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Congenital Syphilis

Congenital Syphilis. Garcia, Lucman , Macaraya , Malilay , Marino. General Data. Caganda, Lorenz 1 week old/M Admitted for the 1 st time at PER-PGH last July 25, 2009. Chief Complaint. Fever. History of Present Illness.

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Congenital Syphilis

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  1. Congenital Syphilis Garcia, Lucman, Macaraya, Malilay, Marino

  2. General Data • Caganda, Lorenz • 1 week old/M • Admitted for the 1st time at PER-PGH last July 25, 2009

  3. Chief Complaint Fever

  4. History of Present Illness • Born Full Term, via SVD, to a 24yo G1P0 mother at Comemebo Lying In Clinic with BW 2.5kg. Mother had PNCU c/o LHC starting at 3mos AOG. (+) UTI at 7mos AOG for which she took unrecalled antibiotics for 7 days. Mother had (+) VDRL and (+) RPR at 7 mos AOG, but was not treated due to financial constraint.

  5. History of Present Illness • At birth, patient was active with good cry, good activity and noted yellowish of sclera. (+) yellowish eye discharge OU. Patient was observed for 2days then advised consult to a tertiary hospital. • Vitamin K given at lying-in • 2 days PTA – (+) fever Tmax of 38.7, (-) cough/colds. No consult done. Paracetamol was given. (+) good suck/cry/activity.

  6. History of Present Illness • 1 day PTC – still with fever, pt was brought to a local hospital A> Sepsis of the Newborn, late onset. Advised transfer to different hospital hence admission at PER-PGH.

  7. Review of System (at the ER) (+) Good suck/activity (+) Good UO/BM (+) “hoarse” cry (-) cough/colds (-) seizure

  8. FMHx (-) BA/HPN/DM/PTB?

  9. Developmental • (+) Moro Reflex • (+) Grasping Reflex • (+) Sucking Reflex

  10. Nutritional • Exclusively Breastfed since birth

  11. Immunization • (+) HepB1

  12. PSHx • Pt is an only child. Mother is a 25 yo unemployed. Father is a 32 yo, works delivery boy.

  13. Physical Examination (ER) • Awake, alert, NICRD with Generalized jaundice and desquamation • 90/60 132 34 38.9 • Pale palpebral conjunctivae, ictericsclerae, (+) greenish discharge fom OU, (-) CLAD, (-) TPC • Equal chest expansion, (-) retractions, Clear breath sounds • Adynamicprecordium, NRRR, (-) murmur • Flat, soft abdomen, (-) masses/organomegaly • Full equal pulses, (-) cyanosis/edema • Neuro Exam: Essentially normal

  14. Assessment (ER) • t/c Neonatal Sepsis • r/o Congenital Syphilis • Hyperbilirubinemia prob 2 to Sepsis

  15. Course at the ER • Labs Facilitated - CBC with PC - Blood CS - Serum Na,K,Cl,BUN,Crea,TB,DB,IB,ALT,AST,RBS,Alb - VDRL, RPR - BT

  16. Course at the ER • LT was done : note of xanthochromic tap. - CSF GS/CS - CSF Q/Q - CSF VDRL, cell count, protein - CSF FTA-ABS/TPHA (confirmatory test) c/o Makati Med

  17. Course at the ER • Tx: - Initially stted on Pen G (50 k ‘u’/kg/d) and Amikacin (15) • Referrals: Ophtha: A> Opthalmia Neonatorum P> Erythomycin eye ointment ENT: A> r/o Congenital syphilis P> for ABR

  18. Laboratories • CBC (wbc 27.7, rbc 3.45, hgh 121, hct 0.354, mcv 102.6, mch 34.9, mchc 340, rdw 16.1, plt 226, neut 0.58, lym 0.24, mono 0.12, band 0.04. • RPR (+) • Blood Chem: Glu 6.08, BUN 2.13, Crea 32, Alb 21, TB 167.8 (9.8) DB 0, IB 167.8 (9.8), AST 22, ALT 25, Ca 2.01, Na 137, K, 4.1, Cl 104)

  19. Laboratories • BT: A+ • CSF Glu 3.19, CSF Protein 1.43 • CSF Qualitative: yellow, slightly hazy, RBC 2 000, WBC 2.6, PMN 7, Lymp 0 • Blood CS: NG2D • CSF GS: (-) PMN, (-) Organisms/encapsulated organisms

  20. Admission • Admitted at W11 B36 last July 28, 2009 • PWI: t/c Neonatal Sepsis r/o Congenital Syphilis Ophthalmia Neonatorum

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