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Delle Cave V, Zito Marinosci G, Ferrara D, Esposito F, Lo Vecchio A, Sciveres M, Mandato C, De Brasi D, Siani P, Ranucci G. Syphilitic hepatitis in infants, the forgotten disease that hepatologists have to brush up on: from a case series to a revision of literature. Eur J Pediatr 2024:10.1007/s00431-024-05698-x. [PMID: 39302442 DOI: 10.1007/s00431-024-05698-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/22/2024] [Accepted: 07/22/2024] [Indexed: 09/22/2024]
Abstract
Clinical manifestations of congenital syphilis (CS) include liver disease with/without impaired liver function, identified as syphilitic hepatitis. Hepatic involvement may be dramatic; therefore, early diagnosis is crucial to provide treatment and prevent fatal outcomes. A new resurgence of CS cases has been described in recent years worldwide. We reported our experience with a case series of infants hospitalized for liver disease with a final diagnosis of CS, highlighting the wide spectrum of liver involvement, the rapid progression in cases with late diagnosis, and the pitfalls of the management of this forgotten but reemerging disease. A retrospective analysis of CS patients with hepatic presentation in the period 2008-2023 was conducted. We collected five cases (three female) with a median age of 13.8 days (range 1-84 days). In three cases, mothers were not screened for syphilis during pregnancy, and in two cases, they were seronegative in the first trimester screening. None practiced specific therapy during pregnancy. Hepatic involvement was characterized by hepatosplenomegaly, in four cases associated with cholestatic jaundice and in three cases with liver failure. Rapid plasma reagin (RPR) and Treponema pallidum hemagglutination assay (TPHA) were positive in all cases in mothers and infants. CS presented with multiorgan involvement and was fatal in one case.Conclusions: It is important to consider CS in infants with cholestasis and acute liver failure, but also in sick infants with isolated hepatomegaly. Early recognition of infants with CS is critical to identify missed cases during pregnancy and to start early treatment.
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Affiliation(s)
- Valeria Delle Cave
- Department of Translational Medical Science, Section of Pediatrics, University Federico II, 80131, Naples, Italy
| | - Geremia Zito Marinosci
- Service of Anesthesia and Critical Care, Department of Anesthesia and Critical Care, Santobono-Pausilipon Children's Hospital, 80129, Naples, Italy
| | - Dolores Ferrara
- Department of Radiology, Santobono-Pausilipon Children's Hospital, 80129, Naples, Italy
| | - Francesco Esposito
- Department of Radiology, Santobono-Pausilipon Children's Hospital, 80129, Naples, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Pediatric Infectious Disease Unit, University of Naples Federico II, 80131, Naples, Italy
| | - Marco Sciveres
- Pediatric Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), University of Pittsburgh Medical Center, 90127, Palermo, Italy
| | - Claudia Mandato
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Pediatrics Section, University of Salerno, 84081, Baronissi, Italy
| | - Daniele De Brasi
- Department of Pediatrics, Santobono-Pausilipon Children's Hospital, 80129, Naples, Italy
| | - Paolo Siani
- Department of Pediatrics, Santobono-Pausilipon Children's Hospital, 80129, Naples, Italy
| | - Giusy Ranucci
- Pediatric Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), University of Pittsburgh Medical Center, 90127, Palermo, Italy.
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Ribeiro RS, Sasaki NSGMDS, Queiroz AMDA, Ferreira ACM, Segura GDS, Santos MDLSG, Souza LHD, Lourenção LG. Factors influencing the positivity of diagnostic tests for congenital syphilis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231006. [PMID: 38656062 DOI: 10.1590/1806-9282.20231006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE The objective of this study was to analyze the factors that influence the positivity of treponemal and non-treponemal tests in cases of congenital syphilis. METHODS This cross-sectional and correlational study was carried out from the analysis of the database of Disease and Notification Information System (SINAN, in Portuguese) using the data obtained through the Epidemiological Surveillance Group 29, with 639 notifications of congenital syphilis between 2007 and 2018. The data were analyzed by a descriptive and inferential analysis from logistic regression with a significance level of 5% (p≤0.05). RESULTS The positivity of the treponemal test was higher by 4.5 times in infants living in rural areas and 19.6 times among those whose mothers obtained the diagnosis of syphilis after birth. The treponemal test showed positivity 3.2 times higher for the variable "having been diagnosed between 2007 and 2015" and 5.5 times higher for the variable "having been diagnosed with maternal syphilis in the postpartum period." CONCLUSION This study shows that testing during prenatal care is essential for early diagnosis and prevention of syphilis complications.
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Affiliation(s)
| | | | | | | | | | | | - Lara Helk de Souza
- Faculty of Medicine of São José do Rio Preto - São José do Rio Preto (SP), Brazil
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Nascimento LFC. CONGENITAL SYPHILIS IN THE PARAÍBA VALLEY USING A SPATIAL APPROACH. REVISTA PAULISTA DE PEDIATRIA 2020; 38:e2018395. [PMID: 32756849 PMCID: PMC7391929 DOI: 10.1590/1984-0462/2020/38/2018395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/28/2019] [Indexed: 11/22/2022]
Abstract
Objective: To compare spatial patterns of congenital syphilis (CS) with those of
socioeconomic and medical variables in Paraíba Valley, São Paulo, between
2012 and 2016. Methods: Ecological and exploratory study developed using spatial analysis tools,
with information on CS cases obtained from official data reports. Rates were
found for CS cases per 1,000 live births, number of family health teams and
pediatricians available in the health system per 100,000 inhabitants, and
social vulnerability index values. Thematic maps were constructed with these
variables and compared using TerraView 4.2.2 software. Estimated global
Moran (IM) indexes were calculated. In order to detect areas with
priority attention regarding the incidence of CS, BoxMaps were developed.
The Spearman correlation was estimated for the variable values and compared
using the Kruskal-Wallis test. P <0.05 was significant. Results: 144,613 births and 870 CS cases (6.04/1000 live births) occurred during the
study period. The average value of CS rates per municipality was 4.0±4.1,
(0.0-17.6/1000 live births). Higher CS rates occurred in municipalities of
the Upper Vale do Paraíba, contrary to the proportions of pediatricians who
were in the far east of the region. The thematic maps of the variables
presented a mosaic aspect, which characterized the random distribution of
the variables. The IM were not significant. No significant
correlation was found between the variables. The BoxMap identified eight
municipalities with high CS rates. Conclusions: Even though it was not possible to identify a spatial pattern of CS rates,
it was shown that eight municipalities deserve the attention of city
managers.
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Khafaja S, Youssef Y, Darjani N, Youssef N, Fattah CM, Hanna-Wakim R. Case Report: A Delayed Diagnosis of Congenital Syphilis-Too Many Missed Opportunities. Front Pediatr 2020; 8:499534. [PMID: 33553061 PMCID: PMC7855964 DOI: 10.3389/fped.2020.499534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/24/2020] [Indexed: 11/13/2022] Open
Abstract
Congenital syphilis remains a significant public health problem nowadays. We describe the presentation of an infant with a delayed diagnosis of congenital syphilis, with a negative initial non-treponemal test. Our aim is to shed light on the incidence of missed prevention, the importance of awareness, maternal screening, and early diagnosis.
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Affiliation(s)
- Sarah Khafaja
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yolla Youssef
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nidale Darjani
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour Youssef
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Rima Hanna-Wakim
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
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