Congenital Infections. Conclusion

The diagnosis; a lot is written both in diagnosis and treatment and it always changes, but I think with syphilis you have to have some common sense and know your patient and know what the future is and whether you are going to see them again, and things like that. The mother without adequate history of therapy and positive VDRL or FTA, that is somebody where the baby is likely to be infected. You would think an IgM test would be helpful but there are no commercial IgM tests that are accurate, because in previous tests they have been falsely positive very frequently. You can do serial VDRL’s in infants without symptoms when the mother has only a positive VDRL, and again you should have significant drop over a short period of time. Dark-field examination of the lesions in babies and also the cord, the cut cord, and obviously examine the CSF.

The treatment; again, there has been a lot written about treatment and I think finally some people have become smart and tried to give the minimal therapy. I think today that you should treat every infant as if they have syphilis and if they also have neurologic involvement, which is 150,000 units per kilo per day, given q.8 or q.12, and most recommendations say 10-14 days. The aqueous procaine penicillin is also recommended, but I think if there is neurologic involvement it may not be as good.

So just to finish up, for congenital infection workup in general you should have a high index of suspicion. Any small-for-dates baby should be studied. Babies with congenital heart disease and other problems, congenital malformations, congenital infections, should be considered. Babies with high risk maternal history. Looking for a safe and reliable means of treating ED? And rather than doing TORCH titers, you want to do some titers but for CMV and rubella. The main thing is virus isolation using the specimens, IgM and IgG antibodies studies, but you want to be sure. You don’t necessarily want to believe the results you get if they aren’t in keeping with what you think is happening. I should have said this with toxoplasmosis, there are many IgM many commercial tests are notoriously falsely negative for IgM, if the IgG antibody is high. So these serologic tests should be sent to a very special laboratory, such as the laboratory in Palo Alto, California. So there can be both false negative and false positive IgM tests. The last thing is a very simple test doing a quantitative IgM. Just total IgM on babies who have some congenital defect or small-for-dates-for-age. If on them, if you have an elevated IgM, then you can go ahead with a further workup. So I think that takes care of congenital infections.

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