Department of Pediatrics, St. Franziskus Hospital, Ahlen, Germany.
World J Pediatr. 2010 May;6(2):125-31. doi: 10.1007/s12519-010-0028-z. Epub 2010 May 21.
With 700,000 to 1.5 million new cases annually, congenital syphilis remains a major infectious cause of morbidity and mortality in neonates, infants and children in resource-poor countries. We therefore analyzed the extent of congenital syphilis in the pediatric patient population at our rural hospital in Tanzania.
For this retrospective analysis, from January 1, 1998 to August 31, 2000, all cases of congenital syphilis were collected from the medical records of the neonatal and pediatric department at Haydom Lutheran Hospital in rural northern Tanzania. Age, sex, weight, clinical signs and symptoms, venereal disease research laboratory (VDRL) results of mother and/or child, hemoglobin concentration, treatment, and outcome were recorded and analyzed.
Fourteen neonates and infants were included. The earlier the diagnosis, the more it rested on maternal data because the presentation of neonatal congenital syphilis resembled neonatal sepsis. Syphilitic skin lesions were only seen in the post-neonatal age group. VDRL results were positive in 11 of the 14 mothers, and in 4 of the infants. Anemia was common in older infants. No patient showed signs of central nervous system involvement. Two patients died, and the remaining were cured after standard treatment with procaine penicillin.
Highlighting the variable picture of congenital syphilis, this report demonstrates how difficult it is to make a correct diagnosis by solely history and clinical presentation in a resource-poor setting. Hence false-positive and false-negative diagnoses are common, and clinicians have to maintain a high index of suspicion in diagnosing congenital syphilis. Therefore, an important approach to control and finally eliminate congenital syphilis as a major public health problem will be universal on-site syphilis screening of all pregnant women at their first antenatal visit and immediate treatment for those who test positive.
每年有 70 万至 150 万例新发病例，先天性梅毒仍是资源匮乏国家中新生儿、婴儿和儿童发病率和死亡率的主要传染病病因。因此，我们分析了坦桑尼亚农村医院儿科患者群体中先天性梅毒的发病程度。
本回顾性分析收集了 1998 年 1 月 1 日至 2000 年 8 月 31 日期间 Haydom Lutheran 医院新生儿和儿科病房的所有先天性梅毒病例。记录并分析了年龄、性别、体重、临床体征和症状、母亲和/或儿童的性病研究实验室（VDRL）结果、血红蛋白浓度、治疗和结局。
纳入了 14 例新生儿和婴儿。诊断越早，越依赖于母亲的数据，因为新生儿先天性梅毒的表现类似于新生儿败血症。梅毒皮肤损伤仅见于新生儿后期。14 例母亲中有 11 例 VDRL 结果阳性，4 例婴儿 VDRL 结果阳性。年长婴儿中贫血很常见。无患者出现中枢神经系统受累迹象。2 例患者死亡，其余患者经普鲁卡因青霉素标准治疗后痊愈。
本报告强调了先天性梅毒的多变表现，表明在资源匮乏的环境中仅通过病史和临床表现做出正确诊断非常困难。因此，假阳性和假阴性诊断很常见，临床医生在诊断先天性梅毒时必须保持高度警惕。因此，控制并最终消除先天性梅毒作为一个主要公共卫生问题的一个重要方法将是对所有初次产前检查的孕妇进行现场梅毒筛查，并对阳性孕妇立即进行治疗。
