[Specificity and sensitivity of immunological diagnosis of congenital neonatal syphilis by the 19S(IgM)-FTA-ABS test (author's transl)]

Abstract

Reports on the significance in the demonstration of IgM class antibodies in congenital syphilis are contradictory. The reason for discrepant observations are of technical or biological source. In order to explain the several uncertainties, serum samples from 1031 newborns and infants of syphilitic mothers were investigated quantitatively with the IgM-FTA-ABS, the 19S (IgM)-FTA-ABS and cardiolipin CF test. If serum specimens of the mothers were available they were investigated in the same tests for treponema-specific 19S(IgM) class and antilipoidal antibodies. In the evaluation of the results, the history of infection and treatment of the mothers as well as clinical observations in the infants were considered. In 26 children a congenital acquired syphilis was strongly indicated by demonstration of treponema-specific 19S(IgM) class antibodies by the 19S(IgM)-FTA-ABS-Test and tae good agreement with the history of untreated mothers. In another 1005 infants a congenital infection by T. pallidum could be excluded by the non-reactive 19S(IgM)-FTA-ABS as well as clinical observations. Furthermore, immunological findings of three children who had acquired syphilis after birth are demonstrated before and after specific treatment. It could be shown that the 19S(IgM)-FTA-ABS is much more infaillable than the IgM-FTA-ABS as far as technical and biological uncertainties are concerned. Considering all possible errors and the results of re-investigations of IgM non-reactive infants of syphilitic mothers (up to one year after birth) it is demonstrated that congenital syphilis can be differentiated from passively transmitted 7S(IgG) class antibodies (of the mother) or 19S(IgM) class anti-antibodies (of the child) with a significance of about 99%. It is finally concluded that serological diagnosis of congenital syphilis should be started in the pregnant women. By making the diagnosis in pregnancy followed by adequate treatment, irreversible damages as well as so-called serological scars can be avoided in the children.