TABLE 1:

Clinical findings related to congenital syphilis in children younger than one year of age

System	Findings
Gestational	Stillbirth Prematurity Small stature for gestational age Nonimmune hydrops
Reticuloendothelial	Generalized, nontender lymphadenopathy Anemia (hemolytic and nonhemolytic) Leukopenia or leukocytosis Thrombocytopenia (in 30%)* Hepatosplenomegaly (in 50% to 90%)* from extramedullary hematopoiesis
Mucocutaneous (in 30% to 60%)*	Snuffles (thick or bloody nasal discharge)† Laryngitis A maculopapular (coppery-brown) skin rash followed by desquamation, blistering and crusting† that is prominent on the palms and soles Mucous patches (palate, perineum) Condyloma lata (perioral and perianal)
Skeletal (in 70% to 80%)*	Symmetrical longbone lesions that are more common in the lower than the upper extremities Metaphyseal osteochondritis with mild to destructive lesions that develop within five weeks of infection Wimberger’s sign (demineralization and destruction of the proximal tibial metaphyses) Diaphyseal periostitis with periosteal new bone formation that develops after 16 weeks of infection Osteitis – alternating linear bands of translucency and radiodensity of long bones that give a ‘celery stick’ appearance Dactylitis with involvement of the metacarpals, metatarsals and proximal phalanges
Neurological	40% to 60%* have cerebrospinal fluid abnormalities (eg, pleiocytosis, elevated protein, low glucose) Venereal Disease Research Laboratory test reactive in cerebral spinal fluid Signs and symptoms of acute meningitis (eg, bulging fontanel, vomiting) Untreated neurosyphilis may lead to chronic meningovascular syphilis with hydrocephalus, cerebral infarctions and cranial nerve palsies
Ocular	Salt and pepper chorioretinitis, glaucoma, uveitis
Other organ involvement	Renal involvement: nephrotic syndrome (immune complex mediated after two to three months of infection) Pulmonary involvement: pneumonia alba (obliterative fibrosis) Myocarditis Pancreatitis Gastrointestinal inflammation and fibrosis

^*Percentages refer to the proportion of symptomatic infants with the given abnormality

^†Snuffles, skin blisters and crusts contain infectious spirochetes. Children with these lesions should be considered contagious and appropriate contact barrier precautions instituted