368 results on '"Syphilis, Congenital drug therapy"'
Search Results
2. Congenital Syphilis.
- Author
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Schueller SS and Strunk T
- Subjects
- Female, Humans, Infant, Newborn, Male, Pregnancy, Anti-Bacterial Agents therapeutic use, Syphilis Serodiagnosis, Treponema pallidum isolation & purification, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Syphilis, Congenital complications, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Hepatomegaly diagnostic imaging, Hepatomegaly etiology
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- 2024
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3. Syphilis Treatment Among People Who Are Pregnant in Six U.S. States, 2018-2021.
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Tannis A, Miele K, Carlson JM, O'Callaghan KP, Woodworth KR, Anderson B, Praag A, Pulliam K, Coppola N, Willabus T, Mbotha D, Abetew D, Currenti S, Longcore ND, Akosa A, Meaney-Delman D, Tong VT, Gilboa SM, and Olsen EO
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- Humans, Female, Pregnancy, Adult, United States epidemiology, Young Adult, Syphilis, Congenital prevention & control, Syphilis, Congenital epidemiology, Syphilis, Congenital drug therapy, Anti-Bacterial Agents therapeutic use, Adolescent, Syphilis epidemiology, Syphilis diagnosis, Syphilis drug therapy, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious epidemiology, Prenatal Care
- Abstract
Objective: To describe syphilis treatment status and prenatal care among people with syphilis during pregnancy to identify missed opportunities for preventing congenital syphilis., Methods: Six jurisdictions that participated in SET-NET (Surveillance for Emerging Threats to Pregnant People and Infants Network) conducted enhanced surveillance among people with syphilis during pregnancy based on case investigations, medical records, and linkage of laboratory data with vital records. Unadjusted risk ratios (RRs) were used to compare demographic and clinical characteristics by syphilis stage (primary, secondary, or early latent vs late latent or unknown) and treatment status during pregnancy (adequate per the Centers for Disease Control and Prevention's "Sexually Transmitted Infections Treatment Guidelines, 2021" vs inadequate or not treated) and by prenatal care (timely: at least 30 days before pregnancy outcome; nontimely: less than 30 days before pregnancy outcome; and no prenatal care)., Results: As of September 15, 2023, of 1,476 people with syphilis during pregnancy, 855 (57.9%) were adequately treated and 621 (42.1%) were inadequately treated or not treated. Eighty-two percent of the cohort received timely prenatal care. Although those with nontimely or no prenatal care were more likely to receive inadequate or no treatment (RR 2.50, 95% CI, 2.17-2.88 and RR 2.73, 95% CI, 2.47-3.02, respectively), 32.1% of those with timely prenatal care were inadequately or not treated. Those with reported substance use or a history of homelessness were nearly twice as likely to receive inadequate or no treatment (RR 2.04, 95% CI, 1.82-2.28 and RR 1.83, 95% CI, 1.58-2.13, respectively)., Conclusion: In this surveillance cohort, people without timely prenatal care had the highest risk for syphilis treatment inadequacy; however, almost a third of people who received timely prenatal care were not adequately treated. These findings underscore gaps in syphilis screening and treatment for pregnant people, especially those experiencing substance use and homelessness, and the need for systems-based interventions, such as treatment outside of traditional prenatal care settings., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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4. Congenital syphilis presenting with granulomatous scalp nodules.
- Author
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Vuong C, Lie E, Ellington N, Moodley A, Hinds B, and Barrio VR
- Subjects
- Humans, Infant, Newborn, Female, Male, Scalp Dermatoses diagnosis, Scalp Dermatoses microbiology, Diagnosis, Differential, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Granuloma diagnosis, Scalp pathology
- Abstract
We describe a case of congenital syphilis in an adopted infant with a unique dermatologic presentation of scalp granulomas, along with lymphadenopathy, anemia, and elevated liver transaminases. To our knowledge, this cutaneous morphology has not been previously reported in the literature. This case highlights the varied clinical presentation of congenital syphilis and the diagnostic challenge it poses for clinicians, especially in the context of unknown prenatal history/unknown risk factors, or if syphilis is acquired during pregnancy after routine screening is performed. As the incidence of congenital syphilis has more than tripled in recent years, this diagnosis should be considered when a neonate or infant presents with unexplained skin nodules., (© 2023 Wiley Periodicals LLC.)
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- 2024
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5. Scoping review of hearing loss attributed to congenital syphilis.
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Amjad Hafeeez A, Cavalcanti Bezerra K, Jimoh Z, Seal FB, Robinson JL, and Gomaa NA
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- Humans, Child, Adult, Incidence, Syphilis, Congenital complications, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology, Syphilis, Congenital diagnosis, Hearing Loss etiology
- Abstract
Background: There are no narrative or systematic reviews of hearing loss in patients with congenital syphilis., Objectives: The aim of this study was to perform a scoping review to determine what is known about the incidence, characteristics, prognosis, and therapy of hearing loss in children or adults with presumed congenital syphilis., Eligibility Criteria: PROSPERO, OVID Medline, OVID EMBASE, Cochrane Library (CDSR and Central), Proquest Dissertations and Theses Global, and SCOPUS were searched from inception to March 31, 2023. Articles were included if patients with hearing loss were screened for CS, ii) patients with CS were screened for hearing loss, iii) they were case reports or case series that describe the characteristics of hearing loss, or iv) an intervention for hearing loss attributed to CS was studied., Sources of Evidence: Thirty-six articles met the inclusion criteria., Results: Five studies reported an incidence of CS in 0.3% to 8% of children with hearing loss, but all had a high risk of bias. Seven reported that 0 to 19% of children with CS had hearing loss, but the only one with a control group showed comparable rates in cases and controls. There were 18 case reports/ case series (one of which also reported screening children with hearing loss for CS), reporting that the onset of hearing loss was usually first recognized during adolescence or adulthood. The 7 intervention studies were all uncontrolled and published in 1983 or earlier and reported variable results following treatment with penicillin, prednisone, and/or ACTH., Conclusions: The current literature is not informative with regard to the incidence, characteristics, prognosis, and therapy of hearing loss in children or adults with presumed congenital syphilis., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hafeeez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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6. Update on syphilis in pregnancy: marrying basic science advances and clinical perseverance to solve an ancient public health problem.
- Author
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Adhikari EH
- Subjects
- Pregnancy, Adult, Female, Humans, Anti-Bacterial Agents therapeutic use, Public Health, Penicillins therapeutic use, Syphilis diagnosis, Syphilis drug therapy, Syphilis prevention & control, Syphilis, Congenital diagnosis, Syphilis, Congenital prevention & control, Syphilis, Congenital drug therapy, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious prevention & control, Vaccines therapeutic use
- Abstract
Purpose of Review: While the clinical disease of syphilis, its consequences in pregnancy, and its sensitivity to penicillin treatment have remained relatively unchanged for a century or more, new technologies and basic discoveries in syphilis research have translated into tangible advances in clinical diagnosis, treatment, and prevention. The purpose of this review is to help the reader understand some of the recent relevant scientific publications on syphilis and its causative organism in a clinical obstetric context., Recent Findings: Rates of adult and congenital syphilis have risen dramatically in the last decade despite public health efforts. Penicillin shortages and lack of screening or adequate treatment have all contributed to global disease burden. Advances in genomic and microbiological characterization of this spirochete have led to new developments in serologic and molecular diagnosis as well as evaluation of potential vaccine candidates. Until a syphilis vaccine is available, substance use disorders and lack of screening in pregnancy are associated with increased congenital syphilis, and these challenges will require novel solutions to fully address this public health crisis., Summary: Addressing the burden of congenital syphilis demands that obstetricians stay well informed of new tools and resources for diagnosis, treatment, and prevention of syphilis now and in the future., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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7. Congenital syphilis: the re-emergence of a forgotten disease.
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Foles AI, Eiras Dias M, Figueiredo M, and Marçal M
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- Pregnancy, Infant, Newborn, Female, Humans, Prenatal Diagnosis, Mothers, Syphilis Serodiagnosis, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis diagnosis, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious prevention & control
- Abstract
A preterm newborn presented at birth with generalised oedema, disseminated bullous and desquamative exanthema with palmoplantar involvement and hepatomegaly, admitted to the neonatal intensive care unit with severe multisystemic disease, haemodynamic instability and respiratory distress. The mother had a history of treated latent syphilis before pregnancy. Venereal Disease Research Laboratory screening was negative in the first trimester, titre 1:2 in second trimester and 1:32 in the third trimester, a result only available to the medical team at birth. The mother's rapid plasma reagin (RPR) titre was 1:64 at birth. The newbon's RPR titre was 1:256, confirming the diagnosis of early congenital syphilis. The newborn was treated with aqueous penicillin G, with clinical and laboratorial progressive recovery. Congenital syphilis is a preventable disease, but despite prenatal screening programmes, it remains a significant public health issue worldwide with high morbidity and mortality., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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8. Pemphigus syphiliticus with Jarisch-Herxheimer reaction in a newborn.
- Author
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Pañgan EAC, Asetre-Luna I, Uy MEV, and Esguerra AKM
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- Infant, Newborn, Infant, Female, Humans, Blister, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Pemphigus diagnosis, Pemphigus drug therapy, Syphilis diagnosis, Syphilis, Cutaneous, Exanthema, Soft Tissue Injuries
- Abstract
Congenital syphilis is a serious, disabling, and life-threatening infection that is transmitted transplacentally from mother to fetus. Early diagnosis is often difficult because affected infants are usually asymptomatic at birth and clinical findings are often subtle and nonspecific. Pemphigus syphiliticus is an early presentation of congenital syphilis which is characterized by fluid-filled vesicles and bullae which appear mostly on the extremities and tend to rapidly desquamate and erode. Awareness of the clinicians to this early cutaneous manifestation and possible treatment reaction will allow for prompt diagnosis and adequate treatment of syphilis-infected patients., (© 2023 Wiley Periodicals LLC.)
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- 2024
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9. [Association between different treatment timings and adverse neonatal outcomes in pregnant women with syphilis during pregnancy].
- Author
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Hu F, Huang ZQ, Cai M, Xu HF, Jiang HB, and Gao S
- Subjects
- Pregnancy, Female, Infant, Newborn, Humans, Pregnant Women, Infectious Disease Transmission, Vertical prevention & control, Syphilis drug therapy, Syphilis epidemiology, Syphilis diagnosis, Pregnancy Complications, Infectious drug therapy, Syphilis, Congenital drug therapy, Premature Birth
- Abstract
Objective: To analyze the association between different treatment timings and adverse neonatal outcomes (premature birth, death, congenital syphilis) in syphilis-infected pregnant women. Methods: The National Management Information System for Prevention of HIV, Syphilis and HBV Mother-to-Child Transmission was used to collect information on the detection and treatment of syphilis-infected pregnant women and their newborns in Guangdong Province from October 2011 to December 2021. According to the gestational weeks of syphilis-infected pregnant women receiving penicillin treatment for the first time, they were divided into four groups: treatment in the first trimester, treatment in the second trimester, treatment in the third trimester, and no treatment during pregnancy. Multivariate logistic regression was used to analyze the association between different treatment timings and adverse neonatal outcomes in syphilis-infected pregnant women. Results: A total of 22 483 syphilis-infected pregnant women were included. The number of pregnant women who started treatment in the first trimester, second trimester, and third trimester and did not receive treatment during pregnancy were 4 549 (20.23%), 8 719 (38.78%), 2 235 (9.94%) and 6 980 (31.05%), respectively. Compared with pregnant women who started treatment in the first trimester, pregnant women who did not receive anti-syphilis treatment during pregnancy had increased risks of neonatal preterm birth ( OR =1.42, 95% CI : 1.24-1.62), death ( OR =4.27, 95% CI : 1.64-14.69) and congenital syphilis ( OR =12.26, 95% CI : 6.35-27.45). At the same time, the risk of congenital syphilis in the newborns of pregnant women who started anti-syphilis treatment in the second trimester ( OR =2.68, 95% CI : 1.34-6.16) and third trimester ( OR =6.27, 95% CI : 2.99-14.80) also increased. Conclusion: Early initiation of anti-syphilis treatment during pregnancy in patients with syphilis can improve neonatal outcomes.
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- 2023
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10. Case Series of Stillbirths Due to Syphilis in Edmonton, Alberta, Canada.
- Author
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Robinson JL, Donovan A, Gratrix J, Smyczek P, and Tse-Chang A
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- Female, Humans, Infant, Pregnancy, Alberta epidemiology, Penicillin G Benzathine therapeutic use, Pregnancy Complications, Infectious diagnosis, Stillbirth epidemiology, Syphilis complications, Syphilis diagnosis, Syphilis drug therapy, Syphilis, Congenital epidemiology, Syphilis, Congenital prevention & control, Syphilis, Congenital drug therapy
- Abstract
Background: Data on the incidence and characteristics of stillbirths attributed to congenital syphilis were collected., Methods: We extracted data on stillbirths in the Edmonton Zone on January 1, 2015, through June 30, 2021, born to persons diagnosed with infectious syphilis (primary, secondary, early latent, or early neurosyphilis) during pregnancy or at the time of delivery., Results: Of 314 infants documented to be exposed to infectious syphilis during gestation, 16 (5.1%) were stillborn. Three of the 16 females with stillbirths were diagnosed with syphilis during pregnancy but not treated, 12 were diagnosed only at the time of stillbirth (1 of whom was treated early in pregnancy and presumably reinfected), and 1 had a stillbirth in the week after one dose of benzathine penicillin G., Conclusions: Stillbirths due to congenital syphilis were all due to failure to treat syphilis in pregnancy. Innovative strategies to prevent syphilis in the community and to reach those experiencing barriers to care are urgently required to not miss opportunities to diagnose and treat syphilis as early as possible during pregnancy., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (Copyright © 2023 American Sexually Transmitted Diseases Association. All rights reserved.)
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- 2023
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11. Congenital Syphilis Infection: A Case Study.
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Church S, Willis S, and Jnah A
- Subjects
- Infant, Newborn, Pregnancy, Female, Humans, Prenatal Care, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis diagnosis, Syphilis drug therapy, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious therapy, Infant, Newborn, Diseases, Fetal Diseases
- Abstract
Congenital syphilis (CS) infection occurs by way of vertical transmission of the bacteria Treponema pallidum from mother to fetus. While nearly eliminated by the turn of the twenty-first century, CS has resurged in recent years and currently represents a worldwide public health calamity secondary to insufficient prenatal care and inadequate maternal treatment. Fetal and neonatal consequences include stillbirth, cutaneous and visceral symptoms, asymptomatic infection, and death. Given the rise in cases in both wealthy and resource-poor areas, neonatal clinicians are obligated to maintain acumen specific to risk factors, manifestations, and treatment regimens. However, limited data guide postnatal treatment regimens, particularly in preterm neonates. We present a case report of a preterm female with CS and integrated review of the literature. Our findings indicate that CS is preventable through efficient and judicious perinatal screening, early detection, and adequate treatment of maternal syphilis during pregnancy., (© Copyright 2023 Springer Publishing Company, LLC.)
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- 2023
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12. Mucocutaneous manifestations of congenital syphilis in the neonate: A review of a surging disease.
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Newton J, Silence C, Boetes J, and Cohen BA
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- Pregnancy, Female, Infant, Newborn, Humans, Treponema pallidum, Public Health, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis diagnosis, Syphilis drug therapy
- Abstract
Syphilis is an infection caused by Treponema pallidum. It is most commonly acquired through sexual transmission, although it can also be transmitted vertically across the placenta, resulting in congenital syphilis. Even with improved public health measures, testing, and treatment capabilities, primary, secondary, and congenital syphilis have all surged since 2012. Given this marked increase in both incidence and prevalence, here we present a comprehensive review of the clinical presentation, treatment, and management of congenital syphilis, with particular consideration given to the mucocutaneous manifestations of the disease in neonates., (© 2022 Wiley Periodicals LLC.)
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- 2023
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13. Congenital syphilis: a rare presentation of a forgotten infection.
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Hegde A, Srinivasan R, and Dinakar C
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- Infant, Newborn, Infant, Humans, Pregnancy, Female, Prenatal Diagnosis, Mothers, Infectious Disease Transmission, Vertical, Syphilis, Congenital complications, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Pregnancy Complications, Infectious diagnosis, Hematologic Diseases, Syphilis
- Abstract
Congenital syphilis (CS), a common but forgotten disease has a broad spectrum of clinical presentation. Vertical transmission of this spirochaetal infection from the pregnant mother to the foetus can result in varied manifestations ranging from asymptomatic infection to life- threatening conditions in the form of stillbirth and neonatal death. The haematological and visceral manifestations of this disease can closely mimic various conditions including haemolytic anaemia and malignancies. Congenital syphilis should be considered as a differential in any infant presenting with hepatosplenomegaly and haematological abnormalities even if the antenatal screen was negative. We report a 6-month-old infant with congenital syphilis presenting with organomegaly, bicytopenia and monocytosis. A strong index of suspicion and early diagnosis is the key to the good outcome as treatment is simple and cost- effective., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2023 Anusha Hegde, Ranjini Srinivasan, Chitra Dinakar.)
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- 2023
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14. [Syphilis in Argentina].
- Author
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Kantor IN
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- Female, Humans, Pregnancy, Adolescent, Young Adult, Adult, Argentina epidemiology, Treponema pallidum, Azithromycin, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology
- Abstract
Syphilis is a disease preventable through sexual protection barriers, and curable with a simple treatment. Despite this, between 2010 and 2019, its incidence almost tripled in Argentina, reaching 56.1/100 000. The most affected are young people (15-24 years old), with a higher percentage of women, especially among pregnant women, in whom it increased from 2.3% to 5.8%, with a peak of 7.7% between 15 and 24 years old. Cases of secondary or tertiary syphilis, detected by control tests, are on the rise. The increase in syphilis is linked to HIV. For this reason, rapid detection tests must be carried out jointly at the first level of care, which facilitates access to the diagnosis and treatment of positive cases, with the corresponding guidance and control. Treatment with penicillin, for which no resistance has been found, is the key component of control. Doxycillin is also used (not in pregnant women), or ceftriaxone. The resistance of Treponema pallidum to azithromycin is increasing, so its use should be avoided. In 2022, 696 cases of congenital syphilis were reported. The national rate is 1.3 per 1000 live births. The majority of reported cases come from the public sector. Maternal syphilis is, in low-income areas, the most common cause of stillbirths. Strict application of existing regulations, strengthening the primary care system, and prevention during pregnancy can contribute to controlling and eliminating the syphilis problem in Argentina.
- Published
- 2023
15. Congenital syphilis as the cause of multiple bone fractures in a young infant case report.
- Author
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Koliou M, Chatzicharalampous E, Charalambous M, and Aristeidou K
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- Infant, Newborn, Pregnancy, Child, Infant, Male, Female, Humans, Rare Diseases, Penicillin G Benzathine therapeutic use, Syphilis, Congenital complications, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis diagnosis, Pregnancy Complications, Infectious diagnosis, Osteogenesis Imperfecta, Fractures, Bone
- Abstract
Background: The differential diagnosis of multiple unexplained bone fractures in a young infant usually includes child abuse or bone disease such as osteogenesis imperfecta. Bone abnormalities can occur in 60-80% of cases with congenital syphilis and may be the sole manifestation. However, this frequent manifestation of this rare disease such as congenital syphilis is frequently disregarded. We describe a case of a young infant with multiple long bone fractures diagnosed with congenital syphilis., Case Presentation: This 2-month-old male patient was referred to our hospital because of fractures of the ulna and distal radius bilaterally and noisy breathing with the suspicion of osteogenesis imperfecta. After thorough examination, the infant had anemia and a palpable spleen. We performed a screen for congenital infections among other investigations, which revealed positive non-treponemal and treponemal antibodies for syphilis. Hence the diagnosis for Congenital Syphilis was made. We performed a lumbar puncture (LP) which showed mild pleocytosis. The patient was treated with intravenous aqueous penicillin G 200 000 UI/KG per day for 10 days. In addition, a single dose of intramuscular penicillin G benzathine 50 000 UI/KG was given due to the abnormal result of CSF. On follow up admission 6 months later, the new syphilis serology had much improved and the new LP revealed no abnormal findings., Conclusions: We present this case report in order to remind of a common manifestation of congenital syphilis, a rare disease which needs to be included in the differential diagnosis of multiple unexplained fractures in early infancy. In our case the fractures were symmetric and bilateral and they were accompanied by anemia and mild hepatosplenomegaly which led to the investigation of congenital syphilis as a possible cause. However, two thirds of infants with congenital syphilis are asymptomatic at birth. All women should have a proper syphilis screening during pregnancy., (© 2022. The Author(s).)
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- 2022
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16. Congenital neurosyphilis presenting as neonatal sepsis.
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Iskandar W, Permatagalih V, Primadi A, and Gamayani U
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- Humans, Infant, Newborn, Male, Treponema pallidum, Neonatal Sepsis diagnosis, Neurosyphilis complications, Neurosyphilis diagnosis, Neurosyphilis drug therapy, Syphilis, Syphilis, Congenital complications, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy
- Abstract
Introduction: Congenital syphilis involves any organs with various symptoms, including neurological signs. Neurosyphilis is a severe syphilis complication that can develop at any stage of illness., Case Presentation: A 2,520 g male infant was spontaneously born at term from an untreated syphilis mother. Physical examination revealed decreased consciousness, respiratory distress, seizure, but without neurologic abnormality sign. The serum and cerebrospinal fluid Venereal Disease Research Laboratory and Treponemal Pallidum Hemagglutination Assay TPHA tests titters were 1:16 and 1:1,280, respectively. The diagnosis at admission was respiratory failure and neonatal sepsis. The infant was mechanically ventilated and treated with early management of sepsis. Blood culture was sterile later on. Then, the infant was administered intramuscular benzathine penicillin G (50,000 units/kg/dose) for a total of three weeks. The infant's condition was improved during the treatment., Conclusions: There are many challenges associated with screening and monitoring neurosyphilis in congenital syphilis. Congenital syphilis presenting as sepsis is easily misdiagnosed as bacterial sepsis., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Wedi Iskandar, Vidi Permatagalih, Aris Primadi, Uni Gamayani.)
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- 2022
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17. Congenital syphilis prevention in the context of methamphetamine use and homelessness.
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Plotzker RE, Burghardt NO, Murphy RD, McLean R, Jacobson K, Tang EC, and Seidman D
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- Female, Humans, Pregnancy, United States, Ill-Housed Persons, Methamphetamine, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious epidemiology, Syphilis diagnosis, Syphilis epidemiology, Syphilis prevention & control, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology, Syphilis, Congenital prevention & control
- Abstract
Background and Objectives: Congenital syphilis (CS) is increasing in the United States and is associated with intersecting social and structural determinants of health. This study aimed to delineate birthing parent characteristics associated with CS in an adjusted model. METHODS (N = 720): People diagnosed with syphilis during pregnancy from 2017 to 2018 who were interviewed and linked to infants in the California state surveillance system were included (herein, "birthing parents"). Sociodemographic and clinical CS risk factors informed a stepwise multivariable logistic regression model in which the outcome of interest was infants born with CS. CS prevention continuums delineated the proportion of pregnant people with syphilis who completed steps (e.g., prenatal care entry, syphilis testing, treatment) needed to prevent CS; the outcome was delivering an infant without CS. We stratified continuums by homelessness and methamphetamine use to explore differences in CS outcomes., Results: Of 720 birthing parents, 245 (34%) delivered an infant with CS. Although CS was initially associated with homelessness (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.6, 4.0) and methamphetamine use (OR = 2.1, 95% CI: 1.4, 3.1), the addition of prenatal care into a final adjusted model attenuated these associations to not significant. In CS prevention continuums, delivering an infant without CS was less likely for people who reported methamphetamine use (p < .001) and/or homelessness (p < .001). However, when examining only those who received prenatal care, statistical differences for these predictors no longer existed. In the final adjusted model the following were associated with CS: no prenatal care (OR = 16.7, 95% CI: 9.2, 30.3) or late prenatal care (OR = 2.9, 95% CI: 1.9, 4.2); early stage of syphilis (OR = 2.6, 95% CI: 1.8, 3.7); living in Central California (OR = 2.1, 95% CI: 1.1, 4.2)., Conclusions and Scientific Significance: This is the first analysis to explore birthing parent characteristics associated with delivering an infant with CS in an adjusted model. We demonstrate that prenatal care, when accessed, can result in effective CS prevention among people who are unhoused and/or using methamphetamine equally well compared to counterparts without these risk factors., (© 2022 American Academy of Addiction Psychiatry.)
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- 2022
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18. Severe Congenital Syphilis in the Neonatal Intensive Care Unit: A Retrospective Case Series.
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Aleem S, Walker LS, Hornik CD, Smith MJ, Grotegut CA, and Weimer KED
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- Female, Humans, Infant, Infant, Newborn, Intensive Care Units, Neonatal, Penicillin G therapeutic use, Pregnancy, Reagins, Retrospective Studies, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy
- Abstract
Background: There has been a 291% relative increase in congenital syphilis (CS) cases in the United States from 2015 to 2019. Although the majority of affected fetuses/infants are stillborn or are asymptomatic, a subset is born with severe clinical illness. We describe a series of severe CS cases in the neonatal intensive care unit., Methods: Retrospective review of infants with CS, admitted to the Duke Intensive Care Nursery from June 2016 to February 2020. We recorded birthweight, gestational age, medications, procedures, diagnoses, laboratory data and outcomes. Severe symptoms included: birth depression, hypoxic ischemic encephalopathy (HIE), disseminated intravascular coagulopathy and/or persistent pulmonary hypertension (PPHN)., Results: Seven infants with CS were identified and 5 with severe presentations were included. Median gestational age was 35.1 weeks (range: 29-37 weeks, median: 35 weeks). All infants required intubation at birth, 2 required chest compressions and epinephrine in the delivery room. One had hydrops fetalis and died in the delivery room. All 4 surviving infants had HIE, severe PPHN, hepatitis and seizures. All infants had a positive rapid plasma reagin, and were treated with penicillin G. Maternal rapid plasma reagin was pending for 3 of 5 infants at delivery, and later returned positive; 2 were positive during pregnancy but not treated. Other infectious work-up was negative. Three infants survived to discharge., Conclusion: CS can be associated with HIE, PPHN and disseminated intravascular coagulopathy in affected infants. Clinicians should have a high index of suspicion and include CS in their differential diagnoses. This study also highlights the importance of adequate treatment of identified cases and screening during the third trimester and at delivery., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2022
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19. Addressing the crisis of congenital syphilis: Key findings from an evaluation of the management of syphilis in pregnancy and the newborn in South-East Queensland.
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Wu M, Seel M, Britton S, Dean JA, Lazarou M, Safa H, Griffin P, and Nourse C
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- Female, Humans, Infant, Infant, Newborn, Placenta, Pregnancy, Queensland, Retrospective Studies, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Syphilis diagnosis, Syphilis drug therapy, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital prevention & control
- Abstract
Background: Syphilis in pregnancy and congenital syphilis (CS) are increasing in Australia. Prevention of adverse outcomes requires adherence to management guidelines., Aims: The aim is to evaluate the management of syphilis in pregnant women and their newborns., Materials and Methods: A retrospective study of public health notifications, clinical records and testing results of women with positive syphilis serology in pregnancy requiring treatment from 2016 to 2018 inclusive across South-East Queensland was conducted. Management was described and compared with contemporary guidelines from the Australasian Society of Infectious Diseases, the Communicable Diseases Network Australia and the United States Centers for Disease Control and Prevention., Results: Of 30 women identified, 22 (73%) had management consistent with the guidelines (stage-appropriate penicillin regimen, appropriate dosing interval and treatment completed greater than 30 days before delivery). Only 14 (47%) women had documentation of partner testing and/or treatment. Of 26 mother-infant pairs with complete data, 16 (62%) had investigations at delivery consistent with recommendations (parallel maternal-infant rapid plasma reagin, infant syphilis immunoglobulin M, placental histopathology +/- syphilis polymerase chain reaction and infant clinical examination). One infant met the criteria for confirmed CS. Five infants received penicillin therapy. Only seven (27%) infants had serological monitoring after discharge., Conclusions: Management can be optimised with timely maternal testing and treatment, comprehensive partner screening and treatment, strict adherence to seven-day penicillin dosing for late latent syphilis and thorough maternal and infant testing after treatment and delivery. If maternal treatment was inadequate in pregnancy, consideration needs to be given to close evaluation and empiric treatment of the infant., (© 2021 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)
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- 2022
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20. Factors associated with congenital syphilis: A retrospective study in Jiangxi Province, China.
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Wan Z, Tao Y, Zhang H, Hu Y, and Shu K
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- China epidemiology, Female, Humans, Infant, Infectious Disease Transmission, Vertical prevention & control, Pregnancy, Retrospective Studies, Risk Factors, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious epidemiology, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology, Syphilis, Congenital prevention & control
- Abstract
Background: There are a lack of studies about factors influencing congenital syphilis (CS) in economically underdeveloped areas, such as Jiangxi Province, China., Methods: A retrospective study was conducted based on the information system of prevention of mother-to-child transmission of syphilis management in Jiangxi Province, China. Pregnant women with syphilis infection who delivered ≥28 gestational weeks and registered in this system from 1 January 2013 to 2030 June 2018 were enrolled. Maternal characteristics and treatment regimens associated with CS were evaluated using multivariable regression analysis., Results: 1196 syphilis infected mothers and their 1207 infants were included in the analyses, and 116 infants were diagnosed with CS, providing an overall incidence of 9.61% (116/1207). Multivariable logistic regression analysis showed that increasing maternal age was barely associated with the risk of CS (adjusted odds ratio (aOR) = 0.97, 95% CI, 0.93-1.00, p = .047). Women with a high nontreponemal serum test titer (≥1:8) had a 126% increased risk of delivering an infant with CS than those with a low titer (<1:8) (aOR = 2.26, 95% CI, 1.51-3.39, p < .001). The risk for CS decreased significantly in infants born to mothers receiving adequate treatment than those receiving no treatment (aOR = 0.36, 95% CI, 0.21-0.61, p < .001)., Conclusions: Adequate treatment is critical for the prevention of CS. Further strategies focusing on early diagnosis and adequate treatment among syphilis infected pregnant women, particularly among those with younger age and high nontreponemal titer, should be strengthened to prevent CS.
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- 2022
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21. An analysis of the clinical features of children with early congenital Syphilis and Syphilitic Hepatitis.
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Yang H, Zhang H, Wang C, and Pang L
- Subjects
- Aspartate Aminotransferases, Child, Female, Humans, Penicillins therapeutic use, Pregnancy, Hepatitis diagnosis, Syphilis complications, Syphilis diagnosis, Syphilis drug therapy, Syphilis, Congenital complications, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy
- Abstract
Background: The infection rate of congenital syphilis is gradually increasing, the clinical manifestations of some children with congenital syphilis are abnormal liver function, which is given the clinical diagnosis of syphilitic hepatitis. At present, there are few studies on the clinical features of children with early congenital syphilis combined with syphilitic hepatitis, so we set out to do such a study. We compared the liver function indicators before and after the treatment of syphilis to find the clinical features that can provide guidance for clinical diagnosis and treatment., Methods: This study collected clinical data on 51 children with early congenital syphilis combined with syphilitic hepatitis in Beijing Ditan Hospital, affiliated with Capital Medical University, between April 2014 and October 2019. We observed their age, gender, clinical symptoms, and physical symptoms, as well as the pregnancy and childbirth history of their mothers. We also compared the liver function indicators before and after the treatment of the syphilis and analyzed the children's clinical features., Results: The results of this study showed that the clinical manifestations in children with early congenital syphilis combined with syphilitic hepatitis were diverse. The most common clinical manifestation was anemia (56.9 %), followed by syphilitic rash (54.9 %), hands, feet, and whole-body peeling (35.3 %), and splenomegaly (29.4 %). Liver damage caused by a syphilis infection tends to result in elevated alanine aminotransferase, aspartate aminotransferase, and bilirubin, while albumin decreases. After the syphilis treatment, the liver function indexes were significantly improved compared with before treatment, and the difference was statistically significant (all p < 0.05)., Conclusions: A child with abnormal liver function, especially with anemia, skin rash, peeling, abdominal distension, and hepatosplenomegaly should be highly suspected of having a syphilis infection. Once the diagnosis is made, the appropriate standard penicillin treatment should be started as soon as possible to improve the condition and prognosis of the child., (© 2021. The Author(s).)
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- 2021
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22. [Syphilis, the forgotten disease].
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Tunbäck P
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- Female, Humans, Pregnancy, Gonorrhea, Neurosyphilis diagnosis, Neurosyphilis drug therapy, Neurosyphilis epidemiology, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious epidemiology, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology
- Abstract
The incidence of syphilis was decreasing during the last decades of the 20th century, partly due to the awareness and fear of hiv. However, an increase is now apparent in many countries. It is still uncommon in Sweden compared to chlamydia and gonorrhoea, and the incidence is 4.6/100.000 inhabitants. The infection can be latent and without symptoms, but also manifest itself as a painless genital ulcer, with rash and fever, or as neurosyphilis. Congenital infection due to transmission of the syphilis spirochete from an infected mother to her fetus is still a problem in many parts of the world. In order to prevent congenital syphilis it is important for all pregnant women to have access to maternal care during their pregnancy, and to get efficient treatment if diagnosed with syphilis.
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- 2021
23. Administration of intravenous benzylpenicillin in 13 infants born to mothers with syphilis infection: A case series.
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Ikuta T, Abe S, Suga S, Nakasone R, Ashina M, Tanimura K, Nozu K, and Fujioka K
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- Female, Humans, Infant, Mothers, Penicillin G therapeutic use, Penicillin G Benzathine therapeutic use, Pregnancy, Pregnancy Complications, Infectious drug therapy, Syphilis drug therapy, Syphilis, Congenital drug therapy
- 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., (Copyright © 2021 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
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- 2021
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24. Diagnosis, treatment, and notification of syphilis during pregnancy in the state of Goiás, Brazil, between 2007 and 2017.
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Oliveira IM, Oliveira RPB, and Alves RRF
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- Brazil epidemiology, Female, Humans, Penicillin G Benzathine therapeutic use, Pregnancy, Pregnant Women, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious epidemiology, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology
- Abstract
Objective: To analyze the evolution of syphilis during pregnancy notification regarding clinical classification, diagnosis and treatment in the state of Goiás, Brazil, between 2007 and 2017., Methods: This is a time-series study, analyzing data provided by the Health Secretariat of the state of Goiás. The variables related to the diagnosis and treatment of pregnant women and their partners were analyzed, and their evolution trend during the years. Descriptive statistics and percentage calculation were used. Cochran-Armitage test with a significance level α = 0.05 was used to determine increase and decrease trends., Results: During the period, 7,774 cases were notified. The highest percentage of notifications occurred in the second trimester of pregnancy (39.8%) and corresponded to primary syphilis (34.1%). The most frequent treatment prescribed was benzathine benzylpenicillin with a dosage of 7.2 million (43.8%). Between 2007 and 2017, there was an increasing trend in the notification percentage of latent (14.1% to 30.7%), secondary (5.2% to 19%), and tertiary syphilis (4.4% to 11.4%). The treatment with benzathine benzylpenicillin with a dosage of 7.2 million also increased (19.3% to 59.6%). The percentages of primary syphilis decreased (43.4% to 22.1%), as well as other treatments' percentages., Conclusions: Latent syphilis notification of pregnant women and treatment with penicillin at the dosage of 7,200,000 IU increased. Notification forms' data completeness also increased for the variables clinical classification and treatment, suggesting improvements in the notification process.
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- 2021
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25. A case of congenital syphilis: the alarming and inequitable rise in congenital syphilis in Aotearoa and a call to action.
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Hall A, de Lore D, Giola M, Edmonds T, Best E, and Webb R
- Subjects
- Anti-Bacterial Agents administration & dosage, Humans, Infant, Newborn, Male, New Zealand, Penicillin G administration & dosage, Syphilis, Congenital drug therapy, Treatment Outcome, Treponema pallidum isolation & purification, Syphilis, Congenital diagnosis
- Abstract
Competing Interests: Nil.
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- 2021
26. Congenital syphilis on the rise: the importance of testing and recognition.
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Wu MX, Moore A, Seel M, Britton S, Dean J, Sharpe J, Inglis G, and Nourse CB
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- Humans, Infant, Male, Syphilis, Congenital drug therapy, Syphilis, Congenital diagnosis
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- 2021
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27. Pseudoparalysis of parrot - Re-emergence of the great mimicker.
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Li Y and Connelly SV
- Subjects
- Anti-Bacterial Agents therapeutic use, Child, Adopted, Elbow diagnostic imaging, Female, Humans, Infant, Penicillins therapeutic use, Periostitis drug therapy, Radius diagnostic imaging, Syphilis, Congenital drug therapy, Ulna diagnostic imaging, Periostitis diagnostic imaging, Syphilis, Congenital diagnosis
- Abstract
We present the case of a 2-month-old adopted female seeking evaluation in the pediatric emergency department due to a one-day history of decreased right arm movement and fussiness. The physical exam was largely unremarkable with the exception of decreased spontaneous movement of the right upper extremity, obvious discomfort with passive movement and subtle edema of the forearm. Because of concern for non-accidental trauma, plain films were obtained which revealed no signs of traumatic injury. Subsequently, a broader investigation ensued with infectious etiologies in mind. Laboratory evaluation demonstrated anemia, transaminitis, and elevated inflammatory markers. These abnormalities led to the consideration of congenitally acquired infections, specifically syphilis, and serologies were confirmatory. Ultimately, the infant was diagnosed with Pseudoparalysis of Parrot - a rare musculoskeletal manifestation secondary to painful syphilitic periostitis. As Emergency Medicine physicians, it is important to be aware of the growing burden of syphilis infection and reacquaint ourselves with its numerous presentations in the young infant., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2021
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28. Congenital Syphilis: A Case Report Demonstrating Missed Opportunities for Screening and Inadequate Treatment Despite Multiple Health Care Encounters During Pregnancy.
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Fukuda A, Katz AR, Park IU, Komeya AY, Chang A, Ching N, Tomas JE, and Wasserman GM
- Subjects
- Delivery of Health Care, Female, Humans, Pregnancy, Prenatal Care, United States, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Syphilis diagnosis, Syphilis drug therapy, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy
- Abstract
Abstract: A case of congenital syphilis due to multiple missed opportunities, highlights the challenges of treating syphilis during pregnancy. Although cases are increasing in the United States, congenital syphilis, a disease with devastating consequences, is preventable., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (Copyright © 2021 American Sexually Transmitted Diseases Association. All rights reserved.)
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- 2021
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29. Estimation of benzathine penicillin G demand for congenital syphilis elimination with adoption of dual HIV/syphilis rapid diagnostic tests in eleven high burden countries.
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Shah S, Garg S, Heath K, Ofili O, Bansal Y, Seghers F, Storey A, and Taylor M
- Subjects
- Female, Humans, Pregnancy, Anti-Bacterial Agents therapeutic use, Diagnostic Tests, Routine, Mass Screening methods, Prenatal Care, Clinical Laboratory Techniques, HIV Infections epidemiology, HIV Infections diagnosis, HIV Infections drug therapy, Infectious Disease Transmission, Vertical prevention & control, Penicillin G Benzathine therapeutic use, Penicillin G Benzathine supply & distribution, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious epidemiology, Pregnancy Complications, Infectious drug therapy, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology
- Abstract
Background: WHO recommends use of rapid dual HIV/syphilis tests for screening pregnant women (PW) during antenatal care to prevent mother-to-child transmission. Scale-up of testing implies a need to accurately forecast and procure benzathine penicillin (BPG) to treat the additionally identified PW with syphilis., Methods: Country-reported ANC coverage, PW syphilis screening and treatment coverage values in 2019 were scaled linearly to EMTCT targets by 2030 (constant increasing slope from 2019 figures to 95% in 2030) for 11 focus countries. Antenatal syphilis screening coverage was substituted with HIV screening coverage to estimate potential contribution of rapid dual HIV/syphilis tests in identifying additional PW with syphilis. BPG demand was calculated for 2019-2030 accordingly., Results: The estimated demand for BPG (in 2.4 million unit vials) using current maternal syphilis prevalence and treatment coverage will increase from a baseline of 414,459 doses in 2019 to 683,067 doses (+65%) in 2021 assuming immediate replacement of single HIV test kits with rapid dual HIV/syphilis tests for these 11 countries. Continued scale up of syphilis screening and treatment coverage to reach elimination coverage of 95% will result in an estimated demand increase of 160%, (663,969 doses) from 2019 baseline for a total demand of 1,078,428 BPG doses by 2030., Conclusions: Demand for BPG will increase following adoption of rapid dual HIV/syphilis test kits due to increases in maternal diagnoses of syphilis. To eliminate congenital syphilis, MNCH clinical programs will need to synergize with disease surveillance programs to accurately forecast BPG demand with scale up of antenatal syphilis screening to ensure adequate treatment is available for pregnant women diagnosed with syphilis., Competing Interests: The authors have declared that no competing interests exist.
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- 2021
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30. A New Call to Action to Combat an Old Nemesis: Addressing Rising Congenital Syphilis Rates in the United States.
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Machefsky AM, Loosier PS, Cramer R, Bowen VB, Kersh EN, Tao G, Gift TL, Hogben M, Carry M, Ludovic JA, Thorpe P, and Bachmann LH
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- Child, Female, Humans, Infant, Pregnancy, Pregnant Women, Stillbirth, United States epidemiology, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious epidemiology, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology, Syphilis, Congenital prevention & control
- Abstract
Congenital syphilis (CS) is on the rise in the United States and is a growing public health concern. CS is an infection with Treponema pallidum in an infant or fetus, acquired via transplacental transmission when a pregnant woman has untreated or inadequately treated syphilis. Pregnant women with untreated syphilis are more likely to experience pregnancies complicated by stillbirth, prematurity, low birth weight, and early infant death, while their children can develop clinical manifestations of CS such as hepatosplenomegaly, bone abnormalities, developmental delays, and hearing loss. One of the ways CS can be prevented is by identifying and treating infected women during pregnancy with a benzathine penicillin G regimen that is both appropriate for the maternal stage of syphilis and initiated at least 30 days prior to delivery. In this article we discuss many of the challenges faced by both public health and healthcare systems with regards to this preventable infection, summarize missed opportunities for CS prevention, and provide practical solutions for future CS prevention strategies.
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- 2021
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31. Congenital syphilis with hydrops fetalis: report of four cases in a general referral hospital in Bogota, Colombia between 2016- 2020
- Author
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Camacho-Montaño AM, Niño-Alba R, and Páez-Castellanos E
- Subjects
- Colombia epidemiology, Female, Hospitals, Humans, Hydrops Fetalis diagnosis, Hydrops Fetalis drug therapy, Hydrops Fetalis etiology, Infant, Infant, Newborn, Penicillin G Benzathine therapeutic use, Pregnancy, Referral and Consultation, Syphilis, Congenital complications, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy
- Abstract
Objective: To report four cases of hydrops fetalis secondary to congenital syphilis and carry out a review of the literature to answer the question, What is the antibiotic regimen used in cases of gestational syphilis with hydrops fetalis as a complication?, Materials and Methods: Four cases of congenital syphilis with hydrops fetalis are presented. Maternal age ranged between 17 and 28 years, gestational age at the time of diagnosis varied between 25 and 30 weeks, and two of the mothers had not initiated prenatal care at that time. Treatment with crystalline penicillin for gestational syphilis was given immediately 6 to 12 weeks before delivery in three cases and partners were prescribed treatment with benzathine penicillin. As for the neonates, two had no active infection or sequelae and one of them was considered to have congenital syphilis based on non-treponemal test titers. In one case, the patient was unable to receive syphilis treatment before delivery and her newborn had signs of active infection. A review of the literature was conducted in the Medline, LILACS and Google Scholar databases using the search terms “hydrops fetalis,” “Lues”, “syphilis – prenatal diagnosis - ultrasound - penicillin – treatment”. The search included case reports and case series or cohorts of newborns with gestational syphilis and hydrops fetalis. Information regarding treatment in the mothers and in the newborns was extracted., Results: Overall, 119 articles were identified. Of these, 13 met the inclusion criteria, three were discarded because the full text could not be accessed. Ten studies with a total of 16 reported cases of hydrops fetalis secondary to congenital infection were reported. Of these, three presented with severe fetal anemia and required intrauterine transfusion; 5 cases received intrauterine penicillin treatment. In four cases the mother received weekly intramuscular injections of benzathine penicillin for 3 weeks, one received additional intravenous crystalline penicillin for 13 days, while another one received intravenous crystalline penicillin for 14 days. Treatment during gestation was not given in a total of 11 cases; and 6 of the 16 cases (37.5%) resulted in perinatal death., Conclusion: Delays in prenatal care and late diagnosis and treatment of gestational syphilis are important causes of persistent congenital syphilis. Randomized studies are required to identify the best treatment in fetuses with congenital syphilis 30 days before delivery and in fetuses with systemic compromise during the second half of gestation.
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- 2021
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32. Severe microcephaly, intellectual disability and epilepsy: the ravages of congenital syphilis.
- Author
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Saini AG, Kamila G, and Vyas S
- Subjects
- Brain, Humans, Epilepsy complications, Intellectual Disability complications, Microcephaly, Syphilis, Congenital complications, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2021
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33. Syphilis in Neonates and Infants.
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Medoro AK and Sánchez PJ
- Subjects
- Adult, Female, Humans, Infant, Infant, Newborn, Infectious Disease Transmission, Vertical, Pregnancy, Prenatal Care, United States epidemiology, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious epidemiology, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology
- Abstract
Syphilis in neonates and infants remains a significant public health problem because it is a major cause of fetal and neonatal morbidity and mortality globally. Despite decades of experience with syphilis in adults and infants, maternal and congenital syphilis are increasing substantially in the United States. The vertical transmission, clinical manifestations, diagnosis, evaluation, treatment, and follow-up are reviewed to guide the health care professional in understanding the optimal management of this preventable disease., Competing Interests: Disclosure Supported in part by grants (1R29 AI 34932-01 to Dr. Sánchez from the National Institute of Allergy and Infectious Diseases and by a contract (C1000 689) with the Centers for Disease Control and Prevention., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
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34. Syphilitic Reinfections During the Same Pregnancy-Florida, 2018.
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Matthias J, Sanon R, Bowen VB, Spencer EC, and Peterman TA
- Subjects
- Female, Florida epidemiology, Humans, Infant, Pregnancy, Reinfection, Pregnancy Complications, Infectious epidemiology, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology
- Abstract
Abstract: We reviewed all cases of syphilis reported among pregnant women in Florida in 2018 for syphilitic reinfection. Nineteen (7.3%) of 261 pregnant women with syphilis were reported as reinfected during the same pregnancy. Timely rescreening and treatment prevented 6 (31.6%) of 19 reinfected women from delivering infants with congenital syphilis., Competing Interests: Conflict of Interest and Sources of Funding: The authors report no known conflicts of interest or relevant financial disclosures., (Copyright © 2020 American Sexually Transmitted Diseases Association. All rights reserved.)
- Published
- 2021
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35. Diagnosis and Treatment of Secondary Syphilis in Women.
- Author
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Bond SM and Blain MLM
- Subjects
- Female, Humans, Pregnancy, United States, Women's Health, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Syphilis diagnosis, Syphilis drug therapy, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital prevention & control
- Abstract
Secondary syphilis develops approximately 3 to 12 weeks following undetected and untreated primary syphilis. Despite historically low rates of syphilis infection in 2000, the United States is now experiencing an alarming resurgence in primary, secondary, and congenital syphilis. This case report describes an unexpected presentation in a young woman presenting for an initial well-woman examination. Social and behavioral drivers of syphilis infection, diagnosis, and treatment are presented. Implications for women's health are examined. The need for new and more effective preventive health strategies is reviewed., (© 2021 by the American College of Nurse-Midwives.)
- Published
- 2021
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36. Treatment administered to newborns with congenital syphilis during a penicillin shortage in 2015, Fortaleza, Brazil.
- Author
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Rocha AFB, Araújo MAL, Taylor MM, Kara EO, and Broutet NJN
- Subjects
- Brazil epidemiology, Cross-Sectional Studies, Female, Humans, Infant, Infant, Newborn, Penicillins therapeutic use, Pregnancy, Retrospective Studies, Pregnancy Complications, Infectious drug therapy, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology
- Abstract
Background: Between 2014 and 2016, Brazil experienced a severe shortage in penicillin supply, resulting in a lack of treatment among some pregnant women and newborns with syphilis and the use of non-evidence-based regimens. This study evaluated all live births in Fortaleza reported with CS in 2015 in order to identify the different therapeutic regimens used in newborns during this period of penicillin shortage., Methods: A retrospective cross-sectional study design was conducted using manually extracted data from medical chart review of maternal and infant cases delivered in 2015 from all public maternity hospitals in the city of Fortaleza. Data collection occurred from June 2017 to July 2018., Results: A total of 575 congenital syphilis cases were reported to the municipality of Fortaleza during 2015 and 469 (81.5%) were analyzed. Of these, only 210 (44.8%) were treated with a nationally-recommended treatment. As alternative therapeutic options, ceftriaxone was used in 65 (13.8%), Cefazolin in 15 (3.2%) and the combination of more than one drug in 179 (38.2%). Newborns with serum VDRL titers ≥1:16 (p = 0.021), who had some clinical manifestation at birth (p = 0.003), who were born premature (p < 0.001), with low birth weight (p = 0.010), with jaundice indicative of the need for phototherapy (p = 0.019) and with hepatomegaly (p = 0.045) were more likely to be treated with penicillin according to national treatment guidelines compared to newborns treated with other regimens., Conclusion: During the period of shortage of penicillin in Fortaleza, less than half of the infants reported with CS were treated with a nationally-recommended regimen, the remaining received treatment with medications available in the hospital of birth including drugs that are not part of nationally or internationally-recommended treatment recommendations.
- Published
- 2021
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37. Clinical presentation of congenital syphilis in a rotavirus vaccine cohort study in Lusaka: a case series.
- Author
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Sukwa N, Simuyandi M, Chirwa M, Kumwimba YM, Chilyabanyama ON, Laban N, Koyuncu A, and Chilengi R
- Subjects
- Child, Cohort Studies, Female, Humans, Infant, Pregnancy, Zambia, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Rotavirus Vaccines, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital prevention & control
- 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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- 2021
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38. An old disease on the rise: new approaches to syphilis in pregnancy.
- Author
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Liew ZQ, Ly V, and Olson-Chen C
- Subjects
- Female, Humans, Infant, Newborn, Penicillins, Pregnancy, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology
- Abstract
Purpose of Review: Maternal and congenital syphilis infection is on the rise in the United States and worldwide. Without adequate testing or provider recognition of infection, treatment can be neglected resulting in significant perinatal morbidity and mortality. This review article discusses the epidemiology of T. pallidum, describes novel diagnostic tests, and considers the need to expand therapeutic options., Recent Findings: A new chemiluminescence immunoassay for use in the reverse-sequence algorithm is more sensitive and specific in pregnant women than previously noted and is helpful for identifying pregnant women at highest risk for neonatal congenital syphilis. Point-of-care testing may be used to detect early syphilitic disease and provide same-day testing and treatment. Randomized control trials of oral cefixime for treatment of syphilis are paving the way for potential use in pregnant women. Penicillin skin testing, challenge, and desensitization in pregnancy can be done safely., Summary: Congenital syphilis is a preventable disease and treatable infection in the modern world, but we are still met with challenges in its eradication. We should proceed with advancing efficient laboratory testing, expanding medical therapy, and implementing public health measures to curb the rise of the disease., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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39. New screening approach to detecting congenital syphilis in China: a retrospective cohort study.
- Author
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Hu F, Guo SJ, Lu JJ, Hua NX, Song YY, Lin SF, and Zhu S
- Subjects
- Adult, Algorithms, China epidemiology, Female, Gestational Age, Humans, Incidence, Infant, Newborn, Infectious Disease Transmission, Vertical prevention & control, Predictive Value of Tests, Pregnancy, Pregnancy Complications, Infectious epidemiology, Pregnancy Complications, Infectious prevention & control, Retrospective Studies, Risk Factors, Sensitivity and Specificity, Syphilis Serodiagnosis methods, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology, Treponema pallidum immunology, Mass Screening methods, Pregnancy Complications, Infectious immunology, Syphilis, Congenital diagnosis, Syphilis, Congenital immunology
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Background: Diagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS., Methods: Confirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women., Results: Among 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively., Conclusions: An algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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40. Outcomes of infants born to pregnant women with syphilis: a nationwide study in Korea.
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Lim J, Yoon SJ, Shin JE, Han JH, Lee SM, Eun HS, Park MS, and Park KI
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- Female, Humans, Infant, Infant, Newborn, Pregnancy, Pregnant Women, Republic of Korea epidemiology, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious epidemiology, Syphilis complications, Syphilis diagnosis, Syphilis drug therapy, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology
- Abstract
Background: Despite the expansion of antenatal syphilis screening programs, congenital syphilis (CS) remains a concern., Purpose: This study aimed to analyze the manifestation and progress of CS, including treatment and follow-up, based on a nationwide study., Methods: From the Korean National Health Insurance Service database, a total of 548 infants were examined for CS during their first year of life from 2013 to 2018. Neurosyphilis and complications were investigated using the International Classification of Diseases-10 codes., Results: The birth rate of infants from mothers with syphilis was 2.8 per 10,000 live births for 5 years, which is not indicative of a decreasing trend. Overall, 148 infants were proven or highly probable or possible of having CS with treatment for 10 days; 66 infants were possible or less likely of having CS with only 1-day treatment. Jaundice (56 %) was common, followed by hearing impairment (14 %), renal disease (8 %), and mental retardation (8 %). Fourteen cases of neurosyphilis occurred. Infants with complications, including mental retardation, eye involvement, hearing impairment, or renal disease, were significantly associated with neurosyphilis (OR 8.49, P < 0.0001). Of 250 patients who received treatment, 92.8 % were treated with one medication: benzathine penicillin was used in 73 % of patients. Only four patients were re-treated due to treatment failure. In addition to the treponemal test, fluorescent treponemal antibody-absorption was the most utilized tool for diagnosis and follow-up., Conclusions: Establishing standardized guidelines for the evaluation of CS, as well as the establishment of treatment regimens and follow up-plans for the disease, at a national level would help improve maternal and neonatal care and facilitate the eradication of CS in Korea.
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- 2021
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41. Congenital syphilis in Argentina: Experience in a pediatric hospital.
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Garcia LN, Destito Solján A, Moroni S, Falk N, Gonzalez N, Moscatelli G, Ballering G, García Bournissen F, and Altcheh JM
- Subjects
- Child, Child, Preschool, Female, Hospitals, Pediatric, Humans, Infant, Infant, Newborn, Male, Syphilis, Congenital complications, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology, Syphilis, Congenital diagnosis
- Abstract
In spite of being preventable, Congenital syphilis (CS) is still an important, and growing health problem worldwide. Fetal infection can be particularly aggressive, but newborns can be asymptomatic at birth and, if left untreated, develop systemic compromise afterwards with poor prognosis. We analyzed 61 CS diagnosis cases between 1987-2019 presenting at the Buenos Aires Children' Hospital. The distribution of cases showed a bimodal curve, with a peak in 1992-1993 and in 2014-2017. Median age at diagnosis was 2 months (IQ 1-6 months). The main clinical findings were: bone alterations (59%); hepatosplenomegaly (54.1%); anemia (62.8%); skin lesions (42.6%) and renal compromise (33.3%). Cerebrospinal fluid (CSF) was abnormal in 5 patients, normal in 45 and was not available for 11 patients. Remarkably, spinal lumbar puncture did not modify therapeutic decisions in any case. Between mothers, only 46% have been tested for syphilis during pregnancy and 60.5% patients had non-treponemal titers equal to or less than fourfold the maternal titer. Intravenous penicillin G was prescribed for all except one patient, who received ceftriaxone with good therapeutic response. During follow-up, 1.6% infants died, 6.5% had persistent kidney disorders and 1.6% showed bone sequelae damage. RPR titers decreased after treatment, reaching negative seroconversion in 43% subjects at a median of 26.4 months. Low adherence to follow up was observed due to inherent vulnerable and low-income population characteristics in our cohort. Our results highlight a rising tendency in cases referred for CS in our population with high morbidity related to delayed diagnosis. A good therapeutic response was observed. CS requires a greater effort from the health system to adequately screen for this disease during pregnancy, and to detect cases earlier, to provide an adequate diagnosis and treatment., Competing Interests: The authors have declared that no competing interests exist
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- 2021
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42. Females treated for syphilis in Bialystok, Poland 2016-2020.
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Serwin AB, Kaczyńska J, and Flisiak I
- Subjects
- Adult, Female, Humans, Middle Aged, Poland epidemiology, Pregnancy, Retrospective Studies, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious epidemiology, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital epidemiology
- Abstract
Background: Syphilis is the third most frequent bacterial sexually transmitted disease globally. Untreated syphilis in a pregnant woman may results in a transmission of the infection to the foetus resulting in congenital syphilis., Aim: To characterise females treated for syphilis in Bialystok, north-east Poland, in years 2016-2020., Material and Methods: Retrospective analysis of age, residency, marital status of patients, stage of syphilis, treatment and adherence to follow-up visits was conducted as well as a detailed analysis of clinical characteristics of pregnant women treated for syphilis., Results: Sixteen women were treated for syphilis in 2016-2020, 11 (68.8%) of them were pregnant. The proportion of pregnant women among all syphilis female patients increased substantially as compared to years 2000-2015 (68.8% vs. 36.2%, respectively, P<0.05). Mean age of patients was 37.12±11.25 years, 10 (62.5%) were residents of urban areas and 10 were married. Late latent syphilis or latent of unknown duration was the most frequent stage of syphilis. Chlamydia trachomatis infection was detected in four (25%) patients with syphilis. Benzathine penicillin was mainly used in the treatment. More than half of patients did not complete follow-up. Only one pregnant woman was treated within the first trimester and five of them (45.45%) were lost to follow-up and the outcome of pregnancy was unknown., Conclusions: Syphilis in females, especially in pregnant ones, is an important problem in the Podlaskie voivodeship. The proportion of pregnant females among all female patients with syphilis is increasing. The detection and the treatment of infection is frequently delayed in pregnant females. The after treatment followup and the knowledge of outcome of pregnancy remains unsatisfactory. The collaboration between dermatovenereologists, gynaecologists and obstetricians should be improved., (© National Institute of Public Health NIH – National Research Institute.)
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- 2021
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43. Congenital Syphilis in Honiara, Solomon Islands.
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Lifigao M, Nasi T, Titiulu C, Lumasa S, and Duke T
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- Female, Humans, Infant, Infant, Newborn, Male, Melanesia, Penicillins therapeutic use, Pregnancy, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious epidemiology, Syphilis diagnosis, Syphilis drug therapy, Syphilis epidemiology, Syphilis Serodiagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital mortality, Tetracycline therapeutic use, Treatment Outcome, Treponema pallidum immunology, Yaws epidemiology, Infant Mortality, Pregnancy Complications, Infectious drug therapy, Stillbirth, Syphilis, Congenital diagnosis, Treponema pallidum isolation & purification
- Abstract
Introduction: Congenital syphilis remains a significant cause of newborn mortality and long-term neurodevelopmental problems in some low- and middle-income countries. This study was done in Honiara, Solomon Islands to determine the incidence of babies born to mothers with a positive venereal disease research laboratory (VDRL) test and a positive Treponema pallidum haemagglutination assay (TPHA); to determine the VDRL status of newborns and features of congenital syphilis; and to estimate the proportion of stillbirths associated with syphilis., Methodology: All neonates born to VDRL-positive mothers, including stillbirths were included between April and July 2019. Neonates were examined, investigated and treated., Results: Among 1534 consecutive births, 1469 were live births and 65 (4.2%) were stillbirths. One hundred and forty-three neonates were born to VDRL-positive mothers: 130 (90.1%) were live infants and 13 (8.9%) stillbirths. Of the 130 VDRL-exposed live-born infants, 72 (55%) had reactive VDRL and a positive TPHA and 7 (9.7%) had clinical signs of congenital syphilis. Five of the infants with clinical signs of syphilis infection had a 4-fold higher VDRL titre than their mother. Four infants of VDRL-positive mothers died during admission, all of whom had clinical signs of syphilis. Ninety percent of affected infants were born to mothers who were not treated or only partially treated during pregnancy., Conclusions: In this study, 1:210 live-born babies had clinical and serological evidence of congenital syphilis, and evidence of Treponema infection was found disproportionately in stillbirths. In a setting where Treponema infections are common, an empirical approach to prevention may be needed., (© The Author(s) [2020]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2020
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44. Who was affected by the shortage of penicillin for syphilis in Rio de Janeiro, 2013-2017?
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Araujo RS, Souza ASS, and Braga JU
- Subjects
- Brazil epidemiology, Female, Humans, Male, Penicillin G Benzathine therapeutic use, Pregnancy, Spatio-Temporal Analysis, Syphilis drug therapy, Syphilis, Congenital drug therapy, Health Services Accessibility, Health Status Disparities, Penicillin G Benzathine supply & distribution, Syphilis epidemiology, Syphilis, Congenital epidemiology
- Abstract
Objective: To analyze the shortage of benzathine penicillin G (BPG), characterizing its temporal evolution and spatial distribution in the city of Rio de Janeiro from 2013 to 2017., Methods: This ecological study used gestational and congenital syphilis notifications, BPG distribution records, and sociodemographic data from the population of Rio de Janeiro. To quantify the shortage, a BPG supply indicator was estimated per quarter for each neighborhood between 2013 and 2017. Thematic maps were created to identify areas and periods with greater BPG shortage, described according to sociodemographic factors, health services network, and epidemiological features in the incidence of syphilis., Results: BPG shortage in Rio de Janeiro from 2013 to 2017 was not homogeneous in space nor in time. The temporal evolution and spatial distribution of BPG scarcity shows that the shortage affected the inhabitants of the municipality in different ways. Shortage was lower in 2013 and 2016 and more severe in 2014, 2015, and 2017, particularly in neighborhoods within the programmatic areas PA3 and PA5, poorer and with higher prevalence rates of gestational and congenital syphilis., Conclusions: Analyzing BPG shortage and its temporal evolution and spatial distribution in Rio de Janeiro allowed us to realize that the inhabitants are affected in different ways. Understanding this process contributes to the planning of actions to face shortage crises, minimizing possible impacts on the management of syphilis and reducing inequality in access to treatment.
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- 2020
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45. Congenital Syphilis Resurgences and Penicillin Shortage.
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Agarwal A and Kumar J
- Subjects
- Female, Humans, Penicillins, Pregnancy, Pregnancy Complications, Infectious, Syphilis, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy
- Published
- 2020
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46. Symptomatic congenital syphilis: still a reality.
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Teles H, Cachão J, Oliveira I, and Neves VH
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- Administration, Intravenous, Female, Humans, Infant, Newborn, Penicillin G administration & dosage, Pregnancy, Pregnancy Complications, Infectious diagnosis, Prenatal Care standards, Syphilis, Congenital drug therapy, Syphilis, Congenital physiopathology, Anti-Bacterial Agents administration & dosage, Syphilis, Congenital diagnosis
- Abstract
Competing Interests: Competing interests: None declared.
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- 2020
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47. Gaps in the elimination of congenital syphilis in a tertiary care center in Thailand.
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Anugulruengkitt S, Yodkitudomying C, Sirisabya A, Chitsinchayakul T, Jantarabenjakul W, Chaithongwongwatthana S, and Puthanakit T
- Subjects
- Adolescent, Adult, Anti-Bacterial Agents therapeutic use, Female, Humans, Infant, Newborn, Penicillins therapeutic use, Pregnancy, Pregnancy Complications, Infectious epidemiology, Pregnancy Complications, Infectious therapy, Pregnancy Outcome, Prenatal Care, Retrospective Studies, Syphilis epidemiology, Syphilis therapy, Syphilis, Congenital drug therapy, Thailand epidemiology, Young Adult, Infectious Disease Transmission, Vertical prevention & control, Syphilis, Congenital epidemiology, Syphilis, Congenital prevention & control, Tertiary Care Centers
- Abstract
Background: The World Health Organization has set a goal to eliminate mother-to-child transmission of syphilis to a target of <50 cases per 100 000 live births. This study aimed to determine the rate of congenital syphilis and identify gaps in prevention., Methods: A retrospective chart review was conducted in a tertiary care center in Bangkok, Thailand. The study included all pregnant women with positive syphilis serology and their infants. All congenital syphilis cases were categorized according to Centers for Disease Control criteria., Results: From 2013 to 2017, 69 syphilis-infected pregnant women were included, with 30 congenital syphilis cases. The rate of congenital syphilis was 115 cases (95% CI 78-164) per 100 000 live births. The median (interquartile range) maternal age was 21 (18-32) years and 12 (17%) women had human immunodeficiency virus co-infection. Regarding maternal treatment, 28 (41%) women had inadequate treatment due to 13 cases (19%) of late or no antenatal care, six cases (8%) of recent infection near delivery, five cases (7%) of failure of treatment provision, and four (6%) others. There were three syphilitic stillbirths who were prematurely born to untreated pregnant women and 67 live births (one set of twins) of which 27 met definitions of probable congenital syphilis. They received complete treatment with penicillin and had non-reactive rapid plasma reagin within the first 6 months of life, with the exception of one who had non-reactive rapid plasma reagin at the age of 7 months., Conclusions: Congenital syphilis remains a problem in our setting. Nearly half of pregnant women who had syphilis had inadequate treatment. There is an urgent need to strengthen diagnosis and the treatment cascade of syphilis during antenatal care., (© 2019 Japan Pediatric Society.)
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- 2020
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48. Congenital syphilis or mercury treatment: dental alterations in a twelfth- or thirteenth-century child from Medinaceli, Soria, Spain.
- Author
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Gómez-González S, de Togores Muñoz CR, and González-Garrido L
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- Child, Humans, History, Medieval, Mandible pathology, Maxilla pathology, Paleopathology, Spain, Tooth drug effects, Tooth pathology, Dental Enamel Hypoplasia diagnosis, Dental Enamel Hypoplasia etiology, Dental Enamel Hypoplasia pathology, Mercury adverse effects, Mercury therapeutic use, Syphilis, Congenital complications, Syphilis, Congenital diagnosis, Syphilis, Congenital drug therapy, Syphilis, Congenital history
- Abstract
Syphilis, together with its variant congenital syphilis, is a disease caused by Treponema pallidum subsp. pallidum . This paper documents possible new skeletal evidence for congenital syphilis from the Medieval Era (twelfth and thirteenth centuries CE) burial site of Medinaceli in the Province of Soria in North-Central Spain. What is involved is dental alteration due to congenital syphilis, mercury treatment, or a combination of both. This study focuses on the hypoplastic dental changes observed in a child approximately eight years of age. Only a fragmented skull with left maxilla and the left side of the mandible were preserved. Macroscopic analysis, X-rays, computerized tomography (CT) and mercury detection analysis by inductively coupled plasma mass spectrometry (ICP-MS) techniques were used to observe dental abnormalities. In addition to extensive caries in the upper second deciduous molar, pulpo-alveolar lesions and facial alterations were observed. The absence of the rest of the skeleton tends to make a diagnosis of congenital syphilis difficult. However, the dental stigmata observed do permit a reasonable diagnosis.
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- 2020
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49. Hypothermia and Vomiting in a Newborn Without Prenatal Care.
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Nichols K, Beavers J, and Beavers J
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- Anti-Bacterial Agents therapeutic use, Diagnosis, Differential, Humans, Infant, Newborn, Male, Penicillins therapeutic use, Syphilis, Congenital drug therapy, Health Services Accessibility, Hypothermia etiology, Prenatal Care, Syphilis, Congenital complications, Syphilis, Congenital diagnosis, Vomiting etiology
- Published
- 2019
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50. Congenital Syphilis Misdiagnosed as Suspected Nonaccidental Trauma.
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Jacobs K, Vu DM, Mony V, Sofos E, and Buzi N
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- Anti-Bacterial Agents therapeutic use, Child Abuse diagnosis, Diagnosis, Differential, Diagnostic Errors, Female, Fractures, Spontaneous etiology, Humans, Humeral Fractures etiology, Infant, Penicillin G therapeutic use, Periostitis microbiology, Skin Ulcer microbiology, Syphilis, Congenital drug therapy, Transaminases blood, Syphilis, Congenital diagnosis
- Abstract
Congenital syphilis (CS) is a preventable infection, yet the incidence has surged to the highest rates in 20 years. Because 50% of live-born infants with CS are asymptomatic at birth, there is an increasing likelihood that pediatric providers will encounter older infants whose diagnoses were missed at birth, emphasizing the importance of timely prenatal screening and treatment. We present one such case of an infant admitted twice at 3 and 4 months of age with long bone fractures and suspected nonaccidental trauma. On her second presentation, several additional symptoms prompted evaluation for and eventual diagnosis of CS. In this case, it is demonstrated that an isolated long bone fracture can be a first presentation of CS, with other classic findings possibly appearing later. Pediatric providers should be familiar with the varied presentations of CS in older children, including the radiographic findings that we describe. The rising rates of CS reveal deficiencies in our current strategy to prevent CS and, thus, we recommend reconsideration of universal syphilis screening in the third trimester and at delivery, with timely treatment to prevent CS during pregnancy., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)
- Published
- 2019
- Full Text
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