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Syphilis, Congenital (Treponema pallidum)
1990 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 (less
than 2 years) may have signs such as hepatosplenomegaly, characteristic
skin rash, condyloma lata, snuffles, jaundice (non-viral hepatitis),
pseudoparalysis, anemia, or edema (nephrotic syndrome and/or
malnutrition). An older child may have stigmata such as 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
Presumptive: the
infection of an infant whose mother had untreated or inadequately
treated* syphilis at delivery, regardless of signs in the infant;
or the infection of 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 long
bone x-ray
- A reactive cerebrospinal fluid (CSF) VDRL
- An elevated CSF cell count or protein (without
other cause)
- A reactive test for fluorescent treponemal
antibody absorbed-19S-IgM antibody
Confirmed: a case (among infants) 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 long bone x-rays may help,
since x-ray changes in the metaphysis and epiphysis are considered
classic for congenitally acquired disease. The decision may ultimately
be based on maternal history and clinical judgment. The possibility
of sexual abuse should be considered.
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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