Syphilis Infection: An Uncommon Etiology of Infectious Nonimmune Fetal Hydrops with Anemia

Abstract

An increased prevalence of syphilis has been observed in many developed countries over the last decade. During pregnancy, syphilis can affect the fetus through development of nonspecific symptoms such as microcephaly, ascites, hepatosplenomegaly, dilated and echogenic bowel, placentomegaly, and, uncommonly, fetal hydrops. Congenital syphilis also leads to hematologic abnormalities such as anemia, thrombocytopenia, leukopenia, and leukocytosis. We present a case of nonimmune fetal hydrops with anemia related to syphilis infection. Diagnosis was confirmed by a maternal serological test and microbiological testing on amniotic fluid, umbilical cord, and placental tissues. The patient was treated with penicillin and the fetus received an intrauterine red blood cell transfusion, but fetal death occurred shortly after. Such a presentation is mostly related to parvovirus B19, and syphilis etiology is poorly mentioned because physicians have rarely seen early congenital syphilis in the past. However, given the increasing prevalence of this disease in the adult population, clinicians should remain alert to the various presentations of congenital syphilis.

Prevalence and clinical profile of microcephaly in South America pre-Zika, 2005-14: prevalence and case-control study

“…3 The aim of a diagnosis of microcephaly at birth is to use small head circumference as an indicator of a high risk of having experienced poor in utero development of the brain. 4 Microcephaly is known to be caused by viral, bacterial, and parasitic infections such as rubella, cytomegalovirus, herpes simplex virus, immunodeficiency virus, toxoplasmosis, and syphilis among others 5 6 7 8 9 (as well as many non-infectious causes), so that an infectious cause of the observed increase in affected babies was plausible. Since then, more evidence has been accumulating to support a causal link, 10 11 including the neurotropic nature of the Zika virus and preliminary reports of epidemiological controlled studies.…”

Sífilis congénita con hídrops fetal: reporte de cuatro casos en un hospital general de referencia en Bogotá, Colombia entre 2016- 2020

“…La edad materna de los casos publicados está entre los 17 y 33 años (29,32), con un promedio de 22,5 años, la edad gestacional al momento del diagnóstico de la sífilis está entre 7 y 35 (27,31) semanas, con un promedio de 20,7 semanas, pero en 6 casos (37,5%) el diagnóstico fue posnatal (29,29,32,35). La edad gestacional al momento del diagnóstico del hídrops está entre 23 y 35 (27,33) semanas con un promedio de 28,9 semanas. La anemia fetal severa se diagnosticó en tres casos mediante doppler de arteria cerebral media, requirieron transfusión intrauterina (30,33,34)…”

“…La edad gestacional al momento del diagnóstico del hídrops está entre 23 y 35 (27,33) semanas con un promedio de 28,9 semanas. La anemia fetal severa se diagnosticó en tres casos mediante doppler de arteria cerebral media, requirieron transfusión intrauterina (30,33,34)…”

Fetüslerin Sifilizden Zarar Görmemesi: Antenatal Bakım, Maternal ve Neonatal Sonuçlar

“…Hepatic and placental involvement would cause increasing the volume of these organs and disrupted erythrocyte production causes anemia fi ndings like elevated peak systolic velocity of the middle cerebral artery, polyhydramnios, ascites, and hydrops fetalis. 18,19 Aft er the administration of maternal treatment, fetal healing could be monitored by ultrasound. It was depicted that anemia dissolves fi rstly, hepatomegaly and placentomegaly dissolves lastly.…”