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Licensed Unlicensed Requires Authentication Published by De Gruyter January 1, 2005

Congenital syphilis: β2-microglobulin in cerebrospinal fluid and diagnosis of neurosyphilis in an affected newborn

  • Alfredo Tagarro , Alfredo García-Alix , Ana Alarcón , Angel Hernanz and José Quero


Meningoencephalitis in neonatal congenital syphilis (CS) is a difficult diagnosis because of the limitation of standard cerebrospinal fluid (CSF) tests. This limitation means that new markers in CSF tests are needed to establish whether meningitis is present in presumptive cases of CS. β2-Microglobulin (β2-m) is raised in CSF recovered from neonates with central nervous system (CNS) infections, but it does not correlate with cellular count or proteins in the CSF. We present a preterm newborn with symptomatic CS. First-day CSF showed 50 cells/mm3, protein of 220 mg/dL and a β2-m concentration of 16.9 mg/dL (normal <2.25 mg/dL). Serial determinations of β2-m showed a marked reduction (76%) after 10 days of appropriate treatment. At 30 days of life, β2-m was already within the normal range (1.8 mg/dL). Cerebral ultrasonography showed ventricular dilatation, moderate periventricular echogenicity, subependimal hemorrhages, and linear hyperechoic areas in the thalamus and basal ganglia. We suggest that β2-microglobulin is very useful in the diagnosis of CNS involvement and in monitoring the response to treatment. In addition, infants with CS may exhibit CNS imaging findings similar to those observed in other intrauterine CNS infections.


Corresponding author: Dr. Alfredo García-Alix, Neonatology Service, La Paz Children's Hospital, Paseo de la Castellana 261 28036 Madrid/Spain. Tel.: +34-91-7277272; Fax.: +34-91-7277127;


1 Beeram MR, N Chopde, Y Dawood, S Siriboe, M Abedin: Lumbar puncture in the evaluation of possible asymptomatic congenital syphilis in neonates. J Pediatr128 (1996) 125Search in Google Scholar

2 Beyne P, F Lisovoski, L Got, P Ayache, E Delacoux: β2-Microglobulin in cerebrospinal fluid in neurology. Presse Med24 (1995) 1071Search in Google Scholar

3 Dattner B, EW Thomas, L de Mello: Criteria for the management of neurosyphilis. Am J Med10 (1951) 463Search in Google Scholar

4 García-Alix A, A Martín-Ancel, MT Ramos, S Salas, A Pellicer, F Cabañas, J Quero: Cerebrospinal fluid β2-microglobulin in neonates with central nervous system infections. Eur J Pediatr154 (1995) 309Search in Google Scholar

5 Gilbert DN, RC Moellering Jr, MA Sande: Clinical approach to initial choice of antimicrobial therapy. The Sanford Guide to Antimicrobial Therapy 2001. Antimicrobial Therapy, Inc., 31st Ed. Hyde Park VT.: 16–17Search in Google Scholar

6 1993 Guidelines for treatment of sexually transmitted diseases. Morb Mort Wkly Rep 42 (1993) 40Search in Google Scholar

7 1998 Guidelines for treatment of sexually transmitted diseases. Morb Mortal Wkly Rep 47 (1998) 41Search in Google Scholar

8 Holland BA, LV Perrett, CM Mills: Meningovascular syphilis: CT and MR findings. Radiology158 (1986) 439Search in Google Scholar

9 Ikeda MK, HB Jenson: Evaluation and treatment of congenital syphilis. J Pediatr117 (1990) 843Search in Google Scholar

10 Ingall D, PJ Sánchez, DM Musher: Syphilis. In: Remington JS, JO Klein (eds): Infectious diseases of the fetus and newborn infant, 4th Ed. Saunders, Philadelphia 1995Search in Google Scholar

11 Johnson RA, M White: Syphilis in the 1990s: cutaneous and neurologic manifestations. Semin Neurol12 (1992) 287Search in Google Scholar

12 Lapunzina PD, JM Altcheh, JC Flichman, H Freilij: Neurosyphilis in an eight-year-old child: usefulness of the SPECT study. Pediatr Neurol18 (1998) 81Search in Google Scholar

13 Michelow IC, GD Wendel, MV Norgard, REN Zeray, N Kreistine Leos, MS Rajiha Alsaadi, PJ Sánchez: Central nervous system infection in congenital syphilis. N Engl J Med346 (2002) 1792Search in Google Scholar

14 Peterslund NA, FT Black, JP Geil, CE Morgensen: β2-Microglobulin in the cerebrospinal fluid of patients with infections of the central nervous system. Acta Neurol Scand 80 (1989) 579Search in Google Scholar

15 Platou RV: Treatment of congenital syphilis with penicillin. Adv Pediatr4 (1949) 3910.1016/S0065-3101(22)00810-6Search in Google Scholar

16 Risser WL, L-Y Hwang: Problems in the current case definitions of congenital syphilis. J Pediatr129 (1996) 499Search in Google Scholar

17 Sánchez PJ, GD Wendel, MV Norgard: IgM antibody to Treponema pallidum in cerebrospinal fluid of infants with congenital syphilis. Am J Dis Child146 (1992) 1171Search in Google Scholar

18 Sheffield JS, PJ Sanchez, G Morris, M Maberry, F Zeray, DD McIntire, GD Wendel Jr: Congenital syphilis after maternal treatment for syphilis during pregnancy. Am J Obstet Gynecol186 (2002) 569Search in Google Scholar

19 Stoll BJ: Congenital syphilis: evaluation and management of neonates born to mothers with reactive serologic tests for syphilis. Pediatr Infect Dis J13 (1994) 84510.1097/00006454-199410000-00001Search in Google Scholar

20 Stoll BJ, FK Lee, S Larsen, E Hale, D Schwartz, RJ Rice, R Ashby, R Holmes, AJ Nahmias: Clinical and serologic evaluation of neonates for congenital syphilis: a continuing diagnostic dilemma. J Infect Dis167 (1993) 1093Search in Google Scholar

21 Thorley JD, RK Holmes, JM Kaplan, GH McCracken Jr, JP Sanford: Passive transfer of antibodies of maternal origin from blood to cerebrospinal fluid in infants. Lancet22 (1975) 651Search in Google Scholar

22 Volpe JJ: Viral, protozoan, and related intracranial infections. In: Neurology of the newborn, 4th Ed. WB Saunders Company, Philadelphia 2001Search in Google Scholar

23 Wolf BHM, K Kalangu: Congenital neurosyphilis revisited. Eur J Pediatr152 (1993) 493Search in Google Scholar

Published Online: 2005-01-01
Published in Print: 2005-01-01

©2005 by Walter de Gruyter Berlin New York

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