Late congenital syphilis
Late congenital syphilis occurs in children older who than 5 years, with increasingly evident between the ages of 5 and 10 years, somewhat less – at an older age and even adults.
Active clinical manifestations of late congenital syphilis can be characterized as gummy lesions similar to those seen in acquired syphilis. On the skin, mucous membranes and internal organs are marked rashes or bumps Gunma bone – osteoperiostity rarely osteomyelitis.
In addition to the active clinical manifestations in patients with late congenital syphilis there are still a variety of degeneration of teeth, bones, skull, legs. Signs of congenital syphilis much. They are divided into proved and probable. The reliability should be borne in mind signs pathognomonic for congenital syphilis and likely to include those based on which one can only suspect congenital syphilis, and then only if the patient or a few signs they are combined with a history relevant and serological data.
Significant stigma late congenital syphilis:
- 1) Hutchinson’s triad – the upper incisors are narrowed at the cutting edge of a crescent recess parenchymal keratitis, deafness
- 2) saber shin.
It should be noted that fully expressed triad Hutchinson now rare; usually it has one of the components of this triad, at least two.
Possible signs of congenital syphilis:
- “saddle nose”;
- Tooth dystrophy (change of teeth in the form of first molars and canines);
- the skull;
- thickening of the sternal end of the clavicle;
- aksifoidiya (no processus xyphoideus);
- perioral scars around the lips and chin, and others.
These probable signs may, however, arise as a result of exposure to other infections and intoxications, so on the basis they can not make the diagnosis of congenital syphilis – they allow a suspected patient of congenital syphilis, and the diagnosis should be established on the basis of complex data: clinical symptoms, serological blood tests, significant signs of congenital syphilis.
We often meet with patients in whom the diagnosis of syphilis established with certainty, but it is unclear whether there is a congenital or acquired syphilis. In such cases, it might be tempting to a diagnosis of congenital syphilis and on the basis of likely symptoms, especially if there are several.
Skin lesions manifest symptoms that occur in the Tertiary period of acquired syphilis. More common Gunma less Bugorkova rash.
The lesions of the mucous membranes in the late congenital syphilis occur much less frequently than in patients with early congenital syphilis. Gummy processes of localization in the nasal septum often leads to its destruction; the localization in the hard and soft palate, or back of the throat as a result of scarring ulcers are formed gummy astringent scars or defects forming communication between the mouth and nose. Sometimes observed in bone fracture the nose with significant deformation.
Visceral with late congenital syphilis are less common than in early; In addition, patients with late congenital syphilis commonly affected one an organ, while in the early, especially in breast, age observed multiple lesions in various organs and systems.
Of the internal organs usually affects the liver, and there are two types of liver lesions:
- The liver is enlarged, palpable edge of her lumpy;
- The liver is enlarged, dense, its surface smooth.
The first type of liver damage is the result of cicatricial constrictions formed after the destruction of the gummy nodes in the liver, and the second – as a result of diffuse interstitial hepatitis; the latter usually becomes hypertrophic cirrhosis, ending atrophic cirrhosis. The defeat of the spleen is observed infrequently.
Damage to the nervous system. Headaches and epileptic seizures respond well to treatment antisyphyllitic normally be regarded as a defeat of syphilitic etiology. Several rarer hemiplegia, speech disorder, paraplegia. Mental retardation is frequently observed in the late period of congenital syphilis and sometimes reaches up to express the degree of idiocy.
Amyelotrophy may show up early enough – from 3-4 years of age. In the foreground symptoms of the eyes: anisocoria, optic atrophy, a symptom Ardzhill – Robertson (lack of reaction of pupils to light, while maintaining it at convergence). Gradually decreases and then disappear knee and Achilles reflexes; long time no symptom of Romberg. Disorders of motor and sensory spheres in children is usually mild, but in the later stages of the disease may develop urinary incontinence.
Progressive paralysis is characterized by memory loss, unusual behavior, speech disorder, delusions. There immobility of the pupils, optic atrophy. In advanced cases – paralysis, seizures and convulsions.
The defeat of the bone is observed mainly in the form of a gummy osteoperiostitov ending sclerosing bone substance, at least – in the form of osteomyelitis. Most often affects the long bones of the shins, forearms, from flat bones – the bones of the skull.
Degenerative processes of the teeth and skull bones described above.
Affected joints. From the joints most commonly affected knee. The disease is characterized by a gradual swelling of the joint and the accumulation of fluid in it (hydrarthrosis). Soreness at the same time, unlike rheumatic insignificant, it is often completely absent; Patients feel it only when walking. Motor abilities of the joint a little broken.
Lymph system in the late period of congenital syphilis occur in the form of a gummy lymphadenitis, which is often accompanied by the collapse of the gummy, ulceration and transition process in the skin. Often there are hybrid forms, t. E. Simultaneous localization in an outbreak of syphilitic and tubercular process.
Disorders of the endocrine system leads to a variety of disorders, depending on in which parts of the system localizes syphilitic process. Often there are complex disorders in the form of polyglandular syndrome.
The diagnosis of congenital syphilis.
The diagnosis of congenital syphilis is based on the following data: 1) the presence of active manifestations of syphilis in the mother or anamnestic evidence of syphilis mother; 2) the presence of a child-specific lesions characteristic of congenital syphilis (diffuse papular infiltration, congenital pemphigus, osteochondritis, and so on. N.); 3) availability of reliable or probable symptoms (stigmata and dystrophies), such as degeneration of teeth, parenchymal keratitis, saber legs and so on. N .; 4) presence of positive serological reactions in the child or the mother.
Forecast congenital syphilis. The prognosis of congenital syphilis is always serious. However, in a timely manner to sound specific treatment significantly softens it, and in some cases even makes favorable. For example, the presence prediction tabes dorsalis and progressive paralysis, despite the specific treatment is unfavorable; If treatment of a sick child with cutaneous manifestations of syphilis began shortly after birth, the prognosis is usually favorable.
Outlook largely depends on the individual: we are physically well-developed children it is more favorable than the frail, frail, premature. Further terms of the child’s life also greatly affect the outcome. In the foreground you need to put regular treatment, child care and nutrition.
Prevention of congenital syphilis.
Preventive measures that prevent disease congenital syphilis, which is closely linked with the general preventive measures aimed at reducing the incidence of syphilis in general. Due to the sharp decline in recent years, the incidence of syphilis, congenital syphilis has become a rare occurrence, and each case is subject to strict accounting. The special commission is subjected to a thorough analysis of all the documentary evidence relating to each case (case histories, hospital card, and so on. N.) Explain the reasons for having a child with symptoms of congenital syphilis, check timeliness and quality of the treatment of the mother. Based on these data and make conclusions take concrete measures to prevent such errors in the future.