Neonatal and post-neonatal onset of early congenital syphilis: a report from Mozambique

Abstract

Congenital syphilis (CS) has been and continues to be a principal public health problem in developing countries. Despite the wide experience acquired, physicians still have problems in diagnostic evaluation. We report 145 cases of CS at the Central Hospital, Maputo, emphasizing the differences in clinical features and in the results of serological and X-ray examinations between the neonatal and post-neonatal age groups. In the post-neonatal age group, the clinical expression of CS is mostly overt. It is commonly recognized that manifestations of CS in the neonatal age group are often poor or negative, yet a relevant percentage of CS that we report were fully symptomatic. In the neonatal age, the Venereal Disease Research Laboratory (VDRL) test in the mother and characteristic osteochondritic lesions on X-ray examination of the long bones help to make the diagnosis; in the post-neonatal age group, the VDRL test in the child is more often positive than in the mother and X-ray examination shows most periostitic lesions.

PIP: Even though congenital syphilis (CS) has been and remains a key public health problem in developing countries, physicians continue to have trouble diagnosing it. Experience with 145 cases of CS reported over the period May 1989-May 1990 at the Central Hospital in Maputo are discussed with particular emphasis and attention given to differences in clinical features and in the results of serological and X-ray examinations between neonatal and post-neonatal age groups. 51% of the newborns were diagnosed with CS on the basis of clinical features of systemic congenital infection; the diagnosis of remaining cases was based upon history or isolated and nonspecific signs such as fever, low birth weight for gestational age, or skin lesions. Condition characteristics were mostly overtly expressed among the post- neonates. While it may be commonly recognized that manifestations of CS among neonates tend to be poor or negative, analysis of the data found a relevant percentage of subjects to be fully symptomatic. The Venereal Disease Research Laboratory (VDRL) test in the mother and characteristic osteochondritic lesions on X-ray examination of the long bones help make the diagnosis at neonatal age. Among post-neonates, the VDRL test in the child is more often positive than in the mother and X-rays show most periostitic lesions.