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Case Conference

Case Conference. Maria Fernanda Ramirez Tovar, MD. HPI…. 5 do Baby boy born FT C/S because of non reassuring FHT AS 9/9 BW 3.465Kg BT A+, RPR negative Transferred Prenatal Care from DR Mother 42yo, G6P3, BT O+, HIV neg, RPR Positive 1:2, MHA-TP Positive, treated with Bicillinx2 PE WNL

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Case Conference

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  1. Case Conference Maria Fernanda Ramirez Tovar, MD

  2. HPI… • 5 do Baby boy born FT C/S because of non reassuring FHT • AS 9/9 • BW 3.465Kg • BT A+, RPR negative • Transferred Prenatal Care from DR • Mother 42yo, G6P3, BT O+, HIV neg, RPR Positive 1:2, MHA-TP Positive, treated with Bicillinx2 • PE WNL • CSF and Long Bone Xrays WNL

  3. Congenital syphilis • Congenital syphilis occurs when the spirochete Treponemapallidumis transmitted from a pregnant woman to her fetus. Infection can result in stillbirth, prematurity, or a wide spectrum of clinical manifestations; only severe cases are clinically apparent at birth

  4. Early Congenital Syphilis

  5. Stigmata of late congenital syphilis

  6. Congenital Syphilis • Mother with reactive Nontreponemal or Treponemal test • Nontreponemal test performed in the Newborn should be the same as the mother’s • Physical examination • Darkfield microscopic examination or DFA of body fluids • Pathologic examination of Placenta and Umbilical Cord, DFA staining • Child found to have a reactive test after 1 month of life • Congenital Vs. Acquired Syphilis (Maternal Hx, Clinical judgment) • CBC, CSF, HIV, LFT • Long bones XR’s, CXR, Abdominal US, Neuroimaging • Ophthalmological evaluation • Auditory brain stem response • Sexual Abuse? Evaluation < 1 mo Evaluation > 1 mo IV Penicillin 10 days

  7. Congenital syphilis neonatal period • Abnormal PE/Positive Darkfield or DFA/VDRL or RPR fourfold or higher than mother’s titers • CBC, CSF, HIV, LFT • Long bones XR’s, CXR, Abdominal US, Neuroimaging • Ophthalmological evaluation, • Auditory brain stem response • Penicillin G for 10 days • Non reactive VDRL/RPR plus Normal PE: no further evaluation • Mother not treated or inadequately treated>Presumptive Syphilis • Mother NT or IT+ Reactive test (not fourfold)+ Normal PE: CBC, CSF, etc. • Mother adequately treated during pregnancy • Mother adequately treated before pregnancy Proven or Highly Probable At Risk Neonates

  8. Inadequate or suboptimal treatment of maternal syphilis

  9. Infant treatment options

  10. Congenital syphilis: evaluation and management. cdc

  11. Evaluation an management of neonates born to women with syphilis or syphilis hx. AAp

  12. References • Syphilis. Erica L. Hyman, MD. Pediatrics in Review Vol. 27 No. 1 January 1, 2006 pp. 37 -39(doi: 10.1542/pir.27-1-37) • Congenital Syphilis: Evaluation, management and prevention. Simon R Dobson. www.Uptodate.com • U.S. Preventive Services Task Force. Screening for syphilis infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2009; 150:705. • Syphilis in Pregnancy. Errol R Norwitz. www.Uptodate.com • CDC. Sexually transmitted disease surveillance, 2008. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Available at http://www.cdc.gov/std/stats08/main.htm. • CDC. Sexually transmitted diseases treatment guidelines, 2006. MMWR 2006;55(No. RR-11). • Hollier LM, Hill J, Sheffield JS, Wendel GD Jr. State laws regarding prenatal syphilis screening in the United States. Am J ObstetGynecol 2003;198:1178--83.

  13. Gracias…

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