| BackgroundSyphilis is a common sexually transmitted disease(STD),infected by Treponema pallidum(TP). The disease not only has the damage of skin and mucous membrane, but also can invade the multiple organs,and produce a variety of clinical manifestations. According to the route of its transmission, syphilis can be divided into acquired syphilis(AS) and congenital syphilis(CS), CS is also known as the prenatal syphilis in clinical. Congenital syphilis occurs by pregnant women with syphilis infection to the fetus through the placenta, in recent years, with the increase of the incidence of syphilis, congenital syphilis is not rare in clinical. Due to the insufficient understanding and attention of the disease, atypical clinical manifestations and other factors, which often cause congenital syphilis to be misdiagnosed in clinical, not to be treated timely or treated improperly, resulting in serious consequences. ObjectiveThrough clinical analysis of the skin manifestations, serology, damage of the systems, the status and causes of the misdiagnosis, treatment and prognosis of congenital syphilis, this study aims to improve the clinical knowledge of congenital syphilis, reduce missed diagnosis, so that the disease can be treated in a regular and timely manner. MethodThe clinical data of 48 subjects with CS that treated in First Affiliated Hospital of Zhengzhou University from January in 2005 to December in 2015 were retrospectively analyzed. The selected patients were diagnosed according to diagnostic criteria of congenital syphilis.The skin manifestations, serological examination, system damage, misdiagnosis, treatment and prognosis of the patients were collected and did statistical analysis. Results1.Gender: In 48 cases of congenital syphilitic children, 19 cases were male patients, 29 cases were female patients, Female are more than male, the ratio of male to female was 0.66:1.2.Age: In selected 48 cases of congenital syphilitic children, the minimum age was 1 days, the maximum was 18 months. 20 cases were within 1 months, 4 cases were between 1 and 2 months, 5 cases were between 2 and 3 months, 19 cases were more than 3 months.3.Skin lesions:In 48 cases of infants with congenital syphilis, there were 21 cases without skin lesions,27 cases with skin lesions. skin lesions were mainly manifested as erythema, blisters, scaling, blister, pustular, bulla and compressed wet wart, hair loss, mouth weeks and perianal radioactive chapped. The lesions are mainly located in the mouth and nose week, trunk, diaper area, palmoplantar.4.Misdiagnosis: 16 cases were misdiagnosed in 27 cases of children with skin lesions, as detailed below. 4 cases were misdiagnosed for eczema,4 cases were misdiagnosed as psoriasis, 2 cases were misdiagnosed for impetigo neonatorum,1 case was misdiagnosed for neonatal lupus erythematosus, 1 case was misdiagnosed as staphylococcal scalded skin syndrome, 1 case was misdiagnosed as congenital epidermolysis pine bullosa, 1 case was misdiagnosed as incontinentia pigmenti,1 case was misdiagnosed Letterer-Siwe, 1 case was misdiagnosed for neonatal varicella; 3 cases were misdiagnosed in 21 cases of children with no skin lesions, as detailed below. 1 case was misdiagnosed as hemorrhagic disease of newborn, 1 case was misdiagnosed as neonatal septicemia, 1 case was misdiagnosed as thrombocytopenic purpura.5.System damage: Liver enlargement in 33 cases, spleen enlargement in 17 cases, lymph node enlargement in 8 cases, the liver enzyme increased in 21 cases, 37 cases had abnormal blood routine, 12 cases of jaundice, edema in 12 cases, 10 cases of hematuria, 5 cases of proteinuria, 2 cases of bleeding manifestations, nervous system abnormalities in 2 cases, eye damage in 3 cases.6.Syphilitic Serological Examination: RPR and TPPA test titers in 48 cases of congenital syphilitic children were positive,including 7 cases of RPR test titers were greater than or equal to 1:64, 11 cases of RPR test titers were 1:32,12 cases of RPR test titers were 1:16,13 cases of RPR test titers were 1:8, 5 cases of RPR test titers were 1:4.7.Mother: RPR and TPPA test titers were positive in 48 mothers, including 6 cases of RPR test titers greater than or equal to 1:16, 13 cases of RPR test titers were 1:8 RPR, 19 cases of RPR test titers were 1:4, 8 cases of RPR test titers were 1:2. 36 cases of mother did not receive treatment, 12 cases were treated with non-standard treatment.8.Treatment: 43 cases of patients with penicillin skin test is negative in 48 cases, they were all given intramuscular injection of penicillin treatment, 23 cases were treated with benzathine penicillin, 20 cases were treated with penicillin G.5 cases of penicillin skin test positive were given oral erythromycin.9.Prognosis: Except 9 cases lost to follow-up, the clinical symptoms and signs of the other 39 cases disappeared after treatment,they were in good general condition. TPPA test titers were positive in 39 cases; RPR test titers were negative in 34 cases, RPR test titers were 1:4 in 2 cases, RPR test titers were 1:2 in 3 cases.Conclusion1.Congenital syphilis is caused by mother to child transmission. We should strengthen the screening before pregnancy for mother, reduce the incidence of congenital syphilis.2.Congenital syphilis is common in clinical, but it is easily to be misdiagnosed due to its complicated clinical symptoms of the skin and visceral, so clinicians should improve the understanding of congenital syphilis.3.The harm of congenital syphilis is great, but if the patient can be diagnosed early, and receive regular treatment, the prognosis is generally good. |
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