Congenital syphilis is a disease that is transmitted to the unborn child through the placenta through maternal blood. This pathology comes in two forms - early and late syphilis.
The early form includes those pathologies that are observed in the fetus, in the infant and in early childhood.
Late congenital syphilis is found, as a rule, after 14-16 years, but until that 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 shown in the photo) develops when a microorganism called treponema pallidum enters the fetus through the umbilical vessels, which can also get there through the lymphatic slits from a mother with syphilis.
An unborn baby can be infected if the mother is infected before pregnancy, and this can happen at any stage of pregnancy. Pathological dysfunctions in the organs of the fetus are detected at about 5-6 months. In other words, duringformation.
Pathogenesis
According to some scientists, such an infection can have a significant impact on the chromosomal apparatus of the mother's cells. They usually differ:
- syphilitic gametopathies, which are degenerative changes that occurred in 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 body of the fetus at 4-22 weeks of development.
The fetus has a variety of physical developmental defects, as well as neurological dysfunctions and intellectual retardation. Mental disorders in congenital syphilis are quite common.
Infection of the unborn child through the placenta can occur if the mother is infected before conception and later, at different stages of its development. Pale treponema, the causative agent of syphilis, enters the fetus through the umbilical vessels. In this case, it is advisable to conduct active antisyphilitic treatment in the early stages of pregnancy, which can guarantee the birth of a he althy baby.
Since secondary syphilis occurs, as a rule, with the phenomena of spirochetemia, there is a high risk of developing pathologies in the child of women who suffer from a similar form of syphilis. In addition, transmission of infection to offspring occurs most often in the first years after the mother has become infected. Later, this ability gradually decreases.
It is believed that the birth of sick children from a mother who sufferscongenital syphilis in the second or even third generation. However, such cases are extremely rare. The outcome of such a pregnancy varies:
- she may end up in a late miscarriage;
- preterm 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 varied pregnancy outcome is typical, and this can happen at any time, due to the degree of infection of the fetus and the activity of the infection itself. The probability of infecting a child by transmitting the disease through spermatozoa has not yet been proven by scientists. But research is being done regularly.
What are the reliable signs of congenital syphilis?
Symptoms of congenital infection
Depending on what clinical symptoms occur in each individual case, the characteristics of the manifestation and the timing of the detection of congenital syphilis, the disease is usually divided into the following categories:
- Fetal syphilis.
- Early congenital syphilis - from birth to 5 years.
- Latent congenital forms seen in different age groups.
- Late congenital syphilis - in children older than 5 years.
Let's consider all these categories in more detail. Let us first describe the early form of the disease.
Early congenital syphilis
This kind of this disease can manifest itself in the form of the following disorders andbaby tissue damage:
- skin lesion;
- mucous membrane;
- visceral syphilis;
- syphilitic laryngitis;
- syphilitic ophthalmopathy;
- syphilitic osteochondropathy;
- syphilitic pharyngitis;
- syphilitic pneumonia;
- syphilitic rhinitis.
Latent syphilis is a congenital infection with no clinical manifestations. However, a serological test and a negative cerebrospinal fluid test in a child are positive.
Congenital syphilis, unspecified, 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
Syphilis infection of the placenta is an increase, hypertrophy of its tissues. Visually, it 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 of 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 a syphilitic lesion, edema forms in the placenta, granulation cells grow, and the villi and blood vessels are damaged. At the same time, they discovercausative agents of the disease - 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 the occurrence of a syphilitic infection in the placenta, the supply of nutrition to the fetus and the necessary metabolism are disrupted, after which intrauterine death and miscarriage may occur. In the first months of pregnancy, pale treponema in the fetus may not be detected, since it penetrates into his body only with the development of placental circulation.
Starting from the 4th month of pregnancy, the fetus shows signs characteristic of such a disease:
- fetus is underweight;
- he shows signs of maceration;
- specific disorders are revealed in the development of organs, which are manifested by diffuse infiltration, hypoplasia of the connective tissue, changes in blood vessels;
- The causative agent of syphilis is found in the tissues of internal organs.
Lung injury
A characteristic sign of congenital syphilis in children may be lung damage, focal or diffuse specific infiltration of the interalveolar septa, as well as hyperplasia of the alveolar epithelium, filling the fatty contents of the alveoli. The lung tissue becomes airless and grayish white in color.
Liver damage in this disease
Liver when infectedsyphilis increases, thickens, its surface becomes smooth. Small cell infiltration and small foci of yellow necrosis are also found, and atrophy of this organ often occurs. When cut, the liver tissue looks yellow-brown, it shows the severity of sclerotic changes. The symptoms of congenital syphilis are hard to miss.
Injury to other organs
The spleen also thickens and enlarges. As for the kidneys of the fetus, their cortical layer is most often affected. There are underdeveloped glomeruli and tubules, cyst formation, foci of diffuse small cell infiltration. In the mucous layer of the stomach and intestines, flat infiltrates and ulcers may be noted.
The heart is rarely affected in congenital syphilis. 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, gonads can often be involved in the pathological process.
Inflammatory disorders of the central nervous system are detected, which manifest themselves as productive leptomeningitis with vascular sclerosis or meningoencephalitis and granular ependymatitis. Gum medulla often develops.
The most common sign of congenital syphilis in a child is the detection of manifestations of specific osteochondritis of 1, 2 and 3 degrees or osteoperiostitis localized at the ends of tubular bones.
Appearance of a child with a similar pathology
The main signs of such a diseasethe following pathological changes in children are considered:
- dry and wrinkled facial skin;
- large head with high frontal tubercles and a pronounced venous network;
- dropping nose bridge;
- areas of pigmentation on the face;
- limbs are thin and bluish;
- the child is very restless, whiny, which is associated with a clear lesion of the central nervous system;
- developmental retardation, severe thinness;
- stubborn runny nose, difficulty breathing and suckling;
- dystrophy with symptoms of a complete absence of fatty tissue, bedsores;
- various skin lesions.
Syphilitic pemphigus
This symptom is one of the main signs of congenital syphilis in children, observed already at birth or in the first days of life.
Such a violation has the following clinical manifestations:
- location on the palms, soles, face, surfaces of the folds of the forearms and lower legs, sometimes all over the body;
- bubble size - 1-2 cm in diameter;
- the surface of the blisters 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 the opening of such formations, infiltrated erosions form;
- papular rashes appear before they appear.
In the absence of adequate antisyphilitic therapy, children tend toare dying.
The pathological process usually involves only individual organs and systems of the body. Mild symptoms are very characteristic, as, for example, in the development of secondary recurrent syphilis. Large papules form on the skin of the perineum and inguinal folds, on the feet: often weeping and vegetating. They sometimes coalesce to form large warts that begin to ulcerate. In weak babies, pustules may appear on the scalp.
Sometimes there are manifestations of syphilitic rhinitis, causing atrophic catarrh and perforation of the nasal septum. Also, diffuse or focal alopecia is often observed, lymph nodes increase.
Almost in most children with congenital syphilis, the skeletal system is affected, characterized by limited periostitis and osteosclerosis. Diffuse periostitis of the fingers often occurs. Bone gummas occur much less frequently. There is an increase in the liver, spleen, nephronephritis develops. The testicles in boys increase and become dense. Lesions of the nervous system are characterized by manifestations of mental retardation, nervous seizures, hydrocephalus, meningitis. Eye damage in the form of chorioretinitis, optic nerve atrophy, and parenchymal keratitis are also possible. 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, symptoms most often begin to appear at age14-15 years old.
Most sick children have almost no signs of congenital syphilis, some may show characteristic changes in appearance and internal organs - a saddle nose, deformity of the skull, etc.
With late syphilis, tubercles on the skin, visceropathy, as well as diseases of the central nervous system, endocrine glands are noted. The clinical symptoms of late congenital syphilis, as a rule, do not differ from those of the tertiary stage of syphilis. There is also a thickening of the liver, lesions of the spleen, nephrosis and nephronephritis. With involvement in the pathological processes of the cardiovascular system, heart valve insufficiency, endocarditis, and myocarditis develop. The lungs and digestive tract are also affected. A typical symptom of this type of disease is damage to the thyroid gland, gonads and adrenal glands.
Diagnosis of congenital syphilis
Diagnostic value can only be the presence of certain dystrophies (stigma) in combination with the main signs of the disease. When establishing a diagnosis, standard serological studies are invaluable, which are regarded as positive in early forms of congenital syphilis. In the presence of late forms, complex serological studies take place, which are regarded as positive in 96% of patients, as well as immunofluorescence reactions and immobilization of pale treponema.
A very important diagnostic role is played by the study of cerebrospinal fluid contents, as well as radiography of the bone apparatus, examination ofpediatrician, ophthalmologist, otolaryngologist, neuropathologist and other specialists.
When establishing a diagnosis of early congenital syphilis or a passive method of transmitting antibodies, great importance is attached to quantitative reactions. Antibody titers in sick children are usually higher than in mothers. In he althy children, they decrease, and a spontaneous negative serological reaction begins to occur. In the presence of causative agents of syphilis, antibody titers are persistent or there is a significant increase. In the first days of life, a serological reaction can be negative, so experts do not advise it to be carried out in the first 14 days.
Diagnostic tactics
It consists of the following activities:
- Simultaneous examination of both mother and child.
- It is not recommended to take blood for serological studies in women 14 days before and the same number after childbirth;
- It is not advisable to take blood for serological studies from the umbilical cord of the fetus in the first 14 days after birth, since protein lability and instability of the colloidal component of serum can be observed during this period.
- When serological studies of mother and child, it is necessary to use a complex of certain serological reactions, for example, the Wasserman reaction, RIF and others.
- Be aware that a positive serological test in a child may be due to passive transfer of antibodies. However, gradually, within a few months after birth, such antibodies may disappear, and the resultsresearch will turn negative.
How is congenital syphilis treated?
Methods of therapy for pathology
The causative agents of syphilis are actually the only microorganisms that have retained to date, despite long periods of penicillin therapy, a unique sensitivity to penicillin. This infection does not produce penicillinases, having no other means of antipenicillin protection, such as mutation of cell wall proteins or polyvalent drug resistance genes, which 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 here is an allergic reaction of a patient to penicillin derivatives or a confirmed resistance of a penicillin derivative isolated from an affected strain of treponema pallidum. Alternative regimens may be recommended with drugs such as erythromycin or other macrolides that are likely to be active as well. However, their effectiveness has not yet been confirmed by the guidelines of the Ministry of He alth, and therefore they are generally not recommended.
Or use tetracycline and cephalosporins. Aminoglycosides in this case are able to suppress the reproduction of pale treponema, but only in high doses, which has a strong toxic effect on the child's body. Therebythe use of these substances as monotherapy for congenital syphilis is not advisable. Sulfonamides are not effective at all.
In case of neurosyphilis, it is imperative to combine oral or intramuscular administration of antibacterial drugs with endolumbar administration, as well as with pyrotherapy, which increases the permeability of the blood-brain barrier for antibiotics.
In the treatment of tertiary syphilis against the background of resistance of the pathogen to antibacterial drugs, as well as with a favorable general condition of the patient, a certain toxicity of the therapy is allowed, and at the same time, bismuth or arsenic derivatives (Miarsenol, Novarsenol) can be added to antibiotics). Such drugs are not available in pharmacies and are only supplied to medical institutions, as they are very highly toxic and are rarely used.
With syphilis, treatment of the patient's sexual partner is mandatory. In the case of primary syphilis, all persons who have had sexual contact with the patient in the last 3 months should be treated. However, in cases of secondary syphilis, all people who had such contacts with the patient during the year are treated.
Prevention of congenital syphilis is also very important.
Disease prognosis
This aspect is determined, as a rule, by the rational therapy of the mother, as well as the severity of the disease of the offspring. Good prognosis has an early start of treatment, a nutritious diet, proper care for the child and mandatory breastfeeding, whichcontributes to positive results. The timing of the start of such activities also plays a major role, since specific treatment started after 6 months is already less effective.
According to statistics, in infants after a full course of therapeutic procedures, standard serological reactions are normalized by the end of the first year of life, with late forms of this disease - much later.
We reviewed the classification of congenital syphilis and its treatment methods.
