pediatrics
Congenital Syphilis
Symptoms and Signs of Congenital Syphilis
Many patients are asymptomatic, and the infection may remain clinically silent throughout their life. Early congenital syphiliscommonly manifests during the first 3 months of life. Manifestations include characteristic vesiculobullous eruptions or a macular,copper-colored rash on the palms and soles and papular lesions around the nose and mouth and in the diaper area, as well as petechial lesions. Generalized lymphadenopathy and hepatosplenomegaly often occur. The infant may fail to thrive and have a characteristic mucopurulent or blood-stained nasal discharge causing snuffles. A few infants develop meningitis, choroiditis, hydrocephalus, or seizures, and others may be intellectually disabled. Within the first 8 months of life, osteochondritis (chondroepiphysitis), especially of the long bones and ribs, may cause pseudoparalysis of the limbs with characteristic radiologic changes in the bones. typically manifests after 2 years of life and causes gummatous ulcers that tend to involve the nose, septum, and hard palate and periosteal lesions that result in saber shins and bossing of the frontal and parietal bones. Neurosyphilis is usually asymptomatic, but juvenile paresis and tabes may develop. Optic atrophy, sometimes leading to blindness, may occur. Interstitial Keratitis , the most common eye lesion, frequently recurs, often resulting in corneal scarring. Sensorineural deafness, which is often progressive, may appear at any age. Hutchinson incisors, mulberry molars, perioral fissures (rhagades), and maldevelopment of the maxilla resulting in “bulldog” facies are characteristic, if infrequent, sequelae. Osteoperiostitis of the tibia leads to characteristic saber shins in this patient with congenital syphilis. Image courtesy of Robert Sumpter via the Public Health Image Library of the Centers for Disease Control and Prevention. Interstitial keratitis manifests with varying degrees of corneal opacification and neovascularization. The neovascularization appears as the faint, pink areas in the peripheral cornea from the 11 o'clock to the 1 o'clock position. © Springer Science+Business Media This photo shows triangular shaped deformity of right upper and left lower incisors caused by congenital syphilis. Image courtesy of Robert E. Sumpter via the Public Health Image Library of the Centers for Disease Control and Prevention. 