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      Pénfigo sifilítico: reporte de un caso Translated title: Syphilitic pemphigus: a case report

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          Abstract

          RESUMEN La sífilis congénita (SC) es el resultado de la infección producida por el Treponema pallidum al feto, en una madre con sífilis gestacional (SG). La enfermedad puede ser asintomática en el 60% de los recién nacidos (RN) afectados, siendo además difícil de diagnosticar clínica e histológicamente, porque tanto sus patrones clínicos como histológicos, pueden imitar otras enfermedades dermatológicas del RN. Siendo la SC una enfermedad prevenible, siguen presentándose casos con manifestaciones clínicas severas. Presentamos el caso de un RN con SC de presentación grave desde el nacimiento, con manifestaciones cutáneas que incluyeron múltiples lesiones tipo vesículas y bulas, con zonas hemorrágicas y áreas denudadas con maceración, descamación y costras, de predominio en palmas y plantas, compatibles con pénfigo sifilítico. Reconocer las diversas manifestaciones clínicas, en especial las cutáneas, es fundamental para realizar un diagnóstico oportuno de SC en RN y lactantes.

          Translated abstract

          ABSTRACT Congenital syphilis (CS) is the result of an fetal infection caused by Treponema pallidum, in a mother with gestational syphilis (GS). The disease can be asymptomatic in 60% of affected newborns (NBs), and is also difficult to diagnose clinically and histologically, because both its clinical and histological patterns can mimic other dermatological diseases of the NB. Since CS is a preventable disease, cases with severe clinical manifestations continue to appear. We present the case of an NB with severe CS presenting from birth, with skin manifestations that included multiple vesicle and bulla-like lesions, with hemorrhagic areas and denuded areas with maceration, scaling and scabs, predominantly on the palms and soles, compatible with syphilitic pemphigus. Recognizing the various clinical manifestations, especially skin manifestations, in this disease, is essential to make a timely diagnosis of CS in newborns and infants.

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          Most cited references15

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          Global burden of maternal and congenital syphilis and associated adverse birth outcomes—Estimates for 2016 and progress since 2012

          Background In 2007 the World Health Organization (WHO) launched the global initiative to eliminate mother-to-child transmission of syphilis (congenital syphilis, or CS). To assess progress towards the goal of <50 CS cases per 100,000 live births, we generated regional and global estimates of maternal and congenital syphilis for 2016 and updated the 2012 estimates. Methods Maternal syphilis estimates were generated using the Spectrum-STI model, fitted to sentinel surveys and routine testing of pregnant women during antenatal care (ANC) and other representative population data. Global and regional estimates of CS used the same approach as previous WHO estimates. Results The estimated global maternal syphilis prevalence in 2016 was 0.69% (95% confidence interval: 0.57–0.81%) resulting in a global CS rate of 473 (385–561) per 100,000 live births and 661,000 (538,000–784,000) total CS cases, including 355,000 (290,000–419,000) adverse birth outcomes (ABO) and 306,000 (249,000–363,000) non-clinical CS cases (infants without clinical signs born to un-treated mothers). The ABOs included 143,000 early fetal deaths and stillbirths, 61,000 neonatal deaths, 41,000 preterm or low-birth weight births, and 109,000 infants with clinical CS. Of these ABOs– 203,000 (57%) occurred in pregnant women attending ANC but not screened for syphilis; 74,000 (21%) in mothers not enrolled in ANC, 55,000 (16%) in mothers screened but not treated, and 23,000 (6%) in mothers enrolled, screened and treated. The revised 2012 estimates were 0.70% (95% CI: 0.63–0.77%) maternal prevalence, and 748,000 CS cases (539 per 100,000 live births) including 397,000 (361,000–432,000) ABOs. The estimated decrease in CS case rates between 2012 and 2016 reflected increased access to ANC and to syphilis screening and treatment. Conclusions Congenital syphilis decreased worldwide between 2012 and 2016, although maternal prevalence was stable. Achieving global CS elimination, however, will require improving access to early syphilis screening and treatment in ANC, clinically monitoring all women diagnosed with syphilis and their infants, improving partner management, and reducing syphilis prevalence in the general population by expanding testing, treatment and partner referral beyond ANC.
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            Congenital syphilis

            Congenital syphilis remains a major public health problem worldwide, and its incidence is increasing in the United States. This review highlights the ongoing problem of this preventable infection, and discusses vertical transmission and clinical manifestations while providing a practical algorithm for the evaluation and management of infants born to mothers with reactive serologic tests for syphilis. Every case of congenital syphilis must be seen as a failure of our public health system to provide optimal prenatal care to pregnant women, as congenital syphilis can be prevented by early and repeated prenatal serologic screening of mothers and penicillin treatment of infected women, their sexual partners, and their newborn infants.
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              Sífilis materna e congênita, subnotificação e difícil controle

              RESUMO: Objetivo: Identificar e descrever casos de sífilis congênita e materna notificados e não notificados em uma cidade brasileira de médio porte. Métodos: Trata-se de estudo descritivo e retrospectivo que avaliou 214 prontuários de gestantes e recém-nascidos (RNs). Iniciou-se com identificação das fichas de notificação epidemiológica, seguida de busca ativa nas maternidades, avaliando-se todos os prontuários que apresentavam sorologia não treponêmica positiva e prontuários do serviço de referência em infectologia, na cidade de Montes Claros, Minas Gerais, no período de 2007 a 2013. As definições de casos seguiram as recomendações do Ministério da Saúde (MS) no Brasil e as variáveis foram descritas utilizando-se frequências absoluta e relativa. Estudo aprovado pelo Comitê de Ética em Pesquisa (Universidade Estadual de Montes Claros). Resultados: De 214 prontuários avaliados, foram identificados 93 casos de sífilis materna e 54 casos de sífilis congênita. As gestantes analisadas foram, predominantemente, de cor parda, apresentando ensino médio/superior, com faixa etária entre 21 e 30 anos e estado civil solteira. Considerando acompanhamento pré-natal das gestantes com sífilis, observou-se predomínio do diagnóstico tardio, após o parto ou a curetagem; a totalidade dos respectivos tratamentos foi considerada inadequada, segundo o MS. Dos RNs de gestantes com sífilis, a maioria não foi referenciada para acompanhamento pediátrico. Apenas 6,5% dos casos de sífilis em gestantes foram notificados; em relação à forma congênita, esse valor foi de 24,1%. Conclusão: Persistindo a transmissão vertical, verificam-se sinais de que a qualidade da atenção pré-natal e neonatal deve ser reestruturada.
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                Author and article information

                Journal
                ped
                Pediatría (Asunción)
                Pediatr. (Asunción)
                Sociedad Paraguaya de Pediatría (Asunción, , Paraguay )
                1683-9803
                April 2021
                : 48
                : 1
                : 78-83
                Affiliations
                [1] Villavicencio Meta orgnameClínica Primavera Colombia
                Article
                S1683-98032021000100078 S1683-9803(21)04800100078
                10.31698/ped.48012021013
                63189ffb-852e-44e8-8894-3a9c1f2e5d31

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 17 February 2021
                : 11 October 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 6
                Product

                SciELO Paraguay

                Categories
                Caso Clínico

                Sífilis congénita,Congenital syphilis,pemphigus,newborn,pénfigo,recién nacido.

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