demographic analysis, specimen types, and Treponema pallidum gene targets. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:170-180. [PMID: 36337605 PMCID: PMC9629728 DOI: 10.3138/jammi-2022-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND A resurgence of syphilis infections has been described in a number of countries including Canada in the last decade. METHODS This study identified polymerase chain reaction (PCR) positive syphilis cases based on detection of Treponema pallidum genes (polA, tpp47, and bmp) in 3,350 clinical specimens obtained from patients in the province of Manitoba, Canada between 2017 and 2020. Patient demographics were obtained from specimen requisition forms. RESULTS PCR identified 740 syphilis cases: 718 were adolescents and adults, while 22 were congenital syphilis cases. For non-congenital syphilis investigation, the clinical specimens with the highest yield of positive PCR results were genital (632), oral (73), and anal (55), while for congenital syphilis, they were nasal or nasopharyngeal secretions (20), followed by blood (5) and umbilical cord (4). Female syphilis cases appeared younger (61.7% between 14 and 29 years), while male syphilis cases appeared older (58.4% between 30 and 65 years). Although, overall more syphilis cases (62.7%) occurred in the urban cities; the proportion of urban cases showed a significant decline from 87.0% in 2017 to 55.6% in 2020, while in rural regions it increased from 13.0% in 2017 to 44.4% in 2020. Most (98.8%) PCR- positive specimens were found to contain all three T. pallidum genes and 99.8% also displayed the macrolide resistance genotype. CONCLUSIONS This study identified the clinical specimen types and T. pallidum genes most suitable for PCR diagnosis of syphilis. Changing demographics of cases were noted over time.
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Affiliation(s)
- Raymond SW Tsang
- Syphilis Diagnostic Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Michelle Shuel
- Syphilis Diagnostic Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - William Hoang
- Syphilis Diagnostic Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Kristy Hayden
- Syphilis Diagnostic Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Rachel Hink
- Syphilis Diagnostic Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Jared Bullard
- Cadham Provincial Laboratory, Manitoba Health, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology and Infectious Diseases, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Van Caeseele
- Cadham Provincial Laboratory, Manitoba Health, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology and Infectious Diseases, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David C Alexander
- Cadham Provincial Laboratory, Manitoba Health, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology and Infectious Diseases, Winnipeg, Manitoba, Canada
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Ringoringo HP, Tambunan KR, Ananda FK, Nawati F, Permana YN. Amoxicillin as an Option in Congenital Syphilis Management: A Case Report. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Congenital syphilis (CS) is the second leading cause of preventable stillbirth globally. This case report shows that CS baby can be managed by amoxicillin with good results.
CASE PRESENTATION: A term female baby was born through section cesarean on suspicion of syphilis of a 29-year-old mother, G4P3A0, 39 weeks gestation with normal APGAR score, and birth weight was 2330 g, birth length was 46 cm, and head circumference 32 cm. There are no abnormalities on physical examination. The baby is active and clinically sound. In history taking, the mother was diagnosed with syphilis in the first trimester of pregnancy but did not want to be treated. After birth, maternal serology showed that Treponema pallidum is reactive. Maternal VDRL was reactive at 1:1, while TPHA was reactive at 1:2560. Baby laboratory results showed Hb 18.4 g/dL, leukocytes 33,480/μL, platelets 278,000/μL, and hematocrit 54.7%. A peripheral blood smear showed neutrophilia with hypersegmentation and monocytosis due to suspected chronic inflammation. Baby VDRL was reactive at 1:16, while TPHA was reactive at 1:1280. The diagnosis was congenital syphilis with low birth weight and small for gestational age. After one month of treatment with oral amoxicillin, baby VDRL was reactive at 1:2, while TPHA was reactive at 1:320. At 1½ months, the baby’s hemoglobin is 10.1 g/dL. X-rays for chest, abdomen, and skeletal were within normal limits. The baby was given oral amoxicillin 50 mg/kg/day for a total of 3 months. When the baby was 4 months old, her growth and development were good with the VDRL reactive 1:1 and the TPHA reactive 1:160.
CONCLUSION: In the unavailability of benzathine penicillin, amoxicillin may be considered an option in CS management.
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Dionisopoulos Z, Kakkar F, Blanchard AC. Delayed diagnosis of maternal and congenital syphilis: An unrecognized epidemic? CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2022; 48:115-118. [PMID: 35342371 PMCID: PMC8890596 DOI: 10.14745/ccdr.v48i23a10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Syphilis is an infection caused by Treponema pallidum spirochetes. The diagnosis of this sexually transmitted disease may be missed, partly due to the painless nature of genital ulcers in its primary stage. Women in Canada are screened for syphilis in their first trimester of pregnancy, but late pregnancy testing is not done in all provinces to date; therefore, undetected vertical transmission of syphilis may occur. This case emphasizes the importance of recognizing congenital syphilis in infants and young children with unexplained growth problems and biochemical and hematological abnormalities. Congenital syphilis remains a rare diagnosis, but in the context of increased syphilis rates in Canada during recent years, clinicians should consider this diagnosis in infants presenting with compatible clinical manifestations.
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Affiliation(s)
- Zachary Dionisopoulos
- Paediatrics Residency Program, Department of Paediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Paediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC
| | - Ana C Blanchard
- Division of Infectious Diseases, Department of Paediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC
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Benoit P, Tennenhouse L, Lapple A, Hill-Carroll G, Shaw S, Bullard J, Plourde P. Congenital syphilis re-emergence in Winnipeg, Manitoba. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2022; 48:89-94. [PMID: 35342366 PMCID: PMC8889919 DOI: 10.14745/ccdr.v48i23a06] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Infectious syphilis rates have been increasing in Winnipeg, Manitoba among individuals during their childbearing years. Untreated or inadequately treated prenatal infection often results in congenital syphilis, with devastating consequences to fetal health and survival. The objective of this study was to review public health surveillance data regarding congenital syphilis incidence and birthing parent risk factors in Winnipeg from 2018 to 2020. METHODS Data extracted from a population-based surveillance database maintained by the Winnipeg Regional Health Authority Public Health investigations for all 2018-2020 probable or confirmed cases of early congenital syphilis or syphilitic stillbirth were reviewed. Rates of congenital syphilis were calculated per 1,000 live births. Descriptive analyses were performed to describe birthing parent age, neighbourhood of residence, intravenous substance use, Child and Family Services involvement, access to prenatal care and obtainment of adequate prenatal treatment. RESULTS There were eight cases of confirmed/probable congenital syphilis in 2018, 22 cases in 2019 and 30 cases in 2020. Average birthing parent age was 26.5-27.0 years. The majority (66.7%) of birthing parents lived in inner city neighbourhoods with known infectious syphilis outbreaks. Over 50% of birthing parents did not receive any prenatal care, or the care received consisted of inadequate treatment or follow-up. Reinfection among birthing parents who did receive prenatal care was suspected in an additional 23.3% of cases. CONCLUSION Congenital syphilis rates in Winnipeg have increased dramatically. Public health and healthcare provider efforts to address the needs of the community are vital for promoting access to safe and effective prenatal care.
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Affiliation(s)
- Peter Benoit
- Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, MB
| | - Lana Tennenhouse
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Alicia Lapple
- Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, MB
| | - Gillian Hill-Carroll
- Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, MB
| | - Souradet Shaw
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Jared Bullard
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
- Cadham Provincial Laboratory, Manitoba Health and Seniors Care, Winnipeg, MB
| | - Pierre Plourde
- Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, MB
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
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15
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Zhao NO, Crowell EL. Epidemiology and Long-term Sequelae of Pediatric Uveitis. Int Ophthalmol Clin 2022; 62:131-142. [PMID: 34965231 DOI: 10.1097/iio.0000000000000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Ono Y, Okumura R, Hatanaka KC, Sato Y, Ota H, Fukushi Y, Wada S, Yamada H. The first case of congenital syphilis diagnosed by 16S ribosome-RNA gene sequence analysis. J Infect Chemother 2021; 28:295-298. [PMID: 34736813 DOI: 10.1016/j.jiac.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/26/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022]
Abstract
Syphilis infection during pregnancy causes perinatal complications and mother-to-child transmission if untreated. A newborn was delivered by emergent cesarean section due to non-reassuring fetal status at 34 weeks of gestation. The mother tested negative for rapid plasma reagin (RPR) and Treponema pallidum hemagglutination (TPHA) in early pregnancy. The newborn had a severe inflammatory reaction, thrombocytopenia, and elevated IgM as well as disseminated intravascular coagulation and multiple organ failure. The 16S ribosomal RNA gene sequence analysis of the amniotic fluid detected Treponema pallidum. The newborn tested positive for RPR, TPHA, and IgM fluorescent treponemal antibody-absorption in the blood, and thus, congenital syphilis was diagnosed. This is the first case that 16S ribosomal RNA gene sequencing of the amniotic fluid led to an early diagnosis of congenital syphilis in a newborn. The 16S rRNA gene sequencing may be a useful method for the early detection of the primary causative microbe of congenital infection.
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Affiliation(s)
- Yosuke Ono
- Department of Obstetrics and Gynecology, India
| | | | - Kanako C Hatanaka
- Department of Pathology, India; Center for Development of Advanced Diagnostics, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yuichiro Sato
- Department of Diagnostic Pathology, Univerisity of Miyazaki, Miyazaki, Japan
| | - Hajime Ota
- Department of Obstetrics and Gynecology, India
| | | | | | - Hideto Yamada
- Center for Recurrent Pregnancy Loss, Teine Keijinkai Hospital, Sapporo, Japan.
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17
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Besen E, Paiva KM, Hillesheim D, Cigana LB, Haas P. Congenital syphilis associated with hearing screening failure in southern Brazilian newborns. Braz J Otorhinolaryngol 2021; 88 Suppl 3:S20-S24. [PMID: 34716107 DOI: 10.1016/j.bjorl.2021.07.003] [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: 04/19/2021] [Revised: 06/24/2021] [Accepted: 07/19/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To estimate the association between congenital syphilis and neonatal hearing screening failure in the state of Santa Catarina between 2017 and 2019. METHODS This is a cross-sectional, retrospective, analytical study with secondary data of neonates from the state of Santa Catarina born between January 2017 and December 2019. We used logistic regression analysis to estimate the association between the main exposure (congenital syphilis) and the study outcome (failure in the Neonatal Hearing Screening). RESULTS The study included 21,434 newborns evaluated in a Brazilian hearing health care service. A total of 351 (1.6%) newborns failed the Neonatal Hearing Screening, and 364 (1.7%) had congenital syphilis. In the adjusted analysis, newborns with congenital syphilis were 3.25 times as likely to fail the Neonatal Hearing Screening as neonates without this disease (95% CI: 2.01; 5.26). As for maternal age, the sample had a higher prevalence (53.5%) of mothers aged 20-29 years. CONCLUSION There was an association between congenital syphilis and failure in Universal Neonatal Hearing Screening in the sample studied. There is a need for investments in public policies to value and strengthen the hearing screening program in the state to provide early diagnosis and intervention. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Eduarda Besen
- Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Karina Mary Paiva
- Universidade Federal de Santa Catarina (UFSC), Departamento de Fonoaudiologia, Florianópolis, SC, Brazil
| | - Danúbia Hillesheim
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, SC, Brazil
| | - Luciana B Cigana
- Instituto Otovida - Clínica de Audição, Voz, Fala e Linguagem, Florianópolis, SC, Brazil
| | - Patrícia Haas
- Universidade Federal de Santa Catarina (UFSC), Curso de Fonoaudiologia, Florianópolis, SC, Brazil.
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18
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Bhagirath AY, Medapati MR, de Jesus VC, Yadav S, Hinton M, Dakshinamurti S, Atukorallaya D. Role of Maternal Infections and Inflammatory Responses on Craniofacial Development. FRONTIERS IN ORAL HEALTH 2021; 2:735634. [PMID: 35048051 PMCID: PMC8757860 DOI: 10.3389/froh.2021.735634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022] Open
Abstract
Pregnancy is a tightly regulated immunological state. Mild environmental perturbations can affect the developing fetus significantly. Infections can elicit severe immunological cascades in the mother's body as well as the developing fetus. Maternal infections and resulting inflammatory responses can mediate epigenetic changes in the fetal genome, depending on the developmental stage. The craniofacial development begins at the early stages of embryogenesis. In this review, we will discuss the immunology of pregnancy and its responsive mechanisms on maternal infections. Further, we will also discuss the epigenetic effects of pathogens, their metabolites and resulting inflammatory responses on the fetus with a special focus on craniofacial development. Understanding the pathophysiological mechanisms of infections and dysregulated inflammatory responses during prenatal development could provide better insights into the origins of craniofacial birth defects.
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Affiliation(s)
- Anjali Y. Bhagirath
- Department of Pediatrics and Physiology, University of Manitoba, Winnipeg, MB, Canada
- Biology of Breathing, Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada
- Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
| | - Manoj Reddy Medapati
- Biology of Breathing, Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada
- Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
| | - Vivianne Cruz de Jesus
- Biology of Breathing, Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada
- Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
| | - Sneha Yadav
- Mahatma Gandhi Institute of Medical Sciences, Wardha, India
| | - Martha Hinton
- Department of Pediatrics and Physiology, University of Manitoba, Winnipeg, MB, Canada
- Biology of Breathing, Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada
| | - Shyamala Dakshinamurti
- Department of Pediatrics and Physiology, University of Manitoba, Winnipeg, MB, Canada
- Biology of Breathing, Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada
| | - Devi Atukorallaya
- Biology of Breathing, Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada
- Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
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19
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Ikuta T, Abe S, Suga S, Nakasone R, Ashina M, Tanimura K, Nozu K, Fujioka K. Administration of intravenous benzylpenicillin in 13 infants born to mothers with syphilis infection: A case series. J Infect Chemother 2021; 27:1662-1664. [PMID: 34246542 DOI: 10.1016/j.jiac.2021.06.022] [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: 04/04/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
The incidence of syphilis infection among pregnant women is persistently high in Japan and in several developed countries. Here, we report the utility of intravenous benzylpenicillin in 13 infants born to mothers with syphilis infection. Because the recommended treatment (intramuscular benzathine benzylpenicillin) is not available in Japan, we intravenously administered benzylpenicillin for 10 days, which is used for treatment in high-risk cases. The administration of benzylpenicillin in low-risk infants resulted in an extended duration of parent-to-infant separation and increased the infants' exposure to invasive procedures. Thus, establishing evidence of the adequacy of no-treatment follow-up in low-risk groups and introducing intramuscular injections of benzathine benzylpenicillin may improve the management of infants suspected with congenital syphilis in Japan.
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Affiliation(s)
- Toshihiko Ikuta
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Shinya Abe
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shutaro Suga
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ruka Nakasone
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mariko Ashina
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Tanimura
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumichi Fujioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
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20
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Sukwa N, Simuyandi M, Chirwa M, Kumwimba YM, Chilyabanyama ON, Laban N, Koyuncu A, Chilengi R. Clinical presentation of congenital syphilis in a rotavirus vaccine cohort study in Lusaka: a case series. J Med Case Rep 2021; 15:149. [PMID: 33789741 PMCID: PMC8015191 DOI: 10.1186/s13256-021-02745-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 02/17/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Despite an otherwise robust national antenatal clinic program, maternal and congenital syphilis remains an important public health issue in Zambia. This case series reports the clinical presentation of seven infants diagnosed with congenital syphilis in Lusaka, Zambia. CASE PRESENTATIONS The cases in this series were incidental findings from a cohort of infants enrolled in a rotavirus vaccine immunogenicity study recruiting infants at 6 weeks of age. As part of clinical care for enrolled participants, we screened mothers of children who presented with adverse events of (i) repeated upper respiratory tract infections/coryza, (ii) skin lesions, and (iii) poor weight gain, for syphilis using rapid plasma reagin test. From a cohort of 214 mother-infant pairs enrolled between September and December 2018, a total of 115 (44.4%) of the mothers reported to have not been screened during antenatal care. Of these, four (3.5%) reported to have tested positive; and only two received treatment. Seven out of 57 (26.6%) children meeting the screening criteria had a positive rapid plasma reagin test result. The mean age at diagnosis was 4.5 months (1.3 months standard deviation), and the common presenting features included coryza (6/7), skin lesions (4/7), conjunctivitis (3/7), pallor/anemia (5/7), wasting (2/7), and underweight (5/7). Three of the seven infants were exposed to human immunodeficiency virus. Following diagnosis, all seven cases received standard treatment according to national treatment guidelines. That is, 6/7 cases received inpatient care with benzylpenicillin for 10 days, while 1/7 was treated as an outpatient and received daily procaine penicillin for 10 days. CONCLUSION These findings suggest that, though screening for syphilis is part of the standard antenatal care in Zambia, it is not offered optimally. There is urgent need to address programmatic shortcomings in syphilis screening and treatment to avoid long-term sequelae. Additionally, clinicians need to raise their index of suspicion and rule out syphilis when confronted with these clinical symptoms, regardless of the mother's human immunodeficiency virus status.
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Affiliation(s)
- Nsofwa Sukwa
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Michelo Simuyandi
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Masuzyo Chirwa
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Yvonne Mutombo Kumwimba
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Obvious N. Chilyabanyama
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Natasha Laban
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Aybüke Koyuncu
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Roma Chilengi
- Enteric Disease and Vaccines Research Unit (EDVRU), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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21
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Mathebula R, Kuonza L, Musekiwa A, Kularatne R, Puren A, Reubenson G, Sherman G, Kufa T. Trends in RPR Seropositivity among Children Younger than 2 Years in South Africa, 2010-2019. J Trop Pediatr 2021; 67:6178988. [PMID: 33742203 DOI: 10.1093/tropej/fmab017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A positive rapid plasma reagin (RPR) result in children under the age of 2 years indicates either passive transplacental transfer of maternal antibodies or active infection with syphilis (possible congenital syphilis). We describe trends in RPR seropositivity in this population using centralized laboratory data. A secondary analysis of laboratory data collected through the National Health Laboratory Service, Corporate Data Warehouse from 2010 to 2019 was conducted. Of the 127 150 children <2 years included in the analysis, 10 969 [8.6%; 95% confidence interval (95% CI) 85-88]) were RPR seropositive. RPR seropositivity increased from 6.5% to 13.0% between 2010 and 2019. Overall, the annual rate of RPR seropositivity was relatively stable between 2010 and 2018 with a range of 89-127/100 000 live births, increasing sharply to 165/100 000 livebirths in 2019. KwaZulu-Natal and North West provinces recorded the largest increases in annual seropositivity rate, while Eastern Cape and Western Cape had the most significant declines. Although this analysis is limited to laboratory results, in the absence of major changes in testing practices, there may be a rise in the burden of antenatal syphilis exposure in utero indicating an increase in maternal syphilis and syphilis transmission in the general population. South Africa needs to intensify Mother-to-Child Transmission of syphilis elimination efforts to reach the WHO target of ≤50 cases per 100 live births by 2030.
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Affiliation(s)
- Rudzani Mathebula
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,South African Field Epidemiology Training Programme (SAFETP), National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Lazarus Kuonza
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,South African Field Epidemiology Training Programme (SAFETP), National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Health Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ranmini Kularatne
- Centre for HIV and STI, National Institute for Communicable Disease, Johannesburg, South Africa.,Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adrian Puren
- Centre for HIV and STI, National Institute for Communicable Disease, Johannesburg, South Africa.,Division of Virology, School of Pathology, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - Gary Reubenson
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gayle Sherman
- Centre for HIV and STI, National Institute for Communicable Disease, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tendesayi Kufa
- School of Health Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Centre for HIV and STI, National Institute for Communicable Disease, Johannesburg, South Africa
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22
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Early congenital syphilis, an old disease still occurring in the modern era: case report and literature review. PEDIATRU.RO 2021. [DOI: 10.26416/pedi.61.1.2021.4724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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23
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Huntington S, Weston G, Seedat F, Marshall J, Bailey H, Tebruegge M, Ahmed I, Turner K, Adams E. Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis. BMJ Open 2020; 10:e038505. [PMID: 33444184 PMCID: PMC7678359 DOI: 10.1136/bmjopen-2020-038505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to high-risk women. DESIGN A decision tree model was developed to assess the incremental costs and health benefits of the two screening strategies. The base case analysis considered short-term costs during the pregnancy and the initial weeks after delivery. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted to assess the robustness of the results. SETTING UK antenatal screening programme. POPULATION Hypothetical cohort of pregnant women who access antenatal care and receive a syphilis screen in 1 year. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the cost to avoid one case of congenital syphilis (CS). Secondary outcomes were the cost to avoid one case of intrauterine fetal demise (IUFD) or neonatal death and the number of women needing to be screened/treated to avoid one case of CS, IUFD or neonatal death. The cost per quality-adjusted life year gained was assessed in scenario analyses. RESULTS Base case results indicated that for pregnant women in the UK (n=725 891), the repeat screening strategy would result in 5.5 fewer cases of CS (from 8.8 to 3.3), 0.1 fewer cases of neonatal death and 0.3 fewer cases of IUFD annually compared with the single screening strategy. This equates to an additional £1.8 million per case of CS prevented. When lifetime horizon was considered, the incremental cost-effectiveness ratio for the repeat screening strategy was £120 494. CONCLUSIONS Universal repeat screening for syphilis in pregnancy is unlikely to be cost-effective in the current UK setting where syphilis prevalence is low. Repeat screening may be cost-effective in countries with a higher syphilis incidence in pregnancy, particularly if the cost per screen is low.
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Affiliation(s)
| | | | - Farah Seedat
- UK National Screening Committee, Public Health England, London, UK
| | - John Marshall
- UK National Screening Committee, Public Health England, London, UK
| | - Heather Bailey
- UCL Institute for Global Health, University College London, London, UK
| | - Marc Tebruegge
- Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK
- Department of Paediatrics, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | | | - Katy Turner
- School of Veterinary Science, University of Bristol, Bristol, UK
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24
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Liao TS, Hashmi A, Lazaroff J, Hennessy RR, Sanders Kim A, Evans Lloyd P, Rosen JB. Effect of Policy Change to Require Laboratory Reporting With Pregnancy Indicated for Syphilis and Hepatitis B Virus Infection, New York City, January 2013-June 2018. Public Health Rep 2020; 135:182S-188S. [PMID: 32735204 DOI: 10.1177/0033354920932542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We evaluated the impact of a 2014 New York City health code change requiring laboratories to indicate if a patient is pregnant or probably pregnant in the electronic laboratory report (ELR) when reporting syphilis and hepatitis B virus (HBV) cases to the New York City Department of Health and Mental Hygiene (DOHMH). METHODS We calculated the number of pregnant persons with syphilis or HBV infection reported to DOHMH from January 1, 2013, through June 30, 2018. We compared the proportion in which the first report to DOHMH was an ELR with pregnancy indicated before and after the policy change. We calculated time between first ELR with pregnancy indicated and subsequent reporting by a method other than ELR and the proportion of cases in which ELR with pregnancy indicated was the only report source. RESULTS A total of 552 new syphilis and 8414 HBV-infected cases were reported to DOHMH. From January 2013-June 2014 (pre-change) to January 2017-June 2018 (post-change), the proportion of cases in which ELR with pregnancy indicated was the first report to DOHMH increased significantly (14.7% [23/156] to 46.2% [80/173] for syphilis; 8.0% [200/2498] to 45.3% [851/1879] for HBV infection [P < .001]). Median time between first ELR with pregnancy indicated and subsequent reporting by a method other than ELR was 9.0 days for syphilis and 51.0 days for HBV infection. ELR with pregnancy indicated was the only report for 43.1% (238/552) of syphilis cases and 23.4% (1452/6200) of HBV cases during the study period. CONCLUSION Including pregnancy status with ELR can increase the ability of public health departments to conduct timely interventions to prevent mother-to-child transmission.
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Affiliation(s)
- Tim S Liao
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Ariba Hashmi
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Julie Lazaroff
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Robin R Hennessy
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.,Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Afua Sanders Kim
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Pamela Evans Lloyd
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Jennifer B Rosen
- 5939 Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
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25
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O'Connor MC, Brankov N, Burden JG, Williams JV. Preterm neonate with blistering. Pediatr Dermatol 2020; 37:935-936. [PMID: 32981163 DOI: 10.1111/pde.14203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/07/2020] [Accepted: 04/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | - Nikoleta Brankov
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Julia G Burden
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA.,Division of Dermatology, Children's Specialty Group, Norfolk, VA, USA
| | - Judith V Williams
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA.,Division of Dermatology, Children's Specialty Group, Norfolk, VA, USA
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26
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Macedo-da-Silva J, Marinho CRF, Palmisano G, Rosa-Fernandes L. Lights and Shadows of TORCH Infection Proteomics. Genes (Basel) 2020; 11:E894. [PMID: 32764347 PMCID: PMC7464470 DOI: 10.3390/genes11080894] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/25/2022] Open
Abstract
Congenital abnormalities cause serious fetal consequences. The term TORCH is used to designate the most common perinatal infections, where: (T) refers to toxoplasmosis, (O) means "others" and includes syphilis, varicella-zoster, parvovirus B19, zika virus (ZIKV), and malaria among others, (R) refers to rubella, (C) relates to cytomegalovirus infection, and (H) to herpes simplex virus infections. Among the main abnormalities identified in neonates exposed to congenital infections are central nervous system (CNS) damage, microcephaly, hearing loss, and ophthalmological impairment, all requiring regular follow-up to monitor its progression. Protein changes such as mutations, post-translational modifications, abundance, structure, and function may indicate a pathological condition before the onset of the first symptoms, allowing early diagnosis and understanding of a particular disease or infection. The term "proteomics" is defined as the science that studies the proteome, which consists of the total protein content of a cell, tissue or organism in a given space and time, including post-translational modifications (PTMs) and interactions between proteins. Currently, quantitative bottom-up proteomic strategies allow rapid and high throughput characterization of complex biological mixtures. Investigating proteome modulation during host-pathogen interaction helps in elucidating the mechanisms of infection and in predicting disease progression. This "molecular battle" between host and pathogen is a key to identify drug targets and diagnostic markers. Here, we conducted a survey on proteomic techniques applied to congenital diseases classified in the terminology "TORCH", including toxoplasmosis, ZIKV, malaria, syphilis, human immunodeficiency virus (HIV), herpes simplex virus (HSV) and human cytomegalovirus (HCVM). We have highlighted proteins and/or protein complexes actively involved in the infection. Most of the proteomic studies reported have been performed in cell line models, and the evaluation of tissues (brain, muscle, and placenta) and biofluids (plasma, serum and urine) in animal models is still underexplored. Moreover, there are a plethora of studies focusing on the pathogen or the host without considering the triad mother-fetus-pathogen as a dynamic and interconnected system.
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Affiliation(s)
- Janaina Macedo-da-Silva
- Glycoproteomics Laboratory, Department of Parasitology, University of Sao Paulo, Sao Paulo 05508-000, Brazil;
| | - Claudio Romero Farias Marinho
- Laboratory of Experimental Immunoparasitology, Department of Parasitology, University of Sao Paulo, Sao Paulo 05508-000, Brazil;
| | - Giuseppe Palmisano
- Glycoproteomics Laboratory, Department of Parasitology, University of Sao Paulo, Sao Paulo 05508-000, Brazil;
| | - Livia Rosa-Fernandes
- Glycoproteomics Laboratory, Department of Parasitology, University of Sao Paulo, Sao Paulo 05508-000, Brazil;
- Laboratory of Experimental Immunoparasitology, Department of Parasitology, University of Sao Paulo, Sao Paulo 05508-000, Brazil;
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Oloya S, Lyczkowski D, Orikiriza P, Irama M, Boum Y, Migisha R, Kiwanuka JP, Mwanga-Amumpaire J. Prevalence, associated factors and clinical features of congenital syphilis among newborns in Mbarara hospital, Uganda. BMC Pregnancy Childbirth 2020; 20:385. [PMID: 32616037 PMCID: PMC7330944 DOI: 10.1186/s12884-020-03047-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/04/2020] [Indexed: 12/04/2022] Open
Abstract
Background While congenital syphilis is a significant public health problem that can cause severe disabilities, little is known about the situation in Uganda. We describe prevalence, associated factors and clinical presentation of congenital syphilis in Mbarara, Uganda. Methods A cross sectional study was carried out among mother- newborn dyads from the postnatal ward of Mbarara Regional Referral Hospital (MRRH). After obtaining informed consent, a structured questionnaire was used to capture data on risk factors for congenital syphilis. A finger prick was performed on the mothers for Treponema Pallidum Haemagglutination Assay (TPHA). If TPHA was positive, a venous blood sample was collected from the mother to confirm active infection using Rapid Plasma Reagin (RPR). Venous blood was drawn from a newborn if the mother tested positive by TPHA and RPR. A newborn with RPR titres 4 times higher than the mother was considered to have congenital syphilis. We fit logistic regression models to determine factors associated with congenital syphilis. Results Between June and September 2015, we enrolled 2500 mothers and 2502 newborns. Prevalence of syphilis was 3.8% (95% CI 3.1–4.6) among newborn infants and 4.1% (95% CI 3.4–5.0) among their mothers. Maternal age <25 years, past history of genital ulcer, a past history of abnormal vaginal discharge, and not receiving treatment of at least one of genital ulcer, genital itching, lower abdominal pain and abnormal vaginal discharge in the current pregnancy were the risk factors associated with congenital syphilis. The most common clinical feature was hepatosplenomegaly. Conclusions We found higher-than-expected syphilis sero-prevalence rates in a high risk population of postnatal mothers and their newborns in Uganda. Bridge populations for syphilis may include mothers not tested during pregnancy, who are usually married and not treated. In accordance with our results, the national policy for syphilis control in Uganda should be strengthened to include universal syphilis screening amongst mother-newborn pairs in postnatal clinics with subsequent partner notification.
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Affiliation(s)
- Sam Oloya
- Mbarara University of Science and Technology, P O Box 1410, Mbarara, Uganda
| | - David Lyczkowski
- Department of Pediatrics, Newton-Wellesley Hospital, 2014, Washington Street, USA
| | - Patrick Orikiriza
- Mbarara University of Science and Technology, P O Box 1410, Mbarara, Uganda.,Epicentre Mbarara Research Centre, P.O. Box 1956, Mbarara, Uganda
| | - Max Irama
- Mbarara University of Science and Technology, P O Box 1410, Mbarara, Uganda
| | - Yap Boum
- Mbarara University of Science and Technology, P O Box 1410, Mbarara, Uganda.,Epicentre Mbarara Research Centre, P.O. Box 1956, Mbarara, Uganda
| | - Richard Migisha
- Mbarara University of Science and Technology, P O Box 1410, Mbarara, Uganda
| | - Julius P Kiwanuka
- Mbarara University of Science and Technology, P O Box 1410, Mbarara, Uganda
| | - Juliet Mwanga-Amumpaire
- Mbarara University of Science and Technology, P O Box 1410, Mbarara, Uganda. .,Epicentre Mbarara Research Centre, P.O. Box 1956, Mbarara, Uganda.
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28
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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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Sung V, Downie L, Paxton GA, Liddle K, Birman CS, Chan WW, Cottier C, Harris A, Hunter M, Peadon E, Peacock K, Roddick L, Rose E, Saunders K, Amor DJ. Childhood Hearing Australasian Medical Professionals network: Consensus guidelines on investigation and clinical management of childhood hearing loss. J Paediatr Child Health 2019; 55:1013-1022. [PMID: 31524978 DOI: 10.1111/jpc.14508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/14/2019] [Accepted: 05/12/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Valerie Sung
- Prevention Innovation, Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Lilian Downie
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Reproductive Epidemiology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital, Monash University, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Monash University, Melbourne, Victoria, Australia
| | - Georgia A Paxton
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Karen Liddle
- Child Development Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Queensland, Australia
| | - Catherine S Birman
- ENT Department, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Cochlear Implant Centre, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Medical School, Macquarie University, Sydney, New South Wales, Australia
| | - Wei Wei Chan
- Department of Paediatrics, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Carolyn Cottier
- The Hearing Support Service, Sydney Children's Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Alison Harris
- Child Development Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Queensland, Australia
| | - Matthew Hunter
- Monash Genetics, Monash Health, Monash University, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth Peadon
- Deafness Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Kenneth Peacock
- Deafness Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Laurence Roddick
- Department of General Paediatrics, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,Department of Paediatric Respiratory Medicine, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,Discipline of Paediatrics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Elizabeth Rose
- Department of Otolaryngology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Otolaryngology, University of Melbourne, Melbourne, Victoria, Australia.,Neurogenetics, Genetics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Otolaryngology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Kerryn Saunders
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Paediatric Hearing Services, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - David J Amor
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Monash University, Melbourne, Victoria, Australia.,Neurodisability and Rehabilitation, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
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Kumbhat N, Folkins A, Hawksley C, Cohen R. Case 2: Infant with Early Direct Hyperbilirubinemia. Neoreviews 2019; 20:e350-e352. [PMID: 31261099 DOI: 10.1542/neo.20-6-e350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Ann Folkins
- Pathology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
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31
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Buyuktimkin B, Zafar H, Saier MH. Comparative genomics of the transportome of Ten Treponema species. Microb Pathog 2019; 132:87-99. [PMID: 31029716 DOI: 10.1016/j.micpath.2019.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/02/2019] [Accepted: 04/23/2019] [Indexed: 02/08/2023]
Abstract
Treponema is a diverse bacterial genus, the species of which can be pathogenic, symbiotic, or free living. These treponemes can cause various diseases in humans and other animals, such as periodontal disease, bovine digital dermatitis and animal skin lesions. However, the most important and well-studied disease of treponemes that affects humans is 'syphilis'. This disease is caused by Treponema pallidum subspecie pallidum with 11-12 million new cases around the globe on an annual basis. In this study we analyze the transportome of ten Treponema species, with emphasis on the types of encoded transport proteins and their substrates. Of the ten species examined, two (T. primitia and T. azonutricium) reside as symbionts in the guts of termites; six (T. pallidum, T. paraluiscuniculi, T. pedis, T. denticola, T. putidum and T. brennaborense) are pathogens of either humans or animals, and T. caldarium and T. succinifaciens are avirulent species, the former being thermophilic. All ten species have a repertoire of transport proteins that assists them in residing in their respective ecological niches. For instance, oral pathogens use transport proteins that take up nutrients uniquely present in their ecosystem; they also encode multiple multidrug/macromolecule exporters that protect against antimicrobials and aid in biofilm formation. Proteins of termite gut symbionts convert cellulose into other sugars that can be metabolized by the host. As often observed for pathogens and symbionts, several of these treponemes have reduced genome sizes, and their small genomes correlate with their dependencies on the host. Overall, the transportomes of T. pallidum and other pathogens have a conglomerate of parasitic lifestyle-assisting proteins. For example, a T. pallidum repeat protein (TprK) mediates immune evasion; outer membrane proteins (OMPs) allow nutrient uptake and end product export, and several ABC transporters catalyze sugar uptake, considered pivotal to parasitic lifestyles. Taken together, the results of this study yield new information that may help open new avenues of treponeme research.
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Affiliation(s)
- Bora Buyuktimkin
- Department of Molecular Biology, Division of Biological Sciences, University of California, San Diego, La Jolla, CA, 92093-0116, USA
| | - Hassan Zafar
- Department of Molecular Biology, Division of Biological Sciences, University of California, San Diego, La Jolla, CA, 92093-0116, USA; Institute of Microbiology, University of Agriculture, Faisalabad, Punjab, Pakistan
| | - Milton H Saier
- Department of Molecular Biology, Division of Biological Sciences, University of California, San Diego, La Jolla, CA, 92093-0116, USA.
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32
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Munoz A, Crane T, Hazboun R, Banerji A, Baerg J. Surgical consultation in neonates with congenital syphilis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2018.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Walker GJA, Walker D, Molano Franco D, Grillo‐Ardila CF. Antibiotic treatment for newborns with congenital syphilis. Cochrane Database Syst Rev 2019; 2:CD012071. [PMID: 30776081 PMCID: PMC6378924 DOI: 10.1002/14651858.cd012071.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- Godfrey JA Walker
- The University of LiverpoolC/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Damian Walker
- Bill & Melinda Gates FoundationCost‐Effectiveness, Integrated Delivery, Global DevelopmentSeattleUSAWA 98102
| | - Daniel Molano Franco
- Fundacion Universitaria de Ciencias de la Salud, Hospital de San JoséDepartment of Critical CareCarrera 19 # 8‐32BogotaBogotaColombia11001
| | - Carlos F Grillo‐Ardila
- Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Obstetrics and GynecologyCarrera 30 No 45‐03BogotaColombia
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Deall H, Faust SN, Pelosi E, Fairhurst J, Elliott K, Patel S. Congenital syphilis presenting with liver lesions. Int J STD AIDS 2018; 30:82-85. [PMID: 30114994 DOI: 10.1177/0956462418779311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Heather Deall
- 1 Department of Paediatric Infectious Diseases and Immunology, University Hospital Southampton NHS Foundation Trust, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Saul N Faust
- 2 Department of Paediatric Infectious Diseases and Immunology, University Hospital Southampton NHS Foundation Trust, Faculty of Medicine and Institute for Life Sciences, NIHR Biomedical Research Centre, NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Emanuela Pelosi
- 3 Department of Infection, University Hospital Southampton NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Joanna Fairhurst
- 4 Department of Radiology, University Hospital Southampton NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kirsten Elliott
- 5 Department of Paediatric Orthopaedics, University Hospital Southampton NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sanjay Patel
- 6 Department of Paediatric Infectious Diseases and Immunology, University Hospital Southampton NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Majors CE, Smith CA, Natoli ME, Kundrod KA, Richards-Kortum R. Point-of-care diagnostics to improve maternal and neonatal health in low-resource settings. LAB ON A CHIP 2017; 17:3351-3387. [PMID: 28832061 PMCID: PMC5636680 DOI: 10.1039/c7lc00374a] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Each day, approximately 830 women and 7400 newborns die from complications during pregnancy and childbirth. Improving maternal and neonatal health will require bringing rapid diagnosis and treatment to the point of care in low-resource settings. However, to date there are few diagnostic tools available that can be used at the point of care to detect the leading causes of maternal and neonatal mortality in low-resource settings. Here we review both commercially available diagnostics and technologies that are currently in development to detect the leading causes of maternal and neonatal mortality, highlighting key gaps in development where innovative design could increase access to technology and enable rapid diagnosis at the bedside.
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Affiliation(s)
- Catherine E Majors
- Department of Bioengineering, Rice University, 6100 Main Street, MS-142, Houston, TX 77005, USA.
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Kikuchi K, Okawa S, Zamawe COF, Shibanuma A, Nanishi K, Iwamoto A, Saw YM, Jimba M. Effectiveness of Continuum of Care-Linking Pre-Pregnancy Care and Pregnancy Care to Improve Neonatal and Perinatal Mortality: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0164965. [PMID: 27788176 PMCID: PMC5082954 DOI: 10.1371/journal.pone.0164965] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 10/04/2016] [Indexed: 11/19/2022] Open
Abstract
REVIEW REGISTRATION PROSPERO International prospective register of systematic reviews (CRD42015023424).
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Affiliation(s)
- Kimiyo Kikuchi
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Institute of Decision Science for a Sustainable Society, Kyushu University, Fukuoka, Japan
| | - Sumiyo Okawa
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Collins O. F. Zamawe
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Keiko Nanishi
- Office of International Academic Affairs, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Azusa Iwamoto
- Bureau of International Medical Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- * E-mail:
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Gupta AG, Adler MD. Management of an Unexpected Delivery in the Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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38
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Affiliation(s)
- Godfrey JA Walker
- The University of Liverpool; C/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health; First Floor, Liverpool Women's NHS Foundation Trust Crown Street Liverpool UK L8 7SS
| | - Damian Walker
- Bill & Melinda Gates Foundation; Cost-Effectiveness, Integrated Delivery, Global Development; Seattle USA WA 98102
| | - Daniel Molano Franco
- Fundacion Universitaria de Ciencias de la Salud, Hospital de San Jose, Clinica universitaria Colombia UNISANITAS; Department of Critical Care; Carrera 19 # 8-32 Bogota Bogota Colombia 11001
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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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40
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George CRR. Diagnosis of congenital syphilis and toxoplasmosis. MICROBIOLOGY AUSTRALIA 2015. [DOI: 10.1071/ma15065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Syphilis, toxoplasmosis, and cytomegalovirus represent disparate entities. The bacterial spirochaete Treponema pallidum ssp. pallidum causes syphilis, the ‘The Great Imitator'; the organism's sole natural host is humans and it remains exquisitely sensitive to penicillin. By contrast, the zoonotic parasite Toxoplasma gondii causes toxoplasmosis. Infection is usually self-limited, although serious disease can occur in the immunocompromised. Meanwhile, the human cytomegalovirus (CMV; human herpesvirus 5) is a relatively prevalent enveloped DNA betaherpesvirus with infection specific to humans. Despite nomenclatural, ecological and therapeutic disparities, however, these agents exhibit several concordances, including various, and at times, cryptic syndromes in child and often mother; congenital infections with potentially devastating outcomes; diagnostic dilemmas. This article primarily discusses the latter of these issues in relationship to congenital syphilis and toxoplasmosis in the Australian context.
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Abstract
In many parts of the world particularly sub-Saharan Africa, congenital syphilis is a significant public health problem. Though it is rare in most affluent countries there has been a slight resurgence recently in several European countries. 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 cornerstone of congenital syphilis control is antenatal screening and treatment of mothers with penicillin and in affluent countries it should be strengthened among those at high risk. In developing countries antenatal care screening needs to be strengthened by implementing point-of-care decentralised screening and treatment, also alternative novel approaches to control congenital syphilis should be looked at and utilized. International health agencies and political parties should take steps urgently to support focused approaches to tackling the problem of continuing congenital syphilis.
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Phiske MM. Current trends in congenital syphilis. Indian J Sex Transm Dis AIDS 2014; 35. [PMID: 24958980 PMCID: PMC4066591 DOI: 10.4103/2589-0557.132404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In many parts of the world particularly sub-Saharan Africa, congenital syphilis is a significant public health problem. Though it is rare in most affluent countries there has been a slight resurgence recently in several European countries. 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 cornerstone of congenital syphilis control is antenatal screening and treatment of mothers with penicillin and in affluent countries it should be strengthened among those at high risk. In developing countries antenatal care screening needs to be strengthened by implementing point-of-care decentralised screening and treatment, also alternative novel approaches to control congenital syphilis should be looked at and utilized. International health agencies and political parties should take steps urgently to support focused approaches to tackling the problem of continuing congenital syphilis.
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Affiliation(s)
- Meghana Madhukar Phiske
- Department of Dermatology, L.T.M.M.C and General Hospital, Sion, Mumbai, Maharashtra, India,Address for correspondence: Dr. Meghana Phiske, N-17, Sector-7, Vashi, Navi Mumbai, Thane - 400 703, Maharashtra, India. E-mail:
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Abstract
Despite comprehensive antenatal screening recommendations and inexpensive treatment, congenital syphilis has long been and continues to be a public health concern, causing substantial morbidity and adverse outcomes. The following article reviews syphilis etiology and presentation, clinical disease, laboratory diagnosis, and treatment of congenital syphilis. A case will be presented describing a 31-week male infant exposed to infectious syphilis in utero. The neonate presented with classic signs of infection at birth. After initial serology testing of the infant, appropriate treatment was commenced. The infant received crystalline penicillin G for a period of ten days in consultation with pediatric infectious disease specialists. As expected, the infant's rapid plasma reagin (RPR) titers declined by three and six months of age. An interdisciplinary approach provided safe and optimal care for this infant. He was discharged, stable, and thriving at 38 weeks corrected age. Long-term multidisciplinary management and follow-up were arranged.
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Affiliation(s)
- Tara Follett
- Northern Alberta Neonatal Intensive Care Program at the Stollery Children's Hospital, Alberta, Canada.
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Jones H, Taylor D, Montgomery CA, Patrick DH, Money D, Vipond JCF, Morshed MG, Ruissard DA, Rekart ML. Prenatal and Congenital Syphilis in British Columbia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2005; 27:467-72. [PMID: 16100641 DOI: 10.1016/s1701-2163(16)30529-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the incidence of maternal syphilis and the corresponding rate of infection in exposed neonates in British Columbia before and after a serious outbreak of infectious syphilis in the heterosexual population. METHODS We conducted a retrospective chart review of pregnant women with positive syphilis serology and reported cases of congenital syphilis in British Columbia from 1994 to 2003. Clinical charts were reviewed for demographic information, staging of maternal syphilis, and stage of pregnancy when treatment was received. The primary outcome measure was the number of cases of congenital syphilis. We conducted a 2-sided z-test and Fisher's exact test to determine differences in the proportion of infectious syphilis in mothers and the number of cases of congenital syphilis before and during the major outbreak. RESULTS In 389 478 live births in British Columbia between 1994 and 2003, 77% of mothers had prenatal syphilis serology. A diagnosis of syphilis was made in 183 mothers, resulting in 5 cases of congenital syphilis. Four of these were in infants whose mothers did not undergo prenatal syphilis testing. The proportion of pregnant women with infectious syphilis was significantly higher after the onset of a major outbreak of syphilis in the community than it was before (P = 0.001), but there was no significant difference in the number of cases of congenital syphilis (3 before and 2 after the outbreak, P = 0.36). CONCLUSION Although syphilis rates in British Columbia during the study period rose steadily, the prevalence of congenital syphilis remained low. Our findings suggest that, in the context of a major outbreak, universal screening and prenatal syphilis testing may contribute to controlling rates of congenital syphilis.
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Affiliation(s)
- Hugh Jones
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
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