IgM antibody to Treponema pallidum in cerebrospinal fluid of infants with congenital syphilis
P. J. Sanchez, G. D. Wendel and M. V. Norgard
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235.
OBJECTIVES--To characterize the neonatal IgG and IgM response to specific
Treponema pallidum antigens in the cerebrospinal fluid (CSF) of infants
with congenital syphilis. DESIGN--Cross-sectional survey. SETTING--Newborn
nursery and neonatal intensive care unit of a county hospital in Dallas,
Tex. PARTICIPANTS--Twenty-one infants born to mothers with reactive
serologic tests for syphilis were enrolled. Group 1 consisted of six
infants with clinical and laboratory evidence of congenital syphilis; group
2, six asymptomatic infants born to mothers with untreated syphilis; and
group 3, nine asymptomatic infants whose mothers were treated for syphilis
before delivery. SELECTION PROCEDURES--Random sample. MEASUREMENTS AND
RESULTS--Immunoblotting was used to examine the IgM and IgG reactivities of
neonatal serum and CSF against T pallidum antigens. Among serum samples of
all group 1 infants, a specific IgM response to T pallidum antigens with
apparent molecular masses of 47, 45, and 17 kd was observed. Cerebrospinal
fluid IgM reactivity to a 47-kd antigen of T pallidum was seen in four
group 1 infants. Serum samples from two group 2 and three group 3 infants
demonstrated IgM reactivity against the 47-kd antigen and, in some cases,
against the 45-kd antigen of T pallidum. None of 15 group 2 and 3 infants
had a positive CSF IgM immunoblot result. The IgG reactivity in CSF was
similar in the three groups and was directed against T pallidum antigens
with apparent molecular masses of 72, 59, 47, 45, 42, 37, 34, 17, and 15
kd. CONCLUSIONS--A specific IgM response to T pallidum antigens,
particularly the 47-kd antigen, was detected in the CSF of some infants
with clinical and laboratory evidence of congenital syphilis. The potential
usefulness of this test for the diagnosis of congenital neurosyphilis
merits further study.
