What is MICROBIAL DISEASES Relatively frequent coexistence of cardiovascular syphilis with neurosyphilis (10 to 15 percent), neurosyphilis with “benign” late syphilis (13 percent), and the latter with cardiovascular syphilis (10 percent) should be kept in mind by the physician? Almost all fatalities in syphilis result from neurosyphilis or syphilis of the heart or aorta. These most serious forms of the disease, are discussed elsewhere in this text and in a monograph on venereology (Willcox).Maternal and Prenatal (“Congenital”) Syphilis.
The manifestations of maternal syphilis depend on the stage of disease; diagnosis is established on usual anamnestic, clinical, and serologic criteria. Serologic screening may detect pregnant women with no past history of the disease. These should be investigated and treated as early latent syphilis. During the first years of infection, most pregnancies will terminate in fetal death if the mother is left without treatment. Later in the course of the infection, the risk decreases and un-treated syphilitic women may give birth to healthy children. Presumably, this is related to the lessen-ing likelihood of the occurrence of treponema with time. Nevertheless, occasionally an untreated syphilitic woman may deliver a congenitally syphilitic child many years after infection.
Early Prenatal Syphilis Early congenital syphilis is prenatally acquired infection diagnosed in children less than two years old. The fetus is infected after the fourth month of pregnancy.
The lesions on delivery depending on the time of infection and may vary from marasmic to ap-parently healthy infants. Fibrotic visceral lesions are characteristic. Osteochondritis is diagnosed by roentgenographic examination. The child may be born with “snuffles” from the affliction of the nasopharynx with mucous and sometimes hemorrhagic discharge. The cutaneous rash after birth can be impressive papular and bullous eruptions in the palms and soles (exceptional-in acquired syphilis) and tend characteristically to affect facial, circumoral, anogenital, and diaper areas, and palms and soles. Such lesions are highly contagious, and. pallidum can easily be demonstrated. Infants without signs of disease, who are suspected of being infected by a seroreactive mother, should be clinically and serologically kept under surveillance for at least six months to establish active infection or passive reagin emia.
Late Prenatal Syphilis. Late congenital syphilis is a prenatally acquired infection that has persisted and developed in children over two years of age. On discovery of MICROBIAL DISEASES, the condition is often latent and should be confirmed by FTA/TPI tests. Residual manifestations of early lesions may be present, notably rhagades radiating from the(Clutton’s joints). The most common affliction is interstitial keratitis, usually appearing in late childhood and eventually becoming bilateral There is photophobia, ground-glass appearance of the cornea, and vascularized: i-Ascent sclera. Other late manifestations r-, of acquired late adult syphilis of sMeningovascular syphilis; paresis.
The profound pathologic processes of pre nazi. MICROBIAL DISEASES syphilis and the personal and social limitations that they impose are preventable through rotate serologic testing of all pregnant women and ade-quate treatment of those found infected. Interpretation of Laboratory Findings. In addition to the clinical and anamnestic examination, the diagnosis of syphilis depends on laboratory findings. In early syphilis dark-field examination of lesions and serologic tests are indispensable; in late syphilis in addition to serologic tests examination of the cerebrospinal fluid is the most important laboratory procedure.
Dark-Field Examination.T. pallidum cannot be readily identified in dried, fixed fluid or tissue specimens by silver, chromatic, or fluorescent staining. Its presence can best be ascertained in the living state by microscopic dark-field examination which can be done by the trained physician. Material for examination includes tissue fluid from initial and secondary lesions after saline washing and gentle squeezing, or aspirate from an enlarged lymph node. Preferably, specimens should be examined on the spot. They can, however, be collected in a capillary tube, sealed with wax, and mailed to a competent laboratory. Care must be taken in interpreting the findings. T. pallidum may resemble spirochetes normally inhabiting genitalia and the oral cavity. The regular corkscrewAike coils, the slow, rotating, for-ward-backward motions, and graCeful sideways bindings help in identification of T. pallidum. Repeated failures to demonstrate 7′. pallidum with adequate technique in. a suspected lesion may mean that the lesion is healing, that the patient has received topical or systemic treatment, or that the lesion is nonsyphilitic. Before the lesion is diagnosed as nonsyphilitic, an examination of Olympic node aspirate should be made. Serologic Tests.
MICROBIAL DISEASES, Serologic tests are indispensable for individual diagnosis of syphilis lig for following the effect of therapy, for routine screening of pregnant women, blood donors and other, “risk groups,” and for the case and M an m a finding in community, national, and international health programs. It is essential for the physician to utilize laboratories that employ standard reagents and methods and that partake in a proficiency LI prolabium and frontal bosses and saber tibia from periostitis of the shaft. There may be osseous destruction (saddle nose) and dental deformities, with wedge-shaped, widely spaced, often notchedtesting program of sensitivity, specificity, and reproducibility in co-operation with a regional or national reference center. Serologic tests detect antibodies formed during the course of the syph-permanent upper central incisors (Hutchinson’s clitic infection.
Other “signs” include eighth nervy deaf-ness and syphilitic synovitis in both knee joints regain tests use cardiolipin antigen according to different methods.