Abnormal Development - Syphilis: Difference between revisions

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==Introduction==
==Introduction==
[[Image:Treponema-pallidum.jpg|thumb|The spirochete bacteria ''treponema pallidum'', the cause of syphillis.]]  
[[Image:Treponema-pallidum.jpg|thumb|The spirochete bacteria ''treponema pallidum'', the cause of syphillis.]]  
The variety of bacterial infections that can occur during pregnancy is as variable as the potential developmental effects, from virtually insignificant to major developmental, abortive or fatal in outcome. Some bacteria are common and are part of the normal genital tract flora (Lactobacillus sp), while other bacterial infections are less common or even rare and initially infect/transmit by air or fluids through the different epithelia (genital tract, lungs, gastrointestinal tract). The genitally transmitted common sexually transmitted diseases (STDs) are the bacterial infections described as syphilis and gonorrhoea.
The variety of bacterial infections that can occur during pregnancy is as variable as the potential developmental effects, from virtually insignificant to major developmental, abortive or fatal in outcome. Some bacteria are common and are part of the normal genital tract flora (Lactobacillus sp), while other bacterial infections are less common or even rare and initially infect/transmit by air or fluids through the different epithelia (genital tract, lungs, gastrointestinal tract). The genitally transmitted common sexually transmitted diseases (STDs) are the bacterial infections described as syphilis and gonorrhoea.


In the USA before 1989, reported cases of congenital syphilis (CS) were defined and classified on the basis of a set of clinical and serologic features known as the "Kaufman criteria". In 1988, the CDC developed a new surveillance case definition "All infants born to mothers who have untreated or inadequately treated syphilis are considered potentially infected. (This criterion is based on the 70%-100% chance that during the first 4 years of infection, an untreated woman will transmit syphilis to her unborn baby)."<ref name="CDC-Congenital Syphilis">'''Congenital Syphilis Case Investigation and Reporting Form Instructions''' [http://www.cdc.gov/std/Program/ConSyphInstr11-2003.pdf PDF]</ref>
In the USA before 1989, reported cases of congenital syphilis (CS) were defined and classified on the basis of a set of clinical and serologic features known as the "Kaufman criteria". In 1988, the CDC developed a new surveillance case definition "All infants born to mothers who have untreated or inadequately treated syphilis are considered potentially infected. (This criterion is based on the 70%-100% chance that during the first 4 years of infection, an untreated woman will transmit syphilis to her unborn baby)."<ref name="CDC-Congenital Syphilis">'''Congenital Syphilis Case Investigation and Reporting Form Instructions''' [http://www.cdc.gov/std/Program/ConSyphInstr11-2003.pdf PDF]</ref>


:{{Bacterial Links}}


:{{Template:Environmental}}
{{Bacterial Links}}


{{Environmental}}
==Some Recent Findings==
==Some Recent Findings==
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* '''Review - Strategies of testing for syphilis during pregnancy'''<ref name=PMID25352226><pubmed>25352226</pubmed></ref> "Each year about two million pregnant women are infected with preventable syphilis infection, mostly in developing countries. Despite the expansion of antenatal syphilis screening programmes over the past few decades, syphilis continues to be a major public health concern in developing countries. Point-of-care syphilis testing may be a useful strategy to substantially prevent syphilis-associated perinatal mortality and other negative consequences in resource-poor settings. However, the evidence on effectiveness has been generated mostly from observational study designs or has been reported as a mixed-intervention effect."
* '''Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality'''<ref><pubmed>21501460</pubmed></ref> "This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4 MU benzathine penicillin (or equivalent) on syphilis-related stillbirths and neonatal mortality. ....Moderate quality evidence (3 studies) supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98%) with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin."
* '''Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality'''<ref><pubmed>21501460</pubmed></ref> "This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4 MU benzathine penicillin (or equivalent) on syphilis-related stillbirths and neonatal mortality. ....Moderate quality evidence (3 studies) supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98%) with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin."
* '''Maternal and congenital syphilis in Shanghai, China, 2002 to 2006.'''<ref><pubmed>20137991</pubmed></ref> "A total of 535,537 pregnant women were included in the analysis. During this period of time, 1471 maternal syphilis cases (298.7 per 100 000 live births) and 334 congenital syphilis cases (62.4 per 100,000 live births) were identified. Both maternal and congenital syphilis rates increased from 2002 until 2005, with a slight decrease in 2006. The rate of maternal syphilis was 156.2 per 100,000 live births in Shanghai residents and 371.7 per 100,000 live births in the migrating population (p<0.001). The compliance to treatment for maternal syphilis was poorer in women with a lower level of education. The rate of congenital syphilis in infants born to mothers with incomplete treatment (50.8%) was much higher than in infants born to mothers with complete treatment (12.5%). Rates of fetal death, neonatal death, and major birth defects were 30.4%, 11.0%, and 3.8%, respectively, in the incomplete treatment group; the corresponding figures were 5.5%, 0.56%, and 0.46%, respectively, in the complete treatment group. Infant outcome was also affected by initial maternal RPR antibody level and time of treatment, with much better outcomes in mothers with low antibody levels and earlier treatment. There has been a resurgence of congenital syphilis in Shanghai, China, especially in the migrating population and other populations with a lower socioeconomic status." (More? [[China Statistics]])
* '''Maternal and congenital syphilis in Shanghai, China, 2002 to 2006.'''<ref><pubmed>20137991</pubmed></ref> "A total of 535,537 pregnant women were included in the analysis. During this period of time, 1471 maternal syphilis cases (298.7 per 100 000 live births) and 334 congenital syphilis cases (62.4 per 100,000 live births) were identified. Both maternal and congenital syphilis rates increased from 2002 until 2005, with a slight decrease in 2006. The rate of maternal syphilis was 156.2 per 100,000 live births in Shanghai residents and 371.7 per 100,000 live births in the migrating population (p<0.001). The compliance to treatment for maternal syphilis was poorer in women with a lower level of education. The rate of congenital syphilis in infants born to mothers with incomplete treatment (50.8%) was much higher than in infants born to mothers with complete treatment (12.5%). Rates of fetal death, neonatal death, and major birth defects were 30.4%, 11.0%, and 3.8%, respectively, in the incomplete treatment group; the corresponding figures were 5.5%, 0.56%, and 0.46%, respectively, in the complete treatment group. Infant outcome was also affected by initial maternal RPR antibody level and time of treatment, with much better outcomes in mothers with low antibody levels and earlier treatment. There has been a resurgence of congenital syphilis in Shanghai, China, especially in the migrating population and other populations with a lower socioeconomic status." (More? [[China Statistics]])
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| [[File:Mark_Hill.jpg|90px|left]] {{Most_Recent_Refs}}
Search term: [http://www.ncbi.nlm.nih.gov/pubmed/?term=Abnormal+Development+Syphilis ''Abnormal Development Syphilis'']


<pubmed limit=5>Abnormal Development Syphilis</pubmed>
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==Treponema pallidum==
==Treponema pallidum==


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===Lineage===
===Lineage===



Revision as of 17:38, 1 March 2015

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Introduction

The spirochete bacteria treponema pallidum, the cause of syphillis.

The variety of bacterial infections that can occur during pregnancy is as variable as the potential developmental effects, from virtually insignificant to major developmental, abortive or fatal in outcome. Some bacteria are common and are part of the normal genital tract flora (Lactobacillus sp), while other bacterial infections are less common or even rare and initially infect/transmit by air or fluids through the different epithelia (genital tract, lungs, gastrointestinal tract). The genitally transmitted common sexually transmitted diseases (STDs) are the bacterial infections described as syphilis and gonorrhoea.


In the USA before 1989, reported cases of congenital syphilis (CS) were defined and classified on the basis of a set of clinical and serologic features known as the "Kaufman criteria". In 1988, the CDC developed a new surveillance case definition "All infants born to mothers who have untreated or inadequately treated syphilis are considered potentially infected. (This criterion is based on the 70%-100% chance that during the first 4 years of infection, an untreated woman will transmit syphilis to her unborn baby)."[1]


Bacterial Links: bacterial infection | syphilis | gonorrhea | tuberculosis | listeria | salmonella | TORCH | Environmental | Category:Bacteria


Environmental Links: Introduction | low folic acid | iodine deficiency | Nutrition | Drugs | Australian Drug Categories | USA Drug Categories | thalidomide | herbal drugs | Illegal Drugs | smoking | Fetal Alcohol Syndrome | TORCH | viral infection | bacterial infection | fungal infection | zoonotic infection | toxoplasmosis | Malaria | maternal diabetes | maternal hypertension | maternal hyperthermia | Maternal Inflammation | Maternal Obesity | hypoxia | biological toxins | chemicals | heavy metals | air pollution | radiation | Prenatal Diagnosis | Neonatal Diagnosis | International Classification of Diseases | Fetal Origins Hypothesis

Some Recent Findings

  • Review - Strategies of testing for syphilis during pregnancy[2] "Each year about two million pregnant women are infected with preventable syphilis infection, mostly in developing countries. Despite the expansion of antenatal syphilis screening programmes over the past few decades, syphilis continues to be a major public health concern in developing countries. Point-of-care syphilis testing may be a useful strategy to substantially prevent syphilis-associated perinatal mortality and other negative consequences in resource-poor settings. However, the evidence on effectiveness has been generated mostly from observational study designs or has been reported as a mixed-intervention effect."
  • Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality[3] "This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4 MU benzathine penicillin (or equivalent) on syphilis-related stillbirths and neonatal mortality. ....Moderate quality evidence (3 studies) supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98%) with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin."
  • Maternal and congenital syphilis in Shanghai, China, 2002 to 2006.[4] "A total of 535,537 pregnant women were included in the analysis. During this period of time, 1471 maternal syphilis cases (298.7 per 100 000 live births) and 334 congenital syphilis cases (62.4 per 100,000 live births) were identified. Both maternal and congenital syphilis rates increased from 2002 until 2005, with a slight decrease in 2006. The rate of maternal syphilis was 156.2 per 100,000 live births in Shanghai residents and 371.7 per 100,000 live births in the migrating population (p<0.001). The compliance to treatment for maternal syphilis was poorer in women with a lower level of education. The rate of congenital syphilis in infants born to mothers with incomplete treatment (50.8%) was much higher than in infants born to mothers with complete treatment (12.5%). Rates of fetal death, neonatal death, and major birth defects were 30.4%, 11.0%, and 3.8%, respectively, in the incomplete treatment group; the corresponding figures were 5.5%, 0.56%, and 0.46%, respectively, in the complete treatment group. Infant outcome was also affected by initial maternal RPR antibody level and time of treatment, with much better outcomes in mothers with low antibody levels and earlier treatment. There has been a resurgence of congenital syphilis in Shanghai, China, especially in the migrating population and other populations with a lower socioeconomic status." (More? China Statistics)
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Search term: Abnormal Development Syphilis

<pubmed limit=5>Abnormal Development Syphilis</pubmed>

Treponema pallidum

Treponema-pallidum.jpg
Treponema pallidum (scanning EM, Image CDC)
  • The bacterium Treponema pallidum (T. pallidum) causes syphilis and congenital syphilis.
  • syphilis is a sexually transmitted disease (STD).
  • a gram-negative spirochete
  • helical-shaped bacteria
  • cannot be cultured on artificial media
  • circular DNA containing about 1.1 million nucleotides encoding about 1,000 genes.

Lineage

  • Bacteria; Spirochaetes; Spirochaetes (class); Spirochaetales; Spirochaetaceae; Treponema; Treponema pallidum; Treponema pallidum subsp. pallidum;
    • Treponema pallidum subsp. pallidum SS14
    • Treponema pallidum subsp. pallidum str. Nichols

Congenital Syphilis

The following information is based upon the 2003 CDC Surveillance Case Definition for Congenital Syphilis.[1]

Confirmed case

Congenital syphilis is an infant or child in whom Treponema pallidum is identified by darkfield microscopy, direct fluorescent antibody, or other specific stains in specimens from lesions, placenta, umbilical cord, or autopsy material.

Presumptive case

Congenital syphilis is either of the following:

A. any infant whose mother had untreated or inadequately treated1 syphilis at the time of delivery, regardless of the findings in the infant or child
B. any infant or child who has a reactive treponemal test for syphilis and any one of the following:
  1. evidence of congenital syphilis on physical examination
  2. evidence of congenital syphilis on long bone X-ray
  3. reactive cerebrospinal fluid CSF-VDRL
  4. elevated CSF cell count or protein (without other cause)
  5. reactive test for IgM antibody.

Syphilitic stillbirth

Defined as a fetal death in which the mother had untreated or inadequately treated syphilis at the time of delivery of a fetus after a 20-week gestation or of a fetus weighing >500g.


Signs of Congenital Syphilis

In an infant or a child younger than 2 years of age may include:

  • condyloma lata
  • snuffles
  • syphilitic skin rash
  • hepatosplenomegaly
  • jaundice due to syphilitic hepatitis
  • pseudoparalysis
  • edema from nephrotic syndrome or malnutrition

In an older child may include:

  • interstitial keratitis
  • nerve deafness
  • anterior bowing of shins
  • frontal bossing
  • mulberry molars
  • Hutchinson’s teeth
  • saddle nose
  • rhagades
  • Clutton’s joints.

Australian Data

The following data is based upon a table from a recent article by Jones and Jones (2010),[5] reminding physicians to be aware of maternal and congenital syphilis.

Number of notifications of syphilis and congenital syphilis in Australia (2004 – 2007)

Year Syphilis Congenital syphilis
Male Female Total Male Female Unknown Total
2007 1231 150 1381 5 2 1 8
2006 689 182 871 6 7 - 13
2005 - - 653 8 6 1 15
2004 - - 636 11 2 - 13

Gram Stain

Bacterial staining procedure named after Hans Christian Gram (1853 - 1938). Generally divides bacteria into either:

  • Gram-positive bacteria purple crystal violet stain is trapped by layer of peptidoglycan (forms outer layer of the cell).
  • Gram-negative bacteria outer membrane prevents stain from reaching peptidoglycan layer in the periplasm, outer membrane then permeabilized and pink safranin counterstain is trapped by peptidoglycan layer.
Links: Histology Stains | Medical Microbiology - Gram stain procedure

Australian NHMRC Recommendations

The Australian NHMRC (1988) recommends neonates be assessed for follow-up care under the following conditions.

  • Birthweight less than 1500g or gestational age less than 32 weeks
  • Small-for-gestational-age neonates
  • Perinatal asphyxia
  • Apgar score less than 3 at 5 minutes
  • clinical evidence of neurological dysfunction
  • delay in onset of spontaneous respiration for more than 5 minutes and requiring mechanical ventilation
  • Clinical evidence of central nervous system abnormalities ie., seizures, hypotonia
  • Hyperbilirubinaemia of greater than 350umol/l in full term neonates
  • Genetic, dysmorphic or metabolic disorders or a family history of serious genetic disorder
  • Perinatal or serious neonatal infection including children of mothers who are HIV positive
  • Psychosocial problems eg., infants of drug-addicted or alcoholic mothers.


Links: NHMRC WWW Page

References

  1. 1.0 1.1 Congenital Syphilis Case Investigation and Reporting Form Instructions PDF
  2. <pubmed>25352226</pubmed>
  3. <pubmed>21501460</pubmed>
  4. <pubmed>20137991</pubmed>
  5. <pubmed>20618256</pubmed>

Reviews

<pubmed>15356936</pubmed> <pubmed>12844452</pubmed> <pubmed>10816189</pubmed> <pubmed>6293753</pubmed>

Articles

<pubmed>16458647</pubmed> <pubmed>10456962</pubmed>

Search Pubmed

Search NCBI Bookshelf: Medical Microbiology - Syphilis Search

Search PubMed: Congenital Syphilis | Abnormal Embryology Syphilis | Abnormal Development Syphilis

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Cite this page: Hill, M.A. (2024, March 28) Embryology Abnormal Development - Syphilis. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_Syphilis

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© Dr Mark Hill 2024, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G