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Case Conference. Maria Fernanda Ramirez Tovar, MD. HPI…. 5 do Baby boy born FT C/S because of non reassuring FHT AS 9/9 BW 3.465Kg BT A+, RPR negative Transferred Prenatal Care from DR Mother 42yo, G6P3, BT O+, HIV neg, RPR Positive 1:2, MHA-TP Positive, treated with Bicillinx2 PE WNL

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Case conference

Case Conference

Maria Fernanda Ramirez Tovar, MD


Case conference
HPI…

  • 5 do Baby boy born FT C/S because of non reassuring FHT

  • AS 9/9

  • BW 3.465Kg

  • BT A+, RPR negative

  • Transferred Prenatal Care from DR

  • Mother 42yo, G6P3, BT O+, HIV neg, RPR Positive 1:2, MHA-TP Positive, treated with Bicillinx2

  • PE WNL

  • CSF and Long Bone Xrays WNL


Congenital syphilis
Congenital syphilis

  • Congenital syphilis occurs when the spirochete Treponemapallidumis transmitted from a pregnant woman to her fetus. Infection can result in stillbirth, prematurity, or a wide spectrum of clinical manifestations; only severe cases are clinically apparent at birth



Stigmata of late congenital syphilis
Stigmata of late congenital syphilis


Congenital syphilis1
Congenital Syphilis

  • Mother with reactive Nontreponemal or Treponemal test

  • Nontreponemal test performed in the Newborn should be the same as the mother’s

  • Physical examination

  • Darkfield microscopic examination or DFA of body fluids

  • Pathologic examination of Placenta and Umbilical Cord, DFA staining

  • Child found to have a reactive test after 1 month of life

  • Congenital Vs. Acquired Syphilis (Maternal Hx, Clinical judgment)

  • CBC, CSF, HIV, LFT

  • Long bones XR’s, CXR, Abdominal US, Neuroimaging

  • Ophthalmological evaluation

  • Auditory brain stem response

  • Sexual Abuse?

Evaluation < 1 mo

Evaluation > 1 mo

IV Penicillin 10 days


Congenital syphilis neonatal period
Congenital syphilis neonatal period

  • Abnormal PE/Positive Darkfield or DFA/VDRL or RPR fourfold or higher than mother’s titers

  • CBC, CSF, HIV, LFT

  • Long bones XR’s, CXR, Abdominal US, Neuroimaging

  • Ophthalmological evaluation,

  • Auditory brain stem response

  • Penicillin G for 10 days

  • Non reactive VDRL/RPR plus Normal PE: no further evaluation

  • Mother not treated or inadequately treated>Presumptive Syphilis

  • Mother NT or IT+ Reactive test (not fourfold)+ Normal PE: CBC, CSF, etc.

  • Mother adequately treated during pregnancy

  • Mother adequately treated before pregnancy

Proven or Highly Probable

At Risk Neonates






References
References syphilis or syphilis

  • Syphilis. Erica L. Hyman, MD. Pediatrics in Review Vol. 27 No. 1 January 1, 2006 pp. 37 -39(doi: 10.1542/pir.27-1-37)

  • Congenital Syphilis: Evaluation, management and prevention. Simon R Dobson. www.Uptodate.com

  • U.S. Preventive Services Task Force. Screening for syphilis infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2009; 150:705.

  • Syphilis in Pregnancy. Errol R Norwitz. www.Uptodate.com

  • CDC. Sexually transmitted disease surveillance, 2008. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Available at http://www.cdc.gov/std/stats08/main.htm.

  • CDC. Sexually transmitted diseases treatment guidelines, 2006. MMWR 2006;55(No. RR-11).

  • Hollier LM, Hill J, Sheffield JS, Wendel GD Jr. State laws regarding prenatal syphilis screening in the United States. Am J ObstetGynecol 2003;198:1178--83.


Gracias
Gracias… syphilis or syphilis