Midwifery care of a newborn with Treponema pallidum infection

Sažetak: Uvod. Sifilis je zarazna bolest uzrokovana spiralnom bakterijom zvanom Treponema pallidum. Infekcija se najčešće prenosi spolnim putem, no može se prenijeti i transplacentarno. Cilj. Cilj ovog rada je opisati mikrobiološka obilježja uzročnika, kliničku sliku, dijagnostičke postupke i načine liječenja u odraslih osoba, trudnica, novorođenčadi i odabranih skupina, te istaknuti ulogu primalje u skrbi za oboljelu trudnicu. Rasprava. Treponema pallidum je Gram neodređena spiroheta složene antigenske strukture koja se može vizualizirati mikroskopiranjem u tamnom polju, no klinički gledano najvažniju ulogu u dijagnosticiranju sifilisa imaju serološki testovi; netreponemski (VDRL, RPR) i treponemski (IFA, TPHA, TPI).Klinička slika sifilisa dijeli se na tri stadija; primarni, sekundarni i tercijarni. Također, uobičajeno je govoriti i o ranom i kasnom stadiju sifilisa. Kongenitalni sifilis nastaje transplacentarnim prijenosom, uobičajeno između 16. i 28. tjedna gestacije. Osim transplacentarno, novorođenče može akvirirati infekciju i u kontaktu s lezijom u vaginalnom kanalu ili dojenjem. U slučaju transplacentarnog prijenosa infekcije, mogu nastati različiti neželjeni ishodi trudnoće. Pri porođaju u novorođenčeta se ne moraju uočavati kliničke manifestacije bolesti.Lijek izbora za liječenje sifilisa je penicilin, a duljina liječenja i način primanja terapije ovise o stadiju bolesti i specifičnosti bolesnika. Uspješnost liječenja potrebno je pratiti klinički i serološki.Primaljska skrb očituje se u edukaciji trudnice o simptomima, prijenosu i načinu zaštite od spolno prenosivih bolesti. U trudnica s potvrđenom dijagnozom sifilisa, primalja sudjeluje u primjeni liječenja koje je ordinirao liječnik specijalist. Primalja bi trebala uočiti rane znakove kongenitalnog sifilisa, te pravovremeno prepoznati čimbenike koji doprinose povećanom riziku za lošije ishode u novorođenčeta. Zaključak. Kongenitalni sifilis može se prevenirati rutinskim probirom trudnica na sifilis. Sve trudnice trebale bi prvi prvom pregledu biti podvrgnute istom, a dodatno testiranje trebalo bi obaviti između 28. i 32. tjedna gestacije. U slučaju postojanja dodatnih čimbenika rizika, testiranje bi trebalo ponoviti neposredno prije ili po porodu. Liječenje kongenitalnog sifilisa uključuje i timski rad specijalista infektologije, neonatologije, pedijatrije, ginekologije i opstetricije, te sestrinskog i primaljskog osoblja.Summary: Introduction. Sypfilis is an infectious disease caused by spirochetal bacteria named Treponema pallidum. Infection is usually sexually transsmited, but could be also transplacentary transmitted. Aim. The aim of this work is to describe the microbiological features, clinical presentation, diagnostic tools and available treatment in adults, pregnant women, newborns and other specific groups of patients. Also, the goal of this work is to point out the role of midwifery care. Discussion. Treponema pallidum is a Gram neutral spirohetal bacteria with complex antigene structure that can be visualized by microscopy in the dark field. From the clinical aspect, serological tests are the most important diagnostic tools in confirming the diagnosis. There are non-treponemal (VDRL, RPR) and treponemal tests (IFA, TPHA, TPI).Cliniacl presentation of syphilis in traditionally divided into three stages; primary, secondary and tertiary. Also, syphilis is divided into early and late onset. Congenital syphilis appears after transplacental transmission usually between 16th and 28th gestation week. Besides transplacentary, newborn may aquire this infection in direct contact with vaginal channel or while breastfeeding. In casese of transplacentar transmission, various unfavorable pregnancy outcomes may occur. At birth, newborns may not show the cliniacl manifestations of acute illness. Penicillin is the medication of choice. The regime and the duration of the therapy are prescribed depending of the stage of illness and the patient specificity. Effectivness of therapy should be monitored with clinical and serologic features.Midwifery care is based on the education about symptoms, ways of transmission and protection against sexually transmitted diseases. In pregnant women with syphilis, midwife participates in treatment procedures proscribed by the specialists doctors. Midwife should be trained to recognize the early signs of congenital syphilis, and to promptly notice the factors that contribute to the increased risk for negative outcomes in newborns. Conclusion. Congenital syphilis is preventable when routine serological tests are made on time in pregnant women. All pregnant women should underwent serological testing at the first visit, and additional testing is recommended to be done between 28th and 32th gestation week. In case of other risk factors, re-testing should be made near delivery or at delivery. Complete treatment process of congenital syphilis is a result of multidisciplinary work of specialities in infectology, neonatology, gynecology and obstetrics, and nursing and midewifery staff