Congenital syphilis laboratory findings: Difference between revisions

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__NOTOC__
__NOTOC__
{{CMG}}
 
{{CMG}} {{AE}} {{KD}}; {{ADI}} {{AKI}}
 
{{Congenital syphilis}}
{{Congenital syphilis}}
==Overview==
==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>


===Serology===
====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]]


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.
== References ==
{{Reflist|2}}


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===
All infants born to women who have reactive serologic tests for syphilis should be examined thoroughly for evidence of congenital syphilis (e.g., [[nonimmune hydrops]], [[jaundice]], [[hepatosplenomegaly]], [[rhinitis]], [[skin rash]], and/or pseudoparalysis of an extremity). Pathologic examination of the placenta or umbilical cord by using specific fluorescent antitreponemal antibody staining is suggested. Darkfield microscopic examination or DFA staining of suspicious lesions or body fluids (e.g., nasal discharge) also should be performed.
==References==
{{Reflist|2}}
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Latest revision as of 21:04, 29 July 2020


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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

Postnatal Diagnosis

References

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.


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