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Congenital Syphilis

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Description: Congenital syphilis is a severe, disabling infection transmitted from an infected mother to her baby during pregnancy or childbirth.
Type: Congenital syphilis is an infectious disease, not a genetic disorder. It is transmitted from an infected mother to her baby during pregnancy or childbirth. The causative agent is the bacterium Treponema pallidum.
Signs And Symptoms: Untreated early syphilis infections results in a high risk of poor pregnancy outcomes, including saddle nose, lower extremity abnormalities, miscarriages, premature births, stillbirths, or death in newborns. Some infants with congenital syphilis have symptoms at birth, but many develop symptoms later. Symptoms may include rash, fever, large liver and spleen, and skeletal abnormalities. Newborns will typically not develop a primary syphilitic chancre but may present with signs of secondary syphilis (i.e. generalized body rash). Often these babies will develop syphilitic rhinitis ("snuffles"), the mucus from which is laden with the T. pallidum bacterium, and therefore highly infectious. If a baby with congenital syphilis is not treated early, damage to the bones, teeth, eyes, ears, and brain can occur.Neurosyphilis in newborns may present as cranial nerve palsies, cerebral infarcts (strokes), seizures or eye abnormalities.Many newborns, 55% by some estimates, do not exhibit any symptoms initially, with signs and symptoms developing days to months later.
Prognosis: The prognosis for congenital syphilis can vary widely depending on the timeliness and adequacy of treatment. If diagnosed and treated early, many infants can recover without long-term complications. However, if left untreated or if treatment is delayed, congenital syphilis can lead to severe, potentially life-threatening complications including developmental delays, neurological problems, and deformities. Early and appropriate medical intervention is crucial for improving outcomes.
Onset: Congenital syphilis typically manifests in infants, but the onset can vary. Early congenital syphilis symptoms usually appear within the first 3 months of life but can present as late as 2 years of age with signs like skin rashes, hepatosplenomegaly, and nasal discharge. Late congenital syphilis can show symptoms later in childhood or even adulthood, including dental anomalies, bone deformities, and neurological complications.
Prevalence: Prevalence data for congenital syphilis varies by region and over time. It is generally more common in areas with higher rates of maternal syphilis and inadequate prenatal care. In the United States, the Centers for Disease Control and Prevention (CDC) reported a rise in congenital syphilis cases in recent years, with prevalence rates increasing significantly from 2013 to 2021. Global prevalence can be higher in resource-limited settings where access to prenatal screening and treatment is less available. Specific prevalence rates may differ based on the most recent data and the region in question.
Epidemiology: Syphilis affects around one million pregnancies a year. In 2016, there were around 473 cases of congenital syphilis per 100,000 live births and 204,000 deaths from the disease worldwide. Of the 660,000 congenital syphilis cases reported in 2016, 143,000 resulted in deaths of unborn babies, 61,000 deaths of newborn babies, 41,000 low birth weights or preterm births, and 109,000 young children diagnosed with congenital syphilis. Around 75% were from the WHO's African and Eastern Mediterranean regions.Cases of congenital syphilis in the United States have been rising since the early 2010s. The Centers for Disease Control and Prevention (CDC) reported 918 cases for 2017, which is more than twice the yearly incidence of the preceding four years. The incidence in the United States has increased by 754% from 2012 to 2021 with a higher incidence seen in those with a lower socioeconomic status, as well as Black people, Native Americans and Native Hawaiians. Reports in 2023 show a rise of more than 900 percent in Mississippi over the preceding five years.
Intractability: Congenital syphilis is not necessarily intractable if it is detected and treated early. Early diagnosis and appropriate antibiotic treatment, usually with penicillin, can effectively manage and cure the disease. However, if left untreated, congenital syphilis can lead to severe, irreversible complications. Early intervention is crucial for a favorable outcome.
Disease Severity: Congenital syphilis can be severe, leading to serious and potentially life-threatening health issues in infants. If untreated, it can cause developmental delays, neurological issues, bone deformities, anemia, jaundice, and enlarged liver and spleen. Severe cases might result in stillbirth or neonatal death. Early detection and treatment are crucial to mitigate these outcomes.
Healthcare Professionals: Disease Ontology ID - DOID:9856
Pathophysiology: **Pathophysiology**: Congenital syphilis occurs when the bacterium *Treponema pallidum* is transmitted from an infected mother to her fetus via the placenta. This transmission can occur at any stage of pregnancy, potentially leading to stillbirth, neonatal death, or a range of clinical manifestations in the newborn. The bacteria can infect multiple organs and tissues, resulting in symptoms such as hepatosplenomegaly, skin rashes, jaundice, anemia, and developmental delays. Severe cases can involve the skeletal system, causing characteristic abnormalities such as periostitis and Hutchinson's teeth. Early detection and treatment during pregnancy are crucial to prevent transmission and adverse outcomes.
Carrier Status: Carrier status is not applicable for congenital syphilis. This condition is transmitted from an infected mother to her baby during pregnancy or childbirth, not through carriers.
Mechanism: Congenital syphilis occurs when Treponema pallidum, the bacterium responsible for syphilis, is transmitted from an infected mother to her baby during pregnancy or childbirth. The mechanism of transmission typically involves the bacterium crossing the placental barrier.

**Molecular mechanisms:**

1. **Bacterial Entry**: Treponema pallidum can pass through the placental barrier, particularly if there are microscopic breaks in the placenta or during placental inflammation.
2. **Immune Evasion**: The bacterium can evade the maternal immune system due to its outer membrane, which has few surface antigens, thereby reducing detectable immune responses.
3. **Dissemination within Fetus**: Once inside the fetus, Treponema pallidum can disseminate through blood and lymphatic circulation, affecting multiple organs.
4. **Tissue Infiltration**: The bacterium infiltrates fetal tissues, leading to inflammation and necrosis. Key affected sites often include the liver, spleen, lungs, skin, and even bones.
5. **Disruption of Development**: The widespread tissue damage and inflammation interfere with the normal development of the fetus, leading to a range of congenital abnormalities and complications.

Early detection and treatment with appropriate antibiotics, primarily penicillin, can significantly reduce the risks associated with congenital syphilis.
Treatment: If a pregnant mother is identified as being infected with syphilis, treatment can effectively prevent congenital syphilis from developing in the fetus, especially if she is treated before the sixteenth week of pregnancy or at least 30 days prior to delivery. Mothers with primary syphilis can be treated with a single dose of intramuscularly injected penicillin, whereas late-latent, secondary syphilis, or disease of an unknown duration is treated with once weekly penicillin injections for three weeks.The fetus is at greatest risk of contracting syphilis when the mother is in the early stages of infection, but the disease can be passed at any point during pregnancy, even during delivery. An affected child can be treated using antibiotics much like an adult; however, any developmental symptoms are likely to be permanent.The greater the duration between the infection of the mother and conception, the better the outcome for the infant including less chance of stillbirth or developing congenital syphilis.The Centers for Disease Control and Prevention recommends treating symptomatic or babies born to an infected mother with unknown treatment status with procaine penicillin G, 50,000 U/kg dose IM a day in a single dose for 10 days. Treatment for these babies can vary on a case-by-case basis. Treatment cannot reverse any deformities, brain, or permanent tissue damage that has already occurred.A Cochrane review found that antibiotics may be effective for serological cure but in general the evidence around the effectiveness of antibiotics for congenital syphilis is uncertain due to the poor methodological quality of the small number of trials that have been conducted.
Compassionate Use Treatment: For congenital syphilis, compassionate use treatment or off-label/experimental treatments are generally considered when standard therapies are not effective or available. However, congenital syphilis is usually effectively treated with standard, approved therapies, specifically using penicillin-based antibiotics.

1. **Penicillin G**: The standard treatment recommended by health authorities. It is highly effective when administered properly.
- **Aqueous crystalline penicillin G**: Administered intravenously, 50,000 units/kg/dose every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days.
- **Procaine penicillin G**: As an intramuscular injection, 50,000 units/kg once daily for 10 days.

2. **Off-Label or Experimental Treatments**:
- **Azithromycin & Erythromycin**: Considered if there is a penicillin allergy, but these options are less effective and not routinely recommended.
- **Ceftriaxone**: Occasionally used as an off-label treatment in neonates, but is not the first-line therapy.

Due to serious long-term consequences of untreated congenital syphilis, strict adherence to the recommended guidelines for penicillin treatment is strongly advised. In cases where the standard treatment protocol is not feasible, consult with an infectious disease specialist to explore safe and effective alternatives.
Lifestyle Recommendations: For congenital syphilis, prevention rather than lifestyle recommendations is key since it is a condition passed from an infected mother to her baby during pregnancy. Here are some critical recommendations:

1. **Regular Prenatal Care**: Pregnant women should attend all prenatal appointments, where they can be screened for syphilis and other infections.
2. **Prompt Treatment**: Immediate treatment with antibiotics (usually penicillin) if syphilis is detected to prevent transmission to the baby.
3. **Safe Sexual Practices**: Use barrier methods such as condoms and ensure that sexual partners are also tested and treated if necessary.
4. **Follow-up Testing**: Adhering to follow-up testing as recommended by healthcare providers to ensure the infection has been completely treated.

Focusing on prevention and early treatment are the best approaches to managing and mitigating the impact of congenital syphilis.
Medication: Congenital syphilis is typically treated with penicillin. The specific regimen often used is aqueous crystalline penicillin G, administered either intravenously or intramuscularly, depending on the age and clinical status of the infant. The duration and dosage of treatment can vary, but a common approach includes:

- Aqueous crystalline penicillin G: 50,000 units/kg/dose IV every 12 hours for the first 7 days of life and every 8 hours thereafter for a total of 10 days.

If intravenous administration is not feasible, procaine penicillin G may be administered intramuscularly:

- Procaine penicillin G: 50,000 units/kg/dose IM once daily for 10 days.

Follow-up and monitoring for treatment efficacy and possible side effects are essential.
Repurposable Drugs: There aren't currently any well-documented repurposable drugs specifically for congenital syphilis. The primary treatment for congenital syphilis remains penicillin, which is highly effective. If you need further information on treatment protocols or alternative research areas, consulting updated medical literature or guidelines is advisable.
Metabolites: Congenital syphilis is a disease caused by the transmission of the bacterium *Treponema pallidum* from an infected mother to her baby during pregnancy. The term "metabolites" refers to the small molecules involved in metabolism, often used to diagnose or monitor diseases. For congenital syphilis, specific metabolites associated with the disease are not well-defined in the way they are for metabolic disorders. Instead, diagnosis and monitoring primarily rely on other laboratory methods such as serological tests to detect antibodies against *Treponema pallidum*.

If "nan" refers to a request for specific metabolic markers (nanomoles per liter or similar measures), it's important to note that such specific metabolites linked to congenital syphilis are not typically used in clinical practice. The focus remains on antibody detection and direct identification of the bacterium.
Nutraceuticals: Nutraceuticals typically refer to products derived from food sources that provide extra health benefits, such as dietary supplements, vitamins, or fortified foods. For congenital syphilis, which is an infection passed from mother to child during pregnancy, the primary mode of treatment and prevention is medical management with antibiotics, specifically penicillin. Nutraceuticals are not considered effective or appropriate for treating congenital syphilis. Proper prenatal care and screening for syphilis in pregnant women are crucial steps in preventing congenital syphilis.
Peptides: It seems there was a misunderstanding in your query. Congenital syphilis is a serious infection caused by the bacteria _Treponema pallidum_ that is transmitted from an infected mother to her baby during pregnancy. Could you please clarify or provide more context related to "peptides, nan" in this context? Are you asking about specific peptide biomarkers or nanotechnology applications for congenital syphilis?