Complicaciones, manifestaciones clínicas de la sífilis congénita y aspectos relacionados a la prevención: revisión integrativa

Rocha, Ana Fátima Braga; Araújo, Maria Alix Leite; Barros, Valéria Lima de; Américo, Camila Félix; Silva Júnior, Geraldo Bezerra da

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 74 (4) • 2021 • https://doi.org/10.1590/0034-7167-2019-0318 copiar

Complicaciones, manifestaciones clínicas de la sífilis congénita y aspectos relacionados a la prevención: revisión integrativa

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

identificar evidencias científicas sobre las complicaciones y manifestaciones clínicas de la sífilis congénita y aspectos relacionados a prevención.

Métodos:

revisión integrativa, mediante búsqueda en bases de datos LILACS y MEDLINE, realizada en marzo de 2018, utilizando los descriptores “syphilis, congenital”, “complications”, “signs and symptoms”, resultando en 27 investigaciones seleccionadas.

Resultados:

encontraron publicaciones entre 1966 y 2017, la mayoría oriundas de Latinoamérica y África. Desfecho desfavorable, la alteración laboratorial y manifestaciones clínicas de la sífilis congénita precoz y tardía más evidenciados fueron, respectivamente, bajo peso al nacer, anemia, hepatoesplenomegalia y alteraciones odontológicas. Observó que la falta de tratamiento de la embarazada en el prenatal fue la principal oportunidad perdida de prevención de las complicaciones de la sífilis congénita.

Conclusiones:

las evidencias científicas analizadas presentan graves complicaciones de la sífilis congénita que serían evitadas desde que oportunidades precoces de diagnóstico y tratamiento de la embarazada no fueran perdidas durante el prenatal.

Descriptores:
Sífilis Congénita; Signos y Síntomas; Complicaciones; Sífilis; Atención Prenatal

Code	Author/Year	Title	Country	Journal	Level of evidence	Type of study
E1	Souza et al., 2017⁽¹³13 Souza LFM, Monteiro PM, Mota AS, Passos MRL, Pellegrini Jr EM. Analysis of congenital syphilis cases notification in a reference hospital of Niterói, Rio de Janeiro State, from 2008 to 2015. DST J Bras Doenças Sex Transm. 2017;29(1):17-21. https://doi.org/10.5533/DST-2177-8264-201729105 https://doi.org/10.5533/DST-2177-8264-20... ⁾	Analysis of congenital syphilis cases notification in a reference hospital of Niteroi, Rio de Janeiro State, from 2008 to 2015	Brazil	J Bras Doenças Sex Transm.	VI	Descriptive
E2	Cardoso et al., 2016⁽¹⁴14 Cardoso ARP, Araújo MAL, Andrade RFV, Saraceni V, Miranda AE, Dourado MIC. Underreporting of congenital syphilis as a cause of fetal and infant deaths in Northeastern Brazil. PLoS ONE. 2016;11(12):e0167255. https://doi.org/10.1371/journal.pone.0167255 https://doi.org/10.1371/journal.pone.016... ⁾	Underreporting of Congenital Syphilis as a Cause of Fetal and Infant Deaths in Northeastern Brazil	Brazil	PLoS ONE	VI	Cross-sectional
E3	Feliz et al., 2016⁽¹⁵15 Feliz MC, Medeiros ARP, Rossoni AM, Tahnus T, Pereira AMVB, Rodrigues C. Adherence to the follow-up of the newborn exposed to syphilis and factors associated with loss to follow-up. Rev Bras Epidemiol. 2016;19(4):727-39. https://doi.org/10.1590/1980-5497201600040004 https://doi.org/10.1590/1980-54972016000... ⁾	Aderência ao seguimento no cuidado ao recém-nascido exposto à sífilis e características associadas à interrupção do acompanhamento	Brazil	Rev. Bras. Epidemiol.	VI	Descriptive
E4	Domingues; Leal, 2016⁽⁷7 Domingues RMSM, Leal MC. Incidência de sífilis congênita e fatores associados à transmissão vertical da sífilis: dados do estudo Nascer no Brasil. Cad Saúde Pública. 2016;32(6):e00082415. https://doi.org/10.1590/0102-311X00082415 https://doi.org/10.1590/0102-311X0008241... ⁾	Incidência de sífilis congênita e fatores associados à transmissão vertical da sífilis: dados do estudo Nascer no Brasil	Brazil	Cad. Saúde Pública	VI	Cross-sectional
E5	Ferreira et al., 2016⁽¹⁶16 Ferreira ST, Correia C, Marçal M, Tuna ML. Skin rash: a manifestation of early congenital syphilis. BMJ Case Reports. 2016;bcr2016216148. https://doi.org/10.1136/bcr-2016-216148 https://doi.org/10.1136/bcr-2016-216148... ⁾	Skin rash: a manifestation of early congenital syphilis	Portugal	BMJ Case Reports	VI	Case report
E6	Lafetá et l., 2016⁽¹⁷17 Lafetá KRG, Martelli Jr H, Silveira MF, Paranaíba LMR. Maternal and congenital syphilis, underreported and difficult to control. Rev Bras Epidemiol. 2016;19(1):63-74. https://doi.org/10.1590/1980-5497201600010006 https://doi.org/10.1590/1980-54972016000... ⁾	Sífilis materna e congênita, subnotificação e difícil controle	Brazil	Rev. Bras. Epidemiol.	VI	Descriptive
E7	Dou et al., 2016⁽¹⁸18 Dou L, Wang X, Wang F, Wang Q, Qiao Y, Su M, et al. Epidemic Profile of Maternal Syphilis in China in 2013. BioMed Research International. 2016;ID9194805. https://doi.org/10.1155/2016/9194805 https://doi.org/10.1155/2016/9194805... ⁾	Epidemic Profile of Maternal Syphilis in China in 2013	China	BioMed Research International	VI	Cross-sectional
E8	Arnesen; Serruya; Duran, 2015⁽¹⁹19 Arnesen L, Martínez G, Mainero L, Serruya S, Durán P. Gestational syphilis and stillbirth in Latin America and the Caribbean. Int J Gynaecol Obstet. 2015;128(3):241-5. https://doi.org/10.1016/j.ijgo.2014.09.017 https://doi.org/10.1016/j.ijgo.2014.09.0... ⁾	Gestational syphilis and stillbirth in the Americas: a systematic review and meta-analysis	-	Rev Panam Salud Publica	I	Systematic review and meta-analysis
E9	Rac et al., 2014⁽²⁰20 Rac MWF, Bryant SN, McIntire DD, Cantey JB, Twickler DM, Wendel Jr GD et al. Progression of ultrasound findings of fetal syphilis after maternal treatment. Am J Obstet Gynecol. 2014;211(4):426e1-e6. https://doi.org/10.1016/j.ajog.2014.05.049 https://doi.org/10.1016/j.ajog.2014.05.0... ⁾	Progression of ultrasound findings of fetal syphilis after maternal treatment	United States	Am J Obstet Gynecol.	IV	Retrospective cohort
E10	Chowdhary et al., 2014⁽²¹21 Chowdhary N, Rani BSK, Mukunda KS, Kiran NK. Early detection of congenital syphilis. J Indian Soc Pedod Prev Dent. 2014;32(4):333-7. https://doi.org/10.4103/0970-4388.140969 https://doi.org/10.4103/0970-4388.140969... ⁾	Early detection of congenital syphilis	India	J Indian Soc Pedod Prev Dent.	VI	Case report
E11	Cavagnaro et al., 2014⁽²²22 Cavagnaro FSM, Pereira TR, Pérez CP, Vargas FDV, Sandoval CC. Sífilis congénita precoz: a propósito de 2 casos clínicos. Rev Chile Pediatr. 2014;85(1):86-93. https://doi.org/10.4067/S0370-41062014000100012 https://doi.org/10.4067/S0370-4106201400... ⁾	Sífilis congénita precoz: a propósito de 2 casos clínicos	Chile	Rev Chil Pediatr.	VI	Case report
E12	Lago; Vaccari; Fiori, 2013⁽⁸8 Lago G, 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 https://doi.org/10.1097/OLQ.0b013e31827b... ⁾	Clinical features and follow-up of congenital syphilis	Brazil	Sex Transm Dis.	IV	Cohort
E13	Newman et al., 2013⁽⁶6 Newman L, Kamb M, Hawkes S, Gomez G, Say L, Seuc A, et al. Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data. PLoS Med. 2013;10(2):e1001396. https://doi.org/10.1371/journal.pmed.1001396 https://doi.org/10.1371/journal.pmed.100... ⁾	Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data	Worldwide research	PLoS Med	VI	Descriptive
E14	Gomez et al., 2013⁽⁵5 Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, Hawkes SJ. Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis. Bull World Health Organ. 2013; 91:217-26. https://doi.org/10.2471/BLT.12.107623 https://doi.org/10.2471/BLT.12.107623... ⁾	Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis	-	Bull World Health Organ.	I	Systematic review and meta-analysis
E15	Arriagada et al., 2012⁽²³23 Arriagada D, Donoso A, Cruces P, Díaz F. Congenital syphilis: presenting as septic shock alter the neonatal period. Rev Chile Infectol. 2012;29(5):558-63. https://doi.org/10.4067/S0716-10182012000600017 https://doi.org/10.4067/S0716-1018201200... ⁾	Sífilis congénita: presentación como shock séptico después del período neonatal	Chile	Rev Chilena Infectol.	VI	Case report
E16	Pessoa; Galvão, 2011⁽²⁴24 Pessoa L, Galvão V. Clinical aspects of congenital syphilis with Hutchinson's triad. BMJ Case Rep. 2011;bcr1120115130. https://doi.org/10.1136/bcr.11.2011.5130 https://doi.org/10.1136/bcr.11.2011.5130... ⁾	Clinical aspects of congenital syphilis with Hutchinson's triad	Brazil	BMJ Case Rep.	VI	Case report
E17	Zhu et al., 2010⁽²⁵25 Zhu L, Qin M, Du L, Xie RH, Wong T, Wen SW. Maternal and congenital syphilis in Shanghai, China, 2002 to 2006. Int J Infect Dis. 2010;14(Suppl 3):e45-8. https://doi.org/10.1016/j.ijid.2009.09.009 https://doi.org/10.1016/j.ijid.2009.09.0... ⁾	Maternal and congenital syphilis in Shanghai, China, 2002 to 2006	China	Int J Infect Dis.	IV	Cohort
E18	Kruger; Malleyeck, 2010⁽²⁶26 Krüger C, Malleyeck I. Congenital syphilis: still a serious, under-diagnosed threat for children in resource-poor countries. World J Pediatr. 2010;6(2):125-31. https://doi.org/10.1007/s12519-010-0028-z https://doi.org/10.1007/s12519-010-0028-... ⁾	Congenital syphilis: still a serious, under-diagnosed threat for children in resource-poor countries	Tanzania	World J Pediatr.	VI	Descriptive
E19	Reyes et al., 2004⁽²⁷27 Reyes JA, Chorbadjian AG, Parada CMA, Turrys CJ, Bravo CN, Araya FCG. Sífilis congénita: optimizando el diagnóstico en 191 neonatos de madres seropositivas. Rev Chile Infectol. 2004;21(4):307-11. https://doi.org/10.4067/S0716-10182004000400004 https://doi.org/10.4067/S0716-1018200400... ⁾	Sífilis congénita: Optimizando el diagnóstico en 191 neonatos de madres seropositivas	Chile	Rev. chil. infectol.	IV	Cohort
E20	Peña et al., 2001⁽²⁸28 Peña A, Cardiel-Marmolejo LE, Matamoros-Márquez M, Iturbide-Cruz LA, Ávalos-Martínez JL, García HJ. Sífilis congénita: presentación de un caso y revisión de la literatura. Rev Méd Hosp Gen Méx [Internet]. 2001 [cited 2019 Apr 8];64(4):240-5. Available from: http://www.medigraphic.com/pdfs/h-gral/hg-2001/hg014i.pdf http://www.medigraphic.com/pdfs/h-gral/h... ⁾	Presentación de un caso y revisión de la literatura	Mexico	Rev. méd. Hosp. Gen. Méx.	VI	Case report
E21	McDermott et al., 1993⁽²⁹29 McDermott J, Steketee R, Larsen S, Wirima J. Syphilis-associated perinatal and infant mortality in rural Malawi. Bull World Health Organ [Internet]. 1993 [cited 2019 Apr 8];71(6):773-80. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2393540/pdf/bullwho00039-0115.pdf https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	Syphilis-associated perinatal and infant mortality in rural Malawi	Malawi	Bull World Health Organ.	IV	Cross-sectional
E22	Boot et al., 1989⁽³⁰30 Boot JM, Orange AP, Menke HE, Van Eijk RV, Stolz E. Congenital syphilis in The Netherlands: diagnosis and clinical features. Genitourin Med. 1989;65(5):300-3. https://doi.org/10.1136/sti.65.5.300 https://doi.org/10.1136/sti.65.5.300... ⁾	Congenital syphilis in The Netherlands: diagnosis and clinical features	Netherlands	Genitourin Med.	VI	Descriptive
E23	Chawla et al., 1988⁽³¹31 Chawla V, Pandit PB, Nkrumah FK. Congenital syphilis in the newborn. Arch Dis Child. 1988;63(11):1393-4. https://doi.org/10.1136/adc.63.11.1393 https://doi.org/10.1136/adc.63.11.1393... ⁾	Congenital syphilis in the newborn	Zimbabwe	Arch Dis Child.	VI	Descriptive
E24	Ewing et al., 1985⁽³²32 Ewing CI, Roberts C, Davison DC, Arya OP. Early congenital syphilis still occurs. Arch Dis Child. 1985;60(12):1128-33. https://doi.org/10.1136/adc.60.12.1128 https://doi.org/10.1136/adc.60.12.1128... ⁾	Early congenital syphilis still occurs	England	Arch Dis Child.	VI	Descriptive
E25	Aguayo T et al., 1985⁽³³33 Aguayo IT, Martínez GD, Munzenmaycr JB, Roscmberg HG, Fuente-Alba JAG. Síndrome Nefrótico Secundario a Lues Congénita. Rev Chile Pediatr. 1985;56(2):103-7. https://doi.org/10.4067/S0370-41061985000200009 https://doi.org/10.4067/S0370-4106198500... ⁾	Síndrome nefrótico secundario a lúes congénita	Chile	Rev. Chil. Pediatr.	VI	Case report
E26	Wiggelinkhuizen et al., 1973⁽³⁴34 Wiggelinkhuizen J, Kaschula ROC, Uys CJ, Kuijten RH, Dale J. Congenital syphilis and glomerulonephritis with evidence for immune pathogenesis. Arch Dis Child. 1973;48(5):375-81. https://doi.org/10.1136/adc.48.5.375 https://doi.org/10.1136/adc.48.5.375... ⁾	Congenital syphilis and glomerulonephritis with evidence for immune pathogenesis	South Africa	Arch Dis Child.	VI	Case report
E27	Freiman; Super, 1966⁽³⁵35 Freiman I, Super M. Thrombocytopenia and congenital syphilis in South African Bantu infants. Arch Dis Child. 1966;41(215):87-90. https://doi.org/10.1136 / adc.41.215.87 https://doi.org/10.1136 / adc.41.215.87... ⁾	Thrombocytopenia and congenital syphilis in South African Bantu infants	South Africa	Arch Dis Child.	VI	Descriptive

Complications and manifestations of congenital syphilis	Analyzed studies (n = 27)
Negative outcomes	Number of studies	*Code of the studies with negative outcomes^ * The studies may have presented more than one type of outcome; VDRL - Venereal Disease Research Laboratory. (n = 18)**
Miscarriage/fetal death	07	E1; E2; E4; E6; E13; E14; E17
Stillbirth	09	E1; E2; E6; E7; E8; E12; E13; E14; E21
Neonate death	09	E1; E2; E4; E7; E13; E14; E17; E21; E23
Post-neonate death	03	E2; E14; E21
Prematurity	08	E3; E4; E7; E11; E13; E14; E18; E24
Low weight at birth	11	E3; E4; E7; E11; E13; E14; E18; E20; E23; E24; E27
Laboratory and radiological changes	Number of studies	Code of the studies that presented laboratory and radiological alterations^* * The studies may have presented more than one type of outcome; VDRL - Venereal Disease Research Laboratory. (n = 14)
Anemia	11	E1; E5; E11; E12; E15; E20; E22; E23; E24; E26; E27
Thrombocytopenia	08	E5; E11; E12; E15; E20; E22; E23; E27
Leukocytosis	07	E11; E12; E15; E20; E22; E25; E27
Leukopenia	01	E12
VDRL titers twice as high than the mother birth	03	E11; E12; E15
Alterations in liquor puncture	07	E3; E11; E12; E15; E19; E20; E22
Findings in the radiography of long bones	10	E1; E3; E12; E15; E19; E20; E22; E24; E26; E27
Early manifestations	Number of studies	Codes of the studies that presented early manifestations^* * The studies may have presented more than one type of outcome; VDRL - Venereal Disease Research Laboratory. (n = 15)
Hepatomegaly	14	E5; E9; E11; E12; E15; E18; E19; E20; E22; E23; E24; E25; E26; E27
Splenomegaly	14	E1; E5; E11; E12; E15; E18; E19; E20; E22; E23; E24; E25; E26; E27
Jaundice	09	E1; E11; E12; E18; E20; E23; E24; E25; E27
Serosanguineous rhinitis	08	E1; E12; E18; E20; E22; E23; E24; E27
Palmoplantar pemphigus	12	E5; E11; E12; E15; E18; E19; E20; E22; E23; E25; E26; E27
Perioral or perianal fissures	05	E12; E15; E18; E20; E22
Paleness	02	E12; E27
Petechias, purpura, and/or rashes	05	E1; E11; E12; E22; E27
Lymphadenopathy	02	E12; E22
Respiratory suffering	02	E12; E23
Pneumonia	03	E5; E12; E18
Fever	02	E12; E18
Ascites	03	E9; E25; E26
Fetal hidropsy	02	E12; E23
Generalized edema	02	E25; E26
Pseudoparalysis	01	E23
Late manifestations	Number of studies	Codes of the studies that presented late manifestations^* * The studies may have presented more than one type of outcome; VDRL - Venereal Disease Research Laboratory. (n = 3)
Hutchinson's teeth	02	E10; E16
Mulberry molars	01	E10
Interstitial keratitis	01	E16
Neurological deafness	02	E12; E16
Frontal bossing	01	E12
Saddle nose	01	E12

Lost opportunities related to the avoidability of congenital syphilis consequences for the baby	Number of studies	Codes of the studies that presented lost opportunities^* * The studies may have presented more than one type of lost opportunity (n = 21)
No prenatal	2	E12, E26
Late prenatal start	3	E04, E20, E24
No test during the prenatal	2	E13, E18
Late diagnosis	4	E01, E07, E11, E12
No treatment during the prenatal	9	E03, E06, E12, E07, E13, E14, E18, E19, E22
Inadequate treatment	3	E03, E12, E17
High titer levels at the moment of birth	3	E20, E21, E25

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[1] Corresponding author: Valéria Lima de Barros E-mail: valeriabarros17@hotmail.com