SYMPTOMATIC EARLY CONGENITAL SYPHILIS

A COMMON BUT FORGOTTEN DISEASE

S. APARNA DEVI, SECOND PROFESSIONAL MBBS

S. AFREEN, SECOND PROFESSIONAL MBBS
RAJIV GANDHI INSTITUTE OF MEDICAL SCIENCES, KADAPA
[SUPPORTED BY: DR. B. VIJAI ANAND BABU, M.D., PROFESSOR AND HOD, DEPARTMENT OF PEDIATRICS]

INTRODUCTION An Infantogram revealed classical signs of congenital syphilis:

Focal erosions involving medial part of upper end of both the Tibia
Congenital syphilis is a severe, disabling infection in infants, often
(WIMBERGER SIGN). Transverse, serrated radio lucent bands were
with grave consequences. As per WHO estimates, two million
present on metaphysis. (WEGENER SIGN) Periosteal changes
pregnant women are newly getting infected with syphilis every year.
(PERIOSTITIS OF PEHU) were seen in diaphysis.
Many of these mothers transmit this infection to their off springs due
to inadequate treatment. As a consequence, the babies are still born,
preterm or born with low birth weight and congenital abnormalities.
UNTREATED SYPHILIS

100%Transplacental Transmission of Treponema

pallidum
WEGENER
SIGN
2/3rd Asymptomatic at birth 1/3 rd Fetal or
manifesting at 3-8 wks of age perinatal deaths WIMBERGER
SIGN

CASE REPORT

2 months old baby boy presented to our OPD with swelling of both
elbows and knees of 7 days duration. Onset was sudden, associated
.
with pain and restricted joint movements.(FIGURE-1). History of low PERIOSTITIS OF PEHU
grade fever along with cough and cold of 3 days duration was there.
History of trauma could not be elicited.
Past history of vesiculo-bullous lesions involving nape of neck,
back & buttocks, healing in 4 days without scar at 1 month of age.
Perinatal history revealed that mother had no antenatal checkups;
Baby was born preterm low birth weight (2 kg) and was immunized
with BCG, OPV, at birth. Baby was the 1st child of consanguineous
couple belonging to low socio economic status. • VDRL TEST: Positive
At the time of examination baby’s anthropometric measurements • TPHA TEST : Positive(1:640 dilutions)
were: Wt 3 Kgs, length 50cms , head circumference 35 cms, chest MOTHER • HBV, HCV&HIV TEST : Negative
circumference 34 cms. Vitals –stable.
Baby was irritable and mild pallor noticed . There was no
significant lymphadenopathy or Rash . Baby did not have any snuffles
Anterior fontanel was flat, and there was no asymmetry of face .
Examination of ears and eyes was normal.
Painful limitation of movements of both upper and lower limbs • VDRL TEST: Positive
was evident by the way the limbs were kept in adduction at shoulder • Treponemal IgM antibody ELISA test: Positive
and hip joints and flexion at elbow and knee joints. There was no BABY • CSF VDRL-negative
local rise of temperature or erythema , and the infant was crying on • CSF analysis -normal
passive movement of the joints . Liver and spleen were palpable.
CVS,RS –clinically normal.
A differential diagnosis of congenital syphilis septic arthritis Based on the clinical manifestations along with pseudo-paralysis,
and traumatic arthritis (Battered Baby Syndrome) and hemophilia was typical radiological findings of osteochondritis, positive VDRL and
considered. TPHA tests, a diagnosis of congenital syphilis was made.
Laboratory parameters were: Hb-8.2 gms,WBC-10,200 cells, MANAGEMENT
CRP positive (1;16), BT, CT, PT, APTT were within normal limits. The infant was managed with crystalline penicillin
Blood culture was sterile. Neurosonogram and Ultrasound abdomen 50,000 units/kg/dose three times a day for a total of 10 days and baby
were normal. was relived of the symptoms and was discharged. Mother was referred
to STD department of our institution for treatment.

CONCLUSIONS
Fig 3 World Health Organization recommends that all pregnant women
should be screened for syphilis prenatally, antenatally at first visit in
the first trimester and again in the late pregnancy and in high risk
mothers 1month after delivery.
We support the recommendation, as vigilant screening prenatally,
at delivery, and an adequate follow-up are critical to reduce the
incidence of congenital syphilis
REFEREENCES

1. WHO global report 2015 Elimination of congenital syphilis.

2. John P .Cloherty Manual of Neonatal Care [7th edition]
3. 20 th edition Nelson textbook of Pediatrics.
4. IADVL textbook of Dermatology [4th edition]
.
TIMELY DIAGNOSIS AND INTERVENTION –CURED THE CHILD OF SYPHILIS