Neurosyphilis in Brazilian newborns: a health problem that could be avoided

Neurosyphilis: insights into its pathogenesis, susceptibility, diagnosis, treatment, and prevention

Background and aim

Invasion of the central nervous system by Treponema pallidum can occur at any stage of syphilis. In the event that T. pallidum is not cleared promptly, certain individuals may experience progression to neurosyphilis, which manifests as cognitive and behavioral abnormalities, limb paralysis, and potentially fatal outcomes. Early identification or prevention of neurosyphilis is therefore crucial. The aim of this paper is to conduct a critical and narrative review of the latest information focusing exclusively to the pathogenesis and clinical management of neurosyphilis.

Methodology

To compile this review, we have conducted electronic literature searches from the PubMed database relating to neurosyphilis. Priority was given to studies published from the past 10 years (from 2013 to 2023) and other studies if they were of significant importance (from 1985 to 2012), including whole genome sequencing results, cell structure of T. pallidum, history of genotyping, and other related topics. These studies are classic or reflect a developmental process.

Results

Neurosyphilis has garnered global attention, yet susceptibility to and the pathogenesis of this condition remain under investigation. Cerebrospinal fluid examination plays an important role in the diagnosis of neurosyphilis, but lacks the gold standard. Intravenous aqueous crystalline penicillin G continues to be the recommended therapeutic approach for neurosyphilis. Considering its sustained prominence, it is imperative to develop novel public health tactics in order to manage the resurgence of neurosyphilis.

Conclusion

This review gives an updated narrative description of neurosyphilis with special emphasis on its pathogenesis, susceptibility, diagnosis, treatment, and prevention.

The Clinical Characteristics and Serological Outcomes of Infants With Confirmed or Suspected Congenital Syphilis in Shanghai, China: A Hospital-Based Study

BACKGROUND

Congenital syphilis (CS) is the infection of an infant or fetus with Treponema pallidum. The aim of this study was to investigate the clinical features and outcomes of serology reversion in infants diagnosed with confirmed or suspected congenital syphilis (CS).

METHODS

Infants admitted to the neonatal department of Children's Hospital of Fudan University from 2013 to 2016 who met the case definition of CS or suspected CS were included in this study. Follow-up was performed in an outpatient clinic until reversion to non-reactivity of both toluidine red unheated serum test (TRUST) and Treponemal pallidum particle agglutination (TPPA). Follow-up data were collected until up to the end of 2019, when the last infant with CS reached 3 years of age.

RESULTS

In total, 682 infants were enrolled in this study, including 63 in the CS group and 619 in the suspected CS group. Forty-seven infants (74.6%) in the CS group had symptoms, and 57 (90.5%) had abnormal laboratory and/or long bone X-ray findings. By 6 months of age, TRUST results were negative in 53.3% of the infants with CS and in 100% of the infants with suspected CS. All the infants in the CS group returned to TRUST non-reactivity by 18 months of age. The TPPA results at 18 months of age showed that only 10.0% (3/30) of the patients in the CS group returned to non-reactivity, while a 99.6% (548/550) non-reactivity rate was observed in the suspected CS group. All the infants in the CS group returned to 19S-IgM-TPPA non-reactivity by 6 months of age.

CONCLUSIONS

Although CS is an burdensome disease that may cause fetal and neonatal death, CS responds well to treatment when diagnosed and treated promptly, even when symptoms or lab/X-ray findings are present at birth.