摘要
西澳大利亚州（WA）的先天性梅毒病例再次出现。建议对新生儿进行适当的微生物学检测以确认感染，包括梅毒免疫球蛋白M（IgM）、与母体样本配对的快速血浆试剂（RPR）以及胎盘和鼻拭子聚合酶链反应（PCR）。我们检查了先天梅毒确诊病例的微生物学检测结果，以及被评估为高风险病例的患者对检测建议的遵守情况。我们回顾了2018年1月1日至2023年12月31日期间西澳大利亚州确诊先天梅毒病例的微生物学结果。此外，我们还审查了2021年1月1日至2023年10月31日期间珀斯大都市被确定为先天性梅毒高风险新生儿的微生物学检测结果。共发现18例先天性梅毒病例，其中一例跨州出生的病例数据不详。在纳入的17例病例中，病死率为35%（6/17；5例死胎，1例围产期死亡）。所有死产病例的胎盘组织 PCR 均呈阳性。在 12 例活产婴儿中，83% 的婴儿在分娩时无症状。对 11 例活产（11/12）进行了围产期检测；55% 的活产（6/11）检测出 IgM。胎盘组织 PCR 阳性率为 88%（7/8 例）。鼻拭子 PCR 阳性率为 57%（4/7 例）。有 22 名新生儿被列为先天性梅毒感染的高危人群，他们都进行了 IgM 和 RPR 检测。64%（14/22）的胎盘组织样本和64%（14/22）的鼻拭子样本进行了梅毒PCR检测。要确认先天性梅毒感染，需要进行全面的微生物检测，包括梅毒 IgM 和胎盘组织 PCR。持续的检测评估对于发现个别病例和监测疫情至关重要。考虑到标本采集不完整的风险，我们的数据支持对有先天性梅毒风险的新生儿采取基于风险的方法，根据母体血清学和治疗史进行管理。Western Australia (WA) has experienced a resurgence of congenital syphilis. Appropriate microbiology testing of the neonate is recommended to confirm infection, including syphilis immunoglobulin M (IgM), rapid plasma reagin (RPR) paired with a maternal sample, and polymerase chain reaction (PCR) on placenta and nasal swabs. We examined the performance of microbiology tests in confirmed congenital syphilis cases and the adherence to testing recommendations in those assessed as high risk. We reviewed the microbiology results of confirmed congenital syphilis cases in WA between 1 January 2018 and 31 December 2023. In addition, microbiology testing of neonates from metropolitan Perth identified as being at a high risk of congenital syphilis between 1 January 2021 and 31 October 2023 was reviewed. Eighteen congenital syphilis cases were identified; data were unavailable for a case born interstate. Of the 17 included cases, the case fatality rate was 35% (6/17; five stillbirths and one perinatal death). Placenta tissue PCR was positive in all stillbirths. Of the 12 live births, 83% were symptomatic at delivery. Perinatal testing was performed in 11 live births (11/12); IgM was detected in 55% (6/11). Placenta tissue PCR was positive in 88% (7/8 tested). Nasal swab PCR was positive in 57% (4/7 tested). There were 22 neonates classified as being at a high risk for congenital syphilis infection; all had IgM and RPR testing. Syphilis PCR was performed on placenta tissue samples in 64% (14/22) and on nasal swabs in 64% (14/22) of cases. Comprehensive microbiological testing, including syphilis IgM and placenta tissue PCR, is required to confirm congenital syphilis infection. Continuous evaluation of testing will be crucial for individual case detection and monitoring of the ongoing outbreak. Given the risk of incomplete specimen collection, our data support the adoption of a risk-based approach for neonates at risk of congenital syphilis, with management guided by maternal serology and treatment history.
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