Congenital Syphilis and the Timing of Immunogenesis in the Human Fœtus

Silverstein, Arthur M.

doi:10.1038/194196a0

Cited by 123 publications

(31 citation statements)

References 5 publications

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“…However, and in contrast to laboratory mice, an adaptive immune system develops in many larger mammals (including human beings) at early stages of fetal development. [22][23][24][25][26][27] Thus, the appearance of immunological tolerance cannot be explained by a failure to generate adaptive immunity to foreign antigen, as was initially thought in mice.…”

Section: A Brief Historical Perspective On the Development Of Lymphocmentioning

confidence: 99%

At the crossroads between tolerance and aggression

Mold

McCune²

2011

Chimerism

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e do not grow absolutely, chronologically. We grow sometimes in one dimension, and not in another; unevenly. We grow partially. We are relative. We are mature in one realm, childish in another. The past, present and future mingle and pull us backward, forward, or fix us in the present. We are made up of layers, cells, constellations."-Anaïs Nin It has long been recognized that the developing immune system exhibits certain peculiarities when compared to the adult immune system. Nonetheless, many still regard the fetal immune system as simply being an immature version of the adult immune system. Here we discuss historical evidence as well as recent findings, which suggest that the human immune system may develop in distinct layers with specific functions at different stages of development. A Brief Historical Perspective on the Development of Lymphocytes in MammalsOver two decades ago, a model was proposed by Leonore and Leonard Herzenberg which suggested that the immune system in mammals did not arise in a linear fashion from immaturity to maturity, as is often believed, but rather in distinct layers which could perform unique functions at different stages of development.1 This model was supported by a series of observations, made first in avian species 2,3 and later in the mouse, 4-10 that revealed the existence of unique waves of lymphocyte production during fetal and neonatal development.

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Section: A Brief Historical Perspective On the Development Of Lymphocmentioning

confidence: 99%

At the crossroads between tolerance and aggression

Mold

McCune²

2011

Chimerism

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“…Realisation of the development of immune competency in the fetus during the latter half of pregnancy (Silverstein, 1962) has led to immunoglobulin M (1gM) levels being estimated in cord blood to help in the diagnosis of intrauterine and perinatal infections (Alford et al, 1967). As IgM does not normally cross the placenta, any present in cord blood is presumed to have been produced by the fetus and it has been suggested there is a close correlation between its circulating level at birth and fetal infection (Alford et al, 1967;Sever, 1969).…”

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confidence: 99%

Significance of raised immunoglobulin M levels in cord blood of small-for-gestational-age infants.

Matthews¹,

O’Herlihy²

1978

Arch Dis Child

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SUMMARY Cord IgM values were determined in small-for-gestational-age infants born at Hammersmith Hospital during a 52-year period. 121 (12.5%) infants had levels >0 2 g/l; in 92 these were between 0 21 and 0 *3 g/l. In only 18 (14 8%) was a level of 0 *4 g/l exceeded, and 5 proved cases of intrauterine infection-rubella (2), syphilis (2), and toxoplasmosis (1)-were in this group. The factor most often associated with cord IgM >0 4 g/l was prolonged rupture of the membranes. There was an increased incidence of blood group B among the mothers, probably reflecting the greater number of nonCaucasian women giving birth to small-for-gestational-age infants. Determination of cord IgM did not help significantly in diagnosis.

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“…In 1962, Silverstein [12] noted marked B cell responses in congenitally infected fetus by syphilis in autopsy specimen. Intense immune response might be responsible for fetal death or preterm delivery in primary or early secondary syphilis and severe growth retardation or some of the manifestations of CS [13].…”

Section: Discussionmentioning

confidence: 99%

A Case Series of 130 Neonates with Congenital Syphilis: Preterm Neonates Had More Clinical Evidences of Infection than Term Neonates

Zhou¹,

Wang²,

Chen³

et al. 2012

Neonatology

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Background: The early clinical manifestations of congenital syphilis (CS) vary from asymptomatic to florid lesions, involving multisystem damage. But little is known about the differences of early clinical features between preterm and term neonates with CS. Objectives: To compare the clinical characteristics between preterm and term neonates with CS and analyze the possible underlying reasons for the differences. Methods: Consecutive medical charts of infants at risk for CS from January 1999 to December 2009 were retrospectively reviewed. Neonates with positive 19S-IgM in serum were included in the study. Results: Among the 1,670 cases at risk for CS, 130 neonatal cases with positive 19S-IgM in serum were included in the analysis, including 58 preterm ones and 72 full-term ones. Compared with term neonates with CS, preterm ones were more likely to have characteristic skin rash (36.2 vs. 9.7%, p < 0.001), hepatomegaly (51.7 vs. 25%, p = 0.02), splenomegaly (32.8 vs. 15.4%, p = 0.02), PRP titer ≥1:8 (96.6 vs. 70.8%, p < 0.001), thrombocytopenia (43.1 vs. 23.6%, p = 0.018), elevated CRP (65.5 vs. 36.5%, p = 0.002), and abnormal long bone X-ray results (94.6 vs. 68.1%, p < 0.001). Fewer mothers of preterm neonates with CS received treatment for syphilis (15.5 vs. 40.3%, p = 0.003). The rate of withdrawal of care was higher in preterm neonates with CS (31 vs.12.5%, p = 0.036). Conclusions: Preterm neonates with CS had more clinical evidences and suffered more than term ones.

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Congenital Syphilis and the Timing of Immunogenesis in the Human Fœtus

Cited by 123 publications

References 5 publications

At the crossroads between tolerance and aggression

At the crossroads between tolerance and aggression

Significance of raised immunoglobulin M levels in cord blood of small-for-gestational-age infants.

A Case Series of 130 Neonates with Congenital Syphilis: Preterm Neonates Had More Clinical Evidences of Infection than Term Neonates

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