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Long-bone radiographic abnormalities as a sign of active congenital syphilis in asymptomatic newborns
1Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
Insights
Radiographs reveal bone lesions in about 20% of asymptomatic newborns with congenital syphilis. Early radiologic assessment is crucial for all infants with positive serology to detect potential bone abnormalities.
Area of Science:
- Pediatrics
- Infectious Diseases
- Radiology
Background:
- Congenital syphilis can cause metaphyseal abnormalities in over 90% of symptomatic infants.
- The prevalence of bone lesions in asymptomatic newborns with congenital syphilis is not well-established.
Purpose of the Study:
- To determine the incidence of radiographically evident bone lesions at birth in asymptomatic newborns diagnosed with congenital syphilis.
Main Methods:
- Long-bone radiographs were performed on all newborns with positive perinatal serology over a 9-month period.
- Infants were assessed for symptomatic presentation and cord serology status.
Main Results:
- Two symptomatic newborns had abnormal radiographs.
- Twelve out of 59 asymptomatic newborns (approximately 20%) exhibited metaphyseal changes indicative of congenital syphilis.
Conclusions:
- Long-bone radiographs are abnormal in approximately 20% of asymptomatic newborns with positive perinatal treponemal serology.
- Radiologic evaluation should be part of the assessment for all newborns with positive serology due to rising congenital syphilis rates.
- Close follow-up is recommended for treated infants due to the risk of late sequelae.
Abstract:
Metaphyseal abnormalities are present in greater than 90% of infants with symptomatic congenital syphilis. The incidence of these lesions in asymptomatic newborns in the present epidemic is not known. To determine the incidence of bone lesions at birth in asymptomatic congenital syphilis, long-bone films were obtained for all babies born during a 9-month period with a positive perinatal serology. Of 2544 newborns, 61 had a positive maternal serology and 40 also had a positive cord serology. Two symptomatic babies had abnormal radiographs and 12 of 59 asymptomatic newborns had metaphyseal changes consistent with congenital syphilis. It is concluded that long-bone radiographs are abnormal in approximately 20% of asymptomatic newborns with positive perinatal treponemal serology. With the increasing incidence of congenital syphilis, radiologic studies should be included in the assessment of all newborns with a positive serology. Indeed, those patients with any sign of active disease should be carefully followed because even treated infants remain at some risk for developing the late sequelae of congenital syphilis.