Congenital Syphilis

Posted by e-Medical PPT Wednesday, July 4, 2012
Severe, disabling, and often life-threatening infection seen in infants
About half of all infected fetuses die shortly before or after birth

Pathophysiology of Congenital Syphilis
Trans placental transmission
Transmission rate:~ 60 - 100%
With early onset disease, manifestations result from trans placental spirochetemia and are analogous to secondary stage of acquired syphilis
Congenital Syphilis does not have a primary stage

Clinical Manifestations

Intra-uterine: Placenta
The placenta is typically large and edematous
Characteristic placental findings include:
-  Hydrops placentalis
Chronic villitis
Perivillous fibrous proliferation
Necrotizing funisitis
Acute chorioamnionitis
Plasma cell deciduitis

Intra-uterine: Fetus
Depends on stage of development at time of infection & duration of untreated infection
Initially characterized by placental involvement and hepatic dysfunction (e.g., abnormal LFT), followed by amniotic fluid infection, hematologic abnormalities, ascites, and hydrops
Stillbirth / Neonatal death

Early- Asymptomatic
Occurs between 0 - 2 years
If asymptomatic :
- Identified on routine prenatal screening
- If not identified and treated, these newborns develop poor feeding and rhinorrhea
- Earliest signs of CS may be poor feeding and snuffles (i.e., syphilitic rhinitis)

Late-onset CS
Manifestations include neurosyphilis and involvement of teeth, bones, eyes, and 8th cranial nerve
E.g.: Frontal bossing, short maxilla, high palatal arch, Hutchinson triad, saddle nose, and perioral fissure (Rhagades = bacterial infection of skin lesions )
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