Gestational/perinatal | |
Stillbirth | |
Prematurity | |
Birth weight <2500 g | |
Nonimmune hydrops fetalis | |
Placenta | Large, thick, pale (send for pathologic/histologic evaluation) |
Umbilical cord | Inflamed with abscess-like foci of necrosis within Wharton's jelly, centered around the umbilical vessels (necrotizing funisitis); barber-pole appearance (send for pathologic/histologic evaluation) |
Systemic | |
Fever | May be more prominent in infants born to mothers who are affected late in pregnancy and whose serology is negative at delivery |
Hepatomegaly | Splenomegaly occurs in approximately one-half of patients with hepatomegaly—isolated splenomegaly does not occur |
Generalized lymphadenopathy | May be as large as 1 cm; generally nontender and firm |
Failure to thrive | |
Edema | Due to anemia/hydrops fetalis, nephrotic syndrome, malnutrition |
Mucocutaneous | |
Syphilitic rhinitis ("snuffles") | Can be an early feature, developing after the first week of life; contains spirochetes and is infectious (use contact precautions) |
Maculopapular rash | Usually appears one to two weeks after rhinitis. Oval lesions, initially red or pink and then coppery brown; may be associated with superficial desquamation or scaling, particularly on the palms or soles; more common on the buttocks, back, posterior thighs, and soles; contains spirochetes and is infectious (use contact precautions). |
Vesicular rash (pemphigus syphiliticus) | May be present at birth, most often develops in first four weeks; widely disseminated; vesicular fluid contains spirochetes and is infectious (use contact precautions) |
Condylomata lata | Single or multiple, flat, wartlike, moist lesions around the mouth, nares, and anus and other areas of the skin where there is moisture or friction; lesions contain spirochetes and are infectious (use contact precautions); frequently present without other signs of infection |
Jaundice | Hyperbilirubinemia secondary to syphilitic hepatitis and/or hemolysis |
Hematologic | |
Anemia | Newborn period: Hemolytic (Coomb's test [direct antiglobulin test] negative); may persist after effective treatment After one month of age: May be chronic and nonhemolytic |
Thrombocytopenia | May be associated with bleeding or petechiae; can be the only manifestation of congenital infection |
Leukopenia | |
Leukocytosis | |
Musculoskeletal | |
Pseudoparalysis of Parrot | Lack of movement of an extremity because of pain associated with bone lesion; affects upper extremities more often than lower; usually unilateral; rarely present at birth; poorly correlated with radiographic abnormalities |
Radiographic abnormalities: | Most frequent abnormality in untreated early congenital syphilis; not usually clinically discernible; typically multiple and symmetric |
Periostitis | Irregular periosteal thickening; usually present at birth, but may appear in the first few weeks of life |
Wegner sign | Metaphyseal serration or "sawtooth metaphysis" |
Wimberger sign | Demineralization and osseous destruction of the upper medial tibial |
Neurologic | |
CSF abnormalities | Reactive CSF VDRL; elevated CSF white blood cell count; elevated CSF protein |
Acute syphilitic leptomeningitis | Onset during the first year of life, usually between 3 and 6 months; presentation similar to bacterial meningitis but CSF findings more consistent with aseptic meningitis (mononuclear predominance); responds to penicillin therapy |
Chronic meningovascular syphilis | Onset toward the end of the first year; hydrocephalus; cranial nerve palsies; intellectual/neurodevelopmental deterioration; cerebral infarction; protracted course |
Miscellaneous | |
Pneumonia/pneumonitis/respiratory distress | Complete opacification of both lung fields on chest radiograph |
Nephrotic syndrome | Usually occurs at two to three months of age and manifests with generalized edema and ascites |
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