Clinical analysis of 60 cases of congenital syphilis
Author: Yangzu Qin Zhen-Long Liu Chunmei
Key words Congenital Mei
Also known as Congenital Syphilis Congenital syphilis is Treponema pallidum through the placenta into the fetal blood circulation caused by congenital infections result. Now our hospital from January 2003 to August 2007 a total of 60 cases of congenital syphilis were treated as follows.
A clinical data
1.1 General Information
The group of 60 patients, male 35 cases, female 25 cases; 28 ~ 37 weeks gestational age in 13 cases, 37 ~ 42 weeks 45 cases, "42 weeks in 2 cases; admission age <24h 8 Li, 1 ~ 7d 32 cases, 8 ~ 28d 20 cases; birth weight 1430 ~ 4120g. Children born in our hospital 42 cases, 18 cases were
born outside the hospital. All were born in our hospital 42 cases of newborns when the mother's production of blood were positive RPR titer 1:1 ~ 1:64, newborn blood TPPA were (+). All patients were collected serum and cerebrospinal fluid samples.
1.2 Clinical features
Enlargement of the liver 42 cases, 31 cases associated with liver damage, accompanied by 20 cases of pathologic jaundice; 38 cases of elevated white blood cell; spleen enlargement in 25 cases; extremities,
palm toe peeling, skin rash develops, 30 cases; perioral anal chapped 8; nasal tears three cases of sepsis; 5 cases of thrombocytopenia; 11 cases of renal dysfunction; fever, 9; abdominal distention, bleeding in 4 cases; heart murmur in 5 cases; hard swelling, edema, 3 cases; three cases of low
body temperature; concurrent six cases of neurosyphilis (convulsions 1 case); 10 cases of pneumonia, anemia in 15 cases, TORCH infection, low blood sugar all 4 cases, septicemia in 2 cases; lungs smell and wet sound,
progressive dyspnea, three concave sign clearly confirmed for the two cases of neonatal hyaline membrane disease, high blood sugar in 1 case. No clinical symptoms in 5 cases. Children with mothers history of three cases of spontaneous abortion, stillbirth history of 2 cases. 60 cases underwent limb long bone X-ray, three cases of abnormal long bone layer showed periosteal proliferation, the backbone of small pieces bone destruction.
Penicillin G needle: 50000 U / (kg * times), intravenous infusion, 1
/ 12h, 7d was later changed to 50000 U / (kg * times), intravenous infusion, 1 / 8h, the total treatment 14d, If the merger is the overall course of neurosyphilis 3 weeks . The combined condition serious bacterial infection increases with the second-generation cephalosporin or
third generation, according to 100mg / (kg * d) intravenous infusion, 1 / d, or 1 / 12h, course of 10 ~ 14d. Symptomatic treatment: active treatment of hyperbilirubinemia, and 1 case of severe hyperbilirubinemia to the
emergency exchange transfusion therapy.
2.1 Syphilis Serology
60 cases of children with rapid serum reagin test (RPR) and Treponema pallidum hemagglutination test (TPPA) were positive reaction, serum RPR
titer of 1:1 ~ 1:64; 60 cases of children with mothers in 55 cases of RPR and TPPA were positive reaction. Children's mother was born in our hospital, 42 cases were positive before delivery TPPA; outside the hospital 13 cases of children with mothers both RPR and TPPA positive
reaction, and the other five cases of children with the mother refused to test; 60 cases of children with fathers 44 cases of RPR and TPPA were positive, 16 cases refused to check. CSF-RPR-positive in 6 cases (1:1 ~
1:8), the 6 cases of CSF-TPPA always make positive, while routine
examination of cerebrospinal fluid abnormalities were expressed as protein increased (PRO> 1800mg / L), CSF leukocytes "15 × 106 / L. HIV antibodies
were negative in all cases.
After treatment, clinical symptoms, hepatic and renal function returned to normal, anemia correction, platelets returned to normal and recovered 30 cases of rash and 2 cases due to severe illness left the hospital, and 1 case of premature very low birth weight infants, NRDS, the
parents give up treatment after discharge automaticallyDeath. RPR in the penicillin treatment of blood 14d discharge review, negative rate of 91.23% (52/57), the other 5 cases are still positive, including two cases of families consented to continue treatment at the undergraduate and another three cases back to a local hospital for further treatment. Well, after they discharge their 2,3,6,9,12,18-month return to hospital out-
patient review, including physical examination, routine blood test, brain
B-, serum RPR (3 months 1 times). Referral information is complete in 28 cases, blood RPR on 3,6,12 months, negative rates were 96.43%, 100%, 100%, most of the growth and development of normal or near normal.
Skin damage is an important signs of early congenital syphilis in this group, 30 cases (50%) showed the characteristic red rash of copper palmoplantar area, mouth chapped weeks perianal, nasal sepsis tears, multiple pus herpes. Lung infections and hepatosplenomegaly is second only
to signs of a rash. Auxiliary examination can be found hypoproteinemia, anemia, thrombocytopenia and multiple organ involvement. This group of 5 cases (8.33%) children with no abnormalities at birth, only positive syphilis serology. Variety of clinical manifestations of congenital syphilis, the lack of specificity, can affect multiple organs, its easy and diaper rash dermatitis, cutaneous candidiasis disease, epidermolysis bullosa confused, without rash occurs in children and feeding breathing
difficulties, jaundice, hepatosplenomegaly and so the performance is also easily misdiagnosed as pneumonia, sepsis, hyperbilirubinemia and other common diseases. Neonatal diagnosis of congenital syphilis can be seen more difficult, which is due to: only a few infants with congenital
syphilis symptoms in the neonatal period; maternal Treponema pallidum IgG antibodies to the fetus via the placenta can not be diagnosed as a separate basis; diagnosis of a lack of gold standard. Although the tissues
and Treponema pallidum examination method is reliable, but not easy to collect specimens, the sensitivity is low, difficult to promote, Guchang be based on clinical, X-ray examination, as well as comprehensive analysis of serological diagnosis . The patients admitted to hospital, when 20
cases of children with parents to conceal or do not know that they have a history of syphilis. In children with newly diagnosed on admission as "sepsis", "pneumonia", "neonatal infections," are mostly found to RPR-
positive after admission, and then check TPPA confirmed. For all newborns with congenital syphilis, lumbar puncture should be done in children with cerebrospinal fluid examination to determine whether there is nerve syphilis, to select treatment and follow-up program. The group of 60
cases, 3 cases of the families refused to do lumbar puncture examination, 2 patients left the hospital, 1 patient died without making a total of six cases of lumbar puncture and the remaining 54 cases to do lumbar puncture in children, diagnosis, six cases of neurosyphilis. Reposted elsewhere in the paper for free download http://
Is generally believed that 16 weeks of gestation before the spirochete was placenta chorionic layer of blocks, Lang Han difficult to enter the fetus, 16 weeks of gestation after Langerhans layer gradually shrinking, the fetus vulnerable to infection . Congenital syphilis causes of death in the primary causes of premature birth, especially common in gestational age "30 weeks, birth weight <2kg of premature
infants . In the 16 weeks of pregnancy prior to full treatment, is almost entirely preventable congenital syphilis occurred; 20 ~ 24 week of pregnancy, adequate treatment, it may cure syphilis, the fetus, but can not achieve absolutely no children were born with congenital syphilis;
begin treatment late in pregnancy , there will be a considerable number of children born with congenital syphilis . Treatment during pregnancy, parturition of the baby's infection rate was 2.2%, no treatment in the
baby's infection rate was 38% . Preterm children in this group 13 cases (accounting for 21.67%), gestational age 28 weeks in 1 case, 31 weeks in 3 cases, 33 weeks in 4 cases, 34 weeks in 2 cases, ? 36 Zhou three cases of
late preterm infants, 28 weeks, 31 weeks clinical symptoms of premature
infants born heavier (28 weeks in children and to abandon the treatment and died NRDS). The smaller the gestational age, clinical symptoms, the more weight, which is consistent with the relevant reports. The patients
treated with penicillin, cured 52 cases, serology cure rate of 91.23%, for all children through the regular treatment after discharge from hospital will urge in a month within 3 months of follow-up of a second, 12 months
after every 6 months 1 month follow-up, a total of 1 to 2 years to observe
the clinical manifestations and serum RPR titer had dropped, the formal treatment RPR should be 1 to 2 years was negative. If an age is not overcast titer continued to rise, suggesting that sustained or recurrent infection should be repeated in the regular drive-mei treatment. CSF is
not normal to be reviewed every 6 months, 1 times, until the normal, if the 2-year-old continued to abnormal, you should consider re-treatment.
Of unexplained preterm infants small for gestational age, pathologic
jaundice, hepatosplenomegaly, umbilical hemorrhage of unknown cause coma and convulsions of unknown causes, combined with rash, mother had history of spontaneous abortion or stillbirth should be considered such as
congenital syphilis may be, timely OK relevant examinations . If the timely treatment of early syphilis, good curative effect and prognosis of good, while the late congenital syphilis, although syphilis be cured, but the remaining bone, nervous system and eye damage such as sustainable
life. So, establish a perfect serological detection of syphilis is very important, especially for pregnant women to carry out in densely populated areas and mobile monitoring of women of childbearing age. Routine prenatal
screening for the RPR, it is proposed first trimester, pregnancy 28 weeks and capacity to conduct three.
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