Authors: Dr Nsofwa Sukwa, Michelo Simuyandi (CIDRZ), Masuzyo Chirwa (CIDRZ), Yvonne Mutombo Kumwimba (CIDRZ), Obvious N Chilyabanyama (CIDRZ), Natasha Laban(CIDRZ), Aybüke Koyuncu (CIDRZ), Roma Chilengi (CIDRZ)
Citation Style For This Article: Sukwa N, Simuyandi M, Chirwa M, et al .Incidence and clinical presentation of Congenital Syphilis, in a Rotavirus vaccine cohort study in Lusaka: a case series report. The Health Press Zambia Bull. 2020; 4(4); pp 25
Background
Despite an otherwise robust national antenatal clinic program, Maternal and congenital syphilis remain an important public health issue in Zambia. This case series reports the clinical presentation of seven infants diagnosed with Congenital Syphilis in Lusaka, Zambia.
Methods
The cases in this series were incidental findings from a cohort of infants enrolled in a rotavirus vaccine immunogenicity study recruiting infants at 6 weeks of age. As part of clinical care for enrolled participants, we screened mothers of children who presented with adverse events of (i) repeated upper respiratory tract infections/coryza, (ii) skin lesions, and (iii) poor weight gain, for syphilis using Rapid Plasma Reagin (RPR) test.
Results
From a cohort of 214 mother-infant pairs enrolled between September and December 2018, a total of 115 (44.4%) of the mothers reported to have not been screened during antenatal care. Of these, 4 (3.5%) reported to have tested positive; and only two received treatment. Seven out of 57 (26.6%) children meeting the screening criteria had a positive RPR test result. The mean age at diagnosis was 4.5 months (1.3 SD), and the common presenting features included: coryza (6/7), skin lesions (4/7), conjunctivitis (3/7), pallor/anemia (5/7), wasting (2/7), and 5/7 were underweight. Regarding maternal HIV infection, 3 of the 7 infants (3/7) were exposed to HIV. Following diagnosis, all 7 cases received standard treatment according to national treatment guidelines i.e. 6/7 cases received inpatient care with benzylpenicillin for ten days, while 1/7 was treated as an outpatient and received daily procaine penicillin for ten days. Conclusion: These findings suggest that though screening for syphilis is part of the standard of care for antenatal in Zambia, it is not offered optimally. There is an urgent need to address programmatic shortcomings in syphilis screening and treatment to avoid long-term sequelae. Additionally, Clinicians need to raise their index of suspicion and rule out syphilis when confronted with these clinical symptoms regardless of the mother’s HIV status