Congenital syphilis in Argentina: experience in a pediatric hospital

Abstract

Although 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.

Acquired Syphilis by Nonsexual Contact in Childhood

“…These lesions contain a high number of highly contagious treponemas to the touch. It is also very frequent to observe these lesions in congenital syphilis cases, 31 but in our series, this means of transmission was ruled out as all our patients' mothers presented negative serology to syphilis during pregnancy. The majority of the lesions that infected mothers presented were in the oral mucosa, tongue and hands.…”

Congenital syphilis in neonates: a case report

“…1-3 It can cause the death of 6.5% of the total cases, and the remaining 80% of patients can still be saved, where premature birth and low birth weight significantly affect the mortality of neonates born from CS cases. 8, 9 In this case, the patient's mother knew she was infected with syphilis began during her second pregnancy. Previously, the patient's mother had a history of miscarriage, and then a curettage was performed in her first pregnancy.…”

Epidemiologia da Sífilis Congênita no estado de Sergipe

“…Um estudo realizado em um hospital infantil de Buenos Aires, que analisou 61 casos de crianças diagnosticadas com SC entre 1987 e 2019, verificou que a distribuição desses casos apresentou uma curva bimodal entre os anos de 1992 e 1993 e entre 2014 e 2017 a idade média de diagnósticos casos foi de 2 meses e os principais achados foram: alterações ósseas, hepatoesplenomegalias, anemia, lesões cutâneas e comprometimento renal (Garcia et al, 2021).…”