Congenital syphilis in Argentina: Experience in a pediatric hospital

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.

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Congenital syphilis in Argentina: experience in a pediatric hospital

10.1101/2020.06.16.20132795 ◽

2020 ◽

Author(s):

Luciana Noemí Garcia ◽

Alejandra Destito Solján ◽

Nicolas Falk ◽

Nicolás Leonel Gonzalez ◽

Griselda Ballering ◽

...

Keyword(s):

Medical Records ◽

Congenital Syphilis ◽

Delayed Diagnosis ◽

Clinical Manifestations ◽

Skin Lesions ◽

Penicillin G ◽

High Morbidity ◽

Laboratory Findings ◽

Therapeutic Decisions

AbstractAlthough congenital syphilis (CS) is preventable, it is still an important health problem worldwide. Recently, an increase in the number of primary and congenital syphilis cases has been observed. Fetal infection can be particularly aggressive, but newborns can be asymptomatic at birth and run the risk of developing systemic compromise with a poor prognosis.We conducted a study (1987-2019) analyzing the medical records of CS diagnosis cases assisted at the Buenos Aires Children’ Hospital. Sixty-one patients were included. Information about demographics, clinical and laboratory findings, T. pallidum serology and treatment was collected. Median age at diagnosis was 2 months (IQ 1-6 months). The distribution of cases showed a bimodal curve, with a peak in 1993 and in 2017. The main clinical findings were: bone alterations in 36/61 (59%); hepatosplenomegaly in 33/61 (54.1%); anemia in 32/51 (62.8%); skin lesions 26/61 (42.6%) and renal compromise in 15/45 (33.3%). Cerebrospinal fluid was studied in 50/61 (81.9%); 5 (10%) were abnormal (reactive VDRL and/or cell alteration count). Only 23 (60.5%) patients had nontreponemal titers fourfold higher than their mothers did. Intravenous penicillin G for an average of 10-14 days was prescribed in 60/61 subjects and one patient received ceftriaxone. Remarkably, only 28 (46%) mothers were tested for syphilis during pregnancy.During follow-up, a decrease in RPR titers was observed reaching seroconversion in 31/34 (91%) subjects at a median of 19.2 months after treatment. Treponemal titers (TPHA) remained reactive.Our results highlighted that an increase in the number of cases of CS is occurring in our population with high morbidity related to delayed diagnosis. A good therapeutic response was observed.CS requires a greater effort from obstetricians to adequately screen for the disease during pregnancy and pediatricians should be alert in order to detect cases earlier, to provide an adequate diagnosis and treatment of CS.Author SummaryCS is caused by mother-to child transmission. Although screening of pregnant women and treatments are available, new cases are increasing worldwide. We reviewed the medical records of CS-patients assisted in our hospital over the past 30 years. Our results showed that there was an increase in the number of CS cases. At birth, most children were asymptomatic and later developed CS clinical manifestations. Penicillin treatment, and in one case ceftriaxone, was prescribed with a good clinical response. Nevertheless, one infant died, four had persistent kidney disorders and one showed bone sequelae damage. Spinal lumbar puncture did not modify therapeutic decisions. In the follow-up, a decrease in nontreponemal antibodies was observed as a marker of treatment response. We concluded that the detection and treatment of CS remains a great challenge for clinical practice in our region.It is crucial that pediatricians and obstetricians give greater attention and make a greater effort to detect this neglected disease in an attempt to reverse its upwards trend.

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Systematic review of temporal trends of congenital syphilis in Brazil

Revista de Epidemiologia e Controle de Infecção ◽

10.17058/reci.v1i1.15151 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Maicon Madureira ◽

Paulo Henrique de Araújo Guerra ◽

Charles Junior Finco ◽

Thais Nascimento Helou ◽

Paulo Roberto Barbato

Keyword(s):

Systematic Review ◽

Low Income ◽

Congenital Syphilis ◽

Temporal Trends ◽

Population Characteristics ◽

Inclusion Criteria ◽

Unified Health System ◽

Black Skin ◽

Low Education ◽

Ethnic Factors

The present study was aimed to retrieve and analyse the temporal trends of congenital syphilis (CS) in Brazil, as well as to list its main associated factors. Methods: In August 2019 a systematic review was developed in four electronic databases (Lilacs, Pubmed, Scielo and Web of Science) and in manual searches on reference lists. It was established that the synthesis of this review would be composed by ecological studies with CS temporal trends in the Brazilian territory, regardless of the population characteristics and data representativeness. More specifically, it was also established that the prevalence of CS of the first and last year of the time series would be presented in the descriptive synthesis. Results: Of the 2,157 initial studies, 14 adequately met the inclusion criteria and composed the synthesis. Twelve (85.7%) of these studies showed increases in time trends, with particular emphasis on the two nationwide studies, which showed positive trends between 2003–2008 (0.4) and 2010–2015 (3.7). Associations were found between CS and socioeconomic and ethnic factors, especially in the groups of women with low income, low education, brown / black skin colour and who had untreated partners. Conclusion: most of the available research showed an increase in the temporal trends of CS, highlighting that these data were observed at the national, state and municipal levels. Since mothers socioeconomic and ethnic factors are associated with higher CS frequencies, efforts are needed to increase the coverage of the Unified Health System to vulnerable women.

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Clinical characteristics, risk factors, and outcomes of POEMS syndrome

Neurology ◽

10.1212/wnl.0000000000009940 ◽

2020 ◽

Vol 95 (3) ◽

pp. e268-e279 ◽

Cited By ~ 3

Author(s):

Stephen Keddie ◽

David Foldes ◽

Francisca Caimari ◽

Stephanie E. Baldeweg ◽

Joshua Bomsztyk ◽

...

Keyword(s):

Risk Factors ◽

Clinical Laboratory ◽

Chronic Inflammatory Demyelinating Polyneuropathy ◽

Delayed Diagnosis ◽

Significant Risk ◽

Skin Lesions ◽

Poems Syndrome ◽

Active Monitoring ◽

Risk Of Death

ObjectivePOEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin lesions) is a paraneoplastic disorder resulting in severe neurologic disability. Understanding the clinical, laboratory, neurophysiologic, and histopathologic features as well as treatment responses of POEMS will assist in more accurate and timely diagnosis, risk stratification, and effective management.MethodsThis was a retrospective longitudinal cohort study from 1998 to March 2019, with 7,184 person-months of follow-up time. Hospital databases were used to collate presenting features, investigations, therapies, and response.ResultsOne hundred patients were included with a median follow-up time of 59 months (range, 1–252). Mean symptom onset to diagnosis was 15 months (range, 1–77), with 54% of patients initially misdiagnosed with chronic inflammatory demyelinating polyneuropathy. Median number of multisystem features at diagnosis was 7. Ninety-six (96%) presented with neuropathy, which was length-dependent in 93 (93%) and painful in 75 (75%). At diagnosis, 35% of patients were wheelchair or bedbound, with median Overall Neuropathy Limitation Score of 6, improving to 3 following treatment (p < 0.05). Five-year survival was 90% and 82% at 10 years, with 5- and 10-year progression-free survival of 65% and 53%. Nontreatment with autologous stem cell transplantation, nonhematologic response, and non–vascular endothelial growth factor response are significant risk factors in multivariate analysis to predict progression or death. Risk factors are incorporated to develop a risk score enabling stratification of high- and low-risk cases.ConclusionsPOEMS syndrome is a rare multisystem condition with delayed diagnosis and poor neurologic function at presentation. Therapy has favorable outcomes. Patients at high risk of death or progression can be identified, which may allow for more active monitoring and influence management.

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Outcome of infants born to pregnant women with syphilis: A nationwide study in Korea

10.21203/rs.3.rs-58669/v1 ◽

2020 ◽

Author(s):

Joohee Lim ◽

So Jin Yoon ◽

Jeong Eun Shin ◽

Jungho Han ◽

Soon Min Lee ◽

...

Keyword(s):

Mental Retardation ◽

Renal Disease ◽

Hearing Impairment ◽

Congenital Syphilis ◽

Day Treatment ◽

National Level ◽

International Classification Of Diseases ◽

Penicillin G ◽

Screening Programs

Abstract BackgroundAlthough expansion of antenatal syphilis screening programs, congenital syphilis (CS) is still remaining issue. This study aimed to analyze the manifestation and progress of CS including treatment and follow-up based on nationwide study.MethodsFrom the Korean National Health Insurance Service database, a total of 548 infants were examined for CS during first year of life from 2013 to 2018. Neurosyphilis and complications were investigated using International Classification of Diseases-10 codes.ResultsThe birth rate from mother with syphilis was 2.8 per 10,000 live birth for 5 years, not showing tendency to decrease. One hundred forty-eight infants were proven or highly probable or possible for CS with treatment over 10 days. Sixty-six infants were possible or less likely CS with only 1-day treatment. Jaundice (56%) was most common and hearing impairment (14%), renal disease (8%), mental retardation (8%) followed. Total of 14 cases of neurosyphilis occurred. Patients who have complications such as mental retardation, eye involvement, hearing impairment and renal disease were significantly associated with neurosyphilis (OR 8.49, P < 0.0001). Among 250 patients with treatment, 92.8% was treated with 1 medication; Benzathine penicillin G was more used (72.4%) than aqueous crystalline penicillin G. Only 4 patients were retreated due to treatment failure. In addition to the treponemal test, fluorescent treponemal antibody-absorption was the most prescribed tool of diagnosis for follow up.ConclusionSharing a standardized guideline for evaluation and treatment regimens and follow up plan at a national level is needed for maternal neonatal care leading to eradication of CS.

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Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro—Brazil

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0010070 ◽

2022 ◽

Vol 16 (1) ◽

pp. e0010070

Author(s):

Izabela Jardim Rodrigues Pitta ◽

Mariana de Andrea Vilas-Boas Hacker ◽

Ligia Rocha Andrade ◽

Clarissa Neves Spitz ◽

Robson Teixeira Vital ◽

...

Keyword(s):

Neurological Examination ◽

Nerve Biopsy ◽

Skin Lesions ◽

Multidrug Therapy ◽

Therapeutic Decisions ◽

Significant Difference ◽

Leprosy Neuropathy ◽

Before And After ◽

Classical Symptom

Introduction Pure Neural Leprosy (PNL) is a rare clinical form of leprosy in which patients do not present with the classical skin lesions but have a high burden of the disability associated with the disease. Clinical characteristics and follow up of patients in PNL are still poorly described in the literature. Objective This paper aims to describe the clinical, electrophysiological and histopathological characteristics of PNL patients, as well as their evolution after multidrug therapy (MDT). Methods Fifty-two PNL patients were selected. Clinical, nerve conduction studies (NCS), histopathological and anti-PGL-1serology were evaluated. Patients were also assessed monthly during the MDT. At the end of the MDT, all of the patients had a new neurological examination and 44 were submitted to another NCS. Results Paresthesia was the complaint most frequently reported by patients, and in the neurological examination the most common pattern observed was impairment in sensory and motor examination and a mononeuropathy multiplex. Painful nerve enlargement, a classical symptom of leprosy neuropathy, was observed in a minority of patients and in the motor NCS axonal injuries, alone or in combination with demyelinating features, were the most commonly observed. 88% of the patients did not present any leprosy reaction during MDT. There was no statistically significant difference between the neurological examinations, nor the NCS pattern, performed before and after the MDT. Discussion The classical hallmarks of leprosy neuropathy are not always present in PNL making the diagnosis even more challenging. Nerve biopsy is an important tool for PNL diagnosis as it may guide therapeutic decisions. This paper highlights unique characteristics of PNL in the spectrum of leprosy in an attempt to facilitate the diagnosis and management of these patients.

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Low-income minority women at risk for cervical cancer: a process to improve adherence to follow-up recommendations

Public Health Reports ◽

10.1016/s0033-3549(04)50094-8 ◽

2001 ◽

Vol 116 (6) ◽

pp. 608-616 ◽

Cited By ~ 20

Author(s):

Virginia A Cardin ◽

Richard M Grimes ◽

Zhi Dong Jiang ◽

Nancy Pomeroy ◽

Luther Harrell ◽

...

Keyword(s):

Cervical Cancer ◽

At Risk ◽

Low Income ◽

Minority Women

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Congenital Syphilis Simulating Bone Neoplasm in 2-Month Old Infant – Case Report

Medical & Clinical Research ◽

10.33140/mcr.02.01.04 ◽

2017 ◽

Vol 2 (1) ◽

Keyword(s):

Case Report ◽

Congenital Syphilis ◽

Eosinophilic Granuloma ◽

Osteolytic Lesion ◽

Lower Limbs ◽

Upper Body ◽

Elective Cesarean Section ◽

Distal Fibula ◽

X Ray

Introduction: Congenital Syphilis (CS) occurs through the transplacental transmission of Treponema pallidum in inadequately treated or non-treated pregnant women, and is capable of severe consequences such as miscarriage, preterm birth, congenital disease and/or neonatal death. CS has been showing an increasing incidence worldwide, with an increase of 208% from 2009 to 2015 in Brazil. Case report: 2-month old infant receives care in emergency service due to edema of right lower limb with pain in mobilization. X-ray with osteolytic lesion in distal fibula. Infant was sent to the Pediatrics Oncology clinic. Perinatal data: 7 prenatal appointments, negative serology at 10 and 30 weeks of gestation. End of pregnancy tests were not examined and tests for mother’s hospital admission were not requested. Mother undergone elective cesarean section at 38 weeks without complications. During the pediatric oncologist appointment, patient showed erythematous-squamous lesions in neck and other scar-like lesions in upper body. A new X-ray of lower limbs showed lesions in right fibula with periosteal reaction associated with aggressive osteolytic lesion compromising distal diaphysis, with cortical bone rupture and signs of pathological fracture, suggestive of eosinophilic granuloma. She was hospitalized for a lesion biopsy. Laboratory tests: hematocrit: 23.1 / hemoglobin 7.7 / leukocytes 10,130 (without left deviation) / platelets 638,000 / Negative Cytomegalovirus IgG and IgM and Toxoplasmosis IgG and IgM / VDRL 1:128. Congenital syphilis diagnosis with skin lesions, bone alterations and anemia. Lumbar puncture: glucose 55 / total proteins 26 / VDRL non reagent / 13 leukocytes (8% neutrophils; 84% monomorphonuclear; 8% macrophages) and 160 erythrocytes / negative VDRL and culture. X-ray of other long bones, ophthalmological evaluation and abdominal ultrasound without alterations. Patient was hospitalized for 14 days for treatment with Ceftriaxone 100mg/kg/day, due to the lack of Crystalline Penicillin in the hospital. She is now under outpatient follow-up. Discussion: CS is responsible for high rates of morbidity and mortality. The ongoing increase of cases of this pathology reflects a severe health issue and indicates failures in policies for the prevention of sexually transmitted diseases, with inadequate follow-up of prenatal and maternity protocols.

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