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Syphilis, Congenital (Treponema pallidum)
1996 Case Definition
Clinical description
A condition caused by infection in utero with Treponema
pallidum. A wide spectrum of severity exists, and only
severe cases are clinically apparent at birth. An infant or
child (aged less than 2 years) may have signs such as hepatosplenomegaly,
rash, condyloma lata, snuffles, jaundice (nonviral hepatitis),
pseudoparalysis, anemia, or edema (nephrotic syndrome and/or
malnutrition). An older child may have stigmata (e.g., interstitial
keratitis, nerve deafness, anterior bowing of shins, frontal
bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades,
or Clutton joints).
Laboratory criteria for diagnosis
-
Demonstration of T. pallidum by darkfield
microscopy, fluorescent antibody, or other specific stains
in specimens from lesions, placenta, umbilical cord, or autopsy
material
Case classification
Probable: a condition
affecting an infant whose mother had untreated or inadequately
treated* syphilis at delivery, regardless of signs in the infant,
or an infant or child who has a reactive treponemal test for
syphilis and any one of the following:
- Any evidence of congenital syphilis on physical
examination
- Any evidence of congenital syphilis on radiographs
of long bones
- A reactive cerebrospinal fluid (CSF) venereal
disease research laboratory (VDRL)
- An elevated CSF cell count or protein (without
other cause)
- A reactive fluorescent treponemal antibody
absorbed--19S-IgM antibody test or IgM enzyme-linked immunosorbent
assay
Confirmed: a case that is laboratory confirmed
Comment
Congenital and acquired syphilis may be difficult
to distinguish when a child is seropositive after infancy. Signs
of congenital syphilis may not be obvious, and stigmata may not
yet have developed. Abnormal values for CSF VDRL, cell count,
and protein, as well as IgM antibodies, may be found in either
congenital or acquired syphilis. Findings on radiographs of long
bones may help because radiographic changes in the metaphysis
and epiphysis are considered classic signs of congenitally acquired
syphilis. The decision may ultimately be based on maternal history
and clinical judgment. In a young child, the possibility of sexual
abuse should be considered as a cause of acquired rather than
congenital syphilis, depending on the clinical picture. For reporting
purposes, congenital syphilis includes cases of congenitally
acquired syphilis among infants and children as well as syphilitic
stillbirths.
*Inadequate treatment consists of any non-penicillin
therapy or penicillin given less than 30 days before delivery.
See also:
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