Amoxicillin as an Option in Congenital Syphilis Management: A Case Report

Harapan Parlindungan Ringoringo; Katherine Richel Tambunan; Fajar Khalis Ananda; Felynawati Nawati; Yanuar Nusca Permana

doi:10.3889/oamjms.2022.10191

Authors

Harapan Parlindungan Ringoringo Department of Child Health, Faculty of Medicine, Lambung Mangkurat University, RSD Idaman Banjarbaru, Banjarbaru, South Kalimantan, Indonesia
Katherine Richel Tambunan Mayapada Hospital Tangerang, Banten, Indonesia
Fajar Khalis Ananda Pediatric Ward, RSD Idaman Banjarbaru, Banjarbaru, South Kalimantan, Indonesia
Felynawati Nawati Pediatric Ward, RSD Idaman Banjarbaru, Banjarbaru, South Kalimantan, Indonesia
Yanuar Nusca Permana Department of Child Health, Faculty of Medicine, Lambung Mangkurat University, RSD Idaman Banjarbaru, Banjarbaru, South Kalimantan, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.10191

Keywords:

Congenital syphilis, Low birth weight, Small for gestational age, Amoxicillin

Abstract

BACKGROUND: Congenital syphilis (CS) is the second leading cause of preventable stillbirth globally. This case report shows that CS baby can be managed by amoxicillin with good results.

CASE PRESENTATION: A term female baby was born through section cesarean on suspicion of syphilis of a 29-year-old mother, G4P3A0, 39 weeks gestation with normal APGAR score, and birth weight was 2330 g, birth length was 46 cm, and head circumference 32 cm. There are no abnormalities on physical examination. The baby is active and clinically sound. In history taking, the mother was diagnosed with syphilis in the first trimester of pregnancy but did not want to be treated. After birth, maternal serology showed that Treponema pallidum is reactive. Maternal VDRL was reactive at 1:1, while TPHA was reactive at 1:2560. Baby laboratory results showed Hb 18.4 g/dL, leukocytes 33,480/μL, platelets 278,000/μL, and hematocrit 54.7%. A peripheral blood smear showed neutrophilia with hypersegmentation and monocytosis due to suspected chronic inflammation. Baby VDRL was reactive at 1:16, while TPHA was reactive at 1:1280. The diagnosis was congenital syphilis with low birth weight and small for gestational age. After one month of treatment with oral amoxicillin, baby VDRL was reactive at 1:2, while TPHA was reactive at 1:320. At 1½ months, the baby’s hemoglobin is 10.1 g/dL. X-rays for chest, abdomen, and skeletal were within normal limits. The baby was given oral amoxicillin 50 mg/kg/day for a total of 3 months. When the baby was 4 months old, her growth and development were good with the VDRL reactive 1:1 and the TPHA reactive 1:160.

CONCLUSION: In the unavailability of benzathine penicillin, amoxicillin may be considered an option in CS management.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

The Lancet. Congenital Syphilis in the USA. Lancet. 2018;392:1168. DOI: https://doi.org/10.1016/S0140-6736(18)32360-2

Shahrook S, Mori R, Ochirbat T, Gomi H. Strategies of testing for syphilis during pregnancy. Cochrane Database Syst Rev. 2014;10:CD010385. https://doi.wiley.com/10.1002/14651858.CD010385.pub2 PMid:25352226 DOI: https://doi.org/10.1002/14651858.CD010385.pub2

Easterlin MC, Ramanathan R, De Beritto T. Maternal-to-fetal transmission of Syphilis and congenital syphilis. Neoreviews. 2021;22(9):e585-99. https://doi.org/10.1542/neo.22-9-e585 PMid:34470760 DOI: https://doi.org/10.1542/neo.22-9-e585

World Health Organization. Syphilis: Overview. Geneva: World Health Organization. Available from: https://www.who.int/health-topics/syphilis#tab=tab_1 [Last accessed on 2022 May 03].

Radolf JD. Treponema. In: Medical Microbiology. Galveston, TX: University of Texas Medical Branch at Galveston; 1996.

Satyaputra F, Hendry S, Braddick M, Sivabalan P, Norton R. The laboratory diagnosis of syphilis. Humphries RM, editor. J Clin Microbiol. 2021;59(10):e00100-21. https://journals.asm.org/doi/10.1128/JCM.00100-21 PMid:33980644 DOI: https://doi.org/10.1128/JCM.00100-21

World Health Organization. Syphilis. Geneva: World Health Organization. Available from: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/stis/prevention/mother-to-child-transmission-of-syphilis [Last accessed on 2022 May 02].

Bowen V, Su J, Torrone E, Kidd S, Weinstock H. Increase in incidence of congenital syphilis United States, 2012-2014. MMWR Morb Mortal Wkly Rep. 2015;64(44):1241-5. DOI: https://doi.org/10.15585/mmwr.mm6444a3

Smullin C, Wagman J, Mehta S, Klausner JD. A narrative review of the epidemiology of congenital syphilis in the United States from 1980 to 2019. Sex Transm Dis. 2021;48(2):71-8. https://doi.org/10.1097/OLQ.0000000000001277 PMid:32925597 DOI: https://doi.org/10.1097/OLQ.0000000000001277

Lago EG, Vaccari A, Fiori RM. Clinical features and follow-up of congenital syphilis. Sex Transm Dis. 2013;40(2):85-94. https://doi.org/10.1097/OLQ.0b013e31827bd688 PMid:23324972 DOI: https://doi.org/10.1097/OLQ.0b013e31827bd688

Ortiz-Lopez N, Diez M, Diaz O, Simon F, Diaz A. Epidemiological surveillance of congenital syphilis in Spain, 2000-2010. Pediatr Infect Dis J. 2012;31(9):988-90. https://doi.org/10.1097/INF.0b013e31825d3152 PMid:22572752 DOI: https://doi.org/10.1097/INF.0b013e31825d3152

Arnold SR, Ford-Jones EL. Congenital syphilis: A guide to diagnosis and management. Paediatr Child Health. 2000;5(8):463-9. https://doi.org/10.1093/pch/5.8.463 PMid:20177559 DOI: https://doi.org/10.1093/pch/5.8.463

Rocha AF, Araújo MA, De Barros VL, Américo CF, Da Silva GB Jr. Complications, clinical manifestations of congenital syphilis, and aspects related to its prevention: An integrative review. Rev Bras de Enferm. 2021;74(4):e20190318. DOI: https://doi.org/10.1590/0034-7167-2019-0318

David M, Hcini N, Mandelbrot L, Sibiude J, Picone O. Fetal and neonatal abnormalities due to congenital syphilis: A literature review. Prenat Diagn. 2022;42(5):643-55. https://doi.org/10.1002/pd.6135 PMid:35352829 DOI: https://doi.org/10.1002/pd.6135

Walker GJ, Walker D, Franco DM, Grillo-Ardila CF. Antibiotic treatment for newborns with congenital syphilis. Cochrane Database Syst Rev. 2019;15(2):CD012071. http://doi.org/10.1002/14651858.CD012071.pub2 PMid:30776081 DOI: https://doi.org/10.1002/14651858.CD012071.pub2

Faber WR, Bos JD, Rietra PJ, Fass H Van Ejik RV. Treponemicidal levels of amoxicillin in cerebrospinal fluid after oral administration. Sex Transm Dis. 1983;10(3):148-50. https://doi.org/10.1097/00007435-198307000-00011 PMid:6359492 DOI: https://doi.org/10.1097/00007435-198307000-00011

Nishijima T, Kawana K, Fukasawa I, Ishikawa N, Taylor MM, Mikamo H, et al. Effectiveness and tolerability of oral amoxicillin in pregnant women with active syphilis, Japan, 2010-2018. Emerg Infect Dis. 2020;26(6):1192-200. https://doi.org/10.3201/eid2606.191300 PMid:32441638 DOI: https://doi.org/10.3201/eid2606.191300

Huntington S, Weston G, Seedat F, Marshall J, Bailey H, Tebruegge M, et al. Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: A cost-effectiveness analysis. BMJ Open. 2020;10(11):e038505. https://doi.org/10.1136/bmjopen-2020-038505 PMid:33444184 DOI: https://doi.org/10.1136/bmjopen-2020-038505

Cantor AG, Pappas M, Daeges M, Nelson HD. Screening for syphilis: Updated evidence report and systematic review for the US preventive services task force. JAMA. 2016;315(21):2328-37. https://doi.org/10.1001/jama.2016.4114 PMid:27272584 DOI: https://doi.org/10.1001/jama.2016.4114

US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, et al. Screening for syphilis infection in pregnant women: US preventive services task force reaffirmation recommendation statement. JAMA. 2018;320(9):911-7. https://doi.org/10.1001/jama.2018.11785 PMid:30193283 DOI: https://doi.org/10.1001/jama.2018.11785

Oliveira JF, Macedo BM, Cordeiro AM, Magalhães KF, Freitas CF, Lemos AQ. Relation between syphilis cases and sex education of women in a family health unit in the city of Lauro de Freitas. Int J Health Educ. 2021;5(1):53-61. DOI: https://doi.org/10.17267/2594-7907ijhe.v5i1.3315