a brief discription on Congenital Syphilis.ppt

a brief discription on Congenital Syphilis.ppt

1. CONGENITAL SYPHILIS
Mrs. Anugrah

2. INTRODUCTION
Congenital syphilis is a severe, disabling, and often life-
threatening infection seen in infants.
A pregnant mother who has syphilis can spread the
disease through the placenta to the unborn infant.

3. DEFINITIONS
Congenital syphilis follows transplacental transmission of
 
T. Pallidum 
to fetus in utero.
A case of congenital syphilis can be defined as:
A confirmed 
case if an infant in whom 
T. pallidum 
is identified in lesions, placenta,
umbilical cord or autopsy tissue.
It is called a
 
Presumptive 
case in : any infant whose mother was untreated 
or 
inadquately
syphilis at delivery, regardless of findings in the infant(or)
Any infant or child who has a reactive treponemal test for syphilis and any one of the
following:
1. Any evidence of CS on physical examination
2. Any evidence of CS on long bone X ray.
3. Reactive CSF VDRL.
4. Elevated CSF cell count of protein (without other cause)
5. reactive CSF VDRL test
 
or 
infant rapid plasma regain four fold higher than mother both
drawn at birth
 
or 
reactive immunoglobulin-M treponemal antibody test in serum.
Syphilitic stillbirth 
a fetal death in which the mother had untreated or inadequately treated
syphilis at delivery of the fetus after 20 week or a fetus weighing >500 gm.

4. TRANSMISSION OF INFECTION
Transmission occurs transplacentally and may occur any
time during gestation; however, risk of transmission to
fetus depends on stage of maternal infection.
primary infection occurs before pregnancy, more benign
the outcome with respect to rate and severity of
infection.
Untreated primary or secondary syphilis in pregnancy
results in 25% risk of stillbirth, 14% risk of neonatal
death, 41% risk of giving birth to a live but infected
infant and 20% chance of giving birth to uninfected
infant.

5. CONTD….
Untreated late syphilis results in 12% risk of stillbirth,
9% risk of neonatal death, 2% risk of giving birth to
infected infant, and 77% chance of giving birth to an
uninfected infant.
Women whose infection manifests itself during 1
st
 
year
after delivery may also infect their infants.

6. CAUSE
Congenital syphilis is caused by the
bacterium
 
Treponema pallidum, which is passed from
mother to child during fetal development or at birth.

7. CLASSIFICATION
•Early
•Late

8. EARLY
Newborns may be asymptomatic and are only identified on
routine
 prenatal screening.
 If not identified and treated, these newborns develop poor
feeding and
 rhinorrhea.
 By definition, early congenital syphilis occurs in children
between 0 and 2 years old.
After, they can develop
 late congenital syphilis.
Symptomatic newborns, if not
 stillborn, are born premature,
with
 hepatosplenomegaly, skeletal
abnormalities,
 pneumonia and a bullous skin disease known as
pemphigus syphiliticus.

9. PEMPHIGUS SYPHILITICUS

10. LATE
 it occurs in children at or greater than 2 years of age who
acquired the infection trans-placentally.
Symptoms include
blunted upper incisor teeth known as
 Hutchinson's teeth
inflammation of the cornea known as interstitial
 keratitis
deafness
 from auditory nerve disease
frontal bossing
saddle nose
hard
 palate defect

11. CONTD…..
swollen knees
saber shins
short maxillae
protruding mandible
A frequently-found group of symptoms is Hutchinson's
triad, which consists of Hutchinson's teeth (notched
incisors), keratitis and deafness and occurs in 63% of
cases.

12. SYMPTOMS
Symptoms in newborns may include:
Failure to gain weight or
 failure to thrive
Fever
Irritability
No bridge to nose (saddle nose)
Rash of the mouth, genitals, and anus
Rash -- starting as small blisters on the palms and soles, and
later changing to
 copper-colored, flat or bumpy rash on the
face, palms, and soles
Watery
 fluid released from the nose

13. FAILURE TO THRIVE
 Saddle Nose

14. SKIN RASH

15. CONTD…….
Symptoms in older infants and young children may
include:
Abnormal notched and peg-shaped teeth, called Hutchinson
teeth
Bone pain
Blindness
Clouding of the cornea
Decreased hearing or deafness
Gray, mucus-like patches on the anus and outer vagina
Joint swelling
Refusal to move a painful arm or leg
Saber shins (bone problem of the lower leg)
Scarring of the skin around the mouth, genitals, and anus

16. HUTCHINSON TEETH
Saber shins

17. DIAGNOSIS
If the disorder is suspected at the time of birth, the placenta
will be examined for signs of syphilis.
A routine blood test for syphilis is done during pregnancy. The
mother may receive the following blood tests:
Fluorescent treponemal antibody absorbed test (FTA-ABS)
Rapid plasma reagin (RPR)
Venereal disease research laboratory test (VDRL)

18. IN NEWBORNS:
Bone x-ray
Dark-field examination to detect syphilis bacteria
under a microscope
Eye examination
Lumbar puncture

19. TREATMENT
Preventive Treatment

20. PREVENTIVE TREATMENT
If a pregnant mother is identified as being infected with
syphilis, treatment can effectively prevent congenital syphilis
from developing in the unborn child, especially if she is treated
before the sixteenth week of pregnancy.
The child is at greatest risk of contracting syphilis when the
mother is in the early stages of infection, but the disease can be
passed at any point during pregnancy, even during delivery (if
the child had not already contracted it).
A woman in the secondary stage of syphilis decreases her
child's risk of developing congenital syphilis by 98% if she
receives treatment before the last month of pregnancy

21. REGIMEN 1 (PROPHYLACTIC TREATMENT)
All asymptomatic babies who meet ALL the
following criteria:
◘ Have no serological evidence of syphilis and
◘ Are born to mothers who were adequately
treated for maternal syphilis with penicillin
during the current pregnancy and
◘ The mother has received the treatment at least
4 weeks prior to delivery Should be treated with
a single dose of prophylactic penicillin:
Benzathine penicillin G 50,000 units/kg given as
a single intramuscular injection

22. REGIMEN 2 (CURATIVE TREATMENT)
This should be given to All symptomatic babies
(newborns and older)
All asymptomatic babies
Asymptomatic newborns
◘ Born to mothers who were treated with penicillin less
than 4 weeks before delivery
◘ Born to mothers who were treated with non-penicillin
regimens (erythromycin or azithromycin) during
pregnancy
◘ Born to mothers whose treatment status is unknown or
undocumented

23. ASYMPTOMATIC INFANT/CHILD
◘ Whose RPR/VDRL titre is four-fold higher than that of
the mother at or after delivery
◘ Born to mothers with clinical evidence of syphilis
◘ With a reactive syphilis IgM antibody test
◘ Born to mothers who did not complete the recommended
course of penicillin during pregnancy
◘ Born to mothers whose RPR/VDRL titres had not
dropped four-fold

24. Intravenous (IV) treatment regimen: Aqueous crystalline
penicillin G 100,000–150,000 million units/kg/day
intravenously. It could be given as 50,000 units/kg/dose IV
every 12 hours during the first 7 days, and thereafter every 8
hours for 3 days to complete a total of 10 days of treatment.
Intramuscular (IM) treatment regimen: Procaine penicillin
50,000 units/kg body weight intramuscularly as a single daily
dose for 10 days; Alternatively, benzathine penicillin G 50,000
units/kg IM in a single dose Hospitalization of the infant should
be considered in order to ensure the full course of treatment. If
more than one day of treatment is missed, the entire course of
treatment should be restarted.

25. FOLLOW-UP
Follow-up should be done during PNC visits as
well as at 6 months and 24 months after the
treatment is received.

26. COMPLICATIONS
Blindness
Deafness
Deformity of the face
Nervous system problems