Congenital syphilis: Difference between revisions

Revision as of 11:02, 8 February 2020

Background

Epidemiology

Rare, with about 20 per 100,000 live births in the US
Greatest risk to child is with untreated primary maternal syphilis

Pathophysiology

Transplacental transmission while bacteremic
Can be transmitted during delivery, as well

Clinical Presentation

Mothers typically have had no prenatal care
To the fetus, can cause spontaneous abortion (40% in untreated primary syphilis), preterm delivery, polyhydramnios, intra-uterine growth restriction, hydrops fetalis, or intra-uterine fetal demise
At birth, two thirds of affected neonates are asymptomatic, with disease developing over the following 6 weeks
Early disease, within the first two years, includes:
- Rhinitis (called snuffles, often bloody and copious), desquamating rash, hepatosplenomegaly, lymphadenopathy, and skeletal abnormalities
- Also: condyloma lata, vesicular rash or bullous rash, periostitis, hydrops, thrombocytopenia, hepatitis, jaundice, or glomerulonephritis
- About 20% involve the CNS
Late disease, after the first two years, includes:
- Sensorineural hearing loss, intellectual impairment, saddle nose deformity, frontal bossing, jaw, dental, and palatal abnormalities including Hutchison teeth, saber tibia, short stature, and keratitis

Diagnosis

Darkfield microscopy and/or PCR on body fluids, including nasal discharge or CSF
Serology
- RPR on infant blood (not cord blood), paired with maternal RPR
- May need CSF analysis
Also check HIV serology, skeletal survey, chest x-ray, ophthalmology, audiology, and cranial ultrasound

Management

Treat syphilis in pregnancy with high-dose penicillin to prevent congenital syphilis
Treat affected infant with penicillin G 50,000 U/kg/day IV q12h for the first 7 days of life, followed by q8h to complete a total of 10 days

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 == Clinical Presentation ==
 * Mothers typically have had no prenatal care
-* To the fetus, can cause spontaneous abortion (40% in untreated primary syphilis), preterm delivery, polyhydramnios, intra-uterine growth restriction, hydrops fetalis, or intrauterine fetal demise
+* To the fetus, can cause [[Causes::spontaneous abortion]] (40% in untreated primary syphilis), [[Causes::preterm delivery]], [[Causes::polyhydramnios]], [[Causes::intra-uterine growth restriction]], [[Causes::hydrops fetalis]], or [[Causes::intra-uterine fetal demise]]
 * At birth, two thirds of affected neonates are asymptomatic, with disease developing over the following 6 weeks
 * Early disease, within the first two years, includes:
-** Rhinitis (called snuffles, often bloody and copious), desquamating rash, hepatosplenomegaly, lymphadenopathy, and skeletal abnormalities
+** [[Causes::Rhinitis]] (called [[Causes::snuffles]], often bloody and copious), [[Causes::desquamating rash]], [[Causes::hepatosplenomegaly]], [[Causes::lymphadenopathy]], and skeletal abnormalities
-** Also: condyloma lata, vesicular or bullous rash, periostitis, hydrops, thrombocytopenia, hepatitis, jaundice, or glomerulonephritis
+** Also: [[Causes::condyloma lata]], [[Causes::vesicular rash]] or [[Causes::bullous rash]], [[Causes::periostitis]], [[Causes::hydrops]], [[Causes::thrombocytopenia]], [[Causes::hepatitis]], [[Causes::jaundice]], or [[Causes::glomerulonephritis]]
 ** About 20% involve the CNS
 * Late disease, after the first two years, includes:
-** Sensorineural hearing loss, intellectual impairment, saddle nose deformity, frontal bossing, jaw, dental, and palatal abnormalities including Hutchison teeth, saber tibia, short stature, and keratitis
+** [[Causes::Sensorineural hearing loss]], [[Causes::intellectual impairment]], [[Causes::saddle nose deformity]], [[Causes::frontal bossing]], jaw, dental, and palatal abnormalities including [[Causes::Hutchison teeth]], [[Causes::saber tibia]], [[Causes::short stature]], and [[Causes::keratitis]]
 == Diagnosis ==