title: Pathology of the umbilical cord in congenital syphilis: analysis of 25 specimens using histochemistry and immunofluorescent antibody to Treponema pallidum.
abstract: Identification of Treponema pallidum in the placenta is important for diagnosis of congenital syphilis; however, spirochetes are difficult to observe in chorionic villi. To determine the sensitivity of umbilical cord examination for T pallidum, and the association of spirochetes with cord pathology, placentas were prospectively obtained from 25 women with untreated syphilis. The most common finding using hematoxylin-eosin staining was a normal-appearing umbilical cord (48%); necrotizing funisitis was the most frequent pathological lesion (36%). Spirochetes were detected using silver and immunofluorescent staining in 89% of cords, including 92% of histologically normal and 84% of abnormal cords. Three specimens showed subamnionic aggregates of spirochetes, consistent with amniotic fluid infection. Necrotizing funisitis was strongly associated with umbilical artery infection by spirochetes (P = .008). There was a 100% correlation between results of silver and immunofluorescent staining. The umbilical cord is a sensitive site for morphological confirmation of T pallidum; it is significant for the pathologist that spirochetes may often be detected in the absence of overt tissue inflammation or necrosis.
authors.affiliation: Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Schwartz
authors.forename: S A
authors.initials: SA
authors.lastname: Larsen
authors.forename: C
authors.initials: C
authors.lastname: Beck-Sague
authors.forename: M
authors.initials: M
authors.lastname: Fears
authors.forename: R J
authors.initials: RJ
authors.lastname: Rice
mesh_terms: D000907:Antibodies, Bacterial / Q000032:analysis*; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology / Q000473:pathology*; D013590:Syphilis, Congenital / Q000382:microbiology / Q000473:pathology*; D014210:Treponema pallidum / Q000276:immunology* / Q000302:isolation & purification; D014470:Umbilical Cord / Q000382:microbiology* / Q000473:pathology*
chemical_list: D000907:Antibodies, Bacterial