Category: Clinical Science
At the end of the session, participants will be able to:
- Recognize the global resurgence of syphilis
- Describe findings of congenital syphilis
- Be aware that IUFD due to congenital syphilis can have mild to no inflammation, and T. pallidum is a
sensitive tool for diagnosis
COI Disclosure:
I do not have a relationship with a for-profit and/or a not-for-profit organization to disclose.
Presenter
Suzy Kosteniuk is a staff neuropathologist in Winnipeg, Manitoba.
Suzy Kosteniuk1, E. Ferreira1, Marc R. Del Bigio1
1University of Manitoba, Department of Pathology
Target Audience:
Residents
Medical Students
CanMEDS:
Health Advocate
Scholar
Collaborator
Leader
Professional
Congenital syphilis in the modern era: novel findings from a series of 26 perinatal and pediatric autopsies
Abstract
The past decade has seen a global resurgence of syphilis. Although syphilis is a curable disease, and despite public health interventions seeking to identify and treat syphilis in pregnancy, a rise in congenital syphilis is accompanying the rise of syphilis infection. This is a case series of all perinatal and pediatric autopsies with known gestational syphilis exposure in Manitoba, Canada between 2016 and 2026 (perinatal n = 15, pediatric n = 11). 14 perinatal and 11 pediatric cases have complete autopsies including neuropathology. Treponema pallidum immunohistochemistry is performed on all cases. 10 of the 15 stillbirths are syphilitic, with T. pallidum spirochetes identified in the fetus. In positive cases, spirochetes are abundant in solid organs and leptomeninges, with mild or no accompanying inflammation. When spirochetes are present in the fetus, they are abundant and disseminated. Fetal death due to syphilis is associated with limited or no prenatal care, and absence of maternal syphilis treatment (p-values 0.0170 and 0.0070 respectively). Although some pediatric cases clinically had congenital syphilis, none have active syphilis at autopsy. By applying Treponema pallidum immunohistochemistry liberally in autopsies with gestational syphilis exposure, we identified syphilis as a cause of death in 66.7% of tested cases. Inflammation is minor or absent in all syphilitic perinatal deaths. It is critical for perinatal and neuropathologists to be aware of this pattern of disease and apply T. pallidum immunohistochemistry appropriately, as it is easy to miss the diagnosis of IUFD due to syphilis.