Congenital Syphilis

Garcia, Lucman, Macaraya, Malilay, Marino

General Data

• Caganda, Lorenz• 1 week old/M• Admitted for the 1st time at PER-PGH last July

25, 2009

Chief Complaint

Fever

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.

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.

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.

Review of System (at the ER)

(+) Good suck/activity(+) Good UO/BM(+) “hoarse” cry

(-) cough/colds(-) seizure

FMHx

(-) BA/HPN/DM/PTB?

Developmental

• (+) Moro Reflex• (+) Grasping Reflex• (+) Sucking Reflex

Nutritional

• Exclusively Breastfed since birth

Immunization

• (+) HepB1

PSHx

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

Physical Examination (ER)• Awake, alert, NICRD with Generalized jaundice and

desquamation• 90/60 132 34 38.9• Pale palpebral conjunctivae, icteric sclerae, (+)

greenish discharge fom OU, (-) CLAD, (-) TPC• Equal chest expansion, (-) retractions, Clear breath

sounds• Adynamic precordium, NRRR, (-) murmur• Flat, soft abdomen, (-) masses/organomegaly• Full equal pulses, (-) cyanosis/edema• Neuro Exam: Essentially normal

Assessment (ER)

• t/c Neonatal Sepsis• r/o Congenital Syphilis• Hyperbilirubinemia prob 2 to Sepsis

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

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

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 ointmentENT: A> r/o Congenital syphilis P> for ABR

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)

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

Admission

• Admitted at W11 B36 last July 28, 2009• PWI:

t/c Neonatal Sepsisr/o Congenital SyphilisOphthalmia Neonatorum