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Ewing A, Larsen N, Chiquoine E, Lee E, Fricchione M. A Preterm Infant with Petechial Rash. Neoreviews 2024; 25:e361-e365. [PMID: 38821906 DOI: 10.1542/neo.25-6-e361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/05/2023] [Accepted: 01/09/2024] [Indexed: 06/02/2024]
Affiliation(s)
- Anne Ewing
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
- Division of Pediatric Infectious Diseases, Hassenfeld Children's Hospital at NYU Langone, New York City, NY
| | - Nicole Larsen
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
- Division of Neonatology, CS Mott Children's Hospital, Ann Arbor, MI
| | - Elizabeth Chiquoine
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
- Division of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Esther Lee
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
- Division of Neonatology, Rush Children's Hospital, Chicago, IL
| | - Marielle Fricchione
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
- Division of Pediatric Infectious Diseases, Rush Children's Hospital, Chicago, IL
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Lee HS, Lee JI, Jeon J. Congenital syphilis unusually presenting with prematurity-related severe neonatal morbidities including meconium obstruction: A case report and review of the literature. Medicine (Baltimore) 2020; 99:e22321. [PMID: 33019408 PMCID: PMC7535783 DOI: 10.1097/md.0000000000022321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Congenital syphilis (CS) can manifest as a variety of clinical presentations according to the severity in symptomatic infants during neonatal period. Preterm neonates with CS may have more clinical evidences of infection and be more severely affected by CS compared with term ones. With increasing survival of markedly premature infants for recent decades, CS may be a challenging problem in those with severe manifestations associated with combined pathophysiologies of CS and prematurity. PATIENT CONCERNS A very low birth weight infant at 32 weeks gestation presented with an unusual CS presentation consisting of prematurity-associated severe neonatal morbidities including meconium obstruction, prolonged cholestatic jaundice with elevated liver enzymes, and disseminated intravascular coagulation with a bleeding diathesis, in addition to common or typical manifestations of CS. DIAGNOSES Congenital syphilis. INTERVENTIONS Therapy consisting of a complete course of parenteral penicillin, blood component therapy, proximal ileotomy with inspissated meconium evacuation and distal loop ileostomy, and other conservative treatments. OUTCOMES Resolution with normal gastrointestinal function and improved liver function was observed. LESSONS This case suggests that in premature infants CS may manifest as unusual severe neonatal morbidities that may result from combination of syphilitic pathologies and contributors or conditions associated with prematurity including multisystem immaturity.
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Affiliation(s)
| | - Jong In Lee
- Pediatric surgery, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
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Kanai M, Arima Y, Shimada T, Hori N, Yamagishi T, Sunagawa T, Tada Y, Takahashi T, Ohnishi M, Matsui T, Oishi K. Sociodemographic characteristics and clinical description of congenital syphilis patients and their mothers in Japan: a qualitative study, 2016. Sex Health 2019; 15:460-467. [PMID: 30236211 DOI: 10.1071/sh18033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/27/2018] [Indexed: 11/23/2022]
Abstract
Background In Japan, congenital syphilis (CS) notifications have increased recently. However, little is known about the CS cases or the clinical and sociodemographic characteristics of the patients' mothers. METHODS Twelve cases of CS were reported through national surveillance in the period March-December 2016, and the mothers of seven patients were included in this study. The patients' mothers and physicians completed a self-administered questionnaire, providing sociodemographic and clinical information of the patients and their mothers. In addition, we explored the awareness and knowledge of, attitudes towards and practices regarding CS occurrence through semistructured interviews with the mothers. RESULTS Of the seven CS patients, three were asymptomatic, with a range of non-specific clinical manifestations in the rest. The mothers tended to be of young age, unmarried and to have a history of commercial sex work, other sexually transmissible infections (STIs) and no or irregular prenatal care visits during pregnancy. Of the four mothers who had had regular prenatal care visits, two had tested negative for syphilis at the first trimester antenatal screening. Themes emerged that indicated challenges in preventing CS, including a lack of guidance or guidelines for physicians to consider testing for syphilis after the first trimester, lack of physicians' awareness or experience of syphilis or CS and a lack of awareness or knowledge in pregnant women regarding STIs. CONCLUSIONS Key characteristics of recent CS patients and their mothers in Japan were revealed, identifying previously reported factors as well as new challenges. A holistic approach, designed to address challenges at the level of the healthcare system, healthcare provider and the pregnant woman and her partner will be important in preventing CS.
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Affiliation(s)
- Mizue Kanai
- Field Epidemiology Training Program, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Yuzo Arima
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Tomoe Shimada
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Narumi Hori
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Takuya Yamagishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Tomimasa Sunagawa
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Yuki Tada
- Travellers' Medical Center, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Takuri Takahashi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Tamano Matsui
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Kazunori Oishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
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Liu Y, Zhu Y, Wang Y, Wan C. Differences between congenital-syphilis presenting as sepsis and neonatal sepsis: A case-control study. Medicine (Baltimore) 2019; 98:e17744. [PMID: 31689826 PMCID: PMC6946349 DOI: 10.1097/md.0000000000017744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Congenital syphilis (CS) can cause serious impact on the fetus. However, congenital syphilis presenting as sepsis is a critical condition but hardly identified by the clinic for the first time. In this study, we aimed to identify the benefit of earlier and accurate diagnosis for the infants who suffer congenital syphilis presenting as sepsis.A retrospective study was performed with patients diagnosed of congenital syphilis presenting as sepsis who were the inpatients in the West China Second Hospital between 2011 and 2018. The control group was collected in the neonatal sepsis patients whose blood culture are positive.Fifty-eight patients were included in the study. In the congenital syphilis group, one patient died and 12 (41.3%) patients get worse to MODS (multiple organ dysfunction syndrome). Symptoms, signs, and lab examinations are found to be significantly different (P < .05) between two groups as below, including rash, palmoplantar desquamation, abdominal distension, splenomegaly, hepatomegaly, etc. And, at the aspect of Hb, PLT, WBC, CRP, ALT, AST, these differences occurred in the different groups. It is obvious that the prognosis of children with syphilis is worse. According to a comparison between the different outcomes in the CS, the worse outcome subgroup of patients is significantly younger and have more severely impaired liver function.Because of the high mortality of these infants, pediatricians should improve awareness of CS. Syphilis screening is recommended for pregnant women.
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Affiliation(s)
- Yang Liu
- Department of Pediatrics, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, People's Republic of China
| | - Yu Zhu
- Department of Pediatrics, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, People's Republic of China
| | - Yibin Wang
- Department of Pediatrics, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, People's Republic of China
| | - Chaomin Wan
- Department of Pediatrics, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, People's Republic of China
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Elarrat Canto SV, Leite Araújo MA, Espinosa Miranda A, Paulo Cardoso AR, Freitas de Almeida RL. Fetal and infant mortality of congenital syphilis reported to the Health Information System. PLoS One 2019; 14:e0209906. [PMID: 30608958 PMCID: PMC6319744 DOI: 10.1371/journal.pone.0209906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background Congenital syphilis (CS) is a major cause of mortality in several countries, especially in Latin America and the Caribbean. This study aimed to analyze fetal and infant mortality of CS reported to the Health Information System in a State in Northeastern Brazil. Methods and results This was a cross-sectional study that analyzed the deaths of CS from 2010 to 2014 through the linkage of the Mortality Information System (SIM) and the Notifiable Diseases Information System (Sinan). The Statistical Package for the Social Sciences (SPSS) version 23.0 was used to calculate the rates of Fetal, Perinatal, Neonatal (early and late), and Postneonatal Mortality. Simple linear regression was performed. Fisher's exact test or Pearson's chi-square test were used for comparison of proportions and Student's t-test was used for comparison of means. Of the 414 cases reported to the SIM as deaths possibly caused by CS, 44 (10.6%) presented CS as the underlying cause. From 2010 to 2014 the Infant Mortality Rate of CS was 16.3 per 100,000 live births (y = 0.65x + 14.33, R2 = 0.2338, p = 0.003). There was an 89.4% underreporting of deaths. Perinatal deaths and fetal deaths of CS accounted for 87.7% and 73.9% of total deaths, respectively. Conclusions The results of the study revealed a significant Fetal and Infant Mortality rate of CS and demonstrated the importance of using the linkage method in studies that involve the analysis of secondary data obtained from mortality and disease reporting systems. The underreporting of CS as a cause of fetal and infant mortality leads to unawareness of the reality of deaths from this disease, hindering the development of public policies aimed at its prevention.
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Affiliation(s)
| | - Maria Alix Leite Araújo
- Collective Health Post Graduation Program, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Angélica Espinosa Miranda
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Ana Rita Paulo Cardoso
- Department of Health Surveillance, Ceará State Secretary of Health, Fortaleza, Ceará, Brazil
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Kucinskiene V, Russetti L, Stoniene D, Vitkauskiene A, Valiukeviciene S, Tameliene R. A Case Report and Review of Early Symptomatic Congenital Syphilis Clinical Variations. Clin Pediatr (Phila) 2016; 55:693-7. [PMID: 26976805 DOI: 10.1177/0009922816638666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
| | - Laura Russetti
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dalia Stoniene
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | - Rasa Tameliene
- Lithuanian University of Health Sciences, Kaunas, Lithuania
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