O Novo protocolo do ministério da saúde de 2019 sobre sífilis congênita: análise crítica e desafios futuros

Abstract

Introduction - syphilis is an infectious disease, sexually transmitted, transplacental or transfusional, being, in the pediatric context, related to a greater propensity for prematurity, low birth weight, abortion, fetal and neonatal death. Objective - Faced with the scenario of increasing the number of cases in Brazil and the recent change in the protocol for reporting cases of congenital syphilis by the Ministry of Health - CLINICAL PROTOCOL AND THERAPEUTIC GUIDELINES FOR PREVENTING THE VERTICAL TRANSMISSION OF HIV, SYPHILIS AND VIAL HEPATITIS, 2019 - this work, based on a wide literature review, aims to analyze the two protocols, discuss what motivated this change and describe the impact that this change had on the service provided at our health service, University Hospital of Universidade Federal da Grande Dourados (HU - UFGD). Methods - Analyze the data recorded at the Health Surveillance Unit of HU- UFGD in the period from January 1, 2018 to June 30, 2019 regarding: the number of notifications of cases of congenital syphilis, the number of lumbar punctures for CSF evaluation performed, the number of long bone X-rays performed on newborns (NBs) vertically exposed to syphilis, comparing with the results obtained in the period of July 2019 - date when the guidance for following the new protocol of the Ministry of Health of 2019 to prevent vertical transmission of the disease was instituted syphilis - in March 2020. A quantitative analysis of the number of results of these tests was performed, which resulted in the treatment of newborns with Penicillin Procaine, intramuscularly (IM), for 10 days or Crystalline Penicillin, intravenously (IV), for 10 days. The analysis was carried out jointly and based on retrospective studies collected on virtual platforms with updated medical content, namely PubMed and UpToDate, with regard to the effectiveness of the performance of the CSF evaluation exams, hereinafter referred to in the text simply as CSF, and X-rays of long bones in the final diagnosis of congenital syphilis. Results - Considering the period from January 2018 to June 2019, we had: 308 notified cases of congenital syphilis; 266 liquors collected, 26 samples with increased proteinorrhagia (9.7%), 1 with positive VDRL (0.3%) and 1 with increased leukocytes (0.3%); 152 radiographs of long bones performed, 132 of which were normal (86.8%) and 20 with indeterminate results (13.1%). With the implementation of the protocol in July 2019, we had from July 2019 to March 2020: 77 notified cases of congenital syphilis; 65 CSFs were collected, with 1 sample with increased proteinorchia (1.5%), 2 with positive VDRL (3.0%) and 2 with increased leukocytes (3.0%); 36 radiographs of long bones performed, 34 of which were normal (94.4%) and 2 with indeterminate results (5.5%). Conclusions - Congenital syphilis remains a public health problem in our country despite all the investments made in primary care in recent years. The problem is even greater when we understand that no diagnostic test used on a large scale for the diagnosis of congenital syphilis is sensitive enough to be used as a basis for treatment institutions. This is because the incidence of positive CSF samples is low and the false positive rate is high, mainly due to the presence of blood resulting from trauma at the time of collection, allowing the passage of antibodies through the blood-brain barrier. As for the radiography of long bones, it does not differentiate between past or present infection.