From the Guidelines
Hutchinson disease, also known as congenital syphilis, presents with symptoms including nonimmune hydrops, jaundice, hepatosplenomegaly, rhinitis, skin rash, and/or pseudoparalysis of an extremity, as noted in the 2002 CDC guidelines for the treatment of sexually transmitted diseases 1. The symptoms of Hutchinson disease can be identified through a thorough examination of the infant, including a physical examination and laboratory tests such as darkfield microscopic examination or direct fluorescent antibody staining of suspicious lesions or body fluids.
- Key symptoms include:
- Nonimmune hydrops
- Jaundice
- Hepatosplenomegaly
- Rhinitis
- Skin rash
- Pseudoparalysis of an extremity
- The diagnosis of congenital syphilis is based on the presence of an abnormal physical examination, a serum quantitative nontreponemal serologic titer that is fourfold greater than the mother's titer, or a positive darkfield or fluorescent antibody test of body fluid(s) 1. The evaluation and treatment of infants with congenital syphilis depend on the presence of symptoms and the results of laboratory tests, with recommended regimens including aqueous crystalline penicillin G or procaine penicillin G for a total of 10 days 1.
- Recommended evaluation includes:
- CSF analysis for VDRL, cell count, and protein
- Complete blood count (CBC) and differential and platelet count
- Other tests as clinically indicated
- The use of other antimicrobial agents, such as ampicillin, is not recommended due to insufficient data, and a full 10-day course of penicillin is preferred, even if ampicillin was initially provided for possible sepsis 1.
From the Research
Symptoms of Hutchinson Disease
The symptoms of Hutchinson disease, also known as congenital syphilis, are characterized by a triad of features, including:
- Interstitial keratitis
- Eighth nerve deafness
- Hutchinson's teeth, which are dental abnormalities 2, 3 These clinical features are related to syphilis present during pregnancy and at birth, but they commonly become apparent after 5 years of age 2.
Dental Abnormalities
Dental abnormalities in congenital syphilis can range from no visible signs to those beyond the classical models of Hutchinson, Moon, and Fournier 4. The dental changes in congenital syphilis can be distinct from those caused by mercury treatment, which can produce a pronounced deficiency in enamel of incisors, canines, and first permanent molars 4.
Other Symptoms
Late congenital syphilis is a rare entity, and its early diagnosis and treatment are essential to prevent significant morbidity 3. The symptoms of Hutchinson disease can become apparent at different ages, with cases reported at 7 years 2 and 14 years 3.
Note: There is no relevant information in reference 5 to assist in answering this question.