Congenital Syphilis

CONGENITAL SYPHILIS (CS) CASE INVESTIGATION ALGORITHM

 

1.For the case definition of congenital syphilis (CS), the mother must have evidence of syphilis by one of thefollowing tests:

(a) a syphilitic lesion at the time of delivery proven by positive darkfield or direct fluorescentantibody (DFA) examination; or (b) a reactive treponemal test (e.g., FTA-ABS, MHA-TP). A treponemal test on the mother may not be available for an infant evaluated outside the newborn period or a child with late CS. In these instances, the investigation may proceed on the basis of infant/child treponemal and nontreponemal tests. An attempt to obtain a maternal treponemal test should be made.

2.Adequate therapy in a non-pregnant woman should be one of the standard treatment regimens recommended for her particular stage of infection .

3.Adequate therapy in a pregnant woman is treatment with a penicillin regimen, appropriate for the mother’s stage of syphilis, started at least 30 days before delivery (see STD Treatment Guidelines). Any non-penicillin treatment or penicillin treatment in the last 30 days of pregnancy is inadequate for the unborn child.

 4.Appropriate response to therapy is a fourfold decline in non-treponemal titer by three months with primary or secondary syphilis, or a fourfold decline in non-treponemal titer by six months with early latent syphilis.An inappropriate response is less than a fourfold drop over the expected time period unless the patient is knownto be serofast (see below). An equivocal response includes instances where it was difficult to assess adequate response because either no interim titers from treatment to delivery were available or insufficient time had passed between treatment and delivery. An unknown response includes those instances where titers before treatment and/or at delivery are not available. The infant/child of a mother with an equivocal or unknown response should be evaluated for CS.

Special consideration is required in the case of a serofast patient. If a mother’s titer was 1:1, 1:2, or 1:4 before pregnancy, there is evidence of adequate treatment, and at delivery her titer is still the same low level, she should be regarded as serofast. Stop the case investigation; this is not a case.

 

 5.A syphilitic stillbirth is defined as a fetal death in which the mother had untreated or inadequately treated syphilis at delivery of a fetus after a 20-week gestation or weighing >500 grams.

 6.Signs of CS (usually in an infant or child <2 years old) include: condyloma lata, snuffles, syphilitic skin rash, hepatosplenomegaly, jaundice due to syphilitic hepatitis, pseudoparalysis, or edema (nephrotic syndrome and/or malnutrition). Stigmata in an older child may include: interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson’s teeth, saddle nose, rhagades, or Clutton’s joints.

7.In the immediate newborn period, interpretation of these tests may be difficult; normal values vary with gestational age and are higher in preterm infants. CSF cell count and protein in a term or preterm infant should be interpreted by the clinician. Beyond the neonatal period, a CSF cell count >5 wbc/mm 3 or a CSF protein >40 mg/dl is abnormal, regardless of CSF serology.

 

Source: CDC,USA

Treatment of syphilis: follows

Nutrition: HIV/AIDS

Dietary Advice for PLWHA

The role of good nutrition to HIV /AIDS patient is well established.  PLWHA needs more energy to fight with infection in compare to person who does not have HIV, means they have to eat MORE than NORMAL. In a choice between taking pills with no immediate or obvious effect, and eating food to survive, food will almost certainly take priority every time.

HIV/AIDS reduces food intake & reduces food absorption

People with HIV/AIDS often do not eat enough because:

• the illness and the medicines taken for it may reduce the appetite, modify the taste of food and prevent the body from absorbing it;
• symptoms such as a sore mouth, nausea and vomiting make it difficult to eat;
• tiredness, isolation and depression reduce the appetite and the willingness to make an effort to prepare food and eat regularly;
• There is not enough money to buy food.

Practical suggestions for food intake in symptomatics

Emotional Health	Talk to them, encourage them to handle their emotional challenge; organise support group(It must be addressed before taking nutrition exercise.): ·          The body needs extra rest. Try to sleep for eight hours every night. Rest whenever you are tired. ·         Try not to worry too much. Stress can harm the immune system. Relax more. Relax with people you love, your family, your children and your friends. Do things you enjoy, e.g. listen to music or read a newspaper or a book. ·         Be kind to yourself. Try to keep a positive attitude. Feeling good is part of being healthy. ·         Take light exercise. Choose a form of exercise that you enjoy. ·         Find support and get good advice. Ask for advice from health workers. Many medical problems can be treated. ·         Ask for help and accept help when it is offered. ·         Stop smoking. It damages the lungs and many other parts of the body and makes it easier for infections to attack your body. ·         Alcohol is harmful to the body, especially the liver. It increases vulnerability to infection and destroys vitamins in the body.
Anorexia	· Investigate cause of anorexia · Encourage foods without strong smell · Encourage cold foods · Provide foods of choice
Vomiting	· Ice cubes · from cooled boiled water · Fluids · cooled boiled water, green tea, diluted fruit juices · Chilled foods · Soups, puddings · Light foods · Try use of ginger
	Increase	Decrease
Sore mouth	· Try to eat soft foods · soups, puddings, mash foods · Encourage fluids · Use a straw if this helps	· Avoid spicy foods · Avoid very hard foods · Avoid acid foods · Avoid extremes of temperatures
Diarrhoea	· Encourage fluids · Increase low fibre starchy foods · rice, noodles, potatoes · Increase protein foods · eggs, pork, chicken, tofu	· Avoid heavily spiced foods · Avoid very fatty foods · Avoid green vegetables

Weight Loss:

How to discover

·         Advice to get his or her weight on the same day once a week and keep a record of the weight and date. ·         For an average adult, serious weight loss is indicated by a 10 percent loss of body weight or 6-7 kg in one month. If a person does not have scales at home it might be possible to make an arrangement with a chemist, clinic or local health unit to weigh him or her. ·         When clothes become loose and no longer fit properly

Goal

To increase weight to normal level ·         Eat more staple foods such as rice, maize, millet, sorghum, wheat, bread, potatoes, sweet potatoes, yams and bananas. ·         Increase intake of beans, soy products, lentils, peas, groundnuts, peanut butter and seeds, such as sunflower and sesame. ·         Include all forms of meat, poultry, fish and eggs as often as possible. Minced meat, chicken and fish are easier to digest. Offal (such as kidney and liver) can be the least expensive source. ·         Eat snacks regularly between meals. Good snacks are nuts, seeds, fruit, yoghurt, carrots, cassava crisps, crab crisps and peanut butter sandwiches. ·         Slowly increase the fat content of the food by using more fats and oils, as well as eating fatty foods - oilseeds such as groundnuts, soy and sesame, avocados and fatty meat. If problems with a high fat intake are experienced (especially diarrhoea), reduce the fat intake until the symptoms are over and then gradually increase it to a level that the body can tolerate. ·         Introduce more dairy products such as full-cream milk, sour milk, buttermilk, yoghurt and cheese into the diet. ·         Add dry milk powder to foods such as porridge, cereals, sauces and mashed potatoes. However, do not use coffee and tea whiteners, which do not have the same nutritional benefits as milk. Note that some people may find milk difficult to digest. It should be avoided if it causes cramps, a feeling of being full or skin rashes. ·         Add sugar, honey, jam, syrup and other sweet products to the food. ·         Make meals as attractive as possible.

Try to eat three good meals daily with frequent snacks in between

Vitamin / Mineral	Importance	Increase  Intake/ Source
Vitamin A	IT is  important to keep the lining of skin, lungs and gut healthy Vitamin A deficiency increases the severity of diseases such as diarrhea while infection will increase the loss of vitamin A from the body.	Good vitamin A sources are dark green, yellow, orange and red vegetables and fruit. These include spinach, pumpkin, cassava leaves, green peppers, squash, carrots, amaranth, yellow peaches, apricots, papaya and mangoes. Vitamin A is also contained in red palm oil, yellow maize, orange and yellow sweet potatoes, egg yolks and liver
Vitamin C	It helps to protect the body from infection and aids in recovery.	It is found particularly in citrus fruits such as oranges, grapefruit, lemons and mandarins. Guavas, mangoes, tomatoes and potatoes are also good sources of vitamin C.
Vitamin E	Protects cells and aids resistance to infection.	Foods containing vitamin E are green leafy vegetables, vegetable oils, peanuts and egg yolks.
Vitamin B-group.	This group is necessary to keep the immune and nervous system healthy. Vitamins, however, may be lost from the body through the use of certain medicines for the treatment of tuberculosis.	Good food sources include white beans, potatoes, meat, fish, chicken, watermelon, maize, grains, nuts, avocados, broccoli and green leafy vegetables.
Iron.	Iron-deficiency anaemia is a widespread problem in many countries, especially among women and children.	Good iron sources are green leafy vegetables, seeds, whole-grain products, dried fruit, sorghum, millet, beans, alfalfa, red meat, chicken, liver, fish, seafood and eggs.
Selenium	is an important mineral because it helps to activate the immune system.	Good sources include whole grains such as wholemeal bread, maize and millet and dairy products such as milk, yoghurt and cheese. Meat, fish, poultry, eggs and other protein-rich foods are also good sources, as are peanut butter, dried beans and nuts.
Zinc	Zinc is  important for the immune system. Zinc deficiency reduces the appetite.	Sources include meat, fish, poultry, shellfish, whole-grain cereals, maize, beans, peanuts and milk and dairy products.
NOTE: it is better to boil, steam and fry vegetables for a short time only. Boil vegetables in a little water and use it afterwards for cooking as it contains considerable amounts of vitamins and minerals. Vegetables will lose some of their vitamins and minerals if soaked for a long time
NOTE: Germs multiply more quickly in warm food. Storing food in a refrigerator or cool place slows down this growth. Cooking on a high heat can also kill most germs. Food should be eaten as soon as it is cooked.
Note: Cook meat and fish well; meat should have no red juices; Wash utensils and surfaces touched by animal products with hot water and soap before preparing other foods. Keep meat and fish separate from other foods. Eggs should be hard boiled. Do not eat soft-boiled eggs, raw eggs, cracked eggs or any foods containing raw eggs.
Always wash hands with clean water and soap before, during and after preparing food or eating, and after visiting the toilet. Dry hands on a clean cloth or towel

Kaushal K. Singh/23.02.13

www.drksingh.blogspot.com