Congenital syphilis differential diagnosis

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Overview

Congenital syphilis must be differentiated from the TORCH infections.

Differential Diagnosis

The most important congenital infections, which can be transmitted vertically from mother to fetus are the TORCH infections. These infections have overlapping features and hence, must be differentiated from congenital syphilis :

Congenital Infection	Cardiac Findings	Skin Findings	Ocular Findings	Hepatosplenomegaly	Hydrocephalus	Microcephaly	Intracranial Calcifications	Hearing deficits
Toxoplasmosis		Petechiae Purpura Maculopapular rash	Chorioretinitis	✔	✔	✔	Diffuse intracranial calcifications
Congenital Syphils		Petechiae Purpura Maculopapular rash	Chorioretinitis Glaucoma	✔
Rubella	Patent ductus arteriosus (PDA) Pulmonary artery stenosis Coarctation of the aorta Myocarditis	Petechiae Purpura	Chorioretinitis Cataracts Glaucoma Microphthalmia	✔	✔	✔		✔
Cytomegalovirus (CMV)	✔	Petechiae Purpura	Chorioretinitis	✔		✔	Periventricular calcifications	✔
Herpes simplex virus (HSV)	Myocarditis	Petechiae Purpura Vesicles	Chorioretinitis	✔	✔	✔		✔
Parvovirus B19	Myocarditis	Petechiae Subcutaneous edema	Chorioretinitis Cataracts	✔