University of Missouri Kansas City, Kansas City, MO; Children's Mercy Hospital, Kansas City, MO; University of Texas Southwestern Medical Center, Dallas, TX; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
University of Texas Southwestern Medical Center, Dallas, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX.
J Pediatr. 2023 Dec;263:113650. doi: 10.1016/j.jpeds.2023.113650. Epub 2023 Aug 1.
To document the case-fatality rate (CFR) of congenital syphilis diagnosed by molecular tools and rabbit infectivity testing (RIT) of clinical specimens in addition to standard evaluation and to compare that with the CFR using the Centers for Disease Control and Prevention (CDC) surveillance case definition.
Prospective, single site, cohort study of all cases of syphilis among mothers and their infants from 1984 to 2002. The diagnosis of congenital syphilis was determined using IgM immunoblotting, polymerase chain reaction, and RIT of fetal or infant specimens in addition to clinical, laboratory, and radiographic criteria. Data were retrospectively reviewed to ascertain fetal and neonatal mortality.
During the 18-year study, there were 191 cases of congenital syphilis confirmed by abnormalities on clinical, laboratory, or radiographic evaluation and/or positive serum IgM immunoblot, blood polymerase chain reaction, or blood/cerebrospinal fluid RIT. Of the 191 cases, 59 died for a CFR of 31%. Of the 59 deaths, 53 (90%) were stillborn and 6 (10%) died in the neonatal period. The majority (74%, 39/53) of stillbirths occurred in the third trimester. The CDC surveillance case definition correctly identified all infants with congenital syphilis, but the CDC CFR was 10% which underestimated the CFR by more than 300%.
Our findings corroborate the high sensitivity of the CDC surveillance definition for congenital syphilis but highlight its poor estimation of its associated mortality. The CFR among infected progeny of pregnant women with syphilis was 31%, due mostly to demise in the third trimester and as such highlights the need for detection and appropriate treatment of syphilis during pregnancy.
除了标准评估外，通过分子工具和临床标本的兔传染性试验（RIT）记录先天梅毒的病死率（CFR），并与使用疾病控制和预防中心（CDC）监测病例定义的 CFR 进行比较。
对 1984 年至 2002 年间所有患有梅毒的母亲及其婴儿的病例进行前瞻性、单站点、队列研究。除了临床、实验室和影像学标准外，还通过 IgM 免疫印迹、聚合酶链反应和胎儿或婴儿标本的 RIT 来确定先天梅毒的诊断。回顾性审查数据以确定胎儿和新生儿的死亡率。
在 18 年的研究中，有 191 例先天梅毒病例通过临床、实验室或影像学评估异常和/或血清 IgM 免疫印迹、血液聚合酶链反应或血液/脑脊液 RIT 阳性得到确认。在 191 例病例中，有 59 例死亡，CFR 为 31%。在 59 例死亡中，有 53 例（90%）为死产，6 例（10%）在新生儿期死亡。大多数（74%，39/53）死产发生在孕晚期。CDC 监测病例定义正确识别了所有患有先天梅毒的婴儿，但 CDC CFR 为 10%，低估了 CFR 超过 300%。
我们的发现证实了 CDC 监测先天梅毒定义的高敏感性，但强调了其对相关死亡率的估计不佳。患有梅毒的孕妇所生感染后代的 CFR 为 31%，主要归因于孕晚期死亡，因此强调了在怀孕期间检测和适当治疗梅毒的必要性。
