congenital syphilis


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congenital syphilis

  1. 1. CONGENITAL SYPHILLISDeepthi Abraham
  2. 2. TORCHT- ToxomoplasmosisO- Others (eg:hepatitisB, varicella zoster, measeles, mumps, HIV, syphilis and human parovo virus)R- RubellaC- Cytomegalovirus infectionH-Herpes simplex
  3. 3. History First described in 17th centrury in pediatric text book In 1905 ,fritz schaudin described the causative role of treponema pallidum.
  4. 4. 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
  5. 5. Organism T .pallidium Treponema (greek,”meaning-turning thread)
  6. 6.  It belongs to spirochadetales It is slender , motile measuring 5.5 in length mm with a thickness about .15 mm
  7. 7. Incidence Increased in number 8.2 -8.5 cases per 100,000 live births.
  8. 8. Treponemal virulenceassociated factors. Host response Host innate response
  9. 9. Host response Infection involves the placenta Lower fetal immune response
  10. 10. 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
  11. 11. Congenital SyphilisHydropsfetalis Nasal discharge Petechial rash Necrotizing funisitis within the matrix of the umbilical cord Hepatomegaly Rash Ostitis , Metaphysitis, P eriostitis Wimberger sign
  12. 12. 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.
  13. 13. 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
  14. 14.  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.
  15. 15.  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.
  16. 16. 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
  17. 17. 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
  18. 18.  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).
  19. 19.  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)
  20. 20. Hutchinsons triad3 Manifestations interstitial keratitis 8th cranial nerve affliction Notched central incisors
  21. 21. Diagnosis History collection Physical examination-Hepatomegaly-bone inflammationFor mother-fluorescent treponemal antibody absorbed test-Rapid plasma reagin(RPR)-VDRL
  22. 22.  Bacteriology Eye examination Lumbar puncture( csf studies- increased protein) Radiology – Wimbergers sign( litic lesion in the upper aspect of tibia)
  23. 23. Complication Blindness Deafness Deformity of the face Nervous system problems
  24. 24. Outcome Mid trimester abortion fetal death in utero; still birth
  25. 25. Prevention Serological blood test before marriage Routine serololigic blood testing of pregnant women in 1st and 3rd trimester treatment of pregnant women before 18th week
  26. 26. Treatment Intravenous crystalline pencilline G 100,000-150,000U//kg/day-im Erythromycine 15mg/kg/day for 10 days