Congenital syphilis laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}} {{AE}} {{KD}}; {{ADI}} | {{CMG}} {{AE}} {{KD}}; {{ADI}} | ||
{{Congenital syphilis}} | {{Congenital syphilis}} | ||
==Laboratory Findings== | |||
*Blood tests | == Laboratory Findings == | ||
* Blood tests | |||
** [[Complete blood count]] | ** [[Complete blood count]] | ||
** Differential count | ** Differential count | ||
** [[Platelet count]] | ** [[Platelet count]] | ||
* CSF analysis | * CSF analysis | ||
Infants delivered of women with a reactive STS should have a cerebrospinal fluid (CSF) evaluation in any of the following circumstances: | Infants delivered of women with a reactive STS should have a cerebrospinal fluid (CSF) evaluation in any of the following circumstances: | ||
:*The infant shows any signs compatible with congenital syphilis OR | |||
:*Maternal therapy was inadequate, unknown, or it occurred late (greater than or equal to 20 weeks) in pregnancy OR | :* The infant shows any signs compatible with congenital syphilis OR | ||
:*Maternal therapy did not include [[penicillin]] OR | :* Maternal therapy was inadequate, unknown, or it occurred late (greater than or equal to 20 weeks) in pregnancy OR | ||
:*Adequate follow-up cannot be ensured | :* Maternal therapy did not include [[penicillin]] OR | ||
:* Adequate follow-up cannot be ensured | |||
Other living infants with a diagnosis of confirmed or compatible congenital syphilis should have a CSF examination before treatment to provide a baseline for follow-up examination. Although the importance of the CSF examination is debated, a quantitative VDRL CSF test can be meaningful if it is done in conjunction with tests for elevated total protein and [[lymphocyte]] count. The RPR card test should not be used for CSF evaluation. | Other living infants with a diagnosis of confirmed or compatible congenital syphilis should have a CSF examination before treatment to provide a baseline for follow-up examination. Although the importance of the CSF examination is debated, a quantitative VDRL CSF test can be meaningful if it is done in conjunction with tests for elevated total protein and [[lymphocyte]] count. The RPR card test should not be used for CSF evaluation. | ||
Regardless of CSF results, however, all children with a diagnosis of confirmed or compatible congenital syphilis should be treated with a regimen effective for [[neurosyphilis]]. | Regardless of CSF results, however, all children with a diagnosis of confirmed or compatible congenital syphilis should be treated with a regimen effective for [[neurosyphilis]]. | ||
=== Evaluation in the First Month of Life === | === Evaluation in the First Month of Life === | ||
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All infants born to mothers who have reactive nontreponemal and treponemal test results should be evaluated with a quantitative nontreponemal serologic test (RPR or VDRL) performed on infant serum, because umbilical cord blood can become contaminated with maternal blood and yield a false-positive result. Conducting a treponemal test (i.e., TP-PA, FTA-ABS, EIA, or chemiluminescence assay) on a newborn’s serum is not necessary. <ref name="urlCDC - Diseases Characterized by Genital, Anal, or Perianal Ulcers - 2010 STD Treatment Guidelines">{{cite web |url=http://www.cdc.gov/std/treatment/2010/genital-ulcers. htm#congenital |title=CDC - Diseases Characterized by Genital, Anal, or Perianal Ulcers - 2010 STD Treatment Guidelines |format= |work= |accessdate=2012-12-21}}</ref> | All infants born to mothers who have reactive nontreponemal and treponemal test results should be evaluated with a quantitative nontreponemal serologic test (RPR or VDRL) performed on infant serum, because umbilical cord blood can become contaminated with maternal blood and yield a false-positive result. Conducting a treponemal test (i.e., TP-PA, FTA-ABS, EIA, or chemiluminescence assay) on a newborn’s serum is not necessary. <ref name="urlCDC - Diseases Characterized by Genital, Anal, or Perianal Ulcers - 2010 STD Treatment Guidelines">{{cite web |url=http://www.cdc.gov/std/treatment/2010/genital-ulcers. htm#congenital |title=CDC - Diseases Characterized by Genital, Anal, or Perianal Ulcers - 2010 STD Treatment Guidelines |format= |work= |accessdate=2012-12-21}}</ref> | ||
===Serology=== | === Serology === | ||
The diagnosis of congenital syphilis is complicated by the transplacental transfer of maternal nontreponemal and tre-ponemal IgG antibodies to the fetus. This transfer of antibodies makes the interpretation of reactive serologic tests for syphilis in infants difficult. | |||
The diagnosis of congenital syphilis is complicated by the transplacental transfer of maternal nontreponemal and tre-ponemal IgG antibodies to the fetus. This transfer of antibodies makes the interpretation of reactive serologic tests for syphilis in infants difficult. | |||
All infants born to mothers who have reactive nontreponemal and treponemal test results should be evaluated with a quantitative nontreponemal serologic test ([[RPR]] or [[VDRL]]) performed on infant serum because [[umbilical cord blood]] can become contaminated with maternal blood and could yield a false-positive result. Conducting a treponemal test (i.e., TP-PA or FTA-ABS) on a newborn’s serum is not necessary. No commercially available immunoglobulin ([[IgM]]) test can be recommended. | All infants born to mothers who have reactive nontreponemal and treponemal test results should be evaluated with a quantitative nontreponemal serologic test ([[RPR]] or [[VDRL]]) performed on infant serum because [[umbilical cord blood]] can become contaminated with maternal blood and could yield a false-positive result. Conducting a treponemal test (i.e., TP-PA or FTA-ABS) on a newborn’s serum is not necessary. No commercially available immunoglobulin ([[IgM]]) test can be recommended. | ||
===Dark Microscopic Examination=== | === Dark Microscopic Examination === | ||
Darkfield microscopic examination or DFA staining of suspicious lesions or body fluids (e.g., nasal discharge) also should be performed. | Darkfield microscopic examination or DFA staining of suspicious lesions or body fluids (e.g., nasal discharge) also should be performed. | ||
===Standard Tests=== | === Standard Tests === | ||
* Antibody Screening Tests (nontreponemal) | * Antibody Screening Tests (nontreponemal) | ||
** Rapid plasma reagin (RPR) | ** Rapid plasma reagin (RPR) | ||
| Line 39: | Line 47: | ||
* Antibody Confirmatory Tests (treponemal) | * Antibody Confirmatory Tests (treponemal) | ||
**Fluorescent treponemal antibody absorption (FTA-ABS) | ** Fluorescent treponemal antibody absorption (FTA-ABS) | ||
**Fluorescent treponemal antibody absorption double staining (FTA-ABS DS) | ** Fluorescent treponemal antibody absorption double staining (FTA-ABS DS) | ||
**Microhemagglutination assay for antibody to T. pallidum (MHA-TP) | ** Microhemagglutination assay for antibody to T. pallidum (MHA-TP) | ||
**Hemagglutination treponemal test for syphilis (HATTS) | ** Hemagglutination treponemal test for syphilis (HATTS) | ||
**Bio-enzaBead Test (ELISA) | ** Bio-enzaBead Test (ELISA) | ||
* Direct Examination of Lesion or Tissue | * Direct Examination of Lesion or Tissue | ||
**Darkfield microscopy | ** Darkfield microscopy | ||
**Direct fluorescent antibody test for T. pallidum (DFA-TP) | ** Direct fluorescent antibody test for T. pallidum (DFA-TP) | ||
**Silver stains (modified Steiner) | ** Silver stains (modified Steiner) | ||
**Hematoxylin and eosin (H & E) stains | ** Hematoxylin and eosin (H & E) stains | ||
=== Non Standard Tests === | |||
* FTA-ABS immunoglobulin (IgM) | * FTA-ABS immunoglobulin (IgM) | ||
* FTA-ABS 19S IgM | * FTA-ABS 19S IgM | ||
* IgM capture ELISA | * IgM capture ELISA | ||
==References== | == References == | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 05:54, 22 December 2012
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]
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Laboratory Findings
- Blood tests
- Complete blood count
- Differential count
- Platelet count
- CSF analysis
Infants delivered of women with a reactive STS should have a cerebrospinal fluid (CSF) evaluation in any of the following circumstances:
- The infant shows any signs compatible with congenital syphilis OR
- Maternal therapy was inadequate, unknown, or it occurred late (greater than or equal to 20 weeks) in pregnancy OR
- Maternal therapy did not include penicillin OR
- Adequate follow-up cannot be ensured
Other living infants with a diagnosis of confirmed or compatible congenital syphilis should have a CSF examination before treatment to provide a baseline for follow-up examination. Although the importance of the CSF examination is debated, a quantitative VDRL CSF test can be meaningful if it is done in conjunction with tests for elevated total protein and lymphocyte count. The RPR card test should not be used for CSF evaluation.
Regardless of CSF results, however, all children with a diagnosis of confirmed or compatible congenital syphilis should be treated with a regimen effective for neurosyphilis.
Evaluation in the First Month of Life
All infants born to mothers who have reactive nontreponemal and treponemal test results should be evaluated with a quantitative nontreponemal serologic test (RPR or VDRL) performed on infant serum, because umbilical cord blood can become contaminated with maternal blood and yield a false-positive result. Conducting a treponemal test (i.e., TP-PA, FTA-ABS, EIA, or chemiluminescence assay) on a newborn’s serum is not necessary. [1]
Serology
The diagnosis of congenital syphilis is complicated by the transplacental transfer of maternal nontreponemal and tre-ponemal IgG antibodies to the fetus. This transfer of antibodies makes the interpretation of reactive serologic tests for syphilis in infants difficult.
All infants born to mothers who have reactive nontreponemal and treponemal test results should be evaluated with a quantitative nontreponemal serologic test (RPR or VDRL) performed on infant serum because umbilical cord blood can become contaminated with maternal blood and could yield a false-positive result. Conducting a treponemal test (i.e., TP-PA or FTA-ABS) on a newborn’s serum is not necessary. No commercially available immunoglobulin (IgM) test can be recommended.
Dark Microscopic Examination
Darkfield microscopic examination or DFA staining of suspicious lesions or body fluids (e.g., nasal discharge) also should be performed.
Standard Tests
- Antibody Screening Tests (nontreponemal)
- Rapid plasma reagin (RPR)
- Venereal Disease Research Laboratory (VDRL)
- Unheated serum reagin (USR)
- Reagin screen test (RST)
- Antibody Confirmatory Tests (treponemal)
- Fluorescent treponemal antibody absorption (FTA-ABS)
- Fluorescent treponemal antibody absorption double staining (FTA-ABS DS)
- Microhemagglutination assay for antibody to T. pallidum (MHA-TP)
- Hemagglutination treponemal test for syphilis (HATTS)
- Bio-enzaBead Test (ELISA)
- Direct Examination of Lesion or Tissue
- Darkfield microscopy
- Direct fluorescent antibody test for T. pallidum (DFA-TP)
- Silver stains (modified Steiner)
- Hematoxylin and eosin (H & E) stains
Non Standard Tests
- FTA-ABS immunoglobulin (IgM)
- FTA-ABS 19S IgM
- IgM capture ELISA
References
- ↑ htm#congenital "CDC - Diseases Characterized by Genital, Anal, or Perianal Ulcers - 2010 STD Treatment Guidelines" Check
|url=value (help). Retrieved 2012-12-21.