Congenital syphilis is a disease that is transmitted to an unborn baby through the placenta through maternal blood. Such a pathology can be of two forms - early syphilis and late.
The early form includes those pathologies that are observed in the fetus, in the infant and in early childhood.
Late congenital syphilis is detected, usually after 14-16 years, but until this time the disease does not manifest itself. Sometimes there are cases when suspicions of syphilis arise earlier, at about the age of 6-7 years. However, this rarely happens.
Causes of pathology
Congenital syphilis (unfortunately the symptoms are not reflected in the photo) develops when a microorganism called pale treponema enters the fetus through the umbilical vessels, which can also get there through the lymphatic slots from a mother with syphilis.
An unborn baby can be infected if the mother becomes infected before pregnancy, and this can happen at any time during pregnancy. Pathological dysfunctions in the fetal organs are detected at about 5-6 months. In other words, during formation.
Pathogenesis
According to some scientists, such an infection can have a significant effect on the chromosomal apparatus of mother cells. They differ, as a rule:
- syphilitic gametopathies, which are degenerative changes that occur in the germ cells long before the fertilization of the egg;
- blastopathies, which are lesions of the embryo during blastogenesis;
- syphilitic embryopathies, which are pathological changes in the fetus at 4-22 weeks of development.
The fetus has various defects in physical development, as well as neurological dysfunctions and a delay in intellectual development. Mental disorders in congenital syphilis occur quite often.
Infection of the unborn child through the placenta can occur in case of infection of the mother before conception and later, at different stages of its development. Pale treponema - the causative agent of syphilis, penetrates the fetus through the umbilical vessels. In this case, it is advisable to conduct active antisyphilitic treatment in early pregnancy, which can guarantee the birth of a healthy baby.
Since secondary syphilis occurs, as a rule, with the phenomena of spirochemia, there is a high risk of developing pathologies in the child of women who suffer from this form of syphilis. In addition, transmission to the offspring occurs most often in the first years after the mother became infected. Later, this ability gradually decreases.
It is believed that the birth of sick children from a mother who suffers from congenital syphilis in the second or even third generation is possible. However, such cases are extremely rare. The outcome of such a pregnancy is different:
- she may end in a miscarriage in the later stages;
- premature birth;
- as well as the birth of children with early or late manifestation of the disease or latent infection.
For women suffering from a certain form of syphilis, a diverse pregnancy outcome is characteristic, and this can happen at any time, due to the degree of infection of the fetus and the activity of the infection itself. The likelihood of infection of the child by transmission of the disease through sperm is still not proven by scientists. But studies are regularly conducted.
What are the reliable signs of congenital syphilis?
Symptoms of Congenital Infection
Depending on what clinical symptoms occur in each individual case, the features of the manifestation and the timing of the detection of congenital syphilis, the ailment, as a rule, is divided into the following categories:
- Syphilis of the fetus.
- Early congenital syphilis - from birth to 5 years.
- Hidden congenital forms that are observed in different age groups.
- Late congenital syphilis - in children older than 5 years.
Let's consider all these categories in more detail. First, we describe an early form of the disease.
Early congenital syphilis
A similar variety of this disease can manifest itself in the form of the following disorders and damage to the tissues of the child:
- skin lesion;
- mucous membrane;
- visceral syphilis;
- syphilitic laryngitis;
- syphilitic ophthalmopathy;
- syphilitic osteochondropathy;
- syphilitic pharyngitis;
- syphilitic pneumonia;
- syphilitic rhinitis.
Latent syphilis - is a congenital infection that does not have clinical manifestations. However, a serological reaction and a negative sample of cerebrospinal fluid in a child are positive indicators.
Congenital syphilis of an unspecified nature is infection without bacteriological or histological evidence in children. In other words, the diagnosis can be established in cases of complete absence of examination of the child’s body or when the clinical picture of the diagnosis does not make it possible to accurately determine the degree of specificity of the pathology.
Syphilis of the placenta
The defeat of syphilis of the placenta is an increase, hypertrophy of its tissues. Visually, she looks flabby, fragile, easily torn, heavy. The mass of the placenta in this case is approximately ¼ of the mass of the fetus. According to statistics, in half the cases, the detection of such a placenta is associated with congenital syphilis. In order to confirm the diagnosis of "syphilis of the placenta" it is necessary to conduct a histological examination. With syphilitic lesions, edema forms in the placenta, granulation cells grow, and villi and blood vessels become damaged. In this case, pathogens are detected - pale treponema.
The main sign of fetal syphilis is the presence of microorganisms in the umbilical cord, where they can be found in large numbers.
Consider the manifestations of congenital syphilis in the fetus.
Fetal syphilis
As a result of syphilitic infection in the placenta, the supply of food to the fetus and the necessary metabolism are disrupted, after which intrauterine death and miscarriage can occur. In the first months of pregnancy, the pale treponema in the fetus may not be detected, since it penetrates into his body only with the development of placental circulation.
Starting from 4 months of pregnancy, the fetus shows signs characteristic of a similar disease:
- the fetus has a low body weight;
- he shows signs of maceration;
- specific disorders are revealed in the development of organs, which are manifested by diffuse infiltration, connective tissue hypoplasia, a change in blood vessels;
- in the tissues of internal organs, the causative agent of syphilis is detected.
Lung damage
A characteristic sign of congenital syphilis in children can be lung damage, focal or spilled specific infiltration of the interalveolar septa, as well as hyperplasia of the alveolar epithelium, filling the fat contents of the alveoli. The lung tissue becomes airless and takes on a grayish-white color.
Damage to the liver with this disease
The liver, when infected with syphilis, enlarges, becomes denser, its surface becomes smooth. Small cell infiltration and small foci of yellow necrosis are also found, often developing atrophy of this organ. When cut, the liver tissue looks yellow-brown, the severity of sclerotic changes is noted on it. Symptoms of congenital syphilis are difficult not to recognize.
The defeat of other organs
The spleen also compacts and enlarges. As for the kidneys of the fetus, their cortical layer is most often affected. Underdeveloped glomeruli and tubules, cyst formation, foci of diffuse small cell infiltration are observed. In the mucous layer of the stomach and intestines, flat infiltrates and ulcers can be noted.
Heart with congenital syphilis is rarely affected. As a rule, foci of small-cell infiltration and swelling of cells around the main vessels, as well as areas of necrosis, are detected.
The adrenal glands, pancreas, and sex glands very often can be involved in the pathological process.
Inflammatory disorders of the central nervous system are revealed, which manifest themselves in the form of productive leptomeningitis with vascular sclerosis or meningoencephalitis and granular ependimatitis. Often there is the development of gum medulla oblongata.
The most common sign of congenital syphilis in a child is the detection of manifestations of specific osteochondritis of the 1st, 2nd and 3rd degree or osteoperiostitis with localization at the ends of the tubular bones.
Appearance of a child with a similar pathology
The main signs of such a disease are the following pathological changes in children:
- dry and wrinkled skin;
- large head with high frontal tubercles and pronounced venous network;
- nose bridge retraction;
- areas of pigmentation on the face;
- limbs are thin and cyanotic;
- the child is very restless, tearful, which is associated with a clear lesion of the central nervous system;
- retardation in development, pronounced thinness;
- persistent runny nose, shortness of breath and an act of sucking;
- dystrophy with symptoms of a complete absence of fatty tissue, pressure sores;
- a variety of skin lesions.
Syphilitic pemphigus
A similar symptom is one of the main signs of congenital syphilis in children, observed already at birth or in the first days of life.
A similar disorder has the following clinical manifestations:
- location on the palms, soles, face, bend surfaces of the forearms and lower legs, sometimes throughout the body;
- bubble size - 1-2 cm in diameter;
- the surface of the bubbles is dense, and the base is significantly hyperemic and infiltrated;
- the contents of the blisters are serous or purulent, less often hemorrhagic (a large number of pathogens are found in it);
- after opening such formations, infiltrated erosion is formed;
- before their occurrence, papular rashes appear.
In the absence of adequate antisyphilitic therapy, children usually die.
In the pathological process, only certain organs and systems of the body are usually involved. Mild symptoms are very characteristic, as, for example, with the development of secondary recurrent syphilis. Large papules are formed on the skin of the perineum and inguinal folds, and on the feet: often wet and vegetative. They sometimes merge with the formation of large warts, which begin to ulcerate. Weak babies may develop pustules on the scalp.
Sometimes there are manifestations of syphilitic rhinitis, causing atrophic catarrh and perforation of the nasal septum. Also, diffuse or focal baldness is often observed, lymph nodes increase.
Almost the majority of children with congenital syphilis have a lesion of the skeletal system, characterized by limited periostitis and osteosclerosis. Often there are diffuse periostitis of the fingers. Bone gummas appear much less frequently. An increase in the liver, spleen, and nephrosonephritis develops. The testicles in boys grow and become dense. Lesions of the nervous system are characterized by manifestations of mental retardation, nervous seizures, hydrocephalus, meningitis. Eye lesions are also possible in the form of chorioretinitis, atrophy of the optic nerve, parenchymal keratitis. Consider the signs of late congenital syphilis.
Late form of the disease
The clinical picture of this form of syphilis becomes most noticeable at the age of 5, sometimes a little earlier. However, most often the symptoms begin to manifest themselves at the age of 14-15 years.
Most sick children have almost no signs of congenital syphilis, and some may show characteristic changes in their appearance and internal organs - the saddle nose, cranial deformity, etc.
With late syphilis on the skin of the tubercle, there are visceropathies, as well as diseases of the central nervous system, endocrine glands. The clinical symptoms of late congenital syphilis, as a rule, do not differ from those of the tertiary stage of syphilis. Liver compaction, spleen lesions, nephrosis and nephrosonephritis are also noted. When involved in the pathological processes of the cardiovascular system, heart valve failure, endocarditis, myocarditis develops. The lungs and digestive tract are also affected. A typical symptom of this type of disease is damage to the thyroid gland, genital glands, and adrenal glands.
Diagnosis of congenital syphilis
Only the presence of certain dystrophies (stigma) in combination with the main signs of the disease can have diagnostic value. In establishing a diagnosis, standard serological studies, which are regarded as positive in the early forms of congenital syphilis, are invaluable. In the presence of late forms, complex serological studies take place, which are regarded as positive in 96% of patients, as well as immunofluorescence and immobilization reactions of pale treponemas.
A very important diagnostic role is played by the study of the cerebrospinal fluid contents, as well as x-ray of the bone apparatus, examination by a pediatrician, ophthalmologist, otolaryngologist, neuropathologist and other specialists.
When establishing a diagnosis of early congenital syphilis or a passive method of transmission of antibodies, quantitative reactions are given great importance. Antibody titers in sick children are, as a rule, higher than in mothers. In healthy children, they decrease, and spontaneous negation of the serological reaction begins to occur. In the presence of syphilis pathogens, antibody titers are persistent or a significant increase is observed. In the first days of life, the serological reaction may be negative, therefore, experts do not recommend it in the first 14 days.
Diagnostic Tactics
It consists in the following activities:
- Simultaneous examination of both mother and child.
- Blood sampling is not recommended for serological studies in women 14 days before and the same after delivery;
- It is not advisable to take blood for serological studies from the umbilical cord of the fetus in the first 14 days after its birth, since during this period protein lability and instability of the colloidal component of serum can be observed.
- In serological studies of the mother and child, it is necessary to use a complex of certain serological reactions, for example, the Wasserman reaction, RIF and others.
- It should be remembered that a positive serological reaction in a child may be due to passive transmission of antibodies. However, gradually, within a few months after birth, such antibodies may disappear, and the research results will become negative.
How is congenital syphilis treated?
Therapies for pathology
The causative agents of syphilis are actually the only microorganisms that have preserved so far, even despite long periods of penicillin therapy, a unique sensitivity to penicillin. This infection does not produce penicillinases without other methods of antipenicillin protection, such as mutations in cell wall proteins or polyvalent drug resistance genes that have long been developed by other common microorganisms. Therefore, today the main method of modern antisyphilitic treatment is the long-term systematic use of penicillin derivatives in high doses.
An exception is the patient’s allergic reaction to penicillin derivatives or the confirmed resistance of pale treponema isolated from the affected strain to the penicillin derivative. Alternative treatment regimens with drugs such as Erythromycin or other macrolides, which are probably also active, may be recommended. However, their effectiveness has not yet been confirmed by the instructions of the Ministry of Health, and therefore, as a rule, they are not recommended.
Either tetracycline and cephalosporins are used. Aminoglycosides in this case are able to suppress the reproduction of pale treponemas, but only in high doses, which has a strong toxic effect on the children's body. As a result, the use of these substances in the form of monotherapy for congenital syphilis is not advisable. Sulfanilamides are not effective at all.
With neurosyphilis, it is imperative to combine oral or intramuscular administration of antibacterial drugs with endolumbal administration, as well as pyrotherapy, which increases the permeability of the blood-brain barrier to antibiotics.
, , («», «»). , .
. , 3 . , .
.
Disease prognosis
, , , . , , , . , , 6 , .
, , – .
.