Congenital syphilis in a 4-month-old infant with limb weakness

2021 ◽  
Vol 14 (2) ◽  
pp. e240532
Author(s):  
Elizabeth Morrisroe ◽  
Syeda Farah Farzana ◽  
James McKinnon
Keyword(s):  
Congenital Syphilis ◽  
Treponema Pallidum ◽  
Maculopapular Rash ◽  
Accidental Injury ◽  
Limb Weakness ◽  
Syphilis Infection ◽  
Life Threatening ◽  
History Of ◽  
Non Accidental Injury ◽  
Developed World

We describe a rare case of a 4-month-old girl presenting with a several month history of reduced movement to the left arm accompanied by a maculopapular rash to the limbs. X-ray findings included inflammatory periosteal changes to the radius and ulna. Treponema pallidum IgM was detected in both baby and mother, and a diagnosis of congenital syphilis was made. This case is an interesting clinical picture with a variety of important differential diagnoses, including non-accidental injury, malignancy, autoimmune disease and other congenital infections. With an increasing rate of congenital syphilis infection in the developed world, it is vital that clinicians are able to recognise symptoms to ensure prompt diagnosis and treatment. In this respect, we can attempt to avoid the chronic and potentially life-threatening complications of untreated infection.

Congenital Syphilis in Honiara, Solomon Islands

2020 ◽  
Vol 66 (6) ◽  
pp. 583-588
Author(s):  
Maxson Lifigao ◽  
Titus Nasi ◽  
Carol Titiulu ◽  
Steven Lumasa ◽  
Trevor Duke
Keyword(s):  
Congenital Syphilis ◽  
Solomon Islands ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Clinical Signs ◽  
Syphilis Infection ◽  
Middle Income ◽  
Middle Income Countries ◽  
Neurodevelopmental Problems

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.

Treponemal infection rates, risk factors and pregnancy outcome in a rural area of Senegal

2003 ◽  
Vol 14 (3) ◽  
pp. 208-215 ◽  
Author(s):  
Emmanuel Lagarde ◽  
Emmanuelle Guyavarch ◽  
Jean-Pierre Piau ◽  
AÏssatou Gueye-Ndiaye ◽  
Karim Seck ◽  
...  
Keyword(s):  
Treponema Pallidum ◽  
Population Based ◽  
Cross Sectional Study ◽  
High Rate ◽  
Syphilis Infection ◽  
Cross Sectional ◽  
History Of ◽  
Treponemal Infection ◽  
Active Syphilis

A rural population of east Senegal has been under demographic surveillance for more than 30 years and a high rate of infertility has been reported. The aim of the study is to describe HIV and treponemal infection epidemiology and association with outcome of pregnancy in a population of rural Senegal. A population-based cross-sectional study was conducted among 952 randomly-selected adults of a rural community of Senegal. No participant was found to be infected with HIV, 11% had evidence of past syphilis and 5% of active syphilis. Active syphilis was associated among men with age, long-term mobility and having partners in an urban area in the last 12 months and among women with being divorced or widowed. No association was found between past or active syphilis and abortion or stillbirth but women aged 40 and more with past or active syphilis were significantly more likely to have had no history of gestation than women with no evidence of syphilis infection. In conclusion our results call for more research to understand the epidemiology of treponemal infection and to elucidate types of Treponema pallidum involved.

Unusual presentation of secondary syphilis: membranoproliferative glomerulonephritis andmuco-cutaneous lesions

2017 ◽  
Vol 29 (4) ◽  
pp. 410-413 ◽  
Author(s):  
Linda Tognetti ◽  
Elisa Cinotti ◽  
Sergio Tripodi ◽  
Guido Garosi ◽  
Pietro Rubegni
Keyword(s):  
Membranoproliferative Glomerulonephritis ◽  
Congenital Syphilis ◽  
Renal Involvement ◽  
Treponema Pallidum ◽  
Membranous Glomerulonephritis ◽  
Secondary Syphilis ◽  
Cutaneous Lesions ◽  
Syphilis Infection ◽  
Cutaneous Manifestations ◽  
Nephritic Syndrome

The worldwide re-emergence of secondary syphilis which happened in the last decade, has led to an increase in primary and secondary syphilis cases, along with the presentation of atypical forms. Nevertheless, reports of renal syphilis with mucosal and/or cutaneous manifestations are nowadays increasing. Typically, secondary syphilis infection in adults causes nephrotic syndrome due to a membranous glomerulonephritis. Here, we report a case of a 30-year-old immunocompetent man presenting with skin rash, oral and perianal erosions and nephritic syndrome. Laboratory investigations revealed a form of membranoproliferative glomerulonephritis secondary to Treponema pallidum infection. Therapy with benzathine penicillin brought prompt and complete remission of the disease. Although well described for congenital syphilis, this histopathologic pattern of renal involvement is very rarely reported in adult patients. In case of detection of an otherwise unexplained nephritic syndrome in sexually active patients with mucosal and/or anal lesions, an unrecognized syphilis infection should be suspected.

scholarly journals Assessment of syphilis infection among pregnant women and its associated risk factors at Sovu health center in Rwanda

2020 ◽  
Vol 1 (3) ◽  
Author(s):  
Augustin Nshimiyimana ◽  
Joseph Mucumbitsi ◽  
Callixte Yadufashije ◽  
Francois N. Niyonzima
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Health Center ◽  
Sexual Behaviors ◽  
Treponema Pallidum ◽  
Health Concern ◽  
Syphilis Infection ◽  
Cross Sectional ◽  
History Of ◽  
Associated Risk Factors

Syphilis in pregnant women caused by Treponema pallidum remains a major cause of reproductive morbidity and poor pregnancy outcomes in developing countries. Severe neonatal infections, stillbirths, perinatal deaths, and low birth weight babies are common among mothers with syphilis infection. The aim of the study was to assess the prevalence and risk factors associated to syphilis in pregnant women. A cross-sectional and retrospective studies were conducted among pregnant women who attended the prenatal service at the Gisovu health center. Participants were pregnant women who tested positive for syphilis based on lab results and responses collected from anonymous questionnaires completed with sexual behaviors, demographics, sexual partners, history of abortion, and knowledge about STDs. The prevalence of syphilis was 5.74%. Syphilis was associated to the history of previous abortion (P = 0.005 < 0.05), a low level of education (P = 0.049 < 0.05), and marital status (P = 0.044 < 0.05). The main associated behavioral factor was women who had sex with different partners using condom and did not acquire syphilis infection (P = 0.00 < 0.05). Syphilis is still a public health concern in patients and especially in pregnant women as shown by the findings of this study. It is very important to screen all pregnant women for syphilis and to strengthen the existing antenatal care services and health education on transmission and prevention of the disease.

Treponema pallidum PCR testing for diagnosis of mucocutaneous ulcers suspicious for syphilis

2021 ◽  
pp. sextrans-2021-055192
Author(s):  
Muhammad Hyder Junejo ◽  
Mark Collery ◽  
Gary Whitlock ◽  
Alan McOwan ◽  
Victoria Tittle ◽  
...  
Keyword(s):  
Demographic Data ◽  
Treponema Pallidum ◽  
Added Value ◽  
Contact Tracing ◽  
Bisexual Men ◽  
Electronic Patient Records ◽  
Serological Tests ◽  
Syphilis Infection ◽  
Cross Sectional ◽  
History Of

BackgroundPrimary syphilis is characterised by the appearance of an ulcerated lesion (chancre) on the anogenital or oral mucosa from which Treponema pallidum DNA may be detectable by PCR. Serological tests for syphilis may be non-reactive in early infection, even after the appearance of a chancre. We reviewed the use of a multiplex-PCR (M-PCR) test to determine the added value of T. pallidum DNA detection in the management of individuals presenting with mucocutaneous ulceration at a sexual health service in central London.MethodsWe performed a cross-sectional analysis of all individuals with detectable T. pallidum DNA from September 2019 to April 2020. Electronic patient records were reviewed and concomitant results for treponemal serology and/or rapid plasma reagin (RPR) extracted, along with demographic data, history of syphilis and indices of sexual behaviour including number of sexual partners contacted. Any subsequent treponemal serology and RPR results were also reviewed.ResultsM-PCR swab specimens were performed in 450 individuals, of whom 63 (14%) had detectable T. pallidum DNA; 60 of 63 (95%) were gay or bisexual men and 11 of 63 (17%) were living with HIV. A history of treated syphilis was present in 17 of 63 (27%). Same-day treponemal serology/RPR testing was performed in 58 of 63 (92%) patients. Of the 58 who had same-day syphilis serology/RPR, 9 (16%) had their syphilis infection confirmed by treponemal DNA PCR alone. A total of 165 partners were traced as contacts of infection, of whom 25 (15%) were contacts of individuals diagnosed by M-PCR testing alone.ConclusionIn individuals with T. pallidum PCR-positive lesions, around one in six in our cohort were negative on standard diagnostic serological tests for syphilis. Treponemal DNA testing is an important addition to serological assays in individuals with mucocutaneous ulceration who are at risk of recent syphilis infection and facilitates early diagnosis and contact tracing.

Case report and evaluation of the frequency of the prozone phenomenon in syphilis serology - an infrequent but important laboratory phenomenon

Sexual Health ◽  
2012 ◽  
Vol 9 (5) ◽  
pp. 488 ◽  
Author(s):  
Jeffrey J. Post ◽  
Candice Khor ◽  
Virginia Furner ◽  
Don E. Smith ◽  
L. Ross Whybin ◽  
...  
Keyword(s):  
Previous History ◽  
Treponema Pallidum ◽  
Delayed Diagnosis ◽  
Secondary Syphilis ◽  
Serum Samples ◽  
Syphilis Infection ◽  
Reactive Sample ◽  
Assay Result ◽  
History Of ◽  
Prozone Phenomenon

Background Treponema pallidum specific serology generally remains reactive for life. Therefore, the diagnosis of syphilis reinfection relies on clinical assessment and nontreponemal (reagin) serologic testing. The prozone phenomenon can lead to a falsely nonreactive rapid plasma reagin (RPR) assay result. Methods: We report a case of secondary syphilis in a HIV infected patient with a previous history of syphilis infection, where a falsely nonreactive RPR assay was associated with a delayed diagnosis of reinfection and infectious syphilis. The prozone phenomenon was detected in several of the patient’s serum samples collected around this time. We subsequently undertook a prospective evaluation for the prozone phenomenon in 3222 consecutive sera, which were assayed using the RPR assay for clinical purposes over a 10-month period. Results: The overall rate of the prozone phenomenon was 2 out of 3222 samples (0.06%; 95% confidence interval (CI): 0.02–0.22%) and the rate per reactive sample was 2 out of 397 (0.5%; 95% CI: 0.14–1.81%). Conclusion: Clinicians should request RPR testing at dilutions of sera when syphilis is suspected clinically and the RPR assay is nonreactive.

scholarly journals Rhabdomyolysis Induced by Coadministration of Fusidic Acid and Atorvastatin: A Case Report and Comprehensive Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Dimitrios Patoulias ◽  
Theodoros Michailidis ◽  
Thomas Papatolios ◽  
Rafael Papadopoulos ◽  
Petros Keryttopoulos
Keyword(s):  
Emergency Department ◽  
Fusidic Acid ◽  
Direct Consequence ◽  
Review Of The Literature ◽  
Limb Weakness ◽  
Comprehensive Review ◽  
Acute Rhabdomyolysis ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication

Statins are among the most widely prescribed medications worldwide. Acute rhabdomyolysis constitutes a potentially life-threatening side effect regardless of whether statins are administered alone or in combination. The potentially fatal combination of a statin and fusidic acid has been well described in the literature. Acute renal failure can be a direct consequence of this drug-drug interaction. We present a case of a 79-year-old woman who presented to our Emergency Department with a one-week history of limb weakness, myalgia, and inability to stand and walk. The patient had been given fusidic acid to treat Methicillin-Sensitive Staphylococcus Aureus (MSSA) positive dermatitis in the 3 weeks prior to admission, while she continued to take her complete therapeutic regimen, which included atorvastatin. Thus, she developed rhabdomyolysis due to the interaction between fusidic acid and atorvastatin. Herein, we report a life-threatening complication of coadministration of fusidic acid and a statin, which is preventable and predictable. The exact mechanism of the interaction is not fully understood, but coadministration of these two medications must be avoided in clinical practice.

Confirmatory serological testing of blood donors positive on TPHA screening in Singapore

1997 ◽  
Vol 8 (12) ◽  
pp. 760-763 ◽  
Author(s):  
S S Wong ◽  
D L T Teo ◽  
R K W Chan
Keyword(s):  
Blood Donors ◽  
Congenital Syphilis ◽  
Past History ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Serological Testing ◽  
Sexually Transmitted ◽  
Blood Transfusion Service ◽  
History Of ◽  
Latent Syphilis

Summary: Seventy-two blood donors who were tested positive by the Singapore Blood Transfusion Service (SBTS) for Treponema pallidum haemagglutination (TPHA) test, were evaluated at the Department of Sexually Transmitted Diseases Clinic (DSC) between November 1994 to December 1996. All underwent syphilis serological testing, including rapid plasma reagin test (RPR), TPHA test and fluorescent treponemal antibody-absorption (FTA-Abs) test. All except one (98.6%) were confirmed TPHA positive by the DSC. Of the 71 TPHA-confirmed-positive donors, 53 (74.6%) were subsequently tested positive for FTA-Abs and 18 (25.4%) were tested negative for FTA-Abs. Twenty-two (31%) of the 71 TPHA-positive blood donors had reactive RPR and 49 (69%) had non-reactive RPR. Of the 22 TPHA-positive donors who had reactive RPR, 19 (86%) had positive FTA-Abs (13 late latent syphilis, 4 serological scar, one late congenital syphilis, one secondary syphilis), and 3 (14%) had negative FTA-Abs (all late latent syphilis). Of the 49 TPHA-positive donors who had non-reactive RPR, 34 (69%) had positive FTA-Abs (24 late latent syphilis, 9 serological scar, one late congenital syphilis) and 15 (31%) had negative FTA-Abs (12 late latent syphilis, 2 serological scar, one false-positive TPHA). Only one TPHA-positive donor referred by the SBTS subsequently turned out to have negative syphilis serology at the DSC. Overall, 68 (95.8%) TPHApositive donors who had a past history of sexual exposure were managed as treated or untreated syphilis, regardless of their RPR or FTA-Abs results. However, FTAAbs was found to be useful in the management of 3 (4.2%) TPHA-positive blood donors in the absence of a history of sexual exposures.

Syphilis gastritis: a case report

2017 ◽  
Vol 29 (7) ◽  
pp. 723-725
Author(s):  
Kuan Lai ◽  
Nicolas Pinto-Sander ◽  
Daniel Richardson ◽  
Shanshan Wei ◽  
Kang Zeng
Keyword(s):  
Gastric Mucosa ◽  
Histopathological Examination ◽  
Epigastric Pain ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Maculopapular Rash ◽  
Skin Lesions ◽  
Lymphoplasmacytic Infiltrate ◽  
Assay Result ◽  
History Of

Awareness of the spectrum of clinical manifestations of syphilis, especially uncommon changes, is essential for diagnosis and effective management of patients. A 48-year-old Han businessman presented to the ear, nose and throat surgeons with an eight-week history of epigastric pain, a four-week history of a widespread non-itchy rash including the scrotal skin and a one-week history of tinnitus and dizziness. On examination, he was afebrile with widespread lymphadenopathy and a maculopapular rash affecting his trunk and scrotum. His abdomen was soft but tender in the epigastrium. The Treponema pallidum particle agglutination assay result was positive, and the rapid plasma reagin was 1:2. Gastroscopy showed ulcers in the gastric antrum and pylorus. Histopathological examination of gastric mucosa lesions showed a large amount of lymphoplasmacytic infiltrate detected in the lamina propria of the gastric mucosa. The T. pallidum Liferiver real time polymerase chain reaction kit assay performed on specimens from skin lesions and gastric mucosal tissue were positive. The patient was treated with intravenous sodium penicillin followed by intramuscular benzathine penicillin. On the fourth day of the treatment, the rash, epigastric pain and lymphadenopathy subsided. Two weeks after treatment, the tinnitus alleviated and vertigo disappeared.

Pharyngeal trauma in children – accidental and otherwise

1995 ◽  
Vol 109 (12) ◽  
pp. 1168-1175 ◽  
Author(s):  
P. M. J. Tostevin ◽  
L. J. Hollis ◽  
C. M. Bailey
Keyword(s):  
Parapharyngeal Space ◽  
Accurate Diagnosis ◽  
High Index ◽  
Accidental Injury ◽  
Pharyngeal Wall ◽  
Penetrating Wounds ◽  
Pharyngeal Perforation ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Non Accidental Injury

AbstractPharyngeal perforation is an uncommon injury in children. Most reported cases to date have been secondary to instrumentation or penetrating wounds. Laceration to the pharyngeal wall may introduce air, secretions and bacteria into the parapharyngeal space and mediastinum and consequently has potentially life-threatening sequelae. The management of these injuries is controversial. We present a series of four children who suffered pharyngeal trauma, accidentally and otherwise, and discuss their management.We recommend a high index of suspicion of pharyngeal injury in all cases of oropharyngeal trauma and overnight admission to hospital for observation until an accurate diagnosis has been established. Non- accidental injury of the child must be seriously considered in all cases.

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