1. CONGENITAL SYPHILLIS
Deepthi Abraham

2. TORCH
T- Toxomoplasmosis
O- Others (eg:hepatitisB, varicella
zoster, measeles, mumps, HIV, syphilis and
human parovo virus)
R- Rubella
C- Cytomegalovirus infection
H-Herpes simplex

3. History
First described in 17th centrury in pediatric
text book
In 1905 ,fritz schaudin described the
causative role of treponema pallidum.

4. Definition
syphilis is a sexually transmitted disease
caused by infection with the bacterium
treponema pallidum
congenital syphilis is defined as disease
transmitted from a pregnant mother to her
fetus

5. Organism
 T .pallidium
 Treponema (greek,”meaning-turning thread)

6.  It belongs to
spirochadetales
 It is slender , motile
measuring 5.5 in length
mm
with a thickness about .15 mm

7. Incidence
 Increased in number
 8.2 -8.5 cases per 100,000 live births.

8. Treponemal virulence
associated factors.
Host response
Host innate response

9. Host response
 Infection involves the placenta
 Lower fetal immune response

10. Host innate response
Direct 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

12. Congenital Syphilis
Hydrops
fetalis
Nasal discharge
Petechial rash
Necrotizing
funisitis
within the matrix of
the umbilical cord
Hepatomegaly
Rash
Ostitis
, Metaphysitis, P
eriostitis
Wimberger sign

13. Decreased
mineralization of the
metaphyses of long
bones of the upper
extremities
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 metaphyseal
Radiographic Abnormalities serration (“sawtooth metaphyses”), and
diaphyseal involvement with periosteal
reaction.

14. Manifestations of
congenital 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

15.  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.

16.  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.

17. 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

18. 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

19.  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).

20.  Syphilis stigmata are result of severe early
congenital syphilis & become evident as the
child grows
It include
-crainal bossing
Flat nose
Defective teeth where permanent teeth are
peg shaped , especially the lower upper
central incisors( hutchison’s teeth)

21. Hutchinson's triad
3 Manifestations
 interstitial keratitis
 8th cranial nerve affliction
 Notched central incisors

22. Diagnosis
 History collection
 Physical examination
-Hepatomegaly
-bone inflammation
For mother
-fluorescent treponemal antibody absorbed
test
-Rapid plasma reagin(RPR)
-VDRL

23.  Bacteriology
 Eye examination
 Lumbar puncture( csf studies- increased
protein)
 Radiology – Wimberger's sign( litic lesion in
the upper aspect of tibia)

24. Complication
 Blindness
 Deafness
 Deformity of the face
 Nervous system problems

25. Outcome
 Mid trimester abortion
 fetal death in utero; still birth

26. 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

27. Treatment
 Intravenous crystalline pencilline G
100,000-150,000U//kg/day-im
 Erythromycine 15mg/kg/day for 10 days