Dr. Ira Shah : Intrauterine Infections - Syphilis During Pregnancy

 
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https://i.ytimg.com/vi/EhV3NQpkx2E/mqdefault.jpg 07/03/2015
Dr. Ira Shah : Intrauterine Infections - Syphilis During Pregnancy
Description
Dr Ira Shah talks on Intrauterine Infections.

Talk starts with a case discussion which also explains the interpretation of VDRL. The diagnosis on basis of positive and negative VDRL tests. Short talk on Congenital syphilis, its time of infection and early clinical features and Late manifestations. What about clinical examination, When to consider treatment, when to do CSF VDRL, follow up and concludes with key messages for Intrauterine infections.

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CASE:
• Primigravida mother detected to have VDRL of 1:4 at time of delivery
• She was asymptomatic with no genital lesions
• Mother’s HbsAg and HIV Elisa- Negative.
• Baby was born at full term and birth weight was 2.25kg on examination, all systems were normal

A PID consult now called. What should be done now?
• Wait and watch
• Do VDRL in the child
• Treat the child for congenital syphilis
• This is false positive VDRL and ignore the report
• Do TPHA in the mother

Case of false positive VDRL:
• Secondary to viral infections(infectious mononucleosis, hepatitis, varicella, measles),
• Lymphoma
• Tuberculosis
• Malaria
• Endocarditis
• Connective tissue disease
• Pregnancy
• Laboratory error

How is false positive VDRL excluded?
• Confirm with treponemal antibody by
- Fluorescent treponemal antibody absorpation (FTA-ABS)
- T.pallidum particle agglutination(TPPA)
• Treponemal test antibody titres remain reactive for life
In this mother
• Treponemal antibody test was positive
• Going back on history – she had tested positive for VDRL in 2nd trimester with a titre of 1:32 and had received one dose of 2.4 million unit of benzathine penicillin.

Should this child be treated for congenital syphilis?
• Do VDRL in child
• Examine for physical evidence of congenital syphilis

Does a positive VDRL in the child suggest congenital syphilis?
• Any positive non-treponemal or treponemal test in infant-may be due to maternal antibody titers
• Does not prove congenital infection
• Passively acquired non-treponemal antibody usually reverts to negative by 6 months, whereas treponemal antibody can persist for 1 year or longer.
• If the infant’s titres are four fold higher than the mother’s titre-may suggest congenital syphilis.
• If infant’s IgM antibodies to T.pallidum are positive- it suggests congenital infection

What are the features of congenital syphilis?
Time of infection
• In utero,
• Contact with an active genital lesion at the time of delivery
• Transmission ranges from 70 to 100% in primary syphilis, 40% for early latent syphilis to 10% for late latent disease.
• Most affected infants are asymptomatic at the birth, with two-thirds developing symptoms by 3-8 weeks. Almost all exhibit symptoms by 3 months of age.
Early clinical features
• Similar to secondary syphilis in adults.
• Persistent rhinitis(snuffles)
• Hepatosplenomegaly,
• Generalized lymphadenopathy
• Vesiculobullous or maculopapular rash occurring on the palms and soles associated with desquamation
• Glomerulonephrities resulting in nephritic syndrome
• Radiological abnormalities- diaphyseal periostitis
• After 3 months- parrot’s pseudo-paralysis, characterized by an asymmetric, painful, flaccid paralysis of the upper limbs and knee.

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