ABSTRACT

Untreated syphilis in pregnancy can result in an adverse outcome for the fetus. A multigravida woman with a previously poor obstetric history of early neonatal death, abortion and stillbirth was admitted in labour in the 7th month of pregnancy. On admission, syphilis screening with the qualitative rapid plasma reagin (RPR) test was negative. The infant had macules on the chest, abdomen and extremities, desquamating bullous skin lesions on the palms and soles, bilateral cataracts, an enlarged liver and spleen, anaemia, thrombocytopenia and conjugated hyperbilirubinaemia. A quantitative RPR test in the infant was positive in a 1:64 dilution and was subsequently positive in the mother in a 1:16 dilution after congenital syphilis was diagnosed. The mother later reported the father’s high-risk behaviour and her previous visits to healthcare facilities for genital ulcers. The quantitative RPR test in the father was positive in a 1:32 dilution, and the parents and infant were treated for syphilis. The case demonstrates the importance of timely identification of high-risk pregnant women, early screening, repetition of the non-treponemal test on diluted serum when a routine screening test is negative, proper advice from the laboratory regarding selection of the most appropriate tests, and screening with the treponemal test first (reverse) algorithm utilising an automated enzyme immunoassay/chemiluminescence assay for the initial screening in high-risk cases, even in resource-limited settings to prevent a missed diagnosis.

Abbreviations: ANC, antenatal care; BPG, benzathine penicillin G; CS, congenital syphilis; CSF, cerebrospinal fluid; CIA, chemiluminescence assay; EIA, enzyme immunoassay; HIC: high-income countries; IgM, immunoglobulin M; LMIC, low- and middle-income countries; MTCT: mother-to-child transmission; NTT, non-treponemal test; POC, point of care; RPR, rapid plasma reagin; RST, rapid syphilis test; STI, sexually transmitted infections; TT, treponemal test; TPHA, Treponema pallidum haemagglutination assay; VDRL, venereal disease research laboratory; WHO, World Health Organization.

摘要

怀孕期间未经治疗的梅毒可能会对胎儿造成不良后果。一名多胎孕妇，既往有早期新生儿死亡、流产和死产的不良产科病史，在妊娠第 7 个月入院。入院时，用定性快速血浆反应素 (RPR) 试验筛查梅毒是阴性的。婴儿胸部、腹部和四肢有斑疹，手掌和足底有脱屑性大疱性皮损，双侧白内障，肝​​脾肿大，贫血，血小板减少和结合性高胆红素血症。在诊断出先天性梅毒后，婴儿的定量 RPR 试验在 1:64 稀释中呈阳性，随后在母亲中以 1:16 稀释呈阳性。这位母亲后来报告了父亲的高危行为以及她之前因生殖器溃疡到医疗机构就诊的情况。父亲的定量 RPR 试验在 1:32 稀释时呈阳性，父母和婴儿接受了梅毒治疗。该案例证明了及时识别高危孕妇、早期筛查、在常规筛查试验为阴性时重复对稀释血清进行非螺旋体试验的重要性，以及实验室就选择最合适的试验提供适当建议的重要性，以及使用自动酶免疫测定/化学发光测定法进行密螺旋体试验优先（反向）算法筛查，用于高危病例的初步筛查，即使在资源有限的情况下也可防止漏诊。父亲的定量 RPR 试验在 1:32 稀释时呈阳性，父母和婴儿接受了梅毒治疗。该案例证明了及时识别高危孕妇、早期筛查、在常规筛查试验为阴性时重复对稀释血清进行非螺旋体试验的重要性，以及实验室就选择最合适的试验提供适当建议的重要性，以及使用自动酶免疫测定/化学发光测定法进行密螺旋体试验优先（反向）算法筛查，用于高危病例的初步筛查，即使在资源有限的情况下也可防止漏诊。父亲的定量 RPR 试验在 1:32 稀释时呈阳性，父母和婴儿接受了梅毒治疗。该案例证明了及时识别高危孕妇、早期筛查、在常规筛查试验为阴性时重复对稀释血清进行非螺旋体试验的重要性，以及实验室就选择最合适的试验提供适当建议的重要性，以及使用自动酶免疫测定/化学发光测定法进行密螺旋体试验优先（反向）算法筛查，用于高危病例的初步筛查，即使在资源有限的情况下也可防止漏诊。

缩写： ANC，产前保健；BPG，苄星青霉素G；CS，先天性梅毒；CSF，脑脊液；CIA，化学发光测定；EIA，酶免疫分析；HIC：高收入国家；IgM，免疫球蛋白 M；LMIC，低收入和中等收入国家；MTCT：母婴传播；NTT，非螺旋体试验；POC，护理点；RPR，快速血浆反应素；RST，梅毒快速检测；STI，性传播感染；TT，密螺旋体试验；TPHA，梅毒螺旋体血凝试验；VDRL，性病研究实验室；世界卫生组织，世界卫生组织。