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Rev Chilena Infectol. 2008 Jun;25(3):155-61. doi: /S0716-10182008000300002. Epub 2008 Jun 24.

[Diagnosis of congenital syphilis at delivery: maternal serum or cord blood?].

[Article in Spanish]

Author information

1
Facultad de Medicina, Departamento de Obstetricia y Ginecología, Pontificia Universidad Católica de Chile, Santiago, Chile. fabarzua@med.puc.cl

Abstract

Congenital syphilis (CS) is an important health problem in Chile, with a rate of 0.25/1,000 live newborn (NB) during year 2004. In 2000, the Chilean Ministry of Public Health recommended to perform a screening in cord blood at the moment of delivery. Instead, the Centers for Disease Control and Prevention guidelines recommend the screening in maternal serum since cord blood has up to 5% of false (-) versus 0.5% of maternal serum, both with respect to the NB serum.

OBJECTIVE:

Maternal serum and NB cord blood were studied during one year to determine the best screening method at delivery.

METHODS:

RPR was performed and positive results were confirmed by treponemic test (immunochromatographyDetermine, ELISA Captia, Ig and IgM, and MHA-Tp). Serologically confirmed patients were evaluated by the specialist to define CS cases.

RESULTS:

Between June 1999 and August 2000 2,741 binomies were studied; of these, 37 (1.3%) were RPR reactive and 2.704 were non-reactive. In 11 of the 37 reactive cases, mother and NB were RPR reactive (Group I), in 9 cases the NB was RPR reactive and the mother was non-reactive (Group II), and the other 17 were NB non-reactive and mother reactive (Group III). In group I, 7/11 (64%) were true (+)s and 4/11(36%)) false (+)s of RPR. In group II, 9/9 (100%) corresponded to false (+)s of RPR in cord blood, and in group III, 11/17 (65%) corresponded to false (+)s of RPR in maternal blood but 6/17 (35%) were found to be cases of syphilis during pregnancy. Three of them were not treated opportunely and were designed as CS. In total 9 NB corresponded to CS (6 in group I and 3 in group III). If the screening had been performed only in cord blood, three NB with CS would have not been diagnosed.

CONCLUSION:

Even when maternal serum has a high rate of false (+)s, it has better sensitivity than cord blood for the diagnosis of CS, thus it is suggested to perform the screening at delivery with maternal serum instead of cord blood samples.

PMID:
18580990
DOI:
/S0716-10182008000300002
[Indexed for MEDLINE]
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