Congenital Syphilis Presenting with Brain Abnormalities at Neuroscan: A Case Report and a Brief Literature Review

Abstract

A case of vertical transmission in a 35-year-old pregnant woman, gravida 4, para 2 with an unknown medical history of carrying primary syphilis is described. A routine 3rd trimester scan was performed at 30 + 5 weeks of pregnancy, which revealed fetal growth restriction (FGR) associated with absent fetal movement, a pathologic neuroscan characterized by cortical calcifications and ominous Doppler waveform analysis of the umbilical artery and ductus venosus. Computerized electronic fetal monitoring (EFM) showed a Class III tracing, according to the American College of Obstetricians and Gynecologists (ACOG) guidelines. An emergency C-section was performed and a female newborn weighing 1470 g was delivered. The Apgar scores were 5 and 8 at the first and fifth min, respectively. Besides the prompted obstetrical and neonatal interventions, the neonate died after 7 days. A histologic examination of the placenta revealed a chorioamnionitis at stage 1/2 and grade 2/3. The parenchyma showed diffuse delayed villous maturation, focal infarcts, and intraparenchymal hemorrhages. The decidua presented with chronic deciduitis with plasma cells. The parents declined the autopsy. Congenital syphilis is an emerging worldwide phenomenon and the multidisciplinary management of the mother and the fetus should be mandatory.

Single-cell RNA sequencing of iPSC-derived brain organoids revealsTreponema palliduminfection inhibiting neurodevelopment

“…As brain organoids reflect developmental stages during pregnancy and the early postnatal, they are currently the most relevant tools for research on neurodevelopmental disorders (Andrews and Kriegstein, 2022), helping to discover novel biological information on the early stages of neurodevelopment and disease eLife 12 of 32 progression, as well as the ability to manipulate these processes in vitro (Trujillo and Muotri, 2018). Tonni et al reported that a routine third-trimester scan of pregnant woman with primary syphilis, which revealed fetal growth restriction associated with absent fetal movement, a pathologic neuroscan characterized by cortical calcifications, and a transabdominal neuroscan was able to detect hyperechogenicity involving both choroid plexuses of the lateral ventricles as well as the falx cerebri, with smooth without recognizable gyri and sulci (Tonni et al, 2022). The imaging features and the neurodevelopmental outcome in the fetal brain were verified by organoids infected with T. pallidum inducing a significant decrease in the overall organoid size and interfering with the formation of neural rosette-like structure of brain organoids in our study.…”

“…Tonni et al upon utilising a transabdominal neuroscan of a pregnant woman with primary syphilis observed hyperechogenicity involving both choroid plexuses of the lateral ventricles and the falx cerebri (Tonni et al, 2022). Moreover, the foetal brain contour exhibited a smooth appearance devoid of discernible gyri and sulci, indicating a significant influence of T. pallidum on fetal brain development and subsequent neurodevelopmental outcomes (Tonni et al, 2022). However, the precise mechanisms underlying the impact of T. pallidum on fetal neurodevelopment remain constrained.…”

“…With the increasing number of syphilis cases in recent years in many countries, there has been a growing focus on the prenatal exposure of the foetus to maternal Treponema pallidum and its consequential effects on the developing brain and subsequent neurodevelopmental outcomes (David et al, 2022; Medoro and Sánchez, 2021). Tonni et al upon utilising a transabdominal neuroscan of a pregnant woman with primary syphilis observed hyperechogenicity involving both choroid plexuses of the lateral ventricles and the falx cerebri (Tonni et al, 2022). Moreover, the foetal brain contour exhibited a smooth appearance devoid of discernible gyri and sulci, indicating a significant influence of T. pallidum on fetal brain development and subsequent neurodevelopmental outcomes (Tonni et al, 2022).…”