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[Congenital syphilis]
C Kurzke1, W Handrick, R Schille
1Universitäts-Kinderklinik, Leipzig, Deutschland.
Insights
Congenital syphilis (Lues connata) can occur even with negative maternal tests during pregnancy. Early diagnosis and penicillin treatment are crucial for infant recovery.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Context:
- Congenital syphilis (Lues connata) presents diagnostic challenges in newborns.
- Maternal syphilis screening tests during pregnancy may yield false negatives.
Purpose:
- To report on four cases of congenital syphilis in infants.
- To highlight diagnostic difficulties and treatment outcomes.
Summary:
- Four infants diagnosed with congenital syphilis are presented, with three in early stages.
- Clinical findings included anemia, abnormal blood counts, hepatosplenomegaly, and bone abnormalities.
- Despite negative maternal prenatal syphilis tests, placental transfer of pathogens was suspected. Treatment with penicillin was effective, with no Jarisch-Herxheimer reactions observed.
Impact:
- Negative maternal syphilis tests do not rule out congenital syphilis in newborns.
- Congenital syphilis should be considered in newborns with undiagnosed infectious conditions.
- Routine serodiagnostic syphilis testing for all newborns before discharge is recommended.
Abstract:
Four infants with Lues connata, three with the early stage of the disease (patients 1-3), are reported. Diagnosis was made after exclusion of other diseases. Initially an infectious disease was expected, since anemia, leucocytosis, thrombocytopenia, hepatomegaly and/or splenomegaly and a bad condition were found. In two patients bone structure was abnormal. Elevated serum concentrations of liver enzymes (ALAT, ASAT) were the indication for liver biopsy in one patient, in whom an accompanying hepatitis was diagnosed. Treatment was performed with penicillin, no JARISCH-HERXHEIMER reaction was observed. The Lues tests were negative during pregnancy but a displacental transfer of pathogenic agents could be assumed. Patient 4 was diagnosed at 9 months of age. Infection of the mother probably occurred in the last 6 weeks of pregnancy. It can not be decided if the baby has a connatal or acquired Lues. The titer decrease of the CMT-test after the end of the penicillin therapy is a marker for a successful treatment. If treatment was started at 2 years of age a total clinical recovery can be expected. The case reports demonstrate that negative Lues test during pregnancy do not exclude Lues connata in newborns. The Lues diagnosis should be considered if an infectious disease in a newborn can not be diagnosed. A general Lues serodiagnostic test is recommended in all newborns before they leave the obstetrics department.