Congenital syphilis in Argentina: Experience in a pediatric hospital

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.

Is Congenital Syphilis Still a Problem?—A 20-Year Retrospective Study from a Northern Portuguese Level II Hospital

“…Regarding congenital syphilis diagnosis, Garcia et al also reported 39% of patients with less than fourfold nontreponemal titers and 29% with equal or even lower titers, not helping to reach diagnosis. 18 In our study, none of the suspected cases had RPR fourfold or higher than maternal titers; nevertheless, all patients were treated if maternal treatment was absent or when adequate and associated with an increase in nontreponemal titers. Since IgM does not cross the placenta, the presence of FTA-ABS IgM positive in four patients confirmed the diagnosis.…”

“…2,10,21 In our study, none of the patients had symptoms, which could be explained by the high percentage of adequately treated mothers without fourfold titer decrease after treatment (55%) and by the small sample size. 4,18,22 An adequate serologic response is defined as a fourfold decline in nontreponemal titers over a period of at least 6 to 12 months of observation. As a result, in pregnant women, the time between treatment and childbirth is typically less than 6 months.…”

“…15 Additionally, 41% of the cases were classified as having social vulnerability, highlighting that, as reported by several authors, low socioeconomic status, low household income, substance use, mental health disorders, recent arrival in the country, and social vulnerability are possible factors related to an increased risk of congenital syphilis. 16 17 18 19 Likewise, in Italy, Salomè et al reported no maternal treatment in 27% of congenital syphilis cases, drug abuse in 2.5%, and other sexually transmitted diseases in 6.8%. 20…”

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.…”

Syphilis in Pregnant Women and Congenital Syphilis: Spatio-temporal Dynamics and Covariates in the Middle-income Country – São Paulo, Brazil

“…Major challenges that needs to be overcome on a worldwide scale is the issues related to the incorrect treatment of syphilis during pregnancy and the lack of audits to identify aws in the care process and the adequacy of the quali cations of health professionals. A study conducted in Brazil demonstrated these di culties 33 and another one conducted in Argentina pointed out that of the children identi ed with CS and born in hospitals (corresponding to 96% of the total CS cases), only 47% of their mothers completed the antenatal care serological screening, and only four were adequately treated 34 .…”