Symptoms of syphilis in a child. Syphilis in children - intrauterine infection

An infectious disease caused by pale treponema, with a predominantly contact mechanism of transmission of the pathogen, a chronic relapsing course and a characteristic periodicity of clinical symptoms, capable of affecting all organs and systems, is syphilis. In this article, we will take a detailed look at the symptoms and ways to treat the disease in children.

The reasons

The causative agent of syphilis Treponema pallidum (subspecies pallidum) was discovered in 1905 by F. Shaudin and E. Hoffman. Pale treponema is a thin mobile spiral microorganism, 0.25 microns wide and 5-20 microns long, has 8-12 uniform curls, can exist in 3 forms - spiral, cystic and L-form. The most frequent (classical) course of syphilis is due to the presence of a spiral form of the pathogen, the remaining forms probably support a long latent course. The causative agent of syphilis is unstable in the external environment and dies when dried; heating at a temperature of 40 ° C for an hour leads to the loss of pathogenic properties; at 48°C, bacteria die within 10 min, but in the cold they persist for up to 50 days. Pale treponema quickly dies under the action of antiseptics. The pathogen isolated protein, polysaccharide and lipid Ag.

source of syphilis

Symptoms of the disease are recorded everywhere. By the middle of the XX century. the incidence has declined significantly, but since the late 80s. note an increase in the number of cases, and in some regions (including Russia) the incidence reaches almost epidemic levels; in 2000 it was 157.3 cases per 100,000 population. The incidence is 8.1-9.2 cases per 100,000 children. The pathogen reservoir is a sick person. The main route of transmission is sexual, but in children great importance it also has a contact route of infection (when using household items, toys, medical instruments, etc., contaminated with the secretions of the patient). The greatest danger is posed by untreated patients with skin signs of primary or secondary syphilis. It is possible to transmit the pathogen from the pregnant woman to the fetus transplacentally or when passing through the birth canal. The pathogen is not able to cross the placenta in the first 4 months. pregnancy; treatment of syphilis in the mother at these times prevents infection of the fetus.

Infection

The pathogen enters the human body through microtrauma of the mucous membranes (genital tract, mouth, rectum) or skin, migrates to the lymph nodes, then into the bloodstream and disseminates. Initially, the body's resistance to the pathogen is low (at this time it quickly disseminates through the tissues), then it increases and limits further spread, but does not ensure complete elimination of the pathogen. Such an equilibrium state is unstable - in some patients it is disturbed with the transition to tertiary syphilis. In the later stages, hypersensitivity to pale treponema develops, leading to the formation of gummy ulcers and necrosis. Already in the early stages of the disease, the central nervous system is affected. In the absence of adequate treatment in the secondary period, liquor changes are found in 1/3 of patients. During the first 5-10 years after infection, mainly the vessels and membranes of the brain suffer (meningovascular neurosyphilis); later, the parenchyma of the brain and spinal cord is affected. Involvement in the pathological process of the cortex and membranes of the brain leads to progressive paralysis. Damage to the posterior columns of the spinal cord causes dorsal tabes.

Classification of syphilis

Acquired syphilis

In untreated patients, acquired syphilis in children lasts for many years, almost a lifetime (self-healing from it, although possible, is unlikely). In the classical course of the disease, four periods are distinguished:

• incubation,
• primary,
• secondary,
• tertiary.

They also allow the possibility of a long-term (long-term) asymptomatic course of acquired syphilis from the very beginning of the disease with the development of later nervous and visceral forms of the disease.

Incubation period

Signs of syphilis in children in this period last an average of 3-4 weeks. With massive infection, the duration of syphilis is reduced to 10-15 days, and with severe concomitant diseases and the use of antibiotics in doses insufficient for the preventive treatment of the disease, it increases to 3-5 months.

Primary Period

Its symptoms continue from the moment of the appearance of a hard chancre until the onset of generalized rashes (6-7 weeks) and is characterized by the development of a hard chancre (ulcus durum) and regional lymphadenitis at the site of the introduction of pale treponema (more often in the genital area). Hard chancre is single, small in size (average 4-5 mm), regular round or oval shape, flat (saucer-shaped) edges, smooth red bottom with poor discharge, dense elastic (cartilaginous) infiltrate at the base. Regional lymphadenopathy develops a week after the appearance of a hard chancre. Without treatment, the hard chancre resolves in 6-12 weeks, leaving behind a small and pigmentless scar. The localization of a hard chancre clearly indicates the route of infection with syphilis. Distinguish sexual, perisexual and extragenital (extragenital) chancres. In children, a hard chancre is often located on the face, lips, oral mucosa (cheeks, tongue, tonsils), sometimes in the esophagus and stomach. In some children, the chancre is absent or disappears quickly.

Primary syphilis is characterized by increasing sensitization of the body to the pathogen. By the 6-7th week of illness, specific AT appear in the body (transition of primary seronegative syphilis to primary seropositive).

Secondary period

Signs of syphilis in this period usually develop after 6-12 weeks. after infection and lasts 3-4 years. From the regional lymph nodes, pale treponema quickly penetrates into the bloodstream, causing a generalized infection - syphilitic septicemia. All organs and systems can be affected, but the main manifestations are rashes on the skin and mucous membranes (secondary syphilides).

The first generalized rash, which usually occurs against the background of a regressing hard chancre, is the most intense (fresh secondary syphilis) and is accompanied by severe polyadenitis. The rash persists for several weeks (less often 2-3 months), then spontaneously disappears for an indefinite time. Repeated episodes of rashes (secondary recurrent syphilis in children) alternate with periods of complete absence of manifestations (secondary latent syphilis). Syphilides contain a large number of pale treponemas, the latter, when ulcerated, easily enter the external environment, which makes this period of syphilis extremely contagious.

The main types of syphilides of the secondary period are as follows:

Syphilitic roseola: a pink spot measuring 0.51 cm, having irregular rounded outlines, does not peel off, disappears when pressed.

Syphilitic papule: a nodule of bluish-red color of a dense consistency with peeling along the periphery.

Varieties of syphilitic papules:

• lenticular, 0.3-0.5 cm in size;
• miliary, the size of a poppy seed;
• inummular (coin-shaped), the size of a large coin, with a tendency to group;
• seborrheic, localized on the face, forehead skin and is distinguished by oily scales on the surface;
• erosive (weeping), characterized by an erosive or weeping surface, with syphilis it is localized on the mucous membrane or in the folds of the skin;
• wide condylomas (vegetative papules), located in places of skin friction (groin), are large in size, vegetation, erosive surface;
• horny papules of the palms and soles, characterized by a powerful development of the stratum corneum on the surface, very reminiscent of corns;
• psoriasiform papules, with pronounced peeling on the surface.

Syphilitic pustules usually occur in debilitated patients with a severe (malignant) course of the process.

Syphilitic baldness is a rapidly developing small-focal or diffuse hair loss on the head without inflammatory changes in the skin.

Syphilitic leukoderma (pigmented syphilide) is localized on the lateral and posterior surfaces of the neck, often on the skin of the trunk; hypopigmented round spots 0.5-1 cm in size appear on the affected areas against the background of hyperpigmentation.

Very often the mucous membranes of the oral cavity and genital organs are affected. Rashes on the mucous membranes are represented by roseola (round spots, often gray-white with a red rim) and papules, rarely pustules.

In addition to rashes on the skin and mucous membranes, secondary syphilis may be accompanied by damage to internal organs (syphilitic hepatitis, nephronephritis, myocarditis, etc.), the central nervous system [syphilitic meningitis (often asymptomatic), syphilis of the cerebral vessels (meningovascular syphilis)], bones (diffuse periostitis with painful swelling, night pain in the bones; less often - osteoperiostitis), joints (polyarthritic synovitis with the formation of effusion in the joint cavity), etc.

Tertiary period

The tertiary period of syphilis ("humous") develops 3-6 years after infection in a small number of patients (who have not received adequate treatment or are weakened, in particular with chronic diseases such as tuberculosis, malaria, etc.). The signs of tertiary syphilis are most severe and can lead to irreversible disfigurement of appearance, disability and death. The syphilides of the Tertiary period are represented by 2 elements - tubercles and nodes (gums), differing in size and depth.

The tertiary period of syphilis is characterized by the appearance of limited foci of inflammation in many organs, followed by their destruction and partial or complete loss of function. Any organs can be involved in the pathological process, but most often the skin and mucous membranes, bones, cardiovascular and nervous systems are affected. Syphilis in children is manifested by the following symptoms: chronic interstitial inflammation with outcome in sclerosis (syphilitic hepatitis, cirrhosis, syphilitic mesaortitis with the formation of heart disease, neurosyphilis: meningitis, dorsal tabes, progressive paralysis, etc.) or the formation of syphilis, causing destruction and compression vital organs (gummas of the liver, kidneys, skin, brain, intestines, lungs, gummous osteomyelitis, osteoperiostitis). Tertiary syphilis, as well as secondary, is characterized by an alternation of overt and latent clinical manifestations of infection, while patients are practically not contagious, since single treponemas in the depth of the infiltrate die during its decay.

congenital syphilis

The disease develops during intrauterine infection of the fetus after the development of placental circulation (20 weeks of gestation). More often infection occurs in the active period in the last 3 months. pregnancy. Pregnancy in women with untreated syphilis may result in late miscarriage, stillbirth, or the birth of a child with active or latent syphilitic infection. The signs and symptoms of the disease are varied, some of them reflect the current infectious process, others represent violations of embryogenesis due to the teratogenic effects of pale treponema.

Fetal syphilis

Accompanied by changes in the internal organs, and somewhat later, the skeletal system. Specific lesions of the internal organs of the fetus are manifested by intercellular infiltration and proliferation of connective tissue. Widespread and severe lesions of the internal organs of the fetus often lead to late miscarriages and stillbirths. Sometimes a child is born alive, but in a serious condition and soon dies.

early congenital syphilis

Its symptoms may first appear both in infancy (up to 12 months) and early childhood (1-4 years). It is an active syphilitic infection similar to the secondary period of acquired syphilis. A hard chancre is not formed in this case, since pale treponema through the umbilical vein immediately enter the internal organs. The debut of the disease is possible both immediately after birth and during the first 2-3 months. life in the form of nonspecific symptoms of a generalized infection (fever, irritability, insufficient weight gain, anemia), polylymphadenopathy and "classic" local lesions. The skin, mucous membranes, bone and nervous systems, parenchymal organs (liver, spleen, lungs) most often suffer, less often the gastrointestinal tract. The main signs of early congenital syphilis are presented in table 294. Patients are contagious and need active treatment.

Table. The main clinical manifestations of early congenital syphilis

Skin and mucous membranes

Syphilitic pemphigus of newborns (symmetrically located blisters on the soles and palms) Syphilitic rhinitis with deformation of the bone and cartilage tissue of the nose ("saddle" nose) Diffuse thickening of the skin around the mouth and anus with an outcome in the radial scars of Robinson-Fournier Spotty and papular rashes on the trunk, limbs, genitals Common vesicular, bullous, weeping elements Wide warts in the anus

Skeletal system

Osteochondritis with pathological fractures Periostitis, osteoperiostitis of long tubular and flat bones Dactylites False palsy Parrot ( severe pain in the bones, causing the child to lie still)

CNS, organ of vision

Meningitis, meningoencephalitis with outcome in chorioretinitis, optic nerve atrophy hydrocephalus

A diagnostically important symptom of syphilis in boys older than a year is the presence of dense, painful testicles. The disease can occur as a monosyndrome (for example, in the form of syphilitic pemphigus, isolated eye damage, or osteochondritis). The characteristic and lifelong signs of early congenital syphilis include Robinson-Fournier scars around the mouth, saddle nose, and skull deformity.

late congenital syphilis

Currently, due to the widespread use of penicillin, this disease is rarely observed. Many authors consider this form of the disease as a relapse of early congenital syphilis or a long-term latent infection. Usually syphilis manifests itself 4-5 years after the birth of a child (sometimes at 14-15 years). Clinical manifestations resemble those of the tertiary period. Reliable signs include the so-called Hutchinson triad, which includes interstitial diffuse keratitis, deafness due to syphilitic labyrinthitis, and barrel-shaped upper incisors with a recess along the free edge (Hutchinson's teeth).

The probable signs of late congenital syphilis include "saber" shins, "Gothic" palate, thickening of the sternal end of the clavicle, various anomalies of the teeth (diastema, macro or microdentia, hypoplasia of the canines, etc.). However, these symptoms of syphilis in a child are also observed in other diseases.

Diagnostics

Diagnosis of syphilis is based on the data of the clinical picture (characteristic skin and visceral manifestations), epidemiological history (the presence of a patient with syphilis in the family) and laboratory tests. For laboratory diagnosis, mainly bacterioscopic and serological studies are used.

The most optimal microscopic methods for detecting treponemas are dark-field and phase-contrast microscopy. It is also possible to prepare histological preparations impregnated with silver. The material for the study is chancre discharge, lymph node punctures, scrapings of roseola, etc.

Serological reactions are the main methods of laboratory diagnosis of syphilis, in addition, they are used to evaluate the effectiveness of treatment and monitor recovery. Serological studies for syphilis are divided into non-specific and specific.

Non-specific tests (without the participation of treponems). The main methods - RSK (Wasserman reaction) and VDRL reaction (from the English. Venereal Disease Research Laboratory, laboratory for the study of sexually transmitted diseases) - a specialized flocculation test on slides using cardio-lipin-lecithin-cholesterol Ag. The reactions are positive, starting from the middle of the primary and during the secondary periods, in the tertiary period they can be negative in 50% of patients.

Of the specific tests, the immobilization reaction of pale treponema, RIF (becomes positive in most patients with syphilis already in the primary seronegative period; positive in all periods of syphilis, including late forms, in almost all patients) and ELISA.

Differential Diagnosis

Primary syphilis must be differentiated from genital herpes, soft chancre, venereal lymphogranuloma, erosive balanitis, inguinal granuloma, tuberculosis. For a hard chancre (uncomplicated), unlike other outwardly similar ulcerative lesions, soreness and acute inflammation are not characteristic.

Secondary syphilis is differentiated from drug dermatitis, rosacea, rubella, erythema multiforme, pityriasis versicolor, and fungal infections. Secondary syphilides have a number of common features that distinguish them from other skin rashes: they are ubiquitous, have a benign course, there are no febrile symptoms of syphilis, there are also no acute inflammatory phenomena and subjective sensations, resistance to local treatment is noted, rapid disappearance under the influence of specific therapy.

Congenital syphilis must be differentiated from other IUIs.

Treatment

Treatment of syphilis in children begins immediately after confirmation of the diagnosis and is carried out in specialized institutions. The number and duration of therapy courses, single and course doses of drugs, the duration of dispensary observation are regulated in the instructional documents.

Treatment drugs for all stages of syphilis are penicillins (water-soluble or durant).

With intolerance to penicillins, erythromycin, cephalosporins, tetracycline are used to treat syphilis.

In tertiary, in addition to antibiotics, bismuth compounds (biyoquinol, bismoverol) are used.

Prevention

Means of specific immunoprophylaxis are absent, so non-specific preventive measures are of primary importance.

Prevention of acquired syphilis: early active detection and treatment of patients (if necessary, by force, in accordance with the legislation on contact tracing), regular preventive examinations of decreed population groups (medical workers, employees of child care facilities, food enterprises, etc.), screening for syphilis of all inpatients. Sanitary education, teaching adolescents the basics of sexual literacy and the rules of personal hygiene, the organization of individual prevention centers, etc., are of great importance.

Prevention of congenital syphilis: dispensary examination of pregnant women in the antenatal clinic with double serological control in the first and second halves of pregnancy. Newborns from mothers who have had the disease are subjected to a thorough comprehensive examination in the first months of life (at 2.5-3 months) and at 1 year; subsequent dispensary observation is carried out until the age of 15.

The prognosis for early detection and adequate treatment of acquired syphilis is favorable. With congenital syphilis, the prognosis is less favorable.

Now you know how syphilis is treated in children, the main signs and symptoms of the disease. Health to your child!

Syphilis (lues) is a sexually transmitted disease, usually chronic, of an infectious nature, characterized by systemicity. It is manifested by specific lesions of the skin, all mucous membranes, most bones, various internal organs, and most importantly, the nervous system. It is caused by a dangerous, very active bacterium, which received a sonorous name - pale treponema. Transmitted (most often) sexually, as well as through household items.

Congenital syphilis is especially dangerous in children, when a dangerous infection is transmitted to a child from a sick mother through the placenta. It can be diagnosed in different ages, in connection with which there are several types of disease.

The classification of congenital syphilis detected in children is based on the age at which this disease manifests itself. The range is quite wide: from infancy to adolescence.

For further prognosis, the time of manifestation of specific lesions is of great importance: the earlier the symptoms are detected, the more favorable it is. Doctors diagnose the following forms of the disease.

early congenital syphilis

• Fetal syphilis

Most often, doctors diagnose early congenital syphilis of the fetus when intrauterine infection occurs. If this happened at 5-6 months, they may begin. The baby is usually born dead, macerated (flabby, swollen, loose body), with pathologies of the lungs, spleen, liver.

• syphilis of infancy

If the infection of the mother occurred in late pregnancy, the symptoms of the disease appear after the birth of the baby. When diagnosing syphilis in infancy, the Wasserman reaction is detected only at the 3rd month of a newborn's life.

• Syphilis in early childhood

This form of the disease is said if it manifested itself between the ages of 1 and 4 years.

late congenital syphilis

In most cases, late congenital syphilis manifests itself and is diagnosed in children in adolescence, until then, without revealing itself in any way. This is a dangerous recurrence of a disease suffered in early childhood - not detected or insufficiently treated in time.

Latent congenital syphilis

This form of the disease can be observed in a child at any age. Its complexity is that it usually proceeds in the absence of symptoms. Therefore, latent congenital syphilis can only be detected as a result of serological studies (carried out on the basis of biological material, most often cerebrospinal fluid).

All these forms of congenital syphilis do not pass without a trace. Among the most dangerous consequences are disability and mortality. The symptomatology of a latent disease allows the child to live up to a certain point, and he will not differ in any way from his peers in his development. However, you need to understand that someday the infection will still manifest itself.

through the pages of history. Syphilis was named in 1530 by an Italian poet and doctor named Girolamo Fracastoro.

Causes of the disease

Pale treponema infects the fetus, penetrating to it into the placenta through the lymphatic slits of the vessels or the umbilical vein. It is transmitted to a child from a mother with syphilis. Children are at risk if:

• the infection of the woman occurred before conception;
• infection was diagnosed at different stages of pregnancy;
• the mother is ill with secondary or congenital syphilis.

The transmission of bacteria from mother to child occurs in the first years of her infection, when the stage of the disease is active. With the passage of age, this ability gradually weakens.

If a woman suffers from a chronic form, but is constantly being treated, she may well have a healthy baby. Therefore, it is necessary to constantly undergo special examinations and carefully monitor the condition of the fetus during its intrauterine development, and then - for its health in the future, in order to detect even a latent form of the disease in time. To do this, you need to know the clinical picture of the course of the infection, i.e., its symptoms.

Keep in mind! The transmission of the infection to the fetus from the sperm has not been scientifically proven, so there is no point in blaming the father of the child for congenital syphilis.

Symptoms

Since there are still chances for a healthy baby to appear if the mother is infected, it is necessary to identify signs of congenital syphilis in time even at the stage of intrauterine development of the fetus. This will allow you to take the necessary measures, find out the degree of infection activity and make at least some forecasts for the future. The symptomatology of the disease is very diverse and largely depends on the stage at which it was detected, that is, on its form.

Symptoms of congenital syphilis of the fetus

• Large size of the fetus;
• small body weight;
• maceration (swelling, friability);
• enlarged liver, its atrophy;
• enlarged, compacted spleen;
• underdeveloped kidneys, covered with a crust;
• stomach ulcers;
• damage to the central nervous system, brain.

Symptoms of congenital syphilis of infancy

• Dry, wrinkled face;
• large sizes head with strongly developed tubercles on the forehead, pronounced venous network, seborrheic crusts;
• pigmentation on the face;
• sunken nose bridge;
• pale, dirty yellow, flabby skin;
• thin, cyanotic limbs;
• the child is restless, constantly crying, sleeping poorly, screaming piercingly;
• poor development;
• weight loss;
• persistent runny nose, which causes difficulty in breathing and sucking;
• with a complete absence of fatty subcutaneous tissue;
• over time, bedsores form;
• syphilitic pemphigus on palms, soles, face, elbows, knees: blisters large size with purulent contents;
• epidemic pemphigus are large blisters merging with each other, bleeding, eroded, accompanied by high temperature, diarrhea, green stools;
• diffuse thickening of the skin - scaly erosion on the palms, face, soles, head, accompanied by loss of hair and eyebrows, swelling of the lips, cracks in the corners of the mouth, crusts on the chin, ulcers on the entire surface of the body;
• erysipelas;
• redness of the heels;
• papular syphilide - the formation of copper-red papules and age spots;
• roseola rash - individual scaly brownish spots that tend to merge;
• syphilitic alopecia - loss of hair, eyelashes, eyebrows;
• syphilitic rhinitis - hypertrophy of the mucous membrane of the nose, mouth, larynx;
• Wegner's syphilitic osteochondritis is a pathological lesion of the skeletal system, which often leads to a false paralysis-like condition, when the upper limbs hang with whips, the lower ones are constantly bent at the knees;
• damage to the joints in congenital syphilis in an infant is expressed by a movement disorder, complete immobility of the limbs;
• eye damage is sometimes the only sign of congenital syphilis: the fundus is pigmented, later - loss of vision, keratitis.

Symptoms of congenital syphilis at an early age

• The skin of the genitals, groin, anus, interdigital folds on the legs are affected by limited large weeping papules;
• roseolous rashes;
• seizures in the corners of the mouth;
• papules on the mucous membrane of the larynx merge, causing a hoarse, hoarse voice, aphonia, stenosis of the larynx;
• syphilitic rhinitis;
• baldness;
• swollen lymph nodes;
• periostitis, osteoperiostitis, osteosclerosis - a pathological lesion of the skeletal system;
• enlargement, hardening of the spleen and liver;
• nephrosonephritis (kidney dystrophy);
• enlargement, hardening of the testicles;
• as a result of damage to the nervous system, mental retardation is often diagnosed with congenital syphilis, as well as epileptiform seizures, hemiplegia (paralysis of one part of the body),;
• eye damage: chorioritinitis, optic nerve atrophy, keratitis.

Symptoms of late congenital syphilis

1. Reliable signs

• Keratitis is a pathological inflammation of the cornea of ​​​​the eye, which is accompanied by clouding of the mucous membrane in separate areas, photophobia, lacrimation, blepharospasm, decreased visual acuity, atrophy of the optic nerve up to complete blindness;
• dental dystrophies;
• specific labyrinthitis - deafness, combined with difficulty in speech, dumbness may occur.

1. Likely signs

• Specific drives - damage to the knee joints, which increase, swell, hurt;
• bone damage leads to the fact that the symptoms of late congenital syphilis are visible to the naked eye: the shins become saber-shaped, and the child's gait changes greatly;
• saddle nose;
• buttock-shaped skull;
• dystrophy of teeth;
• radial scars, which are called Robinson-Fournier, near the mouth, chin;
• due to a serious lesion of the central nervous system, oligophrenia is possible with congenital syphilis, as well as a speech disorder;
• specific retinitis;
• dystrophy (stigma).

The external manifestation of congenital syphilis in a child rarely goes unnoticed, unless it is a latent form of the disease. The damage to internal organs and systems is so powerful and extensive that already in infancy, the symptoms are noticeable even with the naked eye. They are difficult to confuse with signs of other diseases, especially since the infection of the baby is most often talked about during pregnancy.

It is especially important for parents to know how congenital syphilis manifests itself in adolescence (i.e. late), since at the beginning of the child’s life he did not find himself outwardly, while the harmful bacterium destroyed his tissues from the inside. Under laboratory conditions, the diagnosis is refuted or confirmed fairly quickly.

Important information. If the latent form of congenital syphilis is not cured in time, the matured child will be a living carrier of pale treponema, infecting other people with it.

Diagnostics

Since the disease in the mother is detected at any stage of pregnancy, a thorough diagnosis of congenital syphilis in the child is carried out while he is still in the womb. In the future, it represents all kinds of laboratory research.

1. X-ray. The disease is detected on an X-ray examination, which is performed at 5-6 months of pregnancy. It is recognized by specific osteochondritis (inflammation of the bones) or osteoperiostitis (inflammation of the periosteum).
2. Serological reactions of Wasserman, Kolmer, Kahn, Sachs-Vitebsky (KSR). They are based on the fact that an antigen is introduced into the child's blood, and then the body's reaction to it is studied.
3. The reaction of immobilization of bacteria that cause syphilis - pale treponema (RIBT).
4. Immunofluorescence reactions (RIF).
5. Study of the cerebrospinal fluid.
6. X-ray of the osteoarticular apparatus.
7. Examination of a child by such doctors as a pediatrician, neuropathologist, ophthalmologist, otolaryngologist.

All data based on the studies carried out are entered into the protocol for diagnosing congenital syphilis, according to which the disease is being treated. The medical document accompanies the child all his life, the results of analyzes and reactions are regularly entered into it, which are carried out constantly to monitor the patient's condition.

With proper care and a full course of treatment, which was carried out in a timely manner, the prognosis for a sick child can be quite favorable.

through the pages of history. August Wasserman - German microbiologist and immunologist of the late XIX - early XX century, created an express method for diagnosing syphilis.

Forecasts for the future

The prognosis for the future of a child with congenital syphilis can be very different. From the risk of dying in the womb to full recovery after birth. There are many concerns during and after pregnancy:

• late miscarriage;
• premature birth;
• pathology;
• the birth of a dead baby.

It is impossible to predict what will happen in one case or another. A different outcome of pregnancy depends on numerous factors: the stages of the course of the process, the treatment that the mother has undergone or is still undergoing, the degree of intrauterine infection of the fetus, the activity of the infection, and much more.

Given the modern medical technologies that are used to treat congenital syphilis, with proper nutrition, careful care of the baby, breastfeeding, one can hope for positive results and recovery.

The timing of the start of therapy is very important. In infants with this disease, standard serological reactions are restored by the first year of life. With late congenital syphilis, they become negative less often.

Treatment Methods

If the disease was detected in a timely manner, the treatment of congenital syphilis in infants gives positive results. The later the diagnosis was made, as well as with a latent form of infection, the consequences for the health and life of the child can be the most unfavorable, up to death. Treatment includes drug therapy and proper care.

Medical therapy

• Vitamin therapy;
• injections of penicillin and its derivatives (ecmonovocillin, bicillin);
• phenoxypenicillin;
• bismuth (if the child is more than six months old);
• if the child is allergic to penicillin - erythromycin, tetracycline, cephalosporins;
• a combination of muscle injection of antibacterial drugs with endolumbar injection (into the spine) and with pyrotherapy (artificial temperature increase);
• arsenic derivatives (miarsenol, novarsenol);
• immunomodulators;
• biogenic stimulants.

Care

• Regular hygiene procedures, since with such a disease, the skin of the child is primarily affected;
• breast-feeding;
• complete nutrition, which should include foods high in vitamins and proteins;
• daily regimen with meals at the same time, night sleep for at least 9 hours, as well as daytime sleep;
• daily walks or at least stay in the fresh air;
• regular spa specific treatment;
• constant monitoring and visits to the appropriate doctors.

If congenital syphilis of any form and stage is detected, the patient is placed in a venereal dispensary for therapy.

If a woman underwent appropriate treatment during pregnancy and the body of the newborn received all the necessary procedures in the first month of her life, the disease does not pose a threat to the future life of the child. If the diagnosis was made later, with latent forms and a late stage, therapy may not give results. In this case, the consequences may be the most undesirable.

Dangerous Consequences

The dangerous consequences of congenital syphilis for the further health of infected children will depend entirely on the timely course of treatment and the form of the disease. In most cases, they can still be avoided.

In the absence of specific timely therapy, the child may remain disabled for life or die due to the defeat of too many internal organs, systems and tissues by treponema.

Untreated, advanced congenital syphilis can lead to:

• mental and physical retardation;
• external deformities in the form of deformation of the skull, limbs, teeth, nose;
• dystrophy;
• dermatitis;
• baldness;
• loss of vision;
• deafness
• dumbness;
• paralysis;
• impotence in the future in boys and infertility in girls.

All these are symptoms of congenital syphilis, which, if not properly treated, progress and give rise to serious pathologies. As a result, irreversible processes lead to a child's disability for life.

Dangerous consequences, like the disease itself, can be easily avoided if preventive measures are taken in time.

Prevention

If the mother was infected before the 5th month of pregnancy, active and successful prevention of congenital syphilis is possible, since pathological metamorphoses of organs and tissues begin only at the 5th or 6th month. Therefore, treatment of the fetus in early pregnancy leads to the birth of a healthy baby. If a woman has also undergone an appropriate course of therapy, the child is not in danger.

The modern level of medicine and early diagnosis of the disease make it possible to detect and treat congenital syphilis in a child in advance. This allows you to avoid dangerous consequences for the life and health of the baby in the future. An infected woman must also undergo a mandatory course of therapy and be under the close and constant supervision of doctors.

This diagnosis is not a sentence, it does not always end in death or disability, contrary to popular belief. Fight for your children - and even this disease will be defeated!

Syphilis is a chronic sexually transmitted disease caused by Treponema pallidum (Treponema pallidum). The length of this microorganism is from 6 to 20 microns. Outwardly, it looks like a thin spiral moving around its axis. The disease is quickly transmitted through sexual and domestic contact, as well as through the placenta from a sick mother to a child, which causes childhood syphilis.

Pale treponema is quite tenacious; in a humid environment, it can live for several days. Also, the microorganism is practically not sensitive to cold and tolerates temperatures of minus 75 degrees. Get rid of spirochetes only with the help of disinfectants or in the process of boiling.

Ways of infection

Most often, infection of children occurs in utero. In the event that a pregnant woman becomes infected with the disease, spirochetes can penetrate the placenta to the fetus, while at. Intrauterine infection is determined by specific changes in the placenta. If the fetus was affected at 20-28 weeks of development, then the pregnancy may end in premature birth. The fetus is born already dead with characteristic changes in the liver, spleen and respiratory organs.

If the mother was infected with a spirochete at the beginning of the third trimester of pregnancy, the signs of the disease in the newborn appear both in utero and immediately after birth.

Serological blood tests give a positive result for syphilis in the third month of a baby's life. If the mother of a sick child has no signs of an illness, in almost 90% of cases this indicates that her illness proceeds in a latent form.

Other ways of transmission:

• A germinal pathway in which the mother's egg or father's sperm is infected with spirochete pallidum.
• Infection during passage through the birth canal, through the skin, mucous membranes, or when the placenta is torn off.
• If the rules of hygiene are not observed, the pale spirochete enters the body to the child through the umbilical wound.
• Also, a newborn can become infected with syphilis through direct contact with infected relatives through kisses, household items or utensils. In this case, syphilis will be considered acquired.

Signs of early congenital disease

Symptoms of syphilis in newborns appear after a few days or even months. Sometimes a baby is born already with signs of the disease. In the initial stage, the disease affects the skin and mucous membranes. After the first year of the disease, its symptoms disappear, and syphilis becomes chronic.

Pemphigus

It can be congenital or occurs within seven days after the birth of the newborn. It manifests itself in the form of vesicles with cloudy contents along the periphery surrounded by an inflamed border. It affects the soles and palms, the flexion surfaces of the limbs. In more rare cases, pemphigus appears on the baby's body or face.

Runny nose

With syphilis, a runny nose occurs a few days after the birth of the baby:

• Initially, nasal congestion appears.
• Breathing is difficult, there is sniffling. The child is practically unable to suckle at the breast.
• Purulent mucus streaked with blood begins to ooze from the nose.
• Shrinking crusts appear in the nose.
• Ulcers appear on the nasal septum.
• If left untreated, the cartilaginous septum of the palate and nose is destroyed.
• If the larynx is affected, the baby develops hoarseness.

Gochsinger infiltration

A very characteristic symptom of syphilis, affecting the feet, hands, face and genitals. It occurs in 65% of newborns:

• The skin becomes rough and dense, they lose elasticity and shine.
• The baby's face becomes like a mask.
• Around the lips and eyelids and nose, the skin becomes hyperemic, then it becomes covered with scars.
• At the next stage, the skin in the affected area becomes brownish and covered with scabs resembling eczema.
• The child's eyelashes and eyebrows fall out. If the process affects the scalp, partial baldness appears.
• The skin of the soles and palms becomes red and shiny, sometimes it separates in layers.
• The mucous membrane in the mouth is covered with ulcers with a small amount of white plaque.
• The skin of the buttocks is inflamed and covered with weeping erosions, sometimes the process extends to the labia or scrotum.

Changes in the internal organs

Lues usually affects the internal organs of the child:

• Diffuse hepatitis or cirrhosis occurs, which in most cases is not accompanied by jaundice or fluid accumulation in the abdominal cavity. Yellowing of the skin appears when the process of scarring begins and the outflow of bile is disturbed.
• The spleen enlarges to a large size and becomes dense.
• The bronchi expand, the larynx is covered with ulcers.
• With syphilis, children often experience digestive disorders, manifested in the form of vomiting and diarrhea.
• In some cases, the kidneys are affected, and the amount of protein in the urine increases.
• Sometimes boys develop dropsy of the testicles.
• All of these symptoms may be accompanied by fever.

Bone lesion

In newborns with syphilis, the bones are affected very often, and this manifests itself in the form of the following signs:

• Skull deformities. In such children, the frontal tubercles are highly developed, they hang over the eyebrows, and the cranial veins are greatly dilated.
• , in which it becomes too snub-nosed or saddle-shaped.
• In almost 80% of sick children, cartilage and adjacent areas of bones become inflamed (osteochondritis). Most often, the tibia, bones of the shoulder and forearm are affected.
• Less commonly, inflammation of the bone tissue and periosteum occurs.
• Pseudo-paralysis of Parro, in which the arm or leg appears paralyzed as a result of the inflammatory process.

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Damage to the nervous system

Most newborns diagnosed with syphilis have:

• Violations mental development.
• The iris of the eyeball becomes inflamed, inflammation of the choroid of the eyes and retina occurs.
• Hearing is lost.
• There may be dropsy of the brain.
• Seizures.
• Lag in physical development.

Often, children with syphilis have pseudoleukemic anemia. With this pathology, blood clotting is impaired, the number of erythrocytes is reduced, and their sedimentation rate is increased. With syphilis in a newborn, the lymph nodes are enlarged, especially in the elbows.

Signs of late congenital disease

Syphilis in children can occur in a latent form, and its first signs appear in a child no earlier than 3 years old, most often at 14-17 years old. In its clinical picture, it resembles the third degree of the acquired form.

There are three unconditional symptoms that directly indicate a congenital disease, all the rest are probable. At the same time, all the signs of the disease appear very rarely.

Symptom	How does it manifest
Hutchinson's teeth (unconditional symptom).	In children with syphilis, semicircular recesses with missing enamel are formed along the edge of the middle incisors. The tooth thickens in the neck area and resembles a barrel.
Labyrinth deafness (unconditional symptom).	This sign is observed in 6% of children with secondary syphilis. Most often it appears in girls whose age is from 5 to 15 years. As a result of the inflammatory process, the auditory nerves are damaged, and the child becomes deaf. If the symptom develops before the age of 4 years, then deafness is combined with speech problems or muteness.
Parenchymal keratitis (unconditional symptom).	Initially, the disease develops in one eye, after six months it begins in the second. Its manifestations include photophobia, corneal clouding, blepharospasm, lacrimation. The patient has a sharp and irreversible decrease in visual acuity. With atrophy of the optic nerve, complete blindness occurs.
Specific drives (conditional symptom).	Manifested as a chronic inflammation of the synovial membrane. The result is an accumulation of fluid in the joint cavity. Visually, this manifests itself in the form of puffiness. Accompanied by pain and stiffness.
Saber-shaped legs (conditional symptom).	The inflammatory process provokes the rapid growth of bones. In this case, the tibia, under the weight of the weight, bends forward. The cause is syphilitic osteochondritis transferred in infancy.
Nose deformity (conditional symptom).	Almost 20% of children with symptoms of the late form of the disease have a saddle-shaped nose with protruding nostrils. Pathology occurs as a result of the fact that the nasal cartilage and bones are destroyed.
Deformation of the teeth (conditional symptom).	On the underdeveloped chewing surface of the fangs, a thin conical process "pike tooth" appears.

Acquired

In the event that syphilis is transmitted to a child by household means, its incubation period is from 3 to 4 weeks. It develops gradually and at different stages is accompanied by various symptoms.

First stage

• At the initial stage of syphilis, at the end of the incubation period, a single hard chancre develops on the baby's body, most often on the face or oral mucosa, at the site of the introduction of the pale spirochete. It is an ulcer with jagged edges and a smooth bottom. Chancre may be honey or dark in color with a grayish coating in the middle. Purulent contents ooze from the ulcer. To the touch, the bottom of the hard chancre is dense, resembling cartilage.
• The ulcer does not cause pain, so this period of syphilis in 40% of cases goes unnoticed. In parallel, closely spaced lymph nodes increase. They are practically painless, without suppuration and changes in the skin over them.
• After the hard chancre heals, a red scar remains in its place, which turns white over time. The seal under it resolves within a month. In most cases, a child's chancre quickly disappears or does not develop at all.

Second stage

• About two months after the appearance of a hard chancre, the body of the child begins to become covered with a rash. By this time, all peripheral lymph nodes are already enlarged.
• The rash can be in the form of spots, pustules with purulent contents, mother-of-pearl nodules, small ulcers. Weeping often appears in infants. The rash can affect not only the skin, but also the mucous membranes. Moistures are the most contagious, they contain the largest number of treponemas.
• Disappearing, the rash leaves behind brown pigment spots, which eventually lighten and become invisible.
• If the treatment was carried out poorly, syphilis can recur six months after infection. A rash appears on the skin again, and on the mucous membranes there are papules or condylomas, reaching large sizes with an ulcer in the center.
• There are bald spots on the head.

According to foreign authors, the frequency of syphilis in childhood is still 2-4%.

Over the past decades, there has been a decrease in congenital syphilis in children and syphilis in pregnant women.

In the vast majority of cases, the sick mother transmits syphilis to the fetus, while the influence of the father affects mainly the infection of the mother, and the placental mode of transmission must be given priority. Transmission of syphilis by germinal route, through an infected egg cell and through an infected father's seed, is theoretically possible and experimentally proven, but is hardly of practical importance. It has long been known that some women who give birth to children with syphilis do not themselves detect the effects of syphilis and do not become infected with it. From a modern point of view, this immunity of mothers only indicates that this woman is sick with syphilis in a latent form (70-90% of Wasserman's positive reactions). Prophet's position that a mother with syphilis can, without infecting the fetus with syphilis, transmit immunity to him, is now shaken: children are simply sick with syphilis in a latent form (Wasserman's reaction is positive in most of these children). But, undoubtedly, there are children of syphilitic mothers who remain free from syphilis for life and with a negative reaction.

In addition to infection during intrauterine life, infection during childbirth is possible: tearing off the placenta, squeezing it out, damage to the chorionic epithelium contribute to the transition of spirochetes from the placenta to the fetal blood. This includes those cases where children are born healthy, but who show signs of syphilis after a few weeks. Infection during childbirth is also possible by infection through the skin, navel, mucous membrane.

The contagiousness of syphilis for the fetus gradually decreases with the duration of the disease. In the father, the first years are sharply contagious, after 3-4 years the strength of the infection falls, while in the presence of syphilis in the mother, syphilis can also affect after 15-20 years. In recent cases, the case ends with syphilitic abortions, stillbirth, then full-term syphilitic children are born; in the future, healthy children can be born.

The treatment of the mother is of great importance. Often, syphilis of parents affects the offspring in some of its low value and dystrophic-degenerative changes. Untreated mothers give birth to healthy-looking children in only 11% of cases, while treated mothers give birth to good offspring in 80%.

Symptoms of congenital syphilis

A child may be born with symptoms of congenital syphilis, in other cases, syphilis manifests itself after some time, after the so-called latent period, lasting several weeks or even months. For the initial period, the most characteristic are lesions of the skin and mucous membranes.

syphilitic runny nose It manifests itself during the next days after childbirth by difficulty in nasal breathing, a kind of sniffling, the release of a sticky bloody-purulent secretion with infiltration of the nasal passages, ulcerations on the septum, shells and cracks in the skin.

Pemphigus happens already at the birth or comes to light within the first week. The vesicles are filled with serous-turbid, sometimes hemorrhagic contents, in which spirochetes are found. In the circumference of the bubbles, an inflammatory corolla is formed. Favorite localization - on the palms, soles and on the flexor surface of the arms and legs, less often on the trunk and face.

Diffuse cellular infiltration of the skin quite characteristic of syphilis. It leads to thickening and thickening of the skin, loss of elasticity. The most typical lesions are the face, soles, palms. The face takes on a numb, mask-like appearance. In the circumference of the nose, mouth, eyelids, cracks, radial scars are observed against the background of inflammatory redness, and later a scab-like eczema-like rash joins. The color of the skin is brownish-pale, the color of coffee with milk. With the spread of infiltration to the scalp, alopecia develops - hair loss in areas of irregular size and shape, as well as hair loss in the area of ​​\u200b\u200bthe eyebrows and eyelashes. On the mucous membrane of the cheeks, hard and soft palate, superficial sores with a slight whitish coating are sometimes observed, sometimes weeping papules near the anus. On the buttocks, in addition to erythema and continuous infiltration, there are superficial erosions, the process often passes to the scrotum, labia.

Infiltrated sole leather, and sometimes the palms appear reddened, with a characteristic peculiar luster (mirror soles), sometimes with the separation of the stratum corneum in large layers.

One of the early forms of disseminated rashes is papular-pustular syphilis with purulent pustules drying into thick crusts. Often there is a polymorphic maculopapular rash, consisting of small infiltrates of bright red or salmon color on the limbs, soles, palms, neck, face. The suction comes from the center and leaves behind a light brown pigmentation.

Occasionally, acne-like syphilis occurs. Roseola congenital syphilis is not very common.

Sometimes ulceration and weeping in the area of ​​the umbilical wound are of a syphilitic nature; this is proved by the presence of spirochetes in the secret.

Lymph nodes in syphilis are usually enlarged, enlargement of the ulnar nodes is especially characteristic.

Bone lesions are quite common and characteristic. Deformities of the nose, snub nose, saddle shape are often noted. The presence of an Olympic forehead is characteristic, due to the deformation of the cranial bones simultaneously with a strong expansion of the cranial veins. Syphilitic osteochondritis is very common (in 77%), periostitis and osteitis are less common. The bones of the forearm, shoulder, and tibia are predominantly affected. Sometimes, as a result of inflammation, the epiphysis separates from the diaphysis, and the diseased limb lies as if paralyzed (Parro's pseudoparalysis). On the radiograph, the epiphyseal line is expanded, curved, next to it, closer to the diaphysis, there is a light strip of granulation tissue; in the area of ​​periostitis, a dark linear tissue surrounding the bone is determined. The phenomena in the area of ​​fingers are less sharply expressed.

Damage to the internal organs play a prominent role. Particularly characteristic is the enlargement and hardening of the liver. Usually we are talking about diffuse hepatitis, liver cirrhosis, often without jaundice and without ascites. But in the presence of scarring processes or with gummy inflammation of the bile ducts, jaundice also develops.

Enlargement of the spleen is the most constant occurrence in syphilis. It is dense, and its increase reaches a significant size.

Often, kidney damage is found with the appearance of protein, cylinders and erythrocytes in the urine.

Of the gastrointestinal symptoms, one can note the presence of habitual vomiting, diarrhea. Sometimes in connection with syphilis there is an increase in the testicles and their dropsy.

On the part of the respiratory apparatus, pneumonia alba, bronchial dilation, and ulceration in the larynx can be put in connection with syphilis. On the part of the heart, murmurs and interstitial inflammation of the myocardium are occasionally encountered.

On the part of the sense organs, the presence of iritis, inflammation of the retina, choroiditis, atrophy of the optic nerve, and deafness can be noted.

On the part of the nervous system, one can note anxiety, transient convulsions, the presence of head dropsy, retarded mental development, and sometimes meningeal and meningo-encephalic convulsions. The autonomic nervous system and the endocrine apparatus (thyroid gland, adrenal glands) are often affected.

In the blood, the presence of anemia is noted, in severe cases it sometimes proceeds according to the type of pseudoleukemic. The erythrocyte sedimentation reaction is accelerated, the osmotic stability of erythrocytes is increased, coagulability is slowed down, and the viscosity is increased.

Of the general symptoms of untreated syphilis, one can note the poor physical development of children, weight retardation, frailty, predisposition to other diseases. At the same time, general lethargy, apathy, strong screams at night are noted. During the period of occurrence of exanthema or involvement in the process of internal organs, a slight fever is observed.

Symptoms of late syphilis

The so-called late syphilis, which manifests itself most often at the age of 8-14 years, can also be characterized as gummous. Gummas with this form are of various sizes and are located on the soft palate, tonsils, on the sternum, skull, hard palate, and shins. They leave behind ulcers and persistent, bone scars soldered to the skin.

Characteristic of late syphilis is hyperplastic periostitis on the diaphysis of the tibia, leading to the formation of saber-shaped thickenings and bone tumors. So-called nocturnal bone pains are characteristic. Sometimes syphilitic drives develop. The Gutchinson triad is characteristic - keratitis, deafness and Gutchinson's teeth. These latter are characterized by the presence of a lunate recess with a rounded edge on the incisors on the chewing surface. Hummous damage to the liver (with jaundice) and spleen often develops. Damage to the central nervous system gives persistent headaches, epileptiform convulsions, hemiparesis, hemiplegia, mental retardation.

Atypical forms of syphilis and relapses

It should not be thought that every child with syphilis will have the entire symptom complex described above. Quite frequent are cases of congenital syphilis without skin manifestations with an exclusive lesion of the internal organs. Relatively frequent are rudimentary forms with insignificant skin manifestations (slight sniffing through the nose, mild seborrhea of ​​the superciliary arches, slight erythema on the soles, indistinct spots). There are children without any clinical manifestations, but giving a positive Wasserman reaction. Very young children have a septic form with an acute onset, high fever, profuse rash, vomiting, diarrhea, bleeding.

You should always remember about the possibility of recurrence of syphilis. These recurrences represent a repetition of already former skin manifestations. The most common form is condylomas of the skin - weeping papular growths around the anus and genitals. Similar formations can be found on the mucous membranes in the nasal cavity, mouth, pharynx, larynx. Gummy manifestations are less common - gummas of the bones, gummous osteomyelitis, gummas of the liver, kidneys, intestines, testicles, sometimes there are gummas on the skin, in the subcutaneous tissue, in the larynx.

Acquired extrasexual syphilis

Acquired extrasexually, syphilis in children is observed when hygiene rules are violated. Infection occurs through kissing, sucking, through dishes, direct contact. The most common localization of the primary focus is the oral cavity and lower lip. Acquired syphilis in children proceeds as in adults, giving the stage of primary infiltration with buboes, the secondary stage with rash and warts, and the tertiary stage with gummas. The rash is often patchy and roseolous.

Diagnosis and prognosis

Children with syphilis have a slightly lower viability and stamina than healthy ones. For the prognosis, the nature of the syphilis of the parents matters. Cases with pronounced visceral syphilis are not particularly favorable. The earlier treatment is started, the better the prognosis. The prognosis worsens if side infections are mixed with the underlying disease. Relapses of a condylomatous nature proceed favorably. Manifestations in late syphilis are more persistent. Properly treated children with syphilis can remain clinically healthy and develop normally; sometimes a physical or mental retardation develops, sometimes a dystrophic-degenerative condition.

The diagnosis of congenital syphilis is not so easy, since one must be able to make it with mild and unclear clinical manifestations. It is necessary to take into account the entire set of anamnesis data (abortions, stillbirths, etc.). Sometimes an x-ray of the bones solves the problem. The Wasserman reaction is always needed. When evaluating it, it should be remembered that some children without syphilis in the first weeks of life give a positive Wasserman reaction and that in sick children in the first weeks of life, the Wasserman reaction may be negative. It is desirable to supplement this reaction with the Sachs-George, Kahn reaction. Repeated analyzes and systematic observation of the child are necessary. We should not forget the method of finding spirochetes in the products of skin secretions (from blisters of pemphigus, umbilical wound), as well as in conjunctival secretions and in nasal mucus.

Prevention of syphilis

Preventive measures to combat syphilis are determined by the social moments of its spread. Through the properly organized work of women's clinics, it is necessary to establish an accurate record of all pregnant women with syphilis in venereal dispensaries, to conduct treatment and long-term monitoring of them. Family surveys are highly desirable in some cases. To protect children from non-sexual infection, it is necessary to study everyday life, the sanitary and hygienic situation, and sanitary and educational work. Depending on the indications, isolation of children, hospitalization of parents is carried out. It is advisable to hospitalize sick children under one year old with their mother. For ballroom babies, special nurseries are desirable. Older children need to be treated for a long time, leaving them in the usual conditions of the family and school.

As the duration of syphilis increases and the intensity of treatment increases, the harm done to children is greatly mitigated. Although there is no absolute guarantee against infection of children, in practice it is necessary to allow marriage if at least 4 years have passed from infection with syphilis and systematic treatment has been carried out. For the health of the child, timely detection of syphilis in a pregnant woman and timely treatment are extremely important.

A child born to parents with syphilis (in open or latent form) can only be fed by the mother. A mother can feed her child in all cases, regardless of whether she has or does not have symptoms of the disease, and regardless of the presence or absence of signs of lues in the child, but subject to careful monitoring of both and their treatment.

Only if the mother fell ill in the last months of pregnancy and the child was born healthy, is it possible to become infected; therefore, it is desirable to isolate the child from contact with the mother and to feed with expressed milk.

Feeding of children who have lost their mother during the first weeks of life is preferably carried out with expressed milk. Only with a longer observation and repeated negative Wasserman reactions can a child be considered healthy.

Treatment

Children born to mothers with syphilis should be treated if they have, if not pathognomonic, then at least some of the "probable" signs of lues. As for children who look healthy, but born to mothers with syphilis, long-term monitoring, repeated serological tests and treatment according to indications are necessary.

For the treatment of children, mercury and salvarsan were most often used before, as in adults. The dose of novarsenol is calculated for infants at 0.02 per 1 kg of weight, for children 2-4 years old - at 0.01-0.015 and for older children - 0.015 per 1 kg of weight. But it is more advisable to start the first injections in infants with a dose of 0.01-0.015 per 1 kg of weight. For weak children, the first dose should be reduced: 0.005-0.01 per 1 kg of weight. Novarsenol dissolves readily in hot, sterile saline and is administered intravenously.

A good drug for intramuscular injections is miarsenol in the same doses.
The new drug sovarsen is dosed in doses of 0.0025-0.005 up to 1 year, 0.005-0.25 for children 1-3 years old and 0.01-0.03 for children 3-10 years old.

Mercury for injection is used in the form of a 3-5% suspension of calomel or 1% oxycyanic mercury at 0.3-0.5 to 1 year, 0.5-1.0 - 2-5 years and 1.0-1.5 - older children. Sublimate is less commonly used. If mercury injections are poorly tolerated, they are replaced by rubbing a gray mercury ointment at 0.1 per 1 kg of body weight. Sublimate baths are less commonly used (0.75-1.0 sublimate per 20 liters of water).

Good results are obtained by treatment per os. For this purpose, osarsol is used in doses of 0.03 for children under 1 year old 2 times a day, 0.06 for children 1-2 years old, 0.15 for children 2-5 years old 3 times a day.

Instead of calomel injections, treatment with bismuth, the Soviet drug bioquinol, can be used at the rate of 0.5-2.0 ml, depending on age, making injections every other day (8-10 ml for the entire course for infants and 15-25 for older children).

Children also tolerate the so-called one-stage method of treatment: infusion of novarsenol or miarsenol injections and half an hour later on the same day injections of bioquinol or mercury in one and a half dosages. Such treatment can be carried out once a week.

With the phenomena of late syphilis, the use of iodine in the form of potassium iodide 5%, 1 teaspoon (dessert) 3 times a day, is indicated.

Treatment is carried out in series. The child should receive 6 to 8 courses of specific treatment.

When using large doses, they are limited to 12 weeks, during which 12 calomel and 12 neosalvarsan injections are carried out. If the Wasserman reaction remains positive, additional courses of treatment are recommended.

Recently, penicillin has been successfully used to treat congenital syphilis in infants. He is appointed by 200-300 thousand units. per 1 kg of weight per course of treatment. Penicillin is administered at 9-20 thousand units. 5 times a day. On the first day, no more than 30 thousand are administered, in the following days the dose is increased by 30 thousand every day and the dosage is adjusted to 120 thousand. The course of treatment is 10-15 days. In total, about 1.5 million units are needed for the course of treatment. After a break of 2 weeks, another 2 courses of treatment with penicillin are carried out. After a 3-week break, 2-3 courses of combined treatment are carried out.

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