Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands.
Eur J Clin Microbiol Infect Dis. 2010 May;29(5):495-501. doi: 10.1007/s10096-010-0900-8. Epub 2010 Mar 25.
Congenital syphilis (CS) can occur when a mother is inadequately treated or not treated at all for an active Treponema pallidum infection. Symptoms of CS are often subtle and non-specific, and it is estimated that up to 60% of affected infants are asymptomatic at birth, making the diagnosis dependent on laboratory findings. Despite decades of experience with CS, problems still arise in its diagnosis because laboratory test results for children at risk for CS can be inconclusive and no single diagnostic test can be used to diagnose CS. The development of diagnostic tests such as enzyme immunoassays, immunoblotting and polymerase chain reaction (PCR) has increased the sensitivity and specificity of diagnoses, but the detection of specific IgM is currently the most sensitive serological method, and the presence of specific IgM should be considered as evidence of a congenital T. pallidum infection. Suspected cases can also be confirmed or excluded by serial post-partum tests of antibody kinetics. The authors note strongly that it is considered unethical not to treat a baby at risk of contracting CS, even without a definitive diagnosis. In this review, we describe the various microbiological methods-and their shortcomings-used in the laboratory diagnosis of CS.
先天性梅毒（CS）可发生于母体梅毒未经充分治疗或未治疗时。CS 的症状通常较为隐匿且无特异性，据估计，多达 60%的患病婴儿在出生时无症状，这使得该病的诊断依赖于实验室发现。尽管人们对 CS 已有数十年的经验，但该病的诊断仍存在问题，因为 CS 高危患儿的实验室检测结果可能不确定，且没有单一的诊断性检测可用于诊断 CS。酶免疫测定、免疫印迹和聚合酶链反应（PCR）等诊断检测方法的发展提高了诊断的敏感性和特异性，但特异性 IgM 的检测目前是最敏感的血清学方法，特异性 IgM 的存在应被视为先天性梅毒感染的证据。疑似病例也可通过产后抗体动力学的连续检测来确认或排除。作者强烈指出，即使没有明确的诊断，不治疗有感染 CS 风险的婴儿也被认为是不道德的。在这篇综述中，我们描述了实验室诊断 CS 中使用的各种微生物学方法及其缺点。
