Wendel G D, Maberry M C, Christmas J T, Goldberg M S, Norgard M V
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas.
Obstet Gynecol. 1989 Dec;74(6):967-70.
The diagnosis of congenital syphilis is difficult, particularly in stillborn fetuses, who are often macerated and have undergone autolysis. These changes can obscure both syphilitic histologic findings and special stains for spirochetes in tissue specimens used to confirm the diagnosis of congenital syphilis. Five gravidas with untreated syphilis and fetal deaths underwent sonographic examination and amniocentesis. In all five cases, dark-field microscopic examination of the amniotic fluid showed spirochetes with morphology and motility characteristic of Treponema pallidum. Organisms were infrequent, but easily identified at 400x magnification and confirmed using an oil-immersion objective yielding a 900x magnification. After delivery, fetal-placental examination and autopsy showed clinical findings typical of congenital syphilis in all five cases. Histologic changes compatible with syphilis were found in all four autopsied fetuses. Silver impregnation stains were positive in two of five tissue specimens, and anti-treponemal monoclonal antibody immunofluorescence assays were positive in one of three amniotic fluid specimens examined retrospectively, further strengthening the specificity of the dark-field microscopic identification of spirochetes. This technique, which can make the diagnosis of congenital syphilis, is recommended for women with syphilis and a fetal death, especially if sonographic hydrops and/or edema is present or if an autopsy will not be performed.
先天性梅毒的诊断较为困难，尤其是对于死产胎儿，他们往往已经浸软并发生了自溶。这些变化会掩盖用于确诊先天性梅毒的组织标本中的梅毒组织学表现和螺旋体特殊染色结果。对5例未经治疗的梅毒孕妇及胎儿死亡病例进行了超声检查和羊膜腔穿刺术。在所有5例病例中，羊水的暗视野显微镜检查均显示出具有梅毒螺旋体形态和运动特征的螺旋体。微生物数量不多，但在400倍放大倍数下易于识别，并使用油镜物镜确认，放大倍数可达900倍。分娩后，对胎儿-胎盘进行检查和尸检，所有5例病例均显示出先天性梅毒的典型临床表现。在所有4例接受尸检的胎儿中均发现了与梅毒相符的组织学变化。5个组织标本中有2个银浸染染色呈阳性，回顾性检查的3份羊水标本中有1份抗梅毒螺旋体单克隆抗体免疫荧光试验呈阳性，进一步强化了暗视野显微镜下螺旋体鉴定的特异性。对于患有梅毒且胎儿死亡的女性，尤其是存在超声检查发现水肿和/或积液或不进行尸检的情况，推荐使用这种能够诊断先天性梅毒的技术。
