Congenital syphilis

Congenital syphilis occurs during prenatal infection of the fetus from her sick mother. Treponema cross the placenta.
There are congenital syphilis fetus, infants, early childhood (from 1 year to 4 years) and late (from 5 to 17 years).

syphilis placenta
Fig. 5. Syphilis placenta with miliary Hammami.

In case of congenital syphilis fetal placenta, as a rule, large size, has a specific changes. If infection of the fetus occurs on the V-VI month, may be premature birth. The fruit is stillborn, materialnym, the liver, spleen and lungs. When infected mother in the last months of pregnancy signs of syphilis in child may develop after a few weeks, and the positive Wasserman - on the 3rd month of life.
Syphilis infants. The child has the pained look, pale-grey colour, restless. Note lethargy sucking, weak increase weight gain, sweating, groundless increase of temperature and indigestion. Syphilitic disease, unlike water neonates (see Pyoderma in children), is found at birth or in the first days of life and is localized primarily on the soles and palms, where bubbles size from a pea to the cherry on the inflamed base filled with serous-purulent or hemorrhagic fluid with large numbers pale treponem. At the opening bubbles are formed erosion, epitelizatia as resorption of infiltration (Fig. 7).

congenital syphilis
Fig. 1. Diffuse infiltration of the face and cracks on the lips boy (6 weeks). Fig. 2. Sharply fallen bridge, saddle nose, scars on the lips and infiltration of Gachinger (boy 8 weeks). Fig. 3. Surface cracks on the lips, sore at the right corner of his mouth and the scar of the left corner (girl 2,5 months). Fig. 4. Papular rash, erosive papules on the face and neck (girl 2.5 years). Fig. 5. Lamellar peeling outer soles after diffuse infiltration of the skin (baby 5 weeks). Fig. 6. Maculopapular rash (boy 8 days). Fig. 7. Syphilitic disease (boy, 5 days).

Diffuse thickening of the skin (infiltration of Gachinger) occurs in about 60-65% of patients on 8-10 weeks of life. On the face, scalp, back, soles and palms skin infiltrated has a brownish-red, shiny. The thickened lips, swollen, cracked (Fig. 2). Around the mouth for life remain scars, important for the diagnosis. Infiltration of the scalp, eyelashes and eyebrows ends with hair loss. On 4-8 weeks of life on the face of the outer surface of the legs and the soles may receive papular rash brown-red, sharply demarcated from the surrounding skin.
Relatively frequent symptom - syphilis runny nose: from birth the child's nose laid, then appear mucopurulent or blood discharge, suhushina in peel. Breath sharply difficult, sucking impossible. In severe cases can cause the destruction of the cartilaginous septum of the nose and palate (saddle nose, Gothic sky). With the defeat of the larynx voice hoarse, aforizmy. Bone changes - see Osteochondritis. Periostitis.
Almost always affected the liver and spleen, they increased, dense, with a smooth surface. Belly swollen, possible ascites and jaundice. In light is diffuse, the expansion of the connective tissue around the alveoli and small vessels - the so-called white pneumonia (pneumonia alba), which is manifested by cyanosis, dyspnoea, is protracted, prone to the formation of abscesses. Possible damage to the kidneys, gastrointestinal tract, Central nervous system (meningitis, hydrocephalus), heart (endomyocardial).
Syphilis early childhood. The predominant symptom - condylomas anus. On the skin may be dense nodes (gum) and weeping papules in the folds. Often falling hair, bone is affected testicles. The defeat of the Central nervous system. expressed mental retardation, optic atrophy, epilepsy, meningitis. In the brain may be observed gum.
Late congenital syphilis is a relapse transferred in early childhood and insufficiently treated syphilis. Signs late congenital syphilis divided into two groups: reliable and credible. To include reliable triad of Hutchinson: barrel-shaped teeth with another notch on chewing edge (ketchikanalaska teeth), keratit (see), deafness as a result of defeat of the maze. To the probable symptoms are: sabre-Shin, changing the shape of the skull - dolichocephalic skull, high whiskey, Gothic sky, no xiphoid process and other Possible civility on the skin (gum, bumps), liver, spleen, cardiovascular and endocrine systems; disorder of the nervous system - speech impairments, mental retardation.
A child with active manifestations of syphilis on the skin and mucous membranes contagious for children and adults, so if you care staff should work in rubber gloves, disinfect hands. About all the children of early congenital syphilis must be reported to the children's clinic at the place of residence.
Suspected congenital syphilis must send all the blood of the child on serological reactions. The patient is placed for treatment in the hospital and venereal dispensary. Forecast serious, but systematic treatment is 1 month. life can lead to full recovery.
Treatment. A child with congenital syphilis needs good care, proper feeding and mode of vitamin therapy. When therapy is used penicillin and its products (economically, bicillin). Children who cannot receive injections appoint fenoxibenzamin in double doses. If there are changes in the spinal fluid and organs of view dose of penicillin increase by 20%, and children older than 6 months, in addition to penicillin, prescribed drugs bismuth. A number of courses for early congenital syphilis - 6, for late - 8, prophylactic treatment is 3. The intervals between courses is 2 weeks, with additional use of drugs bismuth - 1 month. Dose of penicillin depends on the weight and age of the child according to the instructions 1968
To prevent violent reaction of the organism on the introduction of penicillin, dangerous for weakened children, protevoepilepticescoe treatment start (1st course) with the minimum dose (2500-5000 UNITS every 4 hours) penicillin, increasing it within 8-12 days to a full day. Bicillin used in children older than 2 years only repeated courses (dose of 300 000 IU a day).
Preventive treatment for children born from mothers with syphilis who have never been treated or insufficiently treated, even when children clinical and serological symptoms. After treating children remain under the supervision of clinic for 5 years. With the onset of puberty, they are subject to clinical and serological survey.