TORCHT- ToxomoplasmosisO- Others (eg:hepatitisB, varicella zoster, measeles, mumps, HIV, syphilis and human parovo virus)R- RubellaC- Cytomegalovirus infectionH-Herpes simplex
History First described in 17th centrury in pediatric text book In 1905 ,fritz schaudin described the causative role of treponema pallidum.
Definitionsyphilis is a sexually transmitted disease caused by infection with the bacterium treponema pallidumcongenital syphilis is defined as disease transmitted from a pregnant mother to her fetus
Organism T .pallidium Treponema (greek,”meaning-turning thread)
It belongs to spirochadetales It is slender , motile measuring 5.5 in length mm with a thickness about .15 mm
Incidence Increased in number 8.2 -8.5 cases per 100,000 live births.
Host innate responseDirect interaction of T. pallidum with vascular endothelium also seems to be an important early event in the initiation of host innate immune response to syphilitic infect ion
Congenital SyphilisHydropsfetalis Nasal discharge Petechial rash Necrotizing funisitis within the matrix of the umbilical cord Hepatomegaly Rash Ostitis , Metaphysitis, P eriostitis Wimberger sign
Decreasedmineralization of themetaphyses of longbones of the upperextremities bilateral lytic lesions of the talus, calcareous, and proximal tibia A more specific finding is localized bony destruction of the medial portion of the (Wimberger sign) proximal tibial metaphysic (Wimberger’s medially sign). Other findings include metaphysealRadiographic Abnormalities serration (“sawtooth metaphyses”), and diaphyseal involvement with periosteal reaction.
Manifestations ofcongenital syphilis -Early congenital syphilis Anemia Oedma or wasting Fever Failure to thrive Rhinitis or snaffles is an early symptom Profuse mucopurlent discharge and nasal congestion Skin eruptions Erythematous appearance
Mucuocutaneous lesions occur around the nose, mouth, anus and vulva –moist and readily produce fissuring and bleeding Excoriations and ulcers are common in the genital & perinatal region & on the face Around the mouth may lead to radiating scars called “rhagades” Condyloma latum , which are flat, raised plaques with moist surfaces,occur around the anus and female genitals ;it is usually found in later infancy, between 6 month 2 yrs.
Osteo chondritis and pseudo paralysis are one of the congenital syphilis Swelling and tenderness in localized areas of the limb; generally found at the elbow, wrists or knees Dactylitis- Hepatomegaly- Lymph adenophathy- Edema due to hyperproteniemia& renal problem in severe cases.
Late congenital syphilis Interstitial kerailts Pain,photophobia&lacrimation Vascular infiltration of deep layers of cornea which presents a ground - glass appearance& later become opaque. Secondary iridocystitis
Neurosyphilis Menigovascular syphilis with mental retardation,fits,optic atrophy ,deafness& cranial nerve paralysis may occur. CNS syphilis in children may manifest as antisocial behavior or rarely as juvenile tabes (spinal cord involvement)or juvenile paresis deafness may also occur due to syphilitic middle ear
Gummatous lesions in the skin, mucus membranes and bones( especially the skull) Osteitis of the tibiae resulting in the forward bowing( sabre skin) Painless effusion into both the joints ( clutton’s joints).
Syphilis stigmata are result of severe early congenital syphilis & become evident as the child grows It include-crainal bossingFlat noseDefective teeth where permanent teeth are peg shaped , especially the lower upper central incisors( hutchison’s teeth)