Early congenital syphilis.
Congenital Syphilis is a multisystem infection cause by Treponema pallidum and transmitted to the fetus via the placenta. There are two types:
- a) Early congenital syphilis – lesions occur during the first 2 years of life.
- b) Late congenital syphilis – lesions occur after the first 2 years of life.
- Pathogenesis: The degree of fetal damage depends on the time of infection in the mother.
- Before pregnancy:
- > 2 years – Late
- < 2 years – Early (Intrauterine death or early congenital syphilis)
- During pregnancy:
- 1st half – Intrauterine death or early congenital syphilis
- 2nd half – Mild congenital syphilis or Late long syphilis.
Early Congenital syphilis
The fetus’s immature immune response allows syphilis to run a rapid and damaging course.
Prognosis is poor. It commonly manifests during the first 3 months of life.
- Manifestations include:
- Vesiculo-bullous eruptions;
- Macular, copper-colored rash on the palms and soles;
- Papular lesions around the nose and mouth and in the diaper area;
- Petechial lesions;
- Generalized lymphadenopathy and hepatosplenomegaly often occur;
- The infant may have a characteristic mucopurulent or blood-stained nasal discharge causing snuffles;
- A few infants develop meningitis, choroiditis, hydrocephalus, or seizures, and others may be intellectually disabled;
- Within the first 8 months of life, osteochondritis (chondroepiphysitis), especially of the long bones and ribs, may cause pseudoparalysis of the limbs with characteristic radiologic changes in the bones.
- Diagnosis: Clinical evaluation; darkfield microscopy of lesions, placenta, or umbilical cord; serologic testing of mother and neonate; possibly CSF analysis.
- Treatment: (If ≥ 1 day of therapy is missed, the entire course must be repeated)
- aqueous crystalline penicillin G 50,000 units/kg IV q 12 h for the first 7 days of life;
- procaine penicillin G 50,000 units/kg IM once/day for 10 days;
- In infants with possible syphilis whose mothers were not adequately treated but who are clinically well and have a completely negative full evaluation - single dose of benzathine penicillin 50,000 units/kg IM.
- Infants with possible syphilis whose mothers were adequately treated and who are clinically well - single dose of benzathine penicillin 50,000 units/kg IM