Abnormal Development - Syphilis: Difference between revisions

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The following information is based upon the 2003 CDC guidelines.<ref>'''Congenital Syphilis Case Investigation and Reporting Form Instructions''' [http://www.cdc.gov/std/Program/ConSyphInstr11-2003.pdf PDF]</ref>
The following information is based upon the 2003 CDC guidelines.<ref>'''Congenital Syphilis Case Investigation and Reporting Form Instructions''' [http://www.cdc.gov/std/Program/ConSyphInstr11-2003.pdf PDF]</ref>


'''Confirmed case''' of 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.
===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''' of congenital syphilis is either of the following:
===Presumptive case===
Congenital syphilis is either of the following:


:A. any infant whose mother had untreated or inadequately treated1 syphilis at the time of
:A. any infant whose mother had untreated or inadequately treated1 syphilis at the time of
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'''Syphilitic stillbirth''' is 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.
===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.


==Australian Data==
==Australian Data==

Revision as of 14:27, 14 September 2011

Notice - Mark Hill
Currently this page is only a template and will be updated (this notice removed when completed).

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).

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

  • Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality[1] "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.[2] "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)

Treponema pallidum

Treponema-pallidum.jpg
Treponema pallidum (scanning EM, Image CDC)
  • The bacterium Treponema pallidum causes syphilis which is a sexually transmitted disease (STD).
  • Infection can lead to congenital infection with abortion, prematurity, neonatal death or multiple system abnormalities.

Congenital Syphilis

The following information is based upon the 2003 CDC guidelines.[3]

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.

Australian Data

The following data is based upon a table from a recent article by Jones and Jones (2010),[4] 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: Medical Microbiology | American Society for Microbiology

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. <pubmed>21501460</pubmed>
  2. <pubmed>20137991</pubmed>
  3. Congenital Syphilis Case Investigation and Reporting Form Instructions PDF
  4. <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: Abnormal Embryology Syphilis | Abnormal Development Syphilis

External Links

External Links Notice - The dynamic nature of the internet may mean that some of these listed links may no longer function. If the link no longer works search the web with the link text or name. Links to any external commercial sites are provided for information purposes only and should never be considered an endorsement. UNSW Embryology is provided as an educational resource with no clinical information or commercial affiliation.

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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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