Congenital Syphilis in 2 months old girl present with decrease arms movement with rashes

Abstract

Congenital syphilis is caused by Treponema pallidum infection in pregnant women. The mother-to-child transmission can occur during intrauterine and perinatal periods. Notably, most pregnant women are asymptomatic and are tested positive for syphilis screening, corresponding to “late latent syphilis” phase in the clinical course. This may contribute to 8% increased risk of congenitalsyphilis.InThailand,rate of congenitalsyphilis hasincreased steadily over the past 5 years. Most of infected infants are asymptomatic at birth. Signs and symptoms of congenital syphilis usually occur within the first 5 weeks of life. Common
manifestations include, but not limit to hepatosplenomegaly, maculopapular rash, desquamative rash on palms and soles, failure to thrive, pseudoparalysis of parrot from osteochondritis and periostitis, pneumonia and snuffles. If syphilis is detected in pregnant
women, one to three doses of intramuscular benzathine penicillin should be administered to mothers at least 4 weeks prior to labour to prevent congenitalsyphilis. In this case report, the mother was a newly diagnosed HIV positive patient with negative blood results for other sexually transmitted diseases. The infant received appropriate HIV prophylaxis and blood tests showed HIV negative results. At 2 months of age, the infant presented with decreased arm movement with rashes. Blood test showed VDRL titer 1:256 and maternal VDRL titer 1:32 … expected that the mother was infected in early latent phase of syphilis. According to VDRL titer in infant increase more than 4-fold rising titer when compared with maternal titer and a long bone X-ray film showed osteochondritisthat cause of fractures of both ulna. This clinical manifestation is compatible with congenital syphilis. After retrospective review, it was found that the mother was screened for syphilis only one time when she attended the antenatal care. She might have acquired syphilis later without having the second screening, and this caused congenital syphilis in her offspring. The second screening for syphilis in third trimester of pregnancy by treponemal test will increased in sensitivity for detection
of syphilis in pregnant women.