Optimisation of diagnosis of early congenital syphilis in newborns
The objective. To analyse the results of clinical-laboratory examinations of children born to women with a history of syphilis infection and to present data about the identification of symptoms of disease and also about the informativity of treponemal and non-treponemal tests for diagnosing early congenital syphilis. Patients and methods. The study included 547 children born to women with indications of syphilis in their medical histories. The diagnosis of early congenital syphilis was based on maternal medical history, clinical signs, findings of x-ray examination and results of serological reactions (VDRL/RPR, ELISA, TPHA on the 1st day of life and with the dynamics of antibody titre on the 7-8th day). Results. In children who had ECS with symptoms, a significant IgM titer was noted in 82.9% of cases, IgG - 89.4%; in latent ECS - IgM - 91.2%, IgG - 87.4%. Treponemal serological methods in diagnosis of syphilis infection in newborns are informative enough, in spite of the presence of false-negative and false-positive results, which might be conditioned by both endogenous (specificities of the immune system of the fetus and newborn), and exogenous (terms and duration of therapy, quality of the testing systems) influences. The sensitivity of VDRL in early congenital syphilis with symptoms was 65.8%, in latent - 51.3%, specificity - 100%; the sensitivity of TPHA in ECS with symptoms - 69.3%, latent ECS - 88.9%, specificity - 100% Conclusion. Laboratory diagnosis of early congenital syphilis in newborns during the first day of life necessitates obligatory specifying diagnostics with the use of treponemal reactions (TPHA and ELISA) and further dynamic additional examination.