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Oncologic a Infections virus), meningitis assays; Toxoplasma, CMV, (tuberculosis, cryptococcal EBV titers and other fungal pathogens), encephalitis (viral, Toxoplasma ), infarcts; drug effects Non-Hodgkin lymphomas, CBC, peripheral smear, LDH, leiomyomas, uric acid, serum leiomyosarcomas (all three chemistries, oncology EBV associated), Kaposi consultation sarcoma (HHV-8 associated), anal and cervical carcinomas (HPV associated) more common and/or more severe in HIV-infected children than in immunocompetent children CMV, cytomegalovirus; CBC, complete blood count; UA, urinalysis; CXR, chest radiograph; EBV, Epstein–Barr virus; MAC, Mycobacterium avium complex; PCR, polymerase chain reaction; PJP, Pneumocystis jiroveci pneumonia; GAS, group A streptococcus; LDH, lactate dehydrogenase; HIV, human immunodeficiency virus; EKG, electrocardiogram; BNP, B-type natriuretic peptide; HSV, herpes simplex virus; AIDS, acquired immunodeficiency syndrome; CT, computed tomography; CSF, cerebrospinal fluid; HPV, human papillomavirus; HHV, human herpes virus e-TABLE 94.31 CRITERIA FOR THE DIAGNOSIS OF NEONATAL AND EARLY CONGENITAL SYPHILIS Diagnostic criteria Symptoms, laboratory findings Absolute Treponema pallidum visualized Major clinical Condylomata lata Osteochrondritis, perichondritis Snuffles Minor clinical Fissures Cutaneous lesions Mucous patches Hepatomegaly, splenomegaly Details Dark field microscopy Raised, nontender, moist lesions on skin; highly infections (contact precautions should be used) Most common manifestation (60–80%): humeral and femoral involvement most common Serrated appearance to epiphysis on long-bone XRs Appears between and 12 wks of age; severe longlasting whitish to bloody nasal discharge Fissures around mouth, nares, anus; easily bleed, heal with scarring While not a common finding, fissures are somewhat specific (but not pathognomonic) for congenital syphilis Maculopapular rash more common on hands/feet; can be bullous, and if present at birth is often disseminated (pemphigus syphiliticus); highly infections (contact precautions should be used) Painless patches on mouth, genitals Hepatomegaly almost Lymphadenopathy CNS signs Hemolytic anemia CSF anomalies Serologic Certainty of diagnosis Definite Probable uniformly seen Generalized nontender adenopathy Meningitis, meningismus, seizures, cranial nerve palsies, hydrocephalus, pituitary dysfunction Coombs negative, associated with cryoglobulinemia Other hematologic findings: thrombocytopenia, leukopenia, or leukocytosis Seen in approximately 20%: CSF pleocytosis or elevated CSF protein Reactive (nontreponemal) RPR (serum), VDRL (CSF) serologic tests for syphilis FTA-ABS, TP-PA, or MHA2 Reactive treponemal test TP Reactive serologic test for syphilis that does not revert to nonreactive within mo Rising titer over mo Absolute clinical criterion Any of the following: • Serologic criteria three or four • One major criterion and serologic criterion one or two • Two or more minor clinical criteria and serologic criterion one or two • One major and one minor clinical criterion
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