Congenital syphilis laboratory findings: Difference between revisions
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{{CMG}} {{AE}} {{KD}}; {{ADI}} | {{CMG}} {{AE}} {{KD}}; {{ADI}} {{AKI}} | ||
{{Congenital syphilis}} | {{Congenital syphilis}} | ||
==Overview== | |||
Diagnosis of congenital syphilis can be done prenatally and after birth. The investigations include [[serological test]]s, [[PCR]] of the [[amniotic fluid]], long bone [[radiographs]], [[ultrasound]] and [[CSF analysis]]. [[PCR]] of the [[amniotic fluid]] and [[ultrasound]] are commonly preferred diagnostic modalities in the [[prenatal period]]. Long bone [[radiographs]] along with [[serological test]]s and [[CSF analysis]] are preferred after birth. | |||
== Laboratory Findings == | == Laboratory Findings == | ||
====Prenatal Diagnosis==== | |||
*Detection of [[IgM]] [[antibodies]] aganist [[T.pallidum]] in the blood collected by [[chordocentesis]].<ref name="pmid1923218">{{cite journal |vauthors=Wendel GD, Sánchez PJ, Peters MT, Harstad TW, Potter LL, Norgard MV |title=Identification of Treponema pallidum in amniotic fluid and fetal blood from pregnancies complicated by congenital syphilis |journal=Obstet Gynecol |volume=78 |issue=5 Pt 2 |pages=890–5 |year=1991 |pmid=1923218 |doi= |url=}}</ref><ref name="pmid26753496">{{cite journal| author=Park JY, Han GH, Kwon DY, Hong HR, Seol HJ| title=Prenatal diagnosis of congenital syphilis presenting with transient pleural effusion in the fetus: a case report and rising incidence of congenital syphilis in South Korea. | journal=Clin Exp Obstet Gynecol | year= 2015 | volume= 42 | issue= 6 | pages= 822-4 | pmid=26753496 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26753496 }} </ref> | |||
*[[PCR]] of the [[amniotic fluid]] to detect [[T. pallidum]] [[DNA]].<ref name="MullerEwert2006">{{cite journal|last1=Muller|first1=M|last2=Ewert|first2=I|last3=Hansmann|first3=F|last4=Tiemann|first4=C|last5=Hagedorn|first5=H J|last6=Solbach|first6=W|last7=Roider|first7=J|last8=Nolle|first8=B|last9=Laqua|first9=H|last10=Hoerauf|first10=H|title=Detection of Treponema pallidum in the vitreous by PCR|journal=British Journal of Ophthalmology|volume=91|issue=5|year=2006|pages=592–595|issn=0007-1161|doi=10.1136/bjo.2006.110288}}</ref> | |||
*[[Antenatal]] [[ultrasound]] is commonly done and the findings suggestive of [[congenital syphilis]] include: [[hydrops fetalis]] characterised by scalp edema, [[placental thickening]], serous cavity effusion, and [[polyhydramnios]]. Other additional findings inlcude [[hepatosplenomegaly]], [[placentomegaly]], non-continuous [[gastrointestinal obstruction]] and dilatation of the [[small bowel]].<ref name="pmid9565220">{{cite journal |vauthors=Levine Z, Sherer DM, Jacobs A, Rotenberg O |title=Nonimmune hydrops fetalis due to congenital syphilis associated with negative intrapartum maternal serology screening |journal=Am J Perinatol |volume=15 |issue=4 |pages=233–6 |year=1998 |pmid=9565220 |doi=10.1055/s-2007-993933 |url=}}</ref><ref name="Russell1974">{{cite journal|last1=Russell|first1=Peter|title=Placental Abnormalities of Congenital Syphilis|journal=American Journal of Diseases of Children|volume=128|issue=2|year=1974|pages=160|issn=0002-922X|doi=10.1001/archpedi.1974.02110270034007}}</ref><ref name="pmid7927729">{{cite journal |vauthors=Riley BS, Oppenheimer-Marks N, Radolf JD, Norgard MV |title=Virulent Treponema pallidum promotes adhesion of leukocytes to human vascular endothelial cells |journal=Infect. Immun. |volume=62 |issue=10 |pages=4622–5 |year=1994 |pmid=7927729 |pmc=303152 |doi= |url=}}</ref> | |||
====Postnatal Diagnosis==== | |||
* | *Examination of the [[placenta]] or [[umbilical cord]] using a [[silver stain]] demonstrates [[spirochetes]] or a [[T. pallidum]] [[PCR]] test can be done. | ||
*The use of [[serological tests]] to identify the infection in infants less than 15 months of age born to infected mothers is not performed as passive transfer of [[IgG]] [[antibodies]] to the [[fetus]] occurs during the [[pregnancy]]. | |||
*Other laboratory findings in the [[new born]] include:<ref name="pmid11384701">{{cite journal |vauthors=Hollier LM, Harstad TW, Sanchez PJ, Twickler DM, Wendel GD |title=Fetal syphilis: clinical and laboratory characteristics |journal=Obstet Gynecol |volume=97 |issue=6 |pages=947–53 |year=2001 |pmid=11384701 |doi= |url=}}</ref> | |||
*Elevated [[liver enzymes]] | |||
*[[Leucocytosis]] | |||
*[[Coombs]] negative [[hemolytic anaemia]] | |||
*[[Thrombocytopenia]] | |||
*[[Hypoalbuminemia]] | |||
*[[Hyperbilirubinemia]] | |||
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== References == | == References == | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Neonatology]] | [[Category:Neonatology]] | ||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category:Emergency medicine]] | |||
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[[Category:Infectious disease]] | |||
[[Category:Obstetrics]] | |||
Latest revision as of 21:04, 29 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]; Aditya Govindavarjhulla, M.B.B.S. [3] Aravind Kuchkuntla, M.B.B.S[4]
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Overview
Diagnosis of congenital syphilis can be done prenatally and after birth. The investigations include serological tests, PCR of the amniotic fluid, long bone radiographs, ultrasound and CSF analysis. PCR of the amniotic fluid and ultrasound are commonly preferred diagnostic modalities in the prenatal period. Long bone radiographs along with serological tests and CSF analysis are preferred after birth.
Laboratory Findings
Prenatal Diagnosis
- Detection of IgM antibodies aganist T.pallidum in the blood collected by chordocentesis.[1][2]
- PCR of the amniotic fluid to detect T. pallidum DNA.[3]
- Antenatal ultrasound is commonly done and the findings suggestive of congenital syphilis include: hydrops fetalis characterised by scalp edema, placental thickening, serous cavity effusion, and polyhydramnios. Other additional findings inlcude hepatosplenomegaly, placentomegaly, non-continuous gastrointestinal obstruction and dilatation of the small bowel.[4][5][6]
Postnatal Diagnosis
- Examination of the placenta or umbilical cord using a silver stain demonstrates spirochetes or a T. pallidum PCR test can be done.
- The use of serological tests to identify the infection in infants less than 15 months of age born to infected mothers is not performed as passive transfer of IgG antibodies to the fetus occurs during the pregnancy.
- Other laboratory findings in the new born include:[7]
- Elevated liver enzymes
- Leucocytosis
- Coombs negative hemolytic anaemia
- Thrombocytopenia
- Hypoalbuminemia
- Hyperbilirubinemia
References
- ↑ Wendel GD, Sánchez PJ, Peters MT, Harstad TW, Potter LL, Norgard MV (1991). "Identification of Treponema pallidum in amniotic fluid and fetal blood from pregnancies complicated by congenital syphilis". Obstet Gynecol. 78 (5 Pt 2): 890–5. PMID 1923218.
- ↑ Park JY, Han GH, Kwon DY, Hong HR, Seol HJ (2015). "Prenatal diagnosis of congenital syphilis presenting with transient pleural effusion in the fetus: a case report and rising incidence of congenital syphilis in South Korea". Clin Exp Obstet Gynecol. 42 (6): 822–4. PMID 26753496.
- ↑ Muller, M; Ewert, I; Hansmann, F; Tiemann, C; Hagedorn, H J; Solbach, W; Roider, J; Nolle, B; Laqua, H; Hoerauf, H (2006). "Detection of Treponema pallidum in the vitreous by PCR". British Journal of Ophthalmology. 91 (5): 592–595. doi:10.1136/bjo.2006.110288. ISSN 0007-1161.
- ↑ Levine Z, Sherer DM, Jacobs A, Rotenberg O (1998). "Nonimmune hydrops fetalis due to congenital syphilis associated with negative intrapartum maternal serology screening". Am J Perinatol. 15 (4): 233–6. doi:10.1055/s-2007-993933. PMID 9565220.
- ↑ Russell, Peter (1974). "Placental Abnormalities of Congenital Syphilis". American Journal of Diseases of Children. 128 (2): 160. doi:10.1001/archpedi.1974.02110270034007. ISSN 0002-922X.
- ↑ Riley BS, Oppenheimer-Marks N, Radolf JD, Norgard MV (1994). "Virulent Treponema pallidum promotes adhesion of leukocytes to human vascular endothelial cells". Infect. Immun. 62 (10): 4622–5. PMC 303152. PMID 7927729.
- ↑ Hollier LM, Harstad TW, Sanchez PJ, Twickler DM, Wendel GD (2001). "Fetal syphilis: clinical and laboratory characteristics". Obstet Gynecol. 97 (6): 947–53. PMID 11384701.