Palabras clave
Sífilis Congénita
Neurosífilis
Embarazo
Treponema pallidum
Neurosífilis
Embarazo
Treponema pallidum
Cómo citar
Cifuentes Cifuentes, Y., Angel-Müller, E., & Díaz Moreno, R. C. (2020). Sífilis congénita resultado de una Neurosífilis materna no diagnosticada. Reporte de caso. Médicas UIS, 33(1), 73–80. https://doi.org/10.18273/revmed.v33n1-2020009
Resumen
En el mundo, se ha evidenciado un aumento de los casos de sífilis, de sífilis gestacional y de sífilis congénita. Se presenta el caso de un recién nacido con sífilis congénita, hijo de una madre con sífilis latente de duración indeterminada (VDRL 1:4 diluciones) diagnosticada y tratada a la semana 12 de gestación, VIH negativa, con compañero seronegativo para sífilis; a esar del tratamiento con tres dosis de 2’400 000 U de penicilina benzatínica, no modificó los títulos del VDRL ni en el control de la semana 25 de gestación, ni en el momento del
parto. En el posparto, la madre fue diagnosticada con neurosífilis y recibió tratamiento con penicilina cristalina durante 14 días. El recién nacido fue diagnosticado con sífilis congénita por presentar VDRL 1:4 diluciones, aumento de aminotransferasas, hematuria y proteinuria, recibiendo tratamiento con penicilina cristalina durante 10 días. La paciente evolucionó favorablemente y el control a los 6 meses fue normal. Deben fomentarse medidas útiles en la prevención de la sífilis gestacional: métodos de barrera, conocimiento de la enfermedad y
asistencia a control prenatal. Es fundamental identificar y tratar a las gestantes con sífilis mediante tamizaje serológico para prevenir la sífilis congénita; el seguimiento serológico debe ser estricto para verificar la eficacia del tratamiento e investigar las gestantes que no modifican los títulos después del tratamiento. MÉD.UIS.2020;33(1):73-80.
Referencias
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5. Colombia Ministerio de Salud y Protección Social, Colciencias. Guía de práctica clínica (GPC) basada en la evidencia para la atención integral de la sífilis gestacional y congénita : guía completa
Internet]. 2014 [cited 2018 Apr 24]. p. 126. Available from: https://www.minsalud.gov.co/sites/rid/Lists/ BibliotecaDigital/RIDE/INEC/IETS/gpc –guia-completa-sifilis.pdf
6. Centers for Disease Control and Prevention. Department of Health and Human Services. Congenital Syphilis (cs) Case Investigation and report Disease.
7. Harter C, Benirschke K. Fetal syphilis in the first trimester. Am J Obs Gynecol. 1976;124(7):705–11.
8. Nathan L, Bohman V, Sanchez P, Al. E. In utero infection with Treponema pallidum in early pregnancy. Prenat Diagn. 1997;17(2):119–23.
9. Fiumara N. Serologic responses to treatment of 128 patients with late latent syphilis. Sex Transm Dis. 1979;6(4):243–6.
10. Lago EG, Vaccari A, Fiori RM. Clinical features and follow-up of 79 Sífilis congénita resultado de una Neurosífilis materna no diagnosticada. Reporte de caso congenital syphilis. Sex Transm Dis.
013 Feb;40(2):85–94.
11. Cifuentes-Cifuentes MY, Ojeda-Enriquez C V. [The congenital syphilis protocol used at the Instituto Materno Infantil-Hospital la Victoria, Bogota]. Rev Salud Publica (Bogota). 2013;15(3):434–45.
12. Balaji G, Kalaivani S. Observance of Kassowitz law-late congenital syphilis: Palatal perforation and saddle nose deformity as presenting features. Indian J Sex Transm Dis AIDS. 2013;34(1):35–7.
13. Khetarpal S, Kempf E, Mostow E. Congenital syphilis: early- and late-stage findings of rhagades and dental anomalies. Pediatr Dermatol. 2011;28(4):401–3.
14. Conde-Sendín M, Hernández-Fleta J, Cárdenas-Santana M, Amela- Peris R. Neurosyphilis: Forms of presentation and clinical management. 2002;35:380-6. Rev Neurol. 2002;35:380–6.
15. Workowski KA, Bolan GA. Sexually Transmitted Diseases Treatment Guidelines [Internet]. Vol. 64, Morbidity and Mortality Weekly Report (MMWR). 2015. 1–137 p. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm
16. Myer L, AbdoolKarim S, Lombard C, Wilkinson D. Treatment of maternal syphilisin rural South Africa: effect of multiple doses of benzathine penicillin on pregnancy loss. Trop Med Int Heal. 2004;9(11):1216–21.
17. Blencowe H, Cousens S, Kamb M, Berman S, Lawn JE. Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality.
MC Public Health. 2011 Apr;11 Suppl 3:S9.
18. Seña A, Wolff M, Behets F, Martin D, Al E. Rat of Decline in Nontreponemal Antibody Titers and Seroreversion After Treatment of Early Syphilis. Sex Transm Dis. 2017;44(1):6–10.
19. Brown T, aidi A, Larsen SA, Reynolds GH. Serological response to syphilis treatment. A new analysis of old data. JAMA. 1985 Mar;253(9):1296–9.
20. Alexander JM, Sheffield JS, Sánchez PJ, Mayfield J WG. Efficacy of treatment for syphilis in pregnancy. Obstet Gynecol. 1999;93:5–8.
21. Smith ML, Wilson KL, Bergeron CD. Condom Use for Sexually Transmitted Infection Prevention Among Hispanic Teenage Mothers: A Community-Based Randomized Trial. J Womens Health Larchmt). 2019 Sep;
22. Taylor M, Prescott L, Brown J, Wong W, Allen M, Broussard D, et al. Activities to increase provider awareness of early syphilis in men who have sex with men in 8 cities, 2000-2004. Sex Transm Dis. 2005 Oct;32(10 Suppl):S24-9.
23. Chen Y-F, Ding J-P, Yan H-J, Lu J, Ding P, Chen G-H, et al. The current status of syphilis prevention and control in Jiangsu province, China: A cross-sectional study. PLoS One.
017;12(8):e0183409.
24. Samkange-Zeeb FN, Spallek L, Zeeb H. Awareness and knowledge of sexually transmitted diseases (STDs) among schoolgoing adolescents in Europe: a systematic review of published literature. BMC Public ealth. 2011 Sep;11:727.
25. Qin J-B, Feng T-J, Yang T-B, Hong F-C, Lan L-N, Zhang C-L, et al. Synthesized prevention and control of one decade for motherto-child transmission of syphilis and determinants associated with
ongenital syphilis and adverse pregnancy outcomes in Shenzhen, South China. Eur J Clin Microbiol Infect Dis. 2014 Dec;33(12):2183–98.
26. Katoba J, Kuupiel D, Mashamba-Thompson TP. Toward Improving Accessibility of Point-of-Care Diagnostic Services for Maternal and Child Health in Low- and Middle-Income Countries. Point Care. 2019 Mar;18(1):17–25.
27. Hawkes S, Matin N, Broutet N, Low N. Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis. 2011 Sep;11(9):684–91.
28. Nkamba D, Mwenechanya M, Kilonga AM, Cafferata ML, Berrueta AM, Mazzoni A, et al. Barriers and facilitators to the implementation of antenatal syphilis screening and treatment for the
revention of congenital syphilis in the Democratic Republic of Congo and Zambia: results of qualitative formative research. BMC Health Serv Res. 2017 Aug;17(1):556.
29. Hawkes SJ, Gomez GB, Broutet N. Early antenatal care: does it make a difference to outcomes of pregnancy associated withsyphilis? A systematic review and meta-analysis. PLoS One.
2013;8(2):e56713.
30. Sena AC, Pillay A, Cox DL RJ. Treponema and brachyspira, human host-associated spirochetes. In: Jorgensen JH, Pfaller MA,Carroll KC et al., editor. Manual of Clinical Microbiology. 11th ed.
ashington D.C.: Press, ASM; 2015.
31. French P, Gomberg M, Janier M, Schmidt B, van Voorst Vader P, Young H. IUSTI: 2008 European Guidelines on the Management of Syphilis. Int J STD AIDS. 2009 May;20(5):300–9. 32.
uddenham S, Ghanem KG. Neurosyphilis: Knowledge Gaps and Controversies. Sex Transm Dis. 2018 Mar;45(3):147–51.
33. Drago F, Merlo G, Ciccarese G, Agnoletti A, Cozzani E, Rebora A, et al. Changes in neurosyphilis presentation: a survey on 286 patients. J Eur Acad Dermatol Venereol. 2016;30(11):1886–900.
34. Smibert OC, Jenney AWJ, Spelman DW. Management of neurosyphilis: time for a new approach? Intern Med J. 2018 Feb;48(2):204–6.
35. De Voux A, Kidd S, Torrone EA. Reported Cases of Neurosyphilis Among Early Syphilis Cases-United States, 2009 to 2015. Sex Transm Dis. 2018 Jan;45(1):39–41. Shi M, Peng R-R, Gao Z,
hang S, Lu H, Guan Z, et al. Risk profilesof neurosyphilis in HIV-negative patients with primary, secondary and latent syphilis: implications for clinical intervention. J Eur Acad Dermatol Venereol. 2016
pr;30(4):659–66.
37. Hagihara M, Yamagishi Y, Kato H, Shibata Y, Shiota A, Sakanashi D, et al. Frequency of Treponema pallidum invasion into cerebrospinal fluid in primary or secondary early-stage syphilis. J Infect
hemother Off J Japan Soc Chemother. 2018 ay;24(5):404–6.
38. Cai SN, Long J, Chen C, Wan G, Lun WH. Incidence of asymptomatic neurosyphilis in serofast Chinese syphilis patients. Sci Rep. 2017 Nov;7(1):15456. 39. Xiao Y, Tong M-L, Lin L-R, Liu L-L,
ao K, Chen M-J, et al. Serological Response Predicts Normalization of Cerebrospinal Fluid Abnormalities at Six Months after Treatment in HIVNegative Neurosyphilis Patients. Sci Rep. 2017
ug;7(1):9911.
40. Vallejo C, Cifuentes Y. Characterization and six-month follow-up on a cohort of newborns with congenital syphilis. Biomedica. 2016 Mar;36(1):101–8.
41. Oomeer S, Alagaratnam J, Lyall H, Gurtin D, Goldmeier D. Seven years of undiagnosed syphilis: a missed opportunity for mother and child. Int J STD AIDS. 2015 Nov;26(13):982–4. 42. De la
alle M, Cruceyra M, de Haro M, Magdaleno F, Montero MD, Aracil J, et al. [Syphilis and pregnancy: study of 94 cases]. Med Clin (Barc). 2013 Aug;141(4):141–4.
43. Sheffield JS, Sánchez PJ, Morris G et al. Congenital syphilis after maternal treatment for syphilis during pregnancy. Am J Obs Gynecol. 2002;186:569–73.
2. Korenromp E, Rowley J, Alonso M, Mello M, Wijesooriya N, Al. E. Global burden of maternal and congenital syphilis and associated adverse birth outcomes—Estimates for 2016 and progress since 2012. PLoS One [Internet]. 2019;14(7):e0219613. Available from: https://doi.org/10.1371/journal.pone.0219613
3. Equipo Infecciones de Transmisión Sexual, Grupo Transmisibles IN de S. Protocolo de Vigilancia en Salud Pública sifilis gestacional y sífilis congénita [Internet]. 2015 [cited 2018 Jan 28]. p. 40. vailable from: https://www.minsalud.gov.co/sites/rid/ Lists/BibliotecaDigital/RIDE/IA/INS/protocolo-vigilancia-sifilisgestacional.pdf
4. Ministerio de salud de Colombia. Situación de las infecciones de transmisión sexual diferentes al VIH. Colombia 2009 - 2011 [Internet]. [cited -2018 Apr 24]. Available from: https://www.minsalud.gov.co/salud/Documents/observatorio_vih/documentos/monitoreo_evaluacion/1_vigilancia_salud_ publica/a_situacion_epidimiologica/SITUACIONDELASINFECCIONESDERANSMISION1.pdf
5. Colombia Ministerio de Salud y Protección Social, Colciencias. Guía de práctica clínica (GPC) basada en la evidencia para la atención integral de la sífilis gestacional y congénita : guía completa
Internet]. 2014 [cited 2018 Apr 24]. p. 126. Available from: https://www.minsalud.gov.co/sites/rid/Lists/ BibliotecaDigital/RIDE/INEC/IETS/gpc –guia-completa-sifilis.pdf
6. Centers for Disease Control and Prevention. Department of Health and Human Services. Congenital Syphilis (cs) Case Investigation and report Disease.
7. Harter C, Benirschke K. Fetal syphilis in the first trimester. Am J Obs Gynecol. 1976;124(7):705–11.
8. Nathan L, Bohman V, Sanchez P, Al. E. In utero infection with Treponema pallidum in early pregnancy. Prenat Diagn. 1997;17(2):119–23.
9. Fiumara N. Serologic responses to treatment of 128 patients with late latent syphilis. Sex Transm Dis. 1979;6(4):243–6.
10. Lago EG, Vaccari A, Fiori RM. Clinical features and follow-up of 79 Sífilis congénita resultado de una Neurosífilis materna no diagnosticada. Reporte de caso congenital syphilis. Sex Transm Dis.
013 Feb;40(2):85–94.
11. Cifuentes-Cifuentes MY, Ojeda-Enriquez C V. [The congenital syphilis protocol used at the Instituto Materno Infantil-Hospital la Victoria, Bogota]. Rev Salud Publica (Bogota). 2013;15(3):434–45.
12. Balaji G, Kalaivani S. Observance of Kassowitz law-late congenital syphilis: Palatal perforation and saddle nose deformity as presenting features. Indian J Sex Transm Dis AIDS. 2013;34(1):35–7.
13. Khetarpal S, Kempf E, Mostow E. Congenital syphilis: early- and late-stage findings of rhagades and dental anomalies. Pediatr Dermatol. 2011;28(4):401–3.
14. Conde-Sendín M, Hernández-Fleta J, Cárdenas-Santana M, Amela- Peris R. Neurosyphilis: Forms of presentation and clinical management. 2002;35:380-6. Rev Neurol. 2002;35:380–6.
15. Workowski KA, Bolan GA. Sexually Transmitted Diseases Treatment Guidelines [Internet]. Vol. 64, Morbidity and Mortality Weekly Report (MMWR). 2015. 1–137 p. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm
16. Myer L, AbdoolKarim S, Lombard C, Wilkinson D. Treatment of maternal syphilisin rural South Africa: effect of multiple doses of benzathine penicillin on pregnancy loss. Trop Med Int Heal. 2004;9(11):1216–21.
17. Blencowe H, Cousens S, Kamb M, Berman S, Lawn JE. Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality.
MC Public Health. 2011 Apr;11 Suppl 3:S9.
18. Seña A, Wolff M, Behets F, Martin D, Al E. Rat of Decline in Nontreponemal Antibody Titers and Seroreversion After Treatment of Early Syphilis. Sex Transm Dis. 2017;44(1):6–10.
19. Brown T, aidi A, Larsen SA, Reynolds GH. Serological response to syphilis treatment. A new analysis of old data. JAMA. 1985 Mar;253(9):1296–9.
20. Alexander JM, Sheffield JS, Sánchez PJ, Mayfield J WG. Efficacy of treatment for syphilis in pregnancy. Obstet Gynecol. 1999;93:5–8.
21. Smith ML, Wilson KL, Bergeron CD. Condom Use for Sexually Transmitted Infection Prevention Among Hispanic Teenage Mothers: A Community-Based Randomized Trial. J Womens Health Larchmt). 2019 Sep;
22. Taylor M, Prescott L, Brown J, Wong W, Allen M, Broussard D, et al. Activities to increase provider awareness of early syphilis in men who have sex with men in 8 cities, 2000-2004. Sex Transm Dis. 2005 Oct;32(10 Suppl):S24-9.
23. Chen Y-F, Ding J-P, Yan H-J, Lu J, Ding P, Chen G-H, et al. The current status of syphilis prevention and control in Jiangsu province, China: A cross-sectional study. PLoS One.
017;12(8):e0183409.
24. Samkange-Zeeb FN, Spallek L, Zeeb H. Awareness and knowledge of sexually transmitted diseases (STDs) among schoolgoing adolescents in Europe: a systematic review of published literature. BMC Public ealth. 2011 Sep;11:727.
25. Qin J-B, Feng T-J, Yang T-B, Hong F-C, Lan L-N, Zhang C-L, et al. Synthesized prevention and control of one decade for motherto-child transmission of syphilis and determinants associated with
ongenital syphilis and adverse pregnancy outcomes in Shenzhen, South China. Eur J Clin Microbiol Infect Dis. 2014 Dec;33(12):2183–98.
26. Katoba J, Kuupiel D, Mashamba-Thompson TP. Toward Improving Accessibility of Point-of-Care Diagnostic Services for Maternal and Child Health in Low- and Middle-Income Countries. Point Care. 2019 Mar;18(1):17–25.
27. Hawkes S, Matin N, Broutet N, Low N. Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis. 2011 Sep;11(9):684–91.
28. Nkamba D, Mwenechanya M, Kilonga AM, Cafferata ML, Berrueta AM, Mazzoni A, et al. Barriers and facilitators to the implementation of antenatal syphilis screening and treatment for the
revention of congenital syphilis in the Democratic Republic of Congo and Zambia: results of qualitative formative research. BMC Health Serv Res. 2017 Aug;17(1):556.
29. Hawkes SJ, Gomez GB, Broutet N. Early antenatal care: does it make a difference to outcomes of pregnancy associated withsyphilis? A systematic review and meta-analysis. PLoS One.
2013;8(2):e56713.
30. Sena AC, Pillay A, Cox DL RJ. Treponema and brachyspira, human host-associated spirochetes. In: Jorgensen JH, Pfaller MA,Carroll KC et al., editor. Manual of Clinical Microbiology. 11th ed.
ashington D.C.: Press, ASM; 2015.
31. French P, Gomberg M, Janier M, Schmidt B, van Voorst Vader P, Young H. IUSTI: 2008 European Guidelines on the Management of Syphilis. Int J STD AIDS. 2009 May;20(5):300–9. 32.
uddenham S, Ghanem KG. Neurosyphilis: Knowledge Gaps and Controversies. Sex Transm Dis. 2018 Mar;45(3):147–51.
33. Drago F, Merlo G, Ciccarese G, Agnoletti A, Cozzani E, Rebora A, et al. Changes in neurosyphilis presentation: a survey on 286 patients. J Eur Acad Dermatol Venereol. 2016;30(11):1886–900.
34. Smibert OC, Jenney AWJ, Spelman DW. Management of neurosyphilis: time for a new approach? Intern Med J. 2018 Feb;48(2):204–6.
35. De Voux A, Kidd S, Torrone EA. Reported Cases of Neurosyphilis Among Early Syphilis Cases-United States, 2009 to 2015. Sex Transm Dis. 2018 Jan;45(1):39–41. Shi M, Peng R-R, Gao Z,
hang S, Lu H, Guan Z, et al. Risk profilesof neurosyphilis in HIV-negative patients with primary, secondary and latent syphilis: implications for clinical intervention. J Eur Acad Dermatol Venereol. 2016
pr;30(4):659–66.
37. Hagihara M, Yamagishi Y, Kato H, Shibata Y, Shiota A, Sakanashi D, et al. Frequency of Treponema pallidum invasion into cerebrospinal fluid in primary or secondary early-stage syphilis. J Infect
hemother Off J Japan Soc Chemother. 2018 ay;24(5):404–6.
38. Cai SN, Long J, Chen C, Wan G, Lun WH. Incidence of asymptomatic neurosyphilis in serofast Chinese syphilis patients. Sci Rep. 2017 Nov;7(1):15456. 39. Xiao Y, Tong M-L, Lin L-R, Liu L-L,
ao K, Chen M-J, et al. Serological Response Predicts Normalization of Cerebrospinal Fluid Abnormalities at Six Months after Treatment in HIVNegative Neurosyphilis Patients. Sci Rep. 2017
ug;7(1):9911.
40. Vallejo C, Cifuentes Y. Characterization and six-month follow-up on a cohort of newborns with congenital syphilis. Biomedica. 2016 Mar;36(1):101–8.
41. Oomeer S, Alagaratnam J, Lyall H, Gurtin D, Goldmeier D. Seven years of undiagnosed syphilis: a missed opportunity for mother and child. Int J STD AIDS. 2015 Nov;26(13):982–4. 42. De la
alle M, Cruceyra M, de Haro M, Magdaleno F, Montero MD, Aracil J, et al. [Syphilis and pregnancy: study of 94 cases]. Med Clin (Barc). 2013 Aug;141(4):141–4.
43. Sheffield JS, Sánchez PJ, Morris G et al. Congenital syphilis after maternal treatment for syphilis during pregnancy. Am J Obs Gynecol. 2002;186:569–73.
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