Characterization and six-month follow-up on a cohort of newborns with congenital syphilis
Abstract
Introduction: Congenital syphilis is a preventable disease. However, the incidence in Colombia has increased and reached the figure of 3.28 cases per 1,000 live births in 2011. Objective: To characterize newborns with congenital syphilis and describe follow-up over 6 months following their diagnosis and treatment. Materials and methods: Between August, 2011, and February, 2012, in Hospital La Victoria, sede Instituto Materno Infantil, newborns with congenital syphilis were identified and treated. Clinical and laboratory follow-up was carried out for six months until it was determined that the disease was cured. The analyzed variables included patients’ clinical and laboratory characteristics. Results: In this period, we identified 29 cases that met the criteria of congenital syphilis, with a frequency in the institution of one case per 69 births. There was one stillbirth and one neonatal death, four were premature, and five had growth restriction. Of the 28 live births, 15 were asymptomatic. There were two cases with neurosyphilis, representing 15% of symptomatic newborns. Follow-up was done on 18 out of 27 children (66.6%), including most symptomatic cases and the two cases of neurosyphilis. All cases showed the expected decrease in VDRL titers without clinical sequelae, meeting the criteria of being cured. Conclusions: A high incidence of the disease, failure to prevent it, varied expression in its presentation, and the effectiveness of treatment in the neonatal period were evidenced in this study.
Downloads
References
Walker GJA, Walker DG. Congenital syphilis: A continuing but neglected problem. Semin Fetal Neonatal Med. 2007;12: 198-206. http://dx.doi.org/10.1016/j.siny.2007.01.019
World Health Organization. Investment case for eliminating mother-to-child transmission of syphilis: Promoting better maternal and child health and stronger health systems. 2012. Fecha de consulta: 23 de abril de 2014. Disponible en: http://apps.who.int/iris/bitstream/10665/75480/1/9789241504348_eng.pdf.
Alonso M. Regional Initiative for the Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in Latin America and the Caribbean: Regional Monitoring Strategy. PAHO, WHO, Unicef; 2010. Fecha de consulta: 23 de abril de 2014. Disponible en: http://www.unicef.org/lac/Regional_Monitoring_Strategy.pdf.
Alzate-Granados JP, Sánchez-Bello NF, Amaya-Arias AC, Peralta-Pizza F, Eslava-Schmalbach J. Congenital syphilis incidence disparities in Colombia 2005 to 2011: An ecological study. Rev Salud Pública. 2012;14:71-80.
Casas RL, Rodríguez M, Rivas J. Syphilis and pregnancy: Early diagnosis and timely treatment. Rev Colomb Obstet Ginecol. 2009;60:49-56.
Herremans T, Kortbeek L, Notermans DW. A review of diagnostic tests for congenital syphilis in newborns. Eur J Clin Microbiol Infect Dis. 2010;29:495-501. http://dx.doi.org/10.1007/s10096-010-0900-8.
Woods CR. Syphilis in children: Congenital and acquired. Semin Pediatr Infect Dis. 2005;16:245-57. http://dx.doi.org/10.1053/j.spid.2005.06.005
Wilson CB, Nizet V, Remington JS, Klein JO, Maldonado Y. Infectious diseases of the fetus and newborn. Philadelphia: Elsevier; 2010. p. 7085.
Sánchez PJ, Wendel GD, Grimprel E, Goldberg M, Hall M, Arencibia-Mireles O, et al . Evaluation of molecular methodologies and rabbit infectivity testing for the diagnosis of congenital syphilis and neonatal central nervous system invasion by Treponema pallidum . J Infect Dis. 1993;167:148-57. http://dx.doi.org/10.1093/infdis/167.1.148
Michelow IC, Wendel GD, Norgard MV, Zeray F, Leos NK, Alsaadi R, et al . Central nervous system infection in congenital syphilis. N Engl J Med. 2002;346:1792-8. http://dx.doi.org/10.1056/NEJMoa012684
Rawtron SA, Mehta S, Bromberg K. Evaluation of a Treponema pallidum -specific IgM enzyme immunoassay and Treponema pallidum western blot antibody detection in the diagnosis of maternal and congenital syphilis. Sex Transm Dis. 2004;31:123-6.
Cifuentes Y, Ojeda C. Sífilis congénita en el Instituto Materno Infantil-Hospital La Victoria durante el año 2008. Rev Salud Pública. 2013;15;434-45.
Saloojee H, Velaphi S, Goga Y, Afadapa N, Steen R, Lincetto O. The prevention and management of congenital syphilis: An overview and recommendations. Bull World Health Organ. 2004;82:424-30.
Alexander JM, Sheffield JS, Sánchez PJ, Mayfield J, Wendel GD. Efficacy of treatment for syphilis in pregnancy. Obstet Gynecol. 1999;93:5-8.
Instituto Nacional de Salud. Sífilis congénita. Semana epidemiológica número 53 de 2014 (28 de diciembre al 03 de enero de 2015). Fecha de consulta: 10 de abril de 2015. http://www.ins.gov.co/boletin-epidemiologico/Boletn%20Epidemiolgico/2014%20Boletin%20epidemiologico%20semana%2053.pdf.
Cruz AR1, Castrillón MA, Minotta AY, Rubiano LC, Castaño MC, Salazar JC. Gestational and congenital syphilis epidemic in the Colombian Pacific Coast. Sex Transm Dis. 2013; 40:813-8. http://dx.doi.org/10.1097/OLQ.0000000000000020
Jafari Y, Peeling RW, Shivkumar S, Claessens C, Joseph L, Pai NP. Are Treponema pallidum specific rapid and point-of-care tests for syphilis accurate enough for screening in resource limited settings? Evidence from a meta-analysis. PloS One. 2013;8:e54695. http://dx.doi.org/10.1371/journal.pone.0054695.
Sison CG, Ostrea EM, Reyes MP, Salari V. The resurgence of congenital syphilis: A cocaine-related problem. J Pediatr. 1997;130:289-92. http://dx.doi.org/10.1016/S0022-3476(97)70357-3
World Health Organization. Investment case for eliminating mother-to-child transmission of syphilis: Promoting better maternal and child health and stronger health systems. 2012. Fecha de consulta: 23 de abril de 2014. Disponible en: http://apps.who.int/iris/bitstream/10665/75480/1/9789241504348_eng.pdf.
Rawstron SA, Bromberg K. Failure of recommended maternal therapy to prevent congenital syphilis. Sex Transm Dis. 1991;18:102–6.
Winscott M, Taylor MM, Kenney K. Identifying unre- ported and undiagnosed cases of congenital syphilis in Arizona using live birth and fetal death registries. Sex Transm Dis. 2010;37:244-7. http://dx.doi.org/10.1097/OLQ.0b013e3181c37e2a
McFarlin BL, Bottoms SF, Dock BS, Isada NB. Epidemic syphilis: Maternal factors associated with congenital infection. Am J Obstet Gynecol. 1994;170:535-40. http://dx.doi.org/10.1016/S0002-9378(94)70223-3
Hollier LM, Harstad TW, Sánchez PJ, Twickler DM, Wendel GD. Fetal syphilis: Clinical and laboratory characteristics. Obstet Gynecol. 2001;97:947-53.
Anand NK, Chellani HK, Wadhwa A, Prasanna SB, Mohan M. Congenital syphilitic hepatitis. Indian Pediatr. 1991;28:157-9.
Singh AE, Guenette T, Gratrix J, Bergman J, Parker P, Anderson B, et al . Seroreversion of treponemal tests in infants meeting Canadian surveillance criteria for confirmed early congenital syphilis. Pediatr Infect Dis J. 2013;32:199-202. http://dx.doi.org/10.1097/INF.0b013e318273599c.
Lago EG, Vaccari A, Fiori RM. Clinical features and follow- up of congenital syphilis. Sex Transm Dis. 2013;40:85-94. http://dx.doi.org/10.1097/OLQ.0b013e31827bd688
Some similar items:
- Beatriz E. Orozco-Sebá, Diego Viasus , Esperanza Meléndez , Jairo Fuentes , José Tovar , Elkin A. Amado , Daniela Loaiza , Intrahepatic cholestasis due to Treponema pallidum in an immunocompetent patient , Biomedica: Vol. 43 No. 2 (2023)

Article metrics | |
---|---|
Abstract views | |
Galley vies | |
PDF Views | |
HTML views | |
Other views |