Congenital syphilis - symptoms and signs, treatment
Symptoms and signs, treatment of congenital syphilis in children and prevention. Late congenital syphilis.
Congenital syphilis in children
Early congenital syphilis. The diagnosis is usually suspected based on the results of a mother's serological examination, which is routinely performed in early pregnancy, often during the 3rd trimester and during labor. Newborns from mothers with positive results for syphilis should be carefully examined, a dark-field microscopy of any skin and mucosal lesions should be carried out, as well as non-treponemal diagnosis; Cord blood is not used for serological tests, as the results are less sensitive and nonspecific.
The overall risk of transplacental infection of the fetus is about 60-80%. Usually, infection occurs with untreated primary or secondary syphilis in the mother, with latent and tertiary syphilis infection usually does not occur.As in adults, congenital syphilis has early, latent and late manifestations.
Symptoms and signs of congenital syphilis
In many patients, the course of the disease is asymptomatic, and the disease is not diagnosed throughout life.
Early congenital syphilis in children it is manifested by characteristic bullous eruptions or a spotted, copper-red rash on the palms and soles, papular rash around the nose and mouth and in the crotch area. Often there are generalized lymphadenopathy and hepatosplenomegaly. A child may have hypotrophy with a characteristic "old man" appearance, with cracks around the mouth and mucopurulent or hemorrhagic discharge from the nose, leading to difficulty in nasal breathing. Some children develop meningitis, choroiditis, dark-field or fluorescence microscopy. Children with clinical manifestations of the disease or positive serological tests should also perform lumbar puncture with the definition of cytosis, VDRL and protein in the cerebrospinal fluid; general blood analysis; biochemical blood test to determine liver function; x-ray of long tubular bones.
The diagnosis is confirmed by microscopic visualization of the spirochete of the child or in the placenta. The diagnosis, based on the serological examination of the newborn, is complicated by the possibility of transplacental admission of maternal IgG to the child, which can lead to a positive result in the absence of infection; at the same time, the child’s titer is more than 4 times higher than that of the mother, usually not the result of passive delivery of antibodies through the placenta, and the diagnosis can be considered confirmed or highly probable. If the mother has become infected in the later stages of pregnancy, infection can occur before the formation of antibodies. Therefore, in newborns with low antibody titers, but with typical clinical manifestations, syphilis is also considered highly probable. In newborns with no clinical manifestations and low or negative titer, serologic testing of syphilis is considered likely; The subsequent tactic depends on many factors on the part of the mother and the child. The significance of a fluorescent study to determine protivopremennogo IgM, which do not pass through the placenta, is controversial, but this study was used to detect infection in the newborn.
Late congenital syphilis
The diagnosis is based on anamnesis, characteristic clinical signs and positive serological tests. The Gatchinson's triad - interstitial keratitis, Gatchinson's teeth and deafness due to the defeat of the 8th pair of cranial nerves - is diagnostic. Sometimes standard serological tests for syphilis and the reaction of treponem immobilization are negative, however, the immunofluorescence reaction is usually positive. This diagnosis should be considered in cases of unexplained deafness, progressive mental retardation or keratitis.
Further tactics. All seropositive babies, as well as children from seropositive mothers, should have a VDRL or RPR titer determined in 2-3 months until the test is negative or the titer decreases 4 times. In uninfected and successfully treated children, titres in non-treponemal tests are usually negative by 6 months. Passively obtained antibodies can be detected longer, possibly up to 15 months.
If VDRL or RPR remain positive for more than 6-12 months or if the titer increases, the child should be examined.
Treatment of congenital syphilis in children
Pregnant women with early stages of syphilis get 2doses of benzylpenicillin G. In the later stages of syphilis or in neurosyphilis, the appropriate regimen should be chosen as for non-pregnant patients. Sometimes after such treatment, a severe Jarish – Herksheimer reaction develops, leading to a spontaneous abortion. If you are allergic to penicillin, desensitization can be performed followed by penicillin treatment. RPR and VDRL become negative by the 3rd month after adequate treatment in most patients and by the 6th month in almost all patients. Tetracycline is contraindicated.
Early congenital syphilis. In confirmed or highly probable cases, the CDC management has not been thoroughly investigated in these cases.) Contacts should be limited, patients should be under long-term supervision.
Prevention of congenital syphilis
Pregnant women should be routinely examined for syphilis, and re-examined if they become sexually transmitted diseases during pregnancy. In 99% of cases, adequate treatment during pregnancy heals both the mother and her fetus. At the same time, in some cases, treatment in late pregnancy can lead to the elimination of the infection, but not all the symptoms of syphilis that will manifest after birth.
If a child is diagnosedcongenital syphilis, the rest of the family should be regularly examined to identify physical and serological signs of the disease. Repeated treatment of the mother in subsequent pregnancies is necessary only if the results of the serological study remain positive. Women who remain seropositive after adequate treatment may have been reinfected and must undergo a second course of treatment. If a pregnant woman without symptoms is seronegative but has had sexual intercourse with a patient who has syphilis diagnosed, she should undergo a course of treatment, since there is a 25-50% chance that she has contracted syphilis.