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Rathwa PK, Chauhan J, Patel NP, Shah H, Vara NV. An inscrutable entity: A case report of late congenital syphilis. Indian J Sex Transm Dis AIDS 2022; 43:192-193. [PMID: 36743077 PMCID: PMC9891022 DOI: 10.4103/ijstd.ijstd_1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/17/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Congenital syphilis is an outcome of maternal syphilis that occurs due to the transmission of Treponema pallidum via the placenta of untreated or inadequately treated pregnant women to their newborns. It is now a very rare cause of neurological, developmental, and musculoskeletal disability and death in infants after the advent of penicillin. Here, we report a case of late congenital syphilis presented with classic stigmata of syphilis at the age of 10 years. Reactive serological titer of rapid plasma reagin test and venereal disease research laboratory test confirmed the diagnosis.
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Affiliation(s)
- Pratiksha Kanubhai Rathwa
- Department of Dermatology, Venereology and Leprosy, Government Medical College and S.S.G. Hospital, Vadodara, Gujarat, India
| | - Jatin Chauhan
- Department of Dermatology, Venereology and Leprosy, Government Medical College and S.S.G. Hospital, Vadodara, Gujarat, India
| | - Nidhi Pravinkumar Patel
- Department of Dermatology, Venereology and Leprosy, Government Medical College and S.S.G. Hospital, Vadodara, Gujarat, India
| | - Hiral Shah
- Department of Dermatology, Venereology and Leprosy, Government Medical College and S.S.G. Hospital, Vadodara, Gujarat, India
| | - Nipul V Vara
- Department of Dermatology, Venereology and Leprosy, Government Medical College and S.S.G. Hospital, Vadodara, Gujarat, India
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Patel NU, Oussedik E, Landis ET, Strowd LC. Early Congenital Syphilis: Recognising Symptoms of an Increasingly Prevalent Disease. J Cutan Med Surg 2017; 22:97-99. [PMID: 28821219 DOI: 10.1177/1203475417728360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenital syphilis (CS) is an infectious disease resulting from transplacental transmission of Treponema pallidum spirochetes from an infected mother to fetus during pregnancy. While uncommon, CS has shown an increased incidence in Canada and the United States since 2001 and 2012, respectively. CASE REPORT We present the case of a 5-week-old female infant with blistering rash on the palms and soles. The infant displayed decreased movement of the left upper extremity, clinically consistent with Parrot pseudoparalysis. Cutaneous involvement was limited to few tan crusted papules on the palms and soles. Mother reported a "false-positive" result of rapid plasma reagin (RPR) testing at 31 weeks. Cerebrospinal fluid studies of the infant resulted with positive Venereal Disease Research Laboratory (VRDL) test and positive microhemagglutination assay (MHA-TP). Histopathology of a crusted papule revealed a lichenoid infiltrate composed of lymphocytes, histiocytes, and plasma cells. Immunohistochemical staining for T pallidum was negative. The patient completed treatment with a 10-day course of intravenous penicillin. DISCUSSION While CS is largely considered a historic entity, it has been increasing in incidence in the United States since 2012 and in Canada since the early 2000s. Diagnosis of CS can be difficult as infants may be asymptomatic or present with nonspecific signs. This case highlights the presentation of minimal cutaneous involvement as well as skeletal involvement after birth. RPR testing may result in false negatives or indeterminate results, further complicating diagnosis. Given these difficulties in screening and the increasing incidence of CS, clinicians may need to refamiliarise themselves with its clinical findings.
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Affiliation(s)
- Nupur U Patel
- 1 Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elias Oussedik
- 1 Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Erin T Landis
- 1 Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lindsay C Strowd
- 1 Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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3
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Diagnosis of Mercurial Teeth in a Possible Case of Congenital Syphilis and Tuberculosis in a 19th Century Child Skeleton. ACTA ACUST UNITED AC 2015. [DOI: 10.1155/2015/103842] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Without the presence of “caries sicca,” “sabre shins,” and nodes/expansion of the long bones with superficial cavitation, differential diagnosis of venereal syphilis and tuberculosis (TB) may be difficult as various infections produce similar responses. However, congenital syphilis has distinctive features facilitating a diagnosis. A case study of remains of a juvenile European settler (probably male, 8–10 years old) (B70) buried in the 19th century and excavated in 2000 from the cemetery of the Anglican Church of St. Marys in South Australia is presented. B70 demonstrated that the two diseases might have been present in the same individual, congenital syphilis and TB. Widespread destruction of vertebral bodies and kyphosis-related rib deformations indicate advanced TB. Severe dental hypoplasia is limited to permanent incisors and first molars; there is pitting on the palate, periosteal reaction on the skull vault, and thinned clavicles. Dental signs are not limited to “screwdriver” central incisors and mulberry molars. Apical portions of the crowns of permanent upper, lower, central, and lateral incisors have multiple hypoplastic-disorganized defects; deciduous canines have severely hypoplastic crowns while possibly hypoplastic occlusal surfaces of lower deciduous second molars are largely destroyed by extensive caries. These dental abnormalities resemble teeth affected by mercurial treatment in congenital syphilitic patients as described by Hutchinson.
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McGready R, Kang J, Watts I, Tyrosvoutis MEG, Torchinsky MB, Htut AM, Tun NW, Keereecharoen L, Wangsing C, Hanboonkunupakarn B, Nosten FH. Low and stable rates of antenatal syphilis and HIV in migrant and refugee women on the Thai-Myanmar border: a descriptive study. F1000Res 2014; 3:123. [DOI: 10.12688/f1000research.4190.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 11/20/2022] Open
Abstract
Objective: The antenatal prevalence of syphilis and HIV/AIDS in migrants and refugees is poorly documented. The aim of this study was to audit the first year of routine syphilis screening in migrant and refugee women on the Thai Myanmar border.Methods: From August 2012 to July 2013, 3600 pregnant women were screened for HIV (ELISA) and syphilis (VDRL with TPHA confirmation) at clinics along the Thai-Myanmar border.Results: Seroprevalence for HIV 0.47% (95% CI 0.30-0.76) (17/3,599), and syphilis 0.39% (95% CI 0.23-0.65) (14/3,592), were low. Syphilis was significantly lower in refugees (0.07% 95% CI 0.01-0.38) (1/1,469), than in migrants (0.61% 95% CI 0.36-1.04) (13/2,123). The three active (VDRL≥1:8 and TPHA reactive) syphilis cases with VDRL titres of 1:32 were easy to counsel and treat. Women with low VDRL titres (>75% were < 1:8) and TPHA reactive results, in the absence of symptoms and both the woman and her husband having only one sexual partner in their lifetime, and the inability to determine the true cause of the positive results presented ethical difficulties for counsellors.Conclusion: As HIV and syphilis testing becomes available in more and more settings, the potential impact of false positive results should be considered, especially in populations with low prevalence for these diseases. This uncertainty must be considered in order to counsel patients and partners accurately and safely about the results of these tests, without exposing women to increased risk for abuse or abandonment. Our findings highlight the complexities of counselling patients about these tests and the global need for more conclusive syphilis testing strategies.
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McGready R, Kang J, Watts I, Tyrosvoutis MEG, Torchinsky MB, Htut AM, Tun NW, Keereecharoen L, Wangsing C, Hanboonkunupakarn B, Nosten FH. Audit of antenatal screening for syphilis and HIV in migrant and refugee women on the Thai-Myanmar border: a descriptive study. F1000Res 2014; 3:123. [PMID: 26664698 PMCID: PMC4654433 DOI: 10.12688/f1000research.4190.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/25/2022] Open
Abstract
Objective: The antenatal prevalence of syphilis and HIV/AIDS in migrants and refugees is poorly documented. The aim of this study was to audit the first year of routine syphilis screening in the same population and reassess the trends in HIV rates. Methods: From August 2012 to July 2013, 3600 pregnant women were screened for HIV (ELISA) and syphilis (VDRL with TPHA confirmation) at clinics along the Thai-Myanmar border. Results: Seroprevalence for HIV 0.47% (95% CI 0.30-0.76) (17/3,599), and syphilis 0.39% (95% CI 0.23-0.65) (14/3,592), were low. Syphilis was significantly lower in refugees (0.07% 95% CI 0.01-0.38) (1/1,469), than in migrants (0.61% 95% CI 0.36-1.04) (13/2,123). The three active (VDRL≥1:8 and TPHA reactive) syphilis cases with VDRL titres of 1:32 were easy to counsel and treat. Women with low VDRL titres (>75% were < 1:8) and TPHA reactive results, in the absence of symptoms and both the woman and her husband having only one sexual partner in their lifetime, and the inability to determine the true cause of the positive results presented ethical difficulties for counsellors. Conclusion: As HIV and syphilis testing becomes available in more and more settings, the potential impact of false positive results should be considered, especially in populations with low prevalence for these diseases. This uncertainty must be considered in order to counsel patients and partners accurately and safely about the results of these tests, without exposing women to increased risk for abuse or abandonment. Our findings highlight the complexities of counselling patients about these tests and the global need for more conclusive syphilis testing strategies.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand ; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand ; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Joy Kang
- Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Isabella Watts
- Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Mary Ellen G Tyrosvoutis
- Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Miriam B Torchinsky
- Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Aung Myo Htut
- Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Nay Win Tun
- Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Lily Keereecharoen
- Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Chirapat Wangsing
- Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - François H Nosten
- Shoklo Malaria Research Unit, 63110, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand ; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand ; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
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Abstract
Congenital syphilis is a potentially serious pathology affecting newborns of infected mothers. Even one case of congenital syphilis is a sentinel public health event, since timely diagnosis and treatment of syphilis infected pregnant woman should prevent transmission almost entirely. Here, we are reporting a case of early symptomatic congenital syphilis presented with severe desquamating papulosquamous lesions over multiple body parts along with erosive lesions around oral cavity and nostrils.
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Affiliation(s)
- Rajat Gupta
- Department of Skin and VD, Pramukhswami Medical College, Karamsad, Gujarat, India
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Gupta R, Vora RV. Congenital syphilis, still a reality. Indian J Sex Transm Dis AIDS 2013. [PMID: 23919058 PMCID: PMC3730478 DOI: 10.4103/2589-0557.112941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Congenital syphilis is a potentially serious pathology affecting newborns of infected mothers. Even one case of congenital syphilis is a sentinel public health event, since timely diagnosis and treatment of syphilis infected pregnant woman should prevent transmission almost entirely. Here, we are reporting a case of early symptomatic congenital syphilis presented with severe desquamating papulosquamous lesions over multiple body parts along with erosive lesions around oral cavity and nostrils.
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Affiliation(s)
- Rajat Gupta
- Department of Skin and VD, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Rita V. Vora
- Department of Skin and VD, Pramukhswami Medical College, Karamsad, Gujarat, India,Address for correspondence: Dr. Rita V Vora, B-4/Om Vila, Raja Babu Lane, Opp. Big Bazaar, Vidyanagar Road, Anand, Gujarat - 388 001, India. E-mail:
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Pessoa L, Galvão V. Clinical aspects of congenital syphilis with Hutchinson's triad. BMJ Case Rep 2011; 2011:bcr.11.2011.5130. [PMID: 22670010 DOI: 10.1136/bcr.11.2011.5130] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Congenital syphilis is an infectious disease caused by Treponema pallidum transmitted by infected mother to her baby during pregnancy. Late congenital syphilis is recognised with 2 or more years after birth. One of the main aspects is observed with the triad of Hutchinson, characterised by the presence of interstitial keratitis, eighth nerve deafness and Hutchinson's teeth. This manuscript reports a case of late congenital syphilis presenting with Hutchinson's triad at an age of 7 years. These clinical features are related to syphilis present during pregnancy and at birth, however they commonly become apparent after 5-years of age.
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Affiliation(s)
- Larissa Pessoa
- Department of Medical Sciences, University of Brasilia, Brasília, Brazil.
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Shet A. Congenital and perinatal infections: throwing new light with an old TORCH. Indian J Pediatr 2011; 78:88-95. [PMID: 20953849 DOI: 10.1007/s12098-010-0254-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 09/27/2010] [Indexed: 11/24/2022]
Abstract
Infections acquired in utero or in the immediate post-natal period play a prominent role in perinatal and childhood morbidity. The TORCH constellation continues to be popular among perinatologists and paediatricians, although its limitations are increasingly known. A host of new organisms are now considered to be perpetrators of congenital and perinatal infections, and a diverse range of diagnostic tests are now available for confirming infection in the infant. In general, the collective TORCH serological panel has low diagnostic yield; instead individual tests ordered according to clinical presentation can contribute better towards appropriate diagnosis. This review captures the essence of established congenital infections such as cytomegalovirus, rubella, toxoplasmosis, syphilis and herpes simplex virus, as well as more recent entrants such as HIV and hepatitis B infection, varicella and tuberculosis. Selective screening of the mother and newborn, encouraging good personal hygiene and universal immunization are some measures that can contribute towards decreasing the incidence and morbidity of congenital and perinatal infections.
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Affiliation(s)
- Anita Shet
- Department of Pediatrics, St. John's National Academy of Health Sciences, Bangalore, 560034, India.
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