Case report: bone alterations of congenital syphilis refractory to treatment in a 7-year-old schoolboy
DOI:
https://doi.org/10.33448/rsd-v10i17.24851Keywords:
Congenital syphilis; Treponema pallidum; Bone and bones; Sexually transmitted diseases.Abstract
Objectives: To draw attention to the importance of following up children with congenital syphilis and to present an unusual case of bone changes that persisted up to 7 years of life. Methods: Observational, descriptive and retrospective study using medical records review of three patients with congenital syphilis and literature search, using the Uptodate, PubMed, Medline, Lilacs, Scielo databases covering the period from 2015 to 2021. Results: We describe 3 sisters. with congenital syphilis that were diagnosed and treated at birth and the first-born, rescued at age 7, complained of severe pain when moving her lower limbs since age 5 years. At birth he had VDRL 1:4; non-reactive VDRL parent (NR); mother with VDRL 1:16 and inadequately treated during pregnancy. The first-born had metaphyseal alterations and VDRL in negative CSF, being treated with crystalline penicillin for 10 days, however, she did not comply with outpatient follow-up. During this hospitalization, the physical examination showed no alterations, VDRL NR and long bones radiography with lytic image in the left and right legs suggestive of syphilis. Hospitalization was indicated and treatment with crystalline penicillin 50,000 IU/kg/dose was performed, 6/6 hours for 10 days. At 8 years and 4 months, he no longer had bone changes or pain symptoms when walking. In the second pregnancy she had adequate treatment and in the third pregnancy the father was not treated and the mother received only one dose of medication. The two conceptuses contracted congenital syphilis with bone changes at birth which, in the follow-up at 24 months and 6 months of life, respectively, were no longer detected. Conclusions: The follow-up of children with congenital syphilis should be carried out until all clinical, laboratory and radiological alterations disappear. This case series highlights the importance of diagnosing and treating pregnant women and their sexual partner(s) to eliminate mother-to-child transmission as well as the diagnosis at birth of cases of congenital syphilis and adequate treatment and follow-up.
References
Andrade, A. L. M. B., Magalhães, P. V. V. S., Moraes, M. M., Tresoldi, A. T. & Pereira, R. M. (2018). Diagnóstico tardio de sífilis congênita: uma realidade na atenção à saúde da mulher e da criança no Brasil. Rev Paul Pediatria. 36(3):376-81.
Arora, N. et al. Origin of modern syphilis and emergence of a pandemic Treponema pallidum cluster. (2016). Nat. Microbiol. (2), 16245
Beale, M. A. et al. Genomic epidemiology of syphilis reveals independent emergence of macrolide resistance across multiple circulating lineages (2019). Nat. Commun. (10), 3255.
Beale, M.A., Marks, M., Cole, M. J. et al. (2021). Global phylogeny of Treponema pallidum lineages reveals recent expansion and spread of contemporary syphilis. Nat Microbiol (6), 1549–1560. https://doi.org/10.1038/s41564-021-01000-z
Centers for Disease Control and Prevention (2018). National Notifiable Diseases Surveillance System (NNDSS). Syphilis 2018 Case Definition. https://wwwn.cdc.gov/nndss/conditions/syphilis/case-definition/2018/2018.
Diorio, D., Kroeger, K., & Ross, A. (2018). Social Vulnerability in Congenital Syphilis Case Mothers: Qualitative Assessment of Cases in Indiana, 2014 to 2016. Sex Transm Dis. 2018 Jul;45(7):447-451.
Eickoff, C. A., & Decker, C. F. (2010). Syphilis. Dis Mon. 2016, (62):280-6.
Forrestel, A. K., Kovarik, C. L., & Katz, K. A. (2020). Sexually acquired syphilis: historical aspects, microbiology, epidemiology, and clinical manifestations. J Am Acad Dermatol. 2020, (82):1-14.
Ghanem, K. G., Ram, S., & Rice, P. A. (2020). The modern epidemic of syphilis. N Engl J Med. 2020, (382):845-54.
Gomez, G. B., Kamb, M. L., Newman, L. M., Mark, J., Broutet, N., & Hawkes, S. J. Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis (2013). Bull World Health Organ. 91(3):217–26. 10.2471/BLT.12.107623
Hofer, U. Bottleneck and spread of Treponema pallidum. (2021). Nat Rev Microbiol. https://doi.org/10.1038/s41579-021-00673-x
Janier, M., Unemo, M., Dupin, N., Tiplica, G., Potočnik, M. & Patel, R. (2021), 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol, 35: 574-588. https://doi.org/10.1111/jdv.16946
Kimball, A., Torrone, E., Miele, K., et al. (2020). Missed Opportunities for Prevention of Congenital Syphilis - United States, 2018. MMWR Morb Mortal Wkly Rep. (69):661.
Korenromp, E. L., Rowley, J., Alonso, M., Mello, M. B., Wijesooriya, N. S., Mahiané, S. G., Ishikawa, N., Le, L. V., Newman-Owiredu, M., Nagelkerke, N., Newman, L., Kamb, M., Broutet, N., & Taylor, M. M. (2019). Global burden of maternal and congenital syphilis and associated adverse birth outcomes-Estimates for 2016 and progress since 2012. PloS one, 14(2), e0211720. https://doi.org/10.1371/journal.pone.0211720
Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030 (2016). Lancet. 387(10018):587–603. 10.1016/S0140-6736(15)00837-5.
Ministério da Saúde (BR) (2016). Secretaria de Vigilância em Saúde. Departamento de Vigilância, Prevenção e Controle das Doenças Sexualmente Transmissíveis, Aids e Hepatites Virais. Manual técnico para diagnóstico da sífilis. Brasília (DF): Ministério da Saúde; 2016.
Peeling, R.W., Mabey, D., Kamb, M.L., Xiang-Sheng, C., Radolf, J. D., & Benzaken, A.S.(2017). Nature Reviews Disease. 2017; (3)
Silveira, K. B. da, Silva, J. R. S., Reis, F. P., Melo, Ítalo F. L. de, Santos, T. C. de M., Souza, M. de J., & Feitosa, V. L. C. (2021). Epidemiologia da Sífilis Congênita no estado de Sergipe. Research, Society and Development, 10(14), e562101422061. https://doi.org/10.33448/rsd-v10i14.22061
Watts, P. J., Greenberg, H. L., & Khachemoune, A. (2016). Unusual primary syphilis: presentation of a likely case with a review of the stages of acquired syphilis, its differential diagnoses, management, and current recommendations. Int J Dermatol. 2016, (55):714-28.
WHO. (2016). Guidelines for the treatment of Treponema pallidum (syphilis). http://apps.who.int/iris/bitstream/10665/249572/1/9789241549806-eng.pdf?ua=1.
Yin, R. K. (2015). O estudo de caso. Bookman.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Carla Virginia Vieira Rollemberg; Ana Juliana Pereira Franca Dantas; Izailza Matos Dantas Lopes
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
