congenital syphilis
Introduction
Introduction to congenital syphilis Syphilis (syphilis) is a systemic infectious disease caused by Treponemapallidum, which can be divided into congenital and acquired syphilis. Acquired syphilis (acquired syphilis), sexual contact is its main route of transmission, clinical process can be divided into three phases. Congenitalsyphilis (also known as prenatalsyphilis), the pathogen in the mother through the placental pathway to infect the fetus, can cause stillbirth, premature delivery, pregnancy syphilis is 2.5 times higher risk to the fetus than normal pregnant women. Pregnancy with syphilis has a mortality rate of up to 50%. It is a disease that seriously affects the physical and mental health of infants and young children. basic knowledge The proportion of illness: 0.005% Susceptible people: young children Mode of transmission: mother-to-child transmission Complications: osteomyelitis, neurosyphilis, meningitis, convulsions, convulsions, optic atrophy
Cause
Congenital syphilis etiology
Congenital factors (45%):
Treponema pallidum easily infects the fetus through the placenta, leading to congenital syphilis. Treponema pallidum can cause fetal infection through the placenta after 4 months of gestation due to atrophy of chorionic trophoblast. In recent years, it has been found by electron microscopy that treponema pallidum can infect the fetus through the placenta in the early, middle and late stages of pregnancy.
Pathogenesis
The population is generally susceptible to syphilis. So far, the pathogenesis of syphilis is still not very clear. After the fetus enters the fetus through the placenta, it is proliferated in the liver, spleen, adrenal gland and other visceral tissues of the fetus and released into the blood. Can cause skin, mucous membrane, bone, blood, internal organs and other diseases, severe cases can cause miscarriage, premature delivery, stillbirth, the main pathological changes are vascular endothelial cell swelling, hyperplasia, luminal occlusion, distal local necrosis or cheese-like changes, Or fibrous tissue hyperplasia forms scars, impairing organ structure and function.
Prevention
Congenital syphilis prevention
99% of cases are treated properly during pregnancy, and both the mother and the fetus can heal. However, some cases are treated too late during pregnancy, although the infection can be eliminated, but symptoms of syphilis remain after birth.
Pre-natal STS testing, re-examination of mothers with other sexually transmitted diseases during pregnancy, and appropriate treatment of infected pregnant women can greatly reduce the incidence of congenital syphilis. When making a diagnosis of congenital syphilis, other members of the family should also be routinely examined and serologically tested for syphilis infection. It is only necessary to re-examine the mother who is pregnant again if the serological test is still positive. Women who have been treated appropriately still maintain a serological test positive, may have re-infection, and need to be re-treated. Although the mother has no signs of damage and is serologically negative, she should be treated with syphilis because they have a 25% to 50% chance of being infected with syphilis before the serological test is positive.
1. Strengthen prevention and treatment education: comprehensive systematic monitoring of syphilis and strengthening prevention and education.
2. Strengthen pre-marital, prenatal examination: should be routinely tested for syphilis serum.
3. Dr. plum treatment: Any woman with suspected syphilis pregnancy, VDRL test should be done before the first birth, regular serum blood test, if the diagnosis should be performed, the pregnancy should be stopped, if necessary, to stop the pregnancy.
4. Regular follow-up examination: For high-risk newborns with syphilis, regular follow-up examinations, early detection and early treatment.
Complication
Congenital syphilis complications Complications osteomyelitis, neurosyphilis, meningitis, convulsions, optic atrophy
Osteochondritis, osteomyelitis, meningeal vascular syphilis, meningitis, etc., involving the nervous system can be left with chronic meningitis, spastic paralysis, convulsions, mental retardation, deafness and optic atrophy and other sequelae.
Symptom
Congenital syphilis symptoms Common symptoms Syphilitic liver scarring Rose rash mucosal damage Pathological jaundice pustular spotted lymph nodes swollen wet pimples
Early congenital syphilis
Its onset symptoms are equivalent to the second day of syphilis.
(1) General performance: Severe cases can be born prematurely at birth, with hepatosplenomegaly, systemic skin lesions, anemia, thrombocytopenia, etc.; also have normal or only low birth weight at birth, appearing around 3 weeks after birth Clinical symptoms, manifested as development, poor nutrition, weight loss, weight loss, low response, skin wrinkles, appearance of the elderly, fever, anemia, pathological jaundice, thrombocytopenia.
(2) Skin rash: The rash is similar to the second-phase syphilis. The common rash, papules, and rash are numerous, widely distributed, not painful, and have many forms:
1 spot rash (rose rash): more common in the cranial part of the extremities, dark red or copper red, often in the mouth, around the lips and perianal radial erosion, after healing to form a characteristic radial scar, with diagnostic significance .
2 papular syphilis: can occur throughout the body.
3 flat wet sputum type: is a special form of papular syphilis rash that occurs in moist and wearable parts. It is more common in the perianal and external genital areas. It is slightly higher than the leather surface and has clear boundaries. It can have erosion and exudate. Contains a large number of Treponema pallidum.
4 syphilitic pemphigus is more common, mostly pea-sized pustules in the palmar sac, the base is dark red or copper red, smashed after rupture, characteristic.
(3) rhinitis: syphilitic rhinitis is the most common in mucosal damage, showing nasal mucosa hypertrophy, swelling, serous or pus and bloody secretions and scarring, causing nasal stenosis, blockage, difficulty breathing and sucking, congenital One of the characteristics of syphilis, severe cases can damage the nasal bones and nasal cartilage and cause the nasal roots to sink to form saddle nose.
(4) skeletal damage: bone, chondritis and periostitis are the most common, osteomyelitis and periostitis cause severe pain in the limbs and make the limbs pseudo-sputum.
(5) Others: hepatosplenomegaly, pathological jaundice and generalized lymphadenopathy, lymph nodes with lymphadenopathy on the tibial block are most prominent, and may also have hypoproteinemia, systemic edema, hair loss, chorioretinitis and the like.
2. Late congenital syphilis
Late congenital syphilis is rare in the neonatal period, mostly after 2 years of age, most commonly occurring in 7 to 15 years old, and its performance is similar to the acquired syphilis in the third phase, can be divided into two groups:
(1) Permanent marking: left in the early stage (including in the mother's womb) or damage caused by late lesions to the body's development, no activity, but characteristic, such as forehead round convex, Sabre (the middle edge of the humerus) Periosteal thickening), characteristic Hao Qinsheng teeth (Hutchinson teeth, semi-moon recessed in the lower edge of the upper incision), mulberry teeth, saddle nose, radial cleft palate and scar around the mouth, joint sternal joint hypertrophy and retinitis.
(2) Active damage: clinical manifestations caused by active damage, including substantial keratitis (unilateral/bilateral corneal deep infiltration, corneal opacity, affecting vision), neurological deafness, abnormal changes of cerebrospinal fluid, liver Splenomegaly, nasal or eucalyptus gum, joint hydrops, periostitis, finger inflammation and skin mucosal damage, central nervous system involvement is less common in the early stage, may have meningoencephalitis or hydrocephalus, the number of cells in the cerebrospinal fluid increases, The protein is elevated, the syphilis serum is positive, and the late neurosyphilis is rare.
3. Congenital latent syphilis
Congenital syphilis has no treatment, no clinical symptoms, seropositive, early age is less than 2 years old, and older than 2 years is late congenital latent syphilis.
Examine
Congenital syphilis examination
1. Treponema pallidum examination: directly smear the secretions of damaged skin or mucous membranes, and examine the syphilis spirochetes with dark-field microscopy.
2. Non-treponema pallidum serum test:
(1) Venereal disease research laboratory (VDRL) test: The blood serum is used as an antigen to detect antibodies in the serum of patients. This test is easy to operate, has fast results, high sensitivity, non-specificity, and false positives. Can be used for large-scale screening.
(2) Rapid plasma regin (RPR) annular slide test: It is an improved method of VDRL test. Because of the high purity of colloidal carbon, the reagent reacts with positive serum to produce black agglutination during the test, which is easy to judge. The advantages and disadvantages are the same as above.
(3) Treponema pallidum serum test: using Treponema pallidum as an antigen to detect specific antibodies in serum, can be used for affirmative diagnosis.
1 fluorescence treponemal antibody absorption (FTA-ABS) test: generally positive in the early stage of infection, false positive rate is only 0.18% ~ 0.26%, the disadvantage is that anti-syphilis treatment can still remain positive for 10 years, Can not be used as an indicator of efficacy.
2 Treponema pallidum hemagglutination test (TPHA-TP): syphilis confirmed test, but can not be used to judge the indicators of reinfection and recurrence.
3 Determination of Treponema pallidum IgM type antibody: After 2 weeks of infection, IgM anti- Treponema pallidum antibody can be detected in serum, infants can obtain IgG from maternal, VDRL and TPHA can be false positive, so syphilis-specific IgM antibody is detected. It is of great value in the diagnosis of congenital syphilis. It can be turned negative after treatment of congenital syphilis, and it can be positively positive when it is infected. It can be used as a therapeutic judgment and a diagnostic indicator in infection.
B-ultrasound, CT and X-ray film examinations.
X-ray examination: bone slices can be seen in several layers of new periosteal bone, periosteal laminar hyperplasia, osteoporosis of the metaphysis, osteoarthritis, periostitis, chest inflammatory infiltration.
Diagnosis
Diagnosis and diagnosis of congenital syphilis
diagnosis
Diagnosis can be made based on medical history, clinical performance, and laboratory tests.
1. Family history: The mother is a patient with syphilis.
2. Clinical manifestations: There are typical early or late congenital syphilis lesions or markers.
3. Laboratory examination: FTA-ABStest positive can be diagnosed, sexually transmitted disease research laboratory test (VDKLtest) is more sensitive, early syphilis positive rate of 90%, cord blood test IgM often >0.2g / L, cerebrospinal fluid cells and protein Increased, VDKL test positive, can be diagnosed as neurosyphilis.
Differential diagnosis
1. Skin damage: Identification with pemphigus, leprosy, diaper rash, drug eruption, etc.
2. syphilitic rhinitis: the identification of nasal diphtheria, the age of onset of nasal diphtheria is different, seen in children over 6 months.
3. False sputum: This disease is associated with scurvy and scurvy, rickets, bone tuberculosis and suppurative osteomyelitis. X-ray examination has specific performance and can help identify.
4. Identification with other infections: Newborns should also be differentiated from sepsis, congenital viral infections, etc.
