Congenital syphilis

Congenital syphilis occurs when T. pallidum crosses the placenta from an infected mother to the fetus.
Maternal transmission happens most frequently during primary or secondary syphilis, when the spirochetes are most numerous.

Congenital syphilis may also occur due to passage of the fetus through infected birth canal.
Because manifestations of maternal syphilis may be subtle, routine serologic testing for syphilis is mandatory in all pregnancies.
Congenital syphilis rates continue skyrocketing alongside other STDs.Newborn syphilis incidence has more than doubled,
from 362 cases in 2013
to 918 cases in 2017,
resulting in 64 syphilitic stillbirths and 13 infant deaths that year, according to data published in Sexually Transmitted Disease Surveillance 2017.
Syphilitic infection of the mother.Miscarriage,
Premature birth
Still births
Or death of newborn baby or
A baby with early or late manifestations of congenital syphilis
Intrauterine death and perinatal death each occurs in approximately 25% of cases of untreated congenital syphilis.
Early manifestation of congenital Syphilis: first 2 years.Mucopurulent or blood-stained nasal discharge causing snuffles is seen in the first few months of life.
A desquamating or bullous rash with sloughing of the skin, particularly of the hands and feet and around the mouth and anus.
Vesiculobullous rash on palm, axilla, and face of a newborn with congenital syphilis.
Desquamation on the palms and soles with no rash or desquamation elsewhere is very suggestive of congenital syphilis Circinate lesions and syphilitic pemphigus of the soles present at birth in an infant with congenital syphilis
At the mucocutaneous junction lesions tend to weep and may cause fissures (cheilitis) which often extend from the lips in a radiating fashion over the surrounding skin.
When deep, these lesions may leave residual scars (rhagades).
Marked hepatosplenomegaly in an infant with congenital syphilis.
Hepatomegaly occurs in 50 to 60% of affected infants.
It is frequently associated with jaundice, anemia, splenomegaly and ascites.
The Pathognomonic lesion in the first 6 month of life is syphilitic osteochondritis usually accompanied by periostitis.
These lesions tend to have a symmetrical distribution, although they vary considerably in appearance and extent.
In severe cases the destructive process is so extensive about the growing ends of the long bones that metaphyseal fractures may occur.
Enlargement of epiphyseal ends of bones.
Broadening and irregularity of the epiphyseal lines.
. Irregularity and sclerosis of the zones of provisional calcification ("saw-tooth" metaphysis).
4. Irregular areas of osteoporosis in the bones, particularly in the metaphysis.
Wimberger SignLytic lesions in the medial aspect of proximal tibia (arrows).Syphilitic infant.
Pain in both tibiae.
Bilateral tenderness at upper end of both tibiae and lower end of both radii.
The infant refused to move “Parrot Pseudo-paralysis”
Onionpeel periosteum"):In the second 6 months of life the evidence of periosteal reaction tends to become more intense.
Successive layers of new bone are laid down under the periosteum.
Late manifestation of Congenital Syphilis 2-30 years.“Hutchinson teeth” are small incisors, widely spaced, shaped like a screwdriver or a peg, with notches in the enamel.
Interstitial keratitis with blindness.
In addition to interstitial keratitis, the ocular changes include choroiditis and abnormal retinal pigmentation
It is unusual for the interstitial keratitis that occurs in a congenital syphilis to appear before the age of 5 years.
This patient was 20 years-old at the time of the photo and had been aware of eye problems for a number of years.
Hutchinson’s triad ”:Hutchinson’s teeth
Interstitial keratitis
Eighth-nerve deafness
Syphilitic osteochondritis and periostitis affect all bones, but lesions of the nose and lower legs are most distinctive.
Destruction of the vomer causes collapse of the bridge of the nose and, later on, the characteristic saddle nose deformity.
Saddle nose.Periostitis of the tibia leads to excessive new bone growth on the anterior surfaces with anterior bowing of the tibia giving the characteristic Saber shin.
Classic sign of late congenital syphilis is perforation of the hard palate“FEUERSTEIN LIVER”:The liver is often severely affected in congenital syphilis.
Diffuse fibrosis permeates lobules to isolate hepatic cells into small nests, accompanied by the characteristic lymphoplasmacytic infiltrate and vascular changes.
Gummas are occasionally found in the liver, even in early cases.
This is a “Gumma" in the heart of a fetus with congenital syphilis.
Rhagades (cracks or fissures in the skin around the mouthMulberry Molars.

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[@pathologyprof.dr.tahanyeis3595]

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[@pathologyprof.dr.tahanyeis3595]

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[@pathologyprof.dr.tahanyeis3595]

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[@cabecehuevo]

Thank you for this nice and educational presentation. Is It more frequent that the fetum gets infected during first months of pregnancy?