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Marais YA, Mason D, Barnard A, Saaiman CR, Els HC, Kluge J, Glass AJ, Wright CA, Schubert PT. Placental Syphilis: A Comprehensive Review of Routine Histomorphology, HIV Co-infection, Penicillin Treatment, Immunohistochemistry, and Polymerase Chain Reaction. Fetal Pediatr Pathol 2023; 42:870-890. [PMID: 37668986 DOI: 10.1080/15513815.2023.2253309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/24/2023] [Accepted: 06/28/2023] [Indexed: 09/06/2023]
Abstract
Introduction: Placental examination is valuable for diagnosing congenital syphilis, but the classic histological triad is not always observed. This study aimed to identify additional morphological clues, evaluate the sensitivity of IHC and qPCR, and investigate the impact of HIV co-infection and penicillin treatment on placental morphology. Materials and methods: Two hundred and fifteen placental specimens with treponemal infection were reviewed. Morphological findings, IHC, and qPCR results were analyzed. Results: Chronic villitis (94%), acute chorioamnionitis (91.6%), and villous immaturity (65.6%) were the most common abnormalities. HIV co-infection and penicillin treatment were associated with reduced frequencies of inflammatory lesions. IHC and qPCR exhibited sensitivities of 74.4 and 25.8%, respectively, confirming the diagnosis in 42 cases with negative or unknown serology. Conclusion: Villitis, chorioamnionitis, and villous immaturity were identified as the predominant placental abnormalities. HIV co-infection and penicillin treatment can impact morphology and hamper the diagnosis. IHC and q-PCR are valuable adjuncts when serology is negative.
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Affiliation(s)
- Yolandi Anne Marais
- Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Tygerberg Hospital, National Health Laboratory Service, Stellenbosch University, Cape Town, South Africa
| | - Deidré Mason
- Department of Obstetrics and Gynecology, Tygerberg Hospital, Cape Town, South Africa
| | - Annelize Barnard
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Chestley Rashaell Saaiman
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hester Christine Els
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Judith Kluge
- Department of Obstetrics and Gynecology, Paarl Hospital, Cape Town, South Africa
| | - Allison Joy Glass
- Lancet Laboratories, Johannesburg, South Africa
- Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Colleen Anne Wright
- Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Tygerberg Hospital, National Health Laboratory Service, Stellenbosch University, Cape Town, South Africa
- Lancet Laboratories, Johannesburg, South Africa
| | - Pawel Tomasz Schubert
- Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Tygerberg Hospital, National Health Laboratory Service, Stellenbosch University, Cape Town, South Africa
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Haese NN, Roberts VHJ, Chen A, Streblow DN, Morgan TK, Hirsch AJ. Nonhuman Primate Models of Zika Virus Infection and Disease during Pregnancy. Viruses 2021; 13:2088. [PMID: 34696518 PMCID: PMC8539636 DOI: 10.3390/v13102088] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Since the explosive outbreak of Zika virus in Brazil and South/Central America in 2015-2016, the frequency of infections has subsided, but Zika virus remains present in this region as well as other tropical and sub-tropical areas of the globe. The most alarming aspect of Zika virus infection is its association with severe birth defects when infection occurs in pregnant women. Understanding the mechanism of Zika virus pathogenesis, which comprises features unique to Zika virus as well as shared with other teratogenic pathogens, is key to future prophylactic or therapeutic interventions. Nonhuman primate-based research has played a significant role in advancing our knowledge of Zika virus pathogenesis, especially with regard to fetal infection. This review summarizes what we have learned from these models and potential future research directions.
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Affiliation(s)
- Nicole N. Haese
- The Vaccine & Gene Institute, Oregon Health and Science University, 505 NW 185th Ave, Beaverton, OR 97006, USA; (N.N.H.); (D.N.S.)
| | - Victoria H. J. Roberts
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, 505 NW 185th Ave, Beaverton, OR 97006, USA;
| | - Athena Chen
- Department of Pathology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA; (A.C.); (T.K.M.)
| | - Daniel N. Streblow
- The Vaccine & Gene Institute, Oregon Health and Science University, 505 NW 185th Ave, Beaverton, OR 97006, USA; (N.N.H.); (D.N.S.)
- Division of Pathobiology & Immunology, Oregon National Primate Research Center, 505 NW 185th Ave, Beaverton, OR 97006, USA
| | - Terry K. Morgan
- Department of Pathology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA; (A.C.); (T.K.M.)
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Alec J. Hirsch
- The Vaccine & Gene Institute, Oregon Health and Science University, 505 NW 185th Ave, Beaverton, OR 97006, USA; (N.N.H.); (D.N.S.)
- Division of Pathobiology & Immunology, Oregon National Primate Research Center, 505 NW 185th Ave, Beaverton, OR 97006, USA
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Duby J, Bitnun A, Shah V, Shannon P, Shinar S, Whyte H. Non-immune Hydrops Fetalis and Hepatic Dysfunction in a Preterm Infant With Congenital Syphilis. Front Pediatr 2019; 7:508. [PMID: 31921721 PMCID: PMC6927290 DOI: 10.3389/fped.2019.00508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/22/2019] [Indexed: 11/13/2022] Open
Abstract
We report a case of a preterm infant with congenital syphilis who presented with non-immune hydrops fetalis. Hepatic dysfunction was present at birth and acutely worsened following antibiotic administration. Placental pathology demonstrated infiltration with numerous spirochetes. Although critically ill, the infant recovered with intravenous penicillin G and supportive care. This case demonstrates that congenital syphilis remains a contemporary disease demanding enhanced awareness from clinicians. Manifestations evident in utero or in the newborn can be severe and may result in fetal demise or neonatal death. Moreover, we hypothesize that the treatment resulted in a Jarisch-Herxheimer reaction as manifested by the hepatic deterioration. The incidence of congenital syphilis and its associated complications can be greatly reduced with strict adherence to universal prenatal testing and comprehensive follow-up.
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Affiliation(s)
- Jessica Duby
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Ari Bitnun
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vibhuti Shah
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, ON, Canada
| | - Shiri Shinar
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Hilary Whyte
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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Kitt E, May RM, Steenhoff AP. Rash and hepatosplenomegaly in a newborn. JMM Case Rep 2017; 4:e005098. [PMID: 29026625 PMCID: PMC5630967 DOI: 10.1099/jmmcr.0.005098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/19/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Eimear Kitt
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Suite 1202 ARC 3615, Civic Center Boulevard, Philadelphia, PA 1910-4318, USA
| | - Rebecca M May
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4238, USA
| | - Andrew P Steenhoff
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Suite 1202 ARC 3615, Civic Center Boulevard, Philadelphia, PA 1910-4318, USA
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