Congenital syphilis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
Overview
Pathophysiology of congenital syphilis is still unclear. Several theories have been postulated in regards to duration of infection in mother and stage of pregnancy.
Pathophysiology
Transmission
Congenital syphilis occurs by the transmission of T. pallidum from mother to the fetus through the placenta during pregnancy. Transmission of the infection to the fetus depends on the duration of the disease in the mother. The longer the mother has had the disease at the time of pregnancy, the lesser the chance of fetal infection (40% in early latency and 10% in late latency).[1]
In utero transmission may occur at any stage of disease, but higher rates are seen with untreated infections of first and second trimester. It was postulated by Kassowitz that reduction in transplacental infection with progression of maternal syphilis is related to the evolution of maternal immunity. Recent theories suggest that the possibility of transmission is never eliminated. Fiumara gave an example of a untreated syphilitic mother transmitting disease to her children with decreasing frequency of severity. An interesting observation was that the normal offspring can be preceded and followed by an infected sibling.[2] This can be explained by the changes in pathogenicity of T. pallidum.
Virulence
Virulence of T.pallidum depends on multiple factors.
- Nutritional
- Environmental
- Behavioral
- Immunologic
It can be modulated by a mother's immune response, the genetic make up of the fetus, and the strain of the pathogen. It can explain the reason for difference in presentation of various affected kids. There is a high rate of fetal death associated with pregnancy that occurs immediately before or after infection. This can be explained by fetal and maternal immune reactions causing an intense release of inflammatory cytokines from the inflammatory membranes.
References
- ↑ "Evaluation of Molecular Methodologies and Rabbit Infectivity Testing for the Diagnosis of Congenital Syphilis and Neonatal Central Nervous System Invasion by Treponema pallidum". Retrieved 2012-12-20.
- ↑ Fiumara NJ (1965). "A legacy of syphilis". Archives of Dermatology. 92 (6): 676–8. PMID 5846324. Retrieved 2012-12-20. Unknown parameter
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