Organism
Treponema Pallidum
Spirochete transmitted via
- direct contact with denuded epithelium
- transplacental infection
Types
Primary
Macule at site of contact
- painless hard ulcer
- chancre
Secondary
4-8/52
- a rash (the most characteristic finding)
- fever / headache / malaise / anorexia
- diffuse lymphadenopathy
Tertiary
2-20yrs latency
Gummas / granuloma of skin, mucosa, bone, joints
Painless non tender swelling of long bone or skull
- may be diffuse sclerotic reaction resembling Paget's
Quaternary
Cardiovascular
- ascending aorta aneurysm
Neurosyphilis
- meningovascular - CN palsy, stroke
- general paresis of insane
- tabes dorsalis (sensory ataxia / numb legs / loss reflexes)
- charcot joints
- Argyll Robertson pupil
Congenital Syphilus
Presentation is multi-systemic, non-specific, variable
- 1/3 still birth
- 2/3 Present later
Metaphysitis / Osteitis / Periostitis
Pathological Fracture / Physeal separation
Nodes & Hepatosplenomegaly
Wimberger Sign
- erosion med prox tibial metphysis
DDx
Abuse
CRMO
Leukaemia
CMV
Rubella
Rickets
Investigation
Bone Biopsy
- spirochaetes
RPR Rapid Plasma Reagin
- screening
Fluoroscent Treponemal Antibody Test
- confirmation
Lumbar puncture
- neuro-syphilis
Management
Antibiotics
Penicillin
- no reported resistance
- 100000 U/kg/D tds for 2/52
Syphilus of the bones
Congenital or acquired
- infection is localised to metaphysis and diaphysis
- doesn't cross into joint
Congenital Syphilis
- irritable and restless
- large, tender swelling around joint
- limb immobile
- cutaneous signs of syphilis may be present- skin lesions, mucous patches, and keratitis
X-rays
Show widening of metaphysis with marginal density and an indentation on its epiphyseal border
- diffuse periostitis
- with layers of new bone formation
- affected bone takes on a spindle shape with loss of metaph
Investigation
Serological markers not positive for 3/12 in neonate
- spirochete can be demonstrated on histology
Management
Responds well to Antibiotics
Late Stage / 2-3yrs
Characterised by osteoblastic activity
- a condensing osteitis
- mainly tibia, femur and skull
- subperiosteal bone formation produces characteristic prominent anterior tibia without bowing
- sabre tibia
Clutton's joints
- late stage of congenital syphilis
- 8-18 years
- recurrent bilat,eral painless effusions of knees
- aspirate shows high monomorph infiltrate