Syphilis congenita recens – case report

Česká verzia

Authors: L. Krbková ¹; L. Klapačová ¹; J. Bednářová ²; P. Pospíšilová ³; B. Pinková ⁴; H. Zákoucká ⁵
Authors place of work: Klinika dětských infekčních nemocí LF MU a FN Brno ¹; Oddělení klinické mikrobiologie, FN Brno ²; Laboratoř bakteriální genetiky a genomiky, Biologický ústav LF MU, Brno ³; Dětské kožní oddělení, Pediatrická klinika LF MU a FN Brno ⁴; Národní referenční laboratoř pro diagnostiku syfilis, Státní zdravotní ústav, Praha ⁵
Published in the journal: Čes-slov Pediat 2017; 72 (7): 404-408.
Category: Sympozium: dětské infekční nemoci

Kazuistika byla prezentována jako klinická desetiminutová přednáška na XXI. slovensko-českém kongresu o infekčních chorobách v Bratislavě, 16. 6. 2017

Summary

Treponema pallidum infection can occur during any stage of pregnancy in the case of untreated or insufficiently treated maternal syphilis. Nevertheless, the transmission to the foetus is most probable during spirochetaemia in the early stage of pregnancy.

We present the case of congenital syphilis diagnosed in the third month of age. The screening for hepatitis B and syphilis were negative in the first trimester of pregnancy. The mother was diagnosed with urogenital infection in the sixth month of pregnancy, she was treated with acyclovir as herpes genitalis, but likely primary syphilitic lesions would have been the correct diagnosis. She delivered spontaneously a 2,810 g – female in the 40th week of pregnancy. The screening for treponemal antibodies was not done.

The infection started with coryza syphilitica in the third month of age followed by skin lesions around the mouth and on the thighs. On admission, the infant’s skin changes were significant for congenital syphilis. Anemia, increased liver enzymes and positive non-treponemal and treponemal tests dominated in laboratory findings. RPR was 1:64, ELISA IgM and IgG were repeatedly positive, confirmed by Western blot (antibodies to Tp47, Tp17, Tp15). In clinical samples (from buccal mucosa and from skin lesion) T. pallidum DNA was detected by PCR. The test was positive for one locus from 3 typing genes (TP0548). Either CSF abnormalities or intrathecal synthesis were proven. The infant was treated with ceftriaxone intravenously for 14 days.

Keywords:
Treponema pallidum, congenital syphilis, syphilitic skin lesions, screening during pregnancy/at birth

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