Congenital syphilis — the clinical form of syphilis arising at pre-natal infection of the child with pale treponema. Congenital syphilis can be shown during various periods of life of the child from pre-natal to teenage. It is characterized by specific syphilitic damage of skin, mucous, a bone tissue, somatic bodies and nervous system. Diagnosis of congenital syphilis is based on allocation of the activator from blood separated skin elements and cerebrospinal fluid; positive results of serological reactions and PTsR-diagnostics, inspection of a condition of internals. Treatment of congenital syphilis is carried out by antibiotics, medicines of bismuth and nonspecific funds allocated for increase in immunity.
Syphilis belongs to one of the most widespread venereal diseases. Along with gonorrhea, clamidiosis, a cytomegalic inclusion disease and trichomoniasis it is an infection, sexually transmitted. Except a sexual way of transfer, infection can occur vnutriutrobno and lead to development of congenital syphilis. The patient with congenital syphilis the child constitutes infectious danger to people around, especially, if the disease proceeds with skin manifestations.
Causes of congenital syphilis
The disease of the child of congenital syphilis is caused by transmission of infection from sick mother during pre-natal development. The pale treponema (the causative agent of syphilis) is not capable to pass through a healthy transplacentary barrier. However syphilis at women during pregnancy leads to defeat of a placenta and causes violation of its protective barrier function. As a result of a treponema get into a fruit organism.
Transfer trepony from mother to a fruit is most probable in the first years of a disease of mother, over time this ability dies away. The risk of the birth of the child with congenital syphilis is especially high at women with the secondary form of this disease which is followed by an activator dissemination with blood current. At the fruit of damage of internals infected with treponema develop only on the 5-6th month of pregnancy. Therefore the antisyphilitic treatment which is carried out on early terms can lead to the birth of the healthy child.
Symptoms of congenital syphilis
Depending on features of course of congenital syphilis and terms of emergence of its clinical signs the venereology allocates 4 main forms of a disease.
Syphilis of a fruit develops in time of the pre-natal period, but not earlier than the 5th month of pregnancy. It is characterized by the consolidation and increase in internals (especially a liver and a spleen) happening owing to their inflammatory infiltration. Formation of infiltrates in lungs leads to development of "white" pneumonia of a fruit. The most reliable criterion confirming congenital syphilis of a fruit is radiological detection at a fruit of symptoms of specific osteochondrosis. Developing of congenital syphilis during pre-natal development can become the reason of premature birth, a late abortion, a still birth or birth of the sick child.
Early congenital syphilis is shown at the child aged up to 2 years and subdivided into congenital syphilis of baby age and syphilis of early children's age. At babies symptoms of congenital syphilis can appear for the first 1-2 months of life. This damage of skin and mucous membranes with development of a syphilitic puzyrchatka is the most frequent.
Typical symptoms of congenital syphilis at babies are also syphilitic cold and Gokhzinger's infiltration. Syphilitic cold has a long current with the expressed hypostasis mucous, the difficulty of nasal breath plentiful mucous separated, expressed. It can lead to defeat of bone and cartilaginous structures of a nose with formation of saddle deformation. Gokhzinger's infiltration is expressed by emergence on the 8-10th weeks of life of the child with congenital syphilis of dense infiltrate (sifilid) having in a chin and lips on soles, buttocks and palms. Lips of the child are thickened and edematous, crack and bleed, skin of affected areas loses elasticity, is thickened, its folds are smoothed.
At congenital syphilis of chest age there can be an ulcer damage of a throat to emergence of an osiplost of a voice. Damages of a bone tissue are shown by osteochondrites and periostita of mainly long tubular bones. As at secondary syphilis the specific defeats of somatic bodies caused by congenital syphilis can be observed: hepatitis, myocarditis, perikardit, the endocarditis, glomerulonefrit, hydrocephaly, meningitis, an encephalomeningitis. At boys specific is often observed orkhit, sometimes — small egg dropsy. Damage of lungs at congenital syphilis proceeds with development of interstitsialny diffusion pneumonia that often leads to death of the child on the first days of life.
At early children's age congenital syphilis can be shown by diseases of eyes, defeat of nervous system and limited skin manifestations in the form of not numerous large papules and wide condylomas. At congenital syphilis at children of early age of damage of internals are expressed more weakly. Changes of a bone tissue come to light only on roentgenograms.
Late congenital syphilis begins to be shown clinically after 2-year age, most often — in the teenage period (14-15 years). Its symptoms are similar to a picture of tertiary syphilis. These are the gummozny or bugorkovy sifilida which are localized on a trunk, a face, extremities, mucous a nose and a hard palate. They quickly break up with formation of ulcers. Specific belongs to often found symptoms of late congenital syphilis drives, acinaciform shins, and also dystrophic changes (stigmata) caused by influence of the activator on the formed fabrics and bodies. Stigmata have nonspecific character and can be observed at other infectious diseases (for example, at tuberculosis). Getchinson's triad is specific to late congenital syphilis: syphilitic labirintit, diffusion keratit also Getchinson's teeth — dystrophic changes of the central top cutters.
The latent congenital syphilis can be observed at the child at any age. It proceeds at total absence of clinical symptoms and comes to light only by results of serological researches.
Diagnosis of congenital syphilis
The diagnosis of congenital syphilis is confirmed by detection pale trepony in contents of bubbles of a syphilitic puzyrchatka or separated ulcers. However in case of lack of skin manifestations it is not possible to apply this method of diagnostics. Identification of the activator at congenital syphilis can be carried out by a microscopic research of the cerebrospinal fluid received as a result of a lyumbalny puncture. But the negative result of this research does not exclude existence of the latent form of congenital syphilis.
In diagnosis of congenital syphilis serological reactions have a crucial role. Nonspecific researches (Wasserman's reaction, the RPR test) can yield false positive results. Therefore at suspicion of congenital syphilis also specific serological researches are widely applied: RIF, RIBT, RPGA. PTsR-identification of a pale treponema is carried out with blood, the scrape separated skin elements of patients with congenital syphilis. Result accuracy — 97%.
Diagnostics of syphilitic damage of various internals can include consultation of the pulmonologist, neurologist, hepatologist, nephrologist, oculist, otolaryngologist, carrying out a X-ray analysis of lungs, a radiographic research of bones, ultrasonografiya, EHO-EG, a lyumbalny puncture, ultrasonography of abdominal organs and a liver, ultrasonography of kidneys and so forth.
Treatment of congenital syphilis
The pale treponema, unlike the majority of other microorganisms, still remains highly sensitive to influence of antibiotics of a penicillinic row. Therefore the main therapy of congenital syphilis consists in long system purpose of penicillin (benzylpenicillin in combinations and in combination with ekmoliny). At emergence at the child of allergic reaction to penicillin or detection of stability of a treponema by results of a bakposev with antibiotikogrammy, treatment is carried out by erythromycin, tsefalosporina or derivatives of a tetratsiklin.
At defeat congenital syphilis of nervous system with development of neurosyphilis showed endolyumbalny introduction of antibiotics and performing the pyrotherapy (, pirogenat) improving their penetration through a hematoencephalic barrier. In treatment of late congenital syphilis along with antibiotic treatment appoint bismuth medicines (, ). Also vitamins, biogenous stimulators, immunomodulators are applied.
Prevention of congenital syphilis
The main preventive action in the prevention of congenital syphilis is obligatory twofold serological inspection of all pregnant women on syphilis. At identification of positive serological reaction to syphilis the woman's additional examination is carried out. Establishment on early terms of pregnancy of the diagnosis "syphilis" is the medical indication to performing abortion. At pregnancy preservation, but an early initiation of treatment at the woman infected with syphilis the birth of the healthy child is possible.