Congenital Syphilis Revisited

Mascola, Laurene; Pelosi, Rocco; Blount, Joseph H.; Alexander, Charles E.; Cates, Willard

doi:10.1001/archpedi.1985.02140080045030

Cited by 27 publications

(17 citation statements)

References 9 publications

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“…Congenital syphilis continues to be a major public health problem in developing countries. 310 Untreated syphilis was found to cause fetal death in ϳ22% of pregnancies among infected African mothers; the risks for antepartum and intrapartum stillbirths among infected women were 18-fold and 8-fold higher, respectively. 311 In Malawi, a longitudinal population-based study revealed a populationattributable risk for syphilis of 26% among all fetal deaths and 38% for antepartum fetal deaths.…”

Section: Syphilis Screening and Treatmentmentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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ABSTRACT. Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developingcountry communities has not been reported.Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in communitybased neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning.Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies.Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care.Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy...

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Section: Syphilis Screening and Treatmentmentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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“…En tres series clínicas de 139 niños con sífilis congénita sintomática los hallazgos más comunes fueron: hepato-esplenomegalia (71%), exantema (68%), fiebre (42%), neurosífilis (23%) y neumonitis (17%). Entre las alteraciones de laboratorio destacaban cambios óseos en la radiografía como periostitis u osteocondritis (78%), leucocitosis (72%), anemia (58%), trombocitopenia (40%) y compromiso renal (hematuria, proteinuria) (16%) [17][18][19] .…”

Section: Discussionunclassified

“…Las pruebas no treponémicas muestran la reactividad hacia antígenos de cardiolipina-lecitina-colesterol, para reconocer posibles anticuerpos contra T. pallidum y reflejan la actividad de la enfermedad. Es criterio diagnóstico de sífilis congénita un aumento de los títulos séricos, al menos, cuatro veces mayor que los títulos maternos 17,39 . Estos resultados son sugerentes, pero no son el único marcador utilizado para el diagnóstico.…”

Section: Discussionunclassified

Sífilis congénita: presentación como shock séptico después del período neonatal

Arriagada

Donoso

Cruces

et al. 2012

Rev. chil. infectol.

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Congenital syphilis presenting as septic shock alter the neonatal period Clinical spectrum of congenital syphilis ranges from asymptomatic infection to fulminant sepsis. Treponema pallidum is acquired crossing the placenta from the mother to the fetus during maternal spirochetemia or through direct contact of the child with an infected lesion at delivery. We report a 27 days-old previously healthy girl diagnosed with congenital syphilis. Her mother had an unremarkable previous history, adequate obstetric care and negative prenatal screening test for syphilis. The patient was brought to the ER due to development of skin lesions and fever in the last 24 h. She was admitted to pediatric ICU lethargic and poorly responsive, with hepatosplenomegaly and perioral, palmoplantar erythematous desquamative scaly lesions. Laboratory data revealed anemia, leukocytosis, thrombocytopenia and C-reactive protein of 183 mg/l. Soon after admission she developed septic shock with leukocytosis up to 45,800/mm3 and exacerbation of thrombocytopenia, hypoalbuminemia and metabolic acidosis. Congenital syphilis was diagnosed at the second day of admission with VDRL titers of 1:128 in serum and 1:8 in cerebrospinal fluid. Maternal serum VDRL was positive with titers of 1:32. The patient was treated with penicillin for three weeks with adequate clinical and laboratory response. Congenital syphilis is a life threating infection, but cannot always be diagnosed at birth. Health care workers must be aware of the difficulties in obtaining a definitive diagnosis and must have a high index of suspicion, considering the possible errors of prenatal serology and the diverse possible clinical presentations, including neonatal sepsis during the first month of life.Key words: Syphilis, congenital syphilis, sepsis, pediatrics. Palabras clave: Sífilis, sífilis congénita, sepsis, pediatría. IntroducciónL a sífilis congénita es una de las infecciones más antiguas de las cuales se tiene conocimiento, existiendo reportes desde el siglo XV 1,2 . Puede causar graves efectos en el feto en las distintas etapas de su crecimiento, desarrollo y organogénesis. La transmisión in utero de Treponema pallidum origina una diseminación del organismo en el feto, similar a una sífilis secundaria, describiéndose cambios patológicos tan precoces como a las 15 semanas de gestación 3 . Los sistemas y órganos más afectados son el esquelético, cerebro, hígado y pulmón 3 .Desde fines de los años 80 se ha comunicado un incremento en los casos de sífilis, lo que ha traído como consecuencia un aumento en la incidencia de sífilis congénita. La Organización Mundial de la Salud (OMS) estima que 12 millones de personas son infectadas con sífilis cada año y más de 90% de las infecciones ocurren en países en desarrollo 4 . La sífilis congénita es un problema relevante asociado a embarazos no controlados o infecciones tardías y refleja el comportamiento de la sífilis en general 5 . Ésta puede ocasionar: muerte fetal con aborto espontáneo o mortinato (30 a 40% de los casos), parto prematuro,...

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“…Since the discovery of penicillin, syphilis has become much less common in the western world, but there were 365 cases of less than one year of age in the United States in 1986. 43 Infection spreads from the placenta in the fetal blood stream. The lesion of syphilis in all tissues is of a per ivascular infiltration of lymphocytes, plasma cells and histiocytes, with obliterative endarteritis and extensive fibrosis.…”

Section: Syphilismentioning

confidence: 99%