Sífilis congénita: presentación como shock séptico después del período neonatal

Abstract

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,...

Complications, clinical manifestations of congenital syphilis, and aspects related to its prevention: an integrative review

“…All studies that analyzed clinical findings in children with early CS showed some shortcoming in the management of care to the pregnant woman, especially when related to tracking, diagnosing, and providing proper treatment to the mothers as soon as possible (8,28,32) . Researches carried out in Chile, Mexico, and England exposed cases of early CS in which the mothers were only reactive to the second test applied to them or during birth (22)(23)(27)(28)32) . These women may have been infected during pregnancy and present high titer levels at the moment of birth, corresponding to an early stage of the infection.…”

Hospitalizations due to Congenital Syphilis in Neonates: Associated Factors from the Prenatal Care Process

“…It is worth noting that breast milk does not transmit syphilis from the mother to the child and that, during breastfeeding, transmission can occur only if there is syphilitic breast injury, which is very rare (18). The same criterion applies to skin-to-skin contact, since Treponema pallidum is acquired by crossing the placenta or through direct contact of the child with an infected lesion at birth (19).…”