Congenital syphilis confirmed by pcr as a result of treatment failure for syphilis in pregnancy. case report

ABSTRACT Introduction: Congenital syphilis is a major public health problem, and early diagnosis and treatment are necessary to prevent it. Penicillin G benzathine is the treatment of choice in pregnant women; however, it may fail to prevent fetal infection, as in the present case. Case presentation: Male newborn, son of an HIV negative mother with gestational syphilis (venereal disease research laboratory (VDRL) 1:4 dilution, positive treponemal test) diagnosed at week 21 of gestation and treated with three doses of 2 400 000 IU of penicillin G benzathine. At delivery, the mother presented VDRL 1:1 dilution. The newborn was diagnosed with congenital syphilis due to VDRL 1:4 dilution, positive treponemal test, elevated aspartate aminotransferases, hypos-thenuria, proteinuria, hematuria, and leukocyturia that resolved after treatment with crystalline penicillin for 10 days. The molecular testing in blood showed a high treponemal load. The VDRL test at 3 months was non-reactive. Conclusions: Preventing congenital syphilis with the recommended treatment for gestational syphilis may fail. Moreover, diagnosing this condition in an asymptomatic newborn is difficult. Therefore, clinical and serological tests are recommended to confirm whether maternal treatment was effective in the fetus.

RESUMEN Introducción. La sífilis congénita es un importante problema de salud pública y para prevenirla es necesario diagnosticar y tratar la sífilis gestacional de forma temprana. En el presente caso la gestante recibió el tratamiento de elección (penicilina benzatínica), pero este no previno la infección fetal. Presentación del caso. Recién nacido masculino, hijo de una madre con serología negativa para el virus de la inmunodeficiencia humana y positiva para sífilis gestacional diagnosticada en la semana 21 (prueba VDRL con dilución 1:4 y prueba treponémica rápida positiva) y tratada con tres dosis de 2 400 000 UI de penicilina benzatínica. En el parto, la madre presentó VDRL con dilución 1:1 y el recién nacido fue diagnosticado con sífilis congénita por presentar VDRL con dilución 1:4, prueba treponémica rápida positiva, niveles de aspartato aminotransferasa elevados, hipostenuria, proteinuria, hematuria y leucocituria, condiciones que se resolvieron luego de recibir tratamiento con penicilina cristalina durante 10 días. El estudio molecular en sangre realizado al momento del nacimiento evidenció una alta presencia de Treponema pallidum. La prueba VDRL a los 3 meses fue no reactiva. Conclusiones. Prevenir la sífilis congénita con el tratamiento recomendado para sífilis gestacional puede fallar, además, diagnosticar sífilis congénita en un recién nacido asintomático es difícil, por lo cual se recomienda hacer un seguimiento clínico y serológico para confirmar si el tratamiento materno fue efectivo en el feto.

Effect of benzathine penicillin combined with ceftriaxone on the results of rapid plasma reagin circle card test/toluidine red unheated serum test in the treatment of early syphilis: a meta-analysis / 中华皮肤科杂志

Objective:To systematically evaluate the efficacy of benzathine penicillin combined with ceftriaxone on the negative conversion rate of the rapid plasma reagin circle card test/toluidine red unheated serum test (RPR/TRUST) in the treatment of early syphilis.Methods:According to the search strategy, online databases (PubMed, Web of science, Embase, Cochrane Library, CNKI, Wanfang and VIP) were searched for case-control studies on benzathine penicillin combined with ceftriaxone in the treatment of early syphilis. The Newcastle Ottawa scale (NOS) was used to evaluate the quality of the included articles, and the RevMan5.3 software to analyze the negative conversion rate of RPR/TRUST.Results:A total of 14 case-control studies were included, including 1 160 syphilis patients (585 in the combination treatment group and 575 in the benzathine penicillin alone group) . According to the meta-analysis, the negative conversion rate of serum RPR/TRUST was significantly higher in the combination treatment group than in the benzathine penicillin alone group ( OR=3.70, 95% CI[2.71, 5.06], P<0.001) . Subgroup analysis based on the follow-up duration, the negative conversion rate of serum RPR/TRUST was also significantly higher in the combination treatment group than in the benzathine penicillin alone group after 3-month ( OR=3.68, 95% CI [2.26, 5.98], P<0.001) , 6-month ( OR=3.11, 95% CI[2.26, 4.27], P<0.001) and 12-month treatment ( OR=4.35, 95% CI[2.81, 6.73], P<0.001) . Conclusion:Compared with benzathine penicillin, benzathine penicillin combined with ceftriaxone can more effectively promote serum RPR/TRUST to turn negative in the treatment of early syphilis.

Who was affected by the shortage of penicillin for syphilis in Rio de Janeiro, 2013-2017? / A quem afetou o desabastecimento de penicilina para sífilis no Rio de Janeiro, 2013-2017?

ABSTRACT OBJECTIVE To analyze the shortage of benzathine penicillin G (BPG), characterizing its temporal evolution and spatial distribution in the city of Rio de Janeiro from 2013 to 2017. METHODS This ecological study used gestational and congenital syphilis notifications, BPG distribution records, and sociodemographic data from the population of Rio de Janeiro. To quantify the shortage, a BPG supply indicator was estimated per quarter for each neighborhood between 2013 and 2017. Thematic maps were created to identify areas and periods with greater BPG shortage, described according to sociodemographic factors, health services network, and epidemiological features in the incidence of syphilis. RESULTS BPG shortage in Rio de Janeiro from 2013 to 2017 was not homogeneous in space nor in time. The temporal evolution and spatial distribution of BPG scarcity shows that the shortage affected the inhabitants of the municipality in different ways. Shortage was lower in 2013 and 2016 and more severe in 2014, 2015, and 2017, particularly in neighborhoods within the programmatic areas PA3 and PA5, poorer and with higher prevalence rates of gestational and congenital syphilis. CONCLUSIONS Analyzing BPG shortage and its temporal evolution and spatial distribution in Rio de Janeiro allowed us to realize that the inhabitants are affected in different ways. Understanding this process contributes to the planning of actions to face shortage crises, minimizing possible impacts on the management of syphilis and reducing inequality in access to treatment.

RESUMO OBJETIVO Analisar o desabastecimento da penicilina benzatina (PB), caracterizando sua evolução temporal e distribuição espacial no município do Rio de Janeiro de 2013 a 2017. MÉTODOS Trata-se de estudo ecológico misto realizado com notificações de sífilis gestacional e congênita, registros de distribuição de PB e de dados sociodemográficos da população dos bairros do município do Rio de Janeiro. Para mensurar o desabastecimento foi calculado por trimestre um indicador de abastecimento de PB para cada bairro, entre 2013 e 2017. Mapas temáticos foram produzidos para identificar áreas e períodos com maior desabastecimento de PB, o qual foi descrito segundo condições sociodemográficas, rede de serviços de saúde e aspectos epidemiológicos da incidência de sífilis por bairro. RESULTADOS O desabastecimento de PB no município do Rio de Janeiro, no período de 2013 a 2017, não foi homogêneo no espaço ou no tempo. A evolução temporal e a distribuição espacial da escassez de PB revelam que o desabastecimento afetou de formas distintas os habitantes do município, sendo menor em 2013 e 2016 e mais intenso em 2014, 2015 e 2017, principalmente nos bairros das áreas programáticas AP3 e AP5, mais pobres e com maiores taxas de sífilis gestacional e congênita. CONCLUSÕES Analisar o desabastecimento de PB e sua evolução temporal e distribuição espacial no município do Rio de Janeiro permitiu reconhecer que os habitantes do município são afetados de diferentes modos. Compreender esse processo ajuda a planejar ações para enfrentar crises de desabastecimento, minimizando possíveis impactos no controle da sífilis, além de reduzir a desigualdade no acesso ao tratamento.

Secondary syphilis: The great imitator can't be forgotten / Sífilis secundária: a grande imitadora não pode ser esquecida

Summary Syphilis is an infection caused by Treponema pallidum, mainly transmitted by sexual contact. Since 2001, primary and secondary syphilis rates started to rise, with an epidemic resurgence. The authors describe an exuberant case of secondary syphilis, presenting with annular and lichen planus-like lesions, as well as one mucocutaneous lesion. Physicians must be aware of syphilis in daily practice, since the vast spectrum of its cutaneous manifestations is rising worldwide.

Resumo A sífilis é uma infecção causada pela espiroqueta Treponema pallidum, transmitida principalmente por contato sexual. Desde 2001, houve o ressurgimento dessa epidemia, com aumento das taxas de sífilis primária e secundária. Os autores descrevem um caso exuberante de sífilis secundária apresentando lesões cutâneas anulares e lesões que lembram líquen plano, além de uma lesão mucocutânea. Médicos de todas as especialidades devem estar cientes das diversas apresentações de sífilis: o vasto espectro de manifestações cutâneas da sífilis secundária e as crescentes taxas dessa patologia representam um desafio.

Influences of improved intramuscular injection on quality of benzathine benzylpenicillin medication / 中华护理杂志

Objective To explore influences of improved intramuscular injection on quality of benzathine benzylpenicillin medication.Methods The cluster random sampling was adopted to select 178 patients who needed injection of 240U benzathine benzylpenicillin.A self-control study design was used,and benzathine benzylpenicillin was injected in both sides with each of 1 200 000 units.The left side was injected via routine method,while the right side was injected by an improved intramuscular injection.One-time success rate,degree and duration of pain during and after injection were recorded.Results The differences of one-time success rate,pain during injection,pain after injection,duration of pain after injection and incidence of induration after injection between two groups were statistically significant(P＜0.01).Conclusion The improved intramuscular injection can improve one-time success rate of benzathine benzylpenicillin,reduce pain during injection and local pain after injection,shorten duration of pain and decrease incidence of induration after injection.

Tratamiento anticoagulante y vasodilatador para el síndrome de Nicolau tras la administración de una inyección de bencilpenicilina benzatínica intramuscular a un niño de cuatro años de edad / Anticoagulant and vasodilator therapy for Nicolau syndrome following intramuscular benzathine penicillin injection in a 4 year old boy

El síndrome de Nicolau (SN) es una complicación rara de la inyección de ciertos fármacos por vía intramuscular, intrarticular o subcutánea, que produce necrosis isquémica de la piel, las partes blandas y el tejido muscular circundante. La bencilpenicilina benzatínica es uno de los antibióticos más ampliamente empleados para las infecciones de las vías respiratorias altas y raramente se ha notificado que produzca SN. En este artículo presentamos el caso de un niño de sexo masculino de cuatro años de edad diagnosticado con SN tras la inyección de bencilpenicilina benzatínica tratado satisfactoriamente con heparina fraccionada (enoxaparina) y pentoxifilina. Los médicos deben estar atentos al uso innecesario de bencilpenicilina benzatínica para evitar las probables complicaciones.

Nicolau syndrome (NS) is a rare complication of intramuscular, intraarticular or subcutaneous injection of particular drugs leading to ischemic necrosis of the surrounding skin, soft tissue and muscular tissue. Benzathine penicilin one of the most widely used antibiotic for upper respiratory tract infections and has been rarely reported to cause NS. Here we describe a 4 year old boy with diagnosis of NS after the injection of benzathine penicillin who was successfuly treated with unfractionized heparin (enoxaparine) and pentoxifylline. The practitioners should pay attention for unnecessary use of benzathine penicillin to avoid from probable complications.

Clinical Profile and Factors Related to Compliance with Benzathine Penicillin G Prophylaxis among RF/RHD Patients at the Tarlac Provincial Hospital, Philippines.

Rheumatic fever (RF) and Rheumatic heart disease (RHD), despite a documented decrease in their incidence, remain as problems in both industrialized and industrializing countries even at the beginning of the 21st century. The most devastating effects are on children and young adults in their most productive years. To determine the clinical profiles of RF/RHD patients at Pediatric Department of Tarlac Provincial Hospital, Tarlac city, Philippines and the factors related to their compliance with Benzathine Penicillin G Prophylaxis treatment, the ex post-facto research was done using the charts of patients. Out patients and ward patients diagnosed with RF/RHD patients were identified using the Jones Criteria. They served as the subjects of the study. The onset of the RF/RHD was seen in age ranging from 6 years to 17 years old with most of them occurring at 7-15 age range. The male to female ratio was 1.3:1. The RF/RHD patients came from different towns of Tarlac, the most number of which came from the city of Tarlac. The patients, being clientele of a provincial and non- paying hospital, came from poor family with low educational attainment, and low monthly income from skilled or unskilled work. Carditis (55% of the 58 cases) and polyarthritis (43%) were the most frequent manifestations seen among patients. In the minor manifestations of RF, majority had episodes of acute tonsillopharyngitis (82%) and fever (82%). Laboratory results, showed abnormal ESR (55 or 95% of the 58 cases), ASO titers (47 or 81%), PR intervals (18 or 31%), and leukocytosis (30 or 67%). Of the 26 cases who had valvular involvement cases, 7 mitral regurgitation; 2 (7%) had mitral stenosis; and 1 had aortic regurgitation. The rest had combination or triple combinations of valvular involvement. Compliance with Benzathine Penicillin G treatment was 46.6%. Compliance to treatment is related to the occupation of father (x2= 6.643, significant at .0361 level) and family income (x2= 8.088, significant at .0175 levels. Poor families who have low paying jobs are less likely to complete the treatment of their sick children. The Department of Health must find ways to provide the secondary chemoprophylaxis to RF/RHD patients for free to improve the compliance rate, thus, provide bigger chance for the RF/RHD patients to survive their disease.

Effectivity and safety of three common antisyphilic drugs in treatment of early syphilis / 中国生化药物杂志

Objective To observe the clinical effect of three antisyphilic drugs in the treatment of early syphilis.Methods From January 2007 to March 2013, 90 cases early syphilis in department of dermatology of our hospital were selected and randomly devided into three groups: benzathine penicillin group, clarithromycin group and azithromycin group.The efficacy including the onset time of improvement, recovery time of skin lesions and TRUST negative conversion rate were compared in three groups.Results The onset time of skin lesions improvement in patients with primary syphilis result showed that there was significant difference between benzathine penicillin and clarithromycin (t =14.603, P<0.05), clarithromycin and azithromycin (t=12.682, P<0.05).While in the treatment of primary syphilis and secondary syphilis, there were no significant differences among recovery time of skin lesions.And there were no significant differences the onset time of skin lesions improvement in treatment of secondary syphilis among three groups.The TRUST negative conversion rates of benzathine penicillin and clarithromycin both were 100%, and azithromycin was 96.7%, with no significant difference.Conclusion The antisyphilic efficacy of three drugs are similar.The patients allergic to penicillin may be treated with clarithromycin or azithromycin, who would aquaire a satisfied result.

Diagnosis and Management of Genital Ulcers.

Herpes simplex virus infection and syphilis are the most common causes of genital ulcers in the United States. Other infectious causes include chancroid, lymphogranuloma venereum, granuloma inguinale (donovanosis), secondary bacterial infections, and fungi. Noninfectious etiologies, including sexual trauma, psoriasis, Behçet syndrome, and fixed drug eruptions, can also lead to genital ulcers. Although initial treatment of genital ulcers is generally based on clinical presentation, the following tests should be considered in all patients: serologic tests for syphilis and darkfield microscopy or direct fluorescent antibody testing for Treponema pallidum, culture or polymerase chain reaction test for herpes simplex virus, and culture for Haemophilus ducreyi in settings with a high prevalence of chancroid. No pathogen is identified in up to 25 percent of patients with genital ulcers. The first episode of herpes simplex virus infection is usually treated with seven to 10 days of oral acyclovir (five days for recurrent episodes). Famciclovir and valacyclovir are alternative therapies. One dose of intramuscular penicillin G benzathine is recommended to treat genital ulcers caused by primary syphilis. Treatment options for chancroid include a single dose of intramuscular ceftriaxone or oral azithromycin, ciprofloxacin, or erythromycin. Lymphogranuloma venereum and donovanosis are treated with 21 days of oral doxycycline. Treatment of noninfectious causes of genital ulcers varies by etiology, and ranges from topical wound care for ulcers caused by sexual trauma to consideration of subcutaneous pegylated interferon alfa-2a for ulcers caused by Behçet syndrome.

Preparation of impurity C in benzathine benzylpenicillin products / 中国药学杂志

OBJECTIVE: To prepare impurity C in benzathine benzylpenicillin products. METHODS: Using the mother liquor of benzathine benzylpenicillin, impurity C was prepared by means of vacuum distillation, column chromatography, and recrystallization. Its molecular structure was confirmed with UV, IR, MS, NMR and elemental analysis. Its purity and correction factor were determined by HPLC method. The contents of impurity C in the samples were determined by external standard method. RESULTS: The prepared product was proved to be impurity C by structure confirmation. CONCLUSION: The preparation of impurity C in benzathine benzylpenicillin products has important significance for the control of related substances of benzathine benzylpenicillin products.

Effect of Oral Doxycycline in the Treatment of Korean Early Syphilis Patients / 대한피부과학회지

No abstract available.

Efeito da penicilina G a cada três semanas sobre o surgimento de Streptococcus viridans resistentes à penicilina na microflora oral / Effect of penicillin G every three weeks on oral microflora by penicillin resistant Viridans Streptococci

FUNDAMENTO: Penicilina G benzatina a cada 3 semanas é o protocolo padrão para a profilaxia secundária para febre reumática recorrente. OBJETIVO: Avaliar o efeito da penicilina G benzatina em Streptococcus sanguinis e Streptococcus oralis em pacientes com doença valvular cardíaca, devido à febre reumática com recebimento de profilaxia secundária. MÉTODOS: Estreptococos orais foram avaliados antes (momento basal) e após 7 dias (7º dia) iniciando-se com penicilina G benzatina em 100 pacientes que receberam profilaxia secundária da febre reumática. Amostras de saliva foram avaliadas para verificar a contagem de colônias e presença de S. sanguinis e S. oralis. Amostras de saliva estimulada pela mastigação foram serialmente diluídas e semeadas em placas sobre agar-sangue de ovelhas seletivo e não seletivo a 5% contendo penicilina G. A identificação da espécie foi realizada com testes bioquímicos convencionais. Concentrações inibitórias mínimas foram determinadas com o Etest. RESULTADOS: Não foram encontradas diferenças estatísticas da presença de S. sanguinis comparando-se o momento basal e o 7º dia (p = 0,62). No entanto, o número existente de culturas positivas de S. oralis no 7º dia após a Penicilina G benzatina apresentou um aumento significativo em relação ao valor basal (p = 0,04). Não houve diferença estatística existente entre o momento basal e o 7º dia sobre o número de S. sanguinis ou S. oralis UFC/mL e concentrações inibitórias medianas. CONCLUSÃO: O presente estudo mostrou que a Penicilina G benzatina a cada 3 semanas não alterou a colonização por S. sanguinis, mas aumentou a colonização de S. oralis no 7º dia de administração. Portanto, a susceptibilidade do Streptococcus sanguinis e Streptococcus oralis à penicilina G não foi modificada durante a rotina de profilaxia secundária da febre reumática utilizando a penicilina G. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

BACKGROUND: Benzathine penicillin G every 3 weeks is the standard protocol for secondary prophylaxis for recurrent rheumatic fever. OBJECTIVE: Assess the effect of Benzathine penicillin G on Streptococcus sanguinis and Streptococcus oralis in patients with cardiac valvular disease due to rheumatic fever receiving secondary prophylaxis. METHODS: Oral streptococci were evaluated before (baseline) and after 7 days (day 7) with Benzathine penicillin G in 100 patients receiving routine secondary rheumatic fever prophylaxis. Saliva samples were evaluated for colony count and presence of S. sanguinis and S. oralis. Chewing-stimulated saliva samples were serially diluted and plated onto both nonselective and selective 5% sheep blood agar containing penicillin G. The species were identified using conventional biochemical tests. Minimal inhibitory concentrations were determined with the Etest. RESULTS: No statistical differences were found in the presence of S. sanguinis comparing baseline and day 7 (p = 0.62). However, the existing number of positive cultures of S. oralis on day 7 after Benzathine penicillin G presented a significant increase compared to baseline (p = 0.04). No statistical difference was found between baseline and day 7 concerning the number of S. sanguinis or S. oralis CFU/mL and median minimal inhibitory concentrations. CONCLUSION: This study showed that Benzathine penicillin G every 3 weeks did not change the colonization by S. sanguinis, but increased colonization of S. oralis on day 7 of administration. Therefore, susceptibility of Streptococcus sanguinis and Streptococcus oralis to penicillin G was not modified during the penicillin G routine secondary rheumatic fever prophylaxis. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

The Effect of Benzathine Penicillin-induced Focal Interictal Epileptiform Discharges on the Expression Patterns of c-JUN Protein in the Rat Brain

BACKGROUND: Immediate early gene (IEG) is supposed to be linked in the continuous seizure induced long-term changes of specific neurons. We tried to investigate the effects of focal interictal epileptiform discharges on the c-JUN expression in the rat brain which is not clearly understood. METHODS:Epidural electrodes were placed on a male Sprague-Dawley weighing 150~230 g and benzathine penicillin (Pc) was applied cortically. After focal interictal epileptiform discharges were successfully identified, EEG was recorded regularly. Cardiac perfusion and extraction of the brain was done at 2, 4, 24 hours and 1 week after the Pc application. Sixteen rats were evenly distributed into 4 groups. Immunocytochemical staining with specific antisera (Santa Cruz) was performed. RESULTS: The epileptiform discharges were induced within an hour after topical Pc applications. At 2 hours after Pc application, c-JUN was moderately expressed in the dentate gyrus (DG) and weakly expressed in the CA3 pyramidal cell, amygdala, pyriform cortex, thalamus, and neocortex. At 4 hours, c-JUN was minimally expressed in DG and other regions. Whereas, at 24 hours, c-JUN was maximally expressed in the DG and also in the CA3 pyramidal cell, amygdala, pyriform cortex, thalamus, and neocortex. One week after Pc application, c-JUN was moderately expressed in the DG and weakly expressed in the CA3 pyramidal cell, amygdala, pyriform cortex, and neocortex. CONCLUSIONS: This data showed that even focal interictal epileptic activity can induce IEG encoded c-JUN protein in the specific distant brain regions of a rat until a late period and the expression pattern showed a synchronous and bimodal pattern.

Two Cases of Lichen Planus / 대한피부과학회지

We have experienced 2 cases of lichen planus. Case 1 was a. 76-year-old male who has suffered from discrete, scaly, round to polygonal papules on the trunk and the e:xtremiities for 3 months. The VDRL test for syphilis was reactive at a titer of 1:2 and the TPHA test was positive. The skin lesions were responded to 3 weekly injections of benzathine penicillin 2.4 million units, Case 2 was a 17-year-old male who has suffered from discrete, erythematous to violaceous colored, flat papules on the right shin for several months. He has treated with oral medication of griseofulvin. After 2 weeks of the medication, the skin ]esions showed improvement with gradual reduction of pruritus and flattening of the papules. About one month of the medication, all skin lesions cliappeared with dark brownish hue and hypopigmentation. And recurreci lesions after stopping medication are disappeared after 2 months of retreatment with griseofulvin.