Congenital Syphilis

CONGENITAL SYPHILIS EARLY CONGENITAL SYPHILIS: Manifestations Bullous rash (mainly palms and soles) Other rashes of secondary syphilis (papular and papulosquamous). Old man look Café au lait tint Syphilitic alopecia Syphilitic wig Syphilitic onychia Mucous patches, syphilitic aphonia Syphilitic rhinitis, nasal obstruction, perinasal syphilitic papaules

Stigmata Rhagades

onychia Syphilitis facies ---- saddle nose, high arched palate, underdevelopment of maxilla and prominent mandible (bulldog jaw)

Lymphadenitis Hepatospelomegaly and splenomegaly Kidney ---- slight proteinuria Lungs ---- white pneumonia Testis --- orchitis Nervous system ---- meningeal involvement Bones --- 1st 6 months ---- osteochondritis of long bones (upper end of tibia, lower end of radius and ulna) --syphilitic pseudoparalysis, Wimberger’s sign. 2nd 6 months ---- periostitis (saber tibia and dactylitis) Choriodoretinitis

Huchinson’s teeth (upper central insicors). Mulberry Molars (Lower 1st molar)

Salt and pepper fundus

LATE CONGENITAL SYPHILIS:

MANIFESTATIONS Interstitial keratitis---- corneal scarring Bone ---- gummatous osteoperiosteitis (destruction of palate and nasal septum, parrot’s nodes, saber tibia, inner end of clavicle, dactylitis)

Joints (diffuse arthralgia, Clutton’s joints) Ears ( low grade otitis media, involvement of bones of middle ear, partial conductive deafness, involvement of terminal fibres of cochlear portion of VIII nerve --perceptive deafness) Gummata of SC and submucosal tissues (mainly in soft palate and nasopharynx) Gumma of liver CNS syphilis CVS syphilis Paroxysmal cold hemoglobinuria

STIGMATA Corneal scarring, ghost vessels destruction of palate and nasal septum, parrot’s nodes, saber tibia, inner end of clavicle, dactylitis, frontal bossing, bulldog facies (frontal bossing, saddle nose and bulldog jaws), natiform or ‘ hot cross bun’ skull. Nerve deafness

Primary optic atrophy.

HUTCHINSON’S TRIAD: Huchinson’s teeth, Interstitial keratitis and VIII nerve deafness.

TERTIARY SYPHILIS (after 3-10 years) SYSTEM/ORGAN SKIN MUCOSA

BONES

CARTILAGE JOINTS, BURSA, TENDON SHEATHS MUSCLES STOMACH INTESTINE LIVER

LUNG URINARY TRACT TESTIS

MANIFESTATIONS Nodular, squamous/psoriasiform and SC gummata --- heal with tissue paper scarring. Localized gummata breaking into punched out ulcers with “wash leather base” over mouth, throat, palate, nasal septum, pharynx, larynx --- may cause steonosis, leukoplakia, SCC. Diffuse gummata mainly in the TONGUE (CHRONIC SUPERFICIAL GLOSSITIS) --precancerous. The tongue appears in 3 ways ---- smooth/leukoplakia/deep irregular fissures. The patient presents with a odd looking tongue/with cancer tongue/ with discomfort on eating hot spiced food. 5-25 years after original infection --- osteoperiostis . in long bones --- thickening> destruction leading to saber tibia (symptoms --- deep seated boring pain worst at night). In cranial bones, destruction> thickening --- worm eaten skull, perforation of palate and nasal septum. Perichondritis of costal cartilage, external ear and nasal septum. Rare. Parts most affected are those exposed to stress and strain like the knee joint and prepatellar bursa. The swelling is soft, rubbery with no signs of active inflammation. Occasionally hard fibrous nodules, the so called juxta articular nodes are found along tendon sheaths or SC near joints. RARE. May extend from the SC tissue or bones. Gumma is rare ---- signs of indigestion or peptic ulcer. Filling defect on barium meal or there may be distortion of cardiac end of the stomach. Rare. Most frequent type of abdominal syphilis ---- presents in 2 ways --- (i) diffuse interstitial cirrhosis and (ii) focal gumma with or without subsequent amyloidosis. Mostly presents as LARGE FIRM IRREGULAR MASS (left lobe> right lobe) with or without symptoms. Solitary or multiple gummata ---- fibroid lung and bronchiectasis Gumma of kidney, bladder and prostate are rare. Diffuse or localized gummata ---- testis enlarges painlessly, sensation is lost, consistency is altered and there is dragging sensation ---- enlarges testis has regular surface ---- Billiard ball testis --- unilateral heaviness with secondary hydrocele.

GUMMA: The characteristic lesion of tertiary syphilis is a gumma. GUMMA ARE USUALLY LOCALIZED LESIONS, SOMETIMES THERE MAY BE DIFFUSE TISSUE INFILTRATION. The most typical feature is central area of tissue necrosis (which is usually granular, may be caseous) surrounded by a zone of granulation tissue dull red in color. This zone contains endarteritis obliterans of vessels, perivascular cuffing of lymphocytes and plasma cells, few giant cells and epitheloid cells. Outside this is a narrow zone of tough fibrous tissue. THE GUMMATOUS LESION IS NOT NECESSARILY SELF LIMITING AND IT IS COMMON TO FIND THAT INITIAL LESIONS HEAL WITH SCAR TISSUE AND OTHER LESIONS OCCUR IN THE PERIPHERY. T.pallidum cannot be isolated by DGI but can be demonstrated by inoculation of gummatous material into susceptible animals. Probably gumma represents local tissue allergy in host. SECONDARY SYPHILIS SYSTEM Skin

Mucosa Lymph nodes Eye

MANIFESTATIONS Rashes – macular, papular (corona veneris, annular, follicular, corymbose, condyloma acuminata), papulosquamous, pustular (rupia) , pigmentation and depigmentation (collar of venus), syphilitic onychia, syphilitic alopecia (sides and back of scalp as patchy hair loss) Dull red erythemas, mucous patches (grey white patches with dull red areola) with snail track ulcers (oral mucosa, pharynx, larynx, genitalia), fissuring at the angle of mouth. Enlarged, discrete, non tender Anterior uvietis usually silent, choriodoretinitis

Liver Kidney Arthritis bursitis, periostitis Neurologic and cardiac involvement

Hepatitis (mild jaundice/enlargement of liver/elevation of enzymes) Nephrotic syndrome Swelling without pain/limitation of movement/painful joints/aching pain in long bones/tendon sheaths may be affected. Only CSF abnormalities/evidence of raised intracranial pressure/meningitis/ cranial nerve palsies/ECG abnormalities.