What Are the 3 Things in Hutchinson Triad Again for Congenital Syphilis
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| CASE Written report | ||
| Yr : 2014 | Volume : 32 | Issue : 4 | Page : 333-337 | ||
Early detection of congenital syphilis
1 Professor and Head, Departments of Pedodontics and Preventive Dentistry, Sri Siddhartha Dental College and Hospital, Agalakote, Tumkur, Karnataka, Bharat
2 Senior Lecturer, Sri Siddhartha Dental Higher and Hospital, Agalakote, Tumkur, Karnataka, Republic of india
3 Professor, Sri Siddhartha Dental College and Hospital, Agalakote, Tumkur, Karnataka, Bharat
iv Reader, Sri Siddhartha Dental Higher and Hospital, Agalakote, Tumkur, Karnataka, Republic of india
| Appointment of Web Publication | 17-Sep-2014 |
Correspondence Address:
Nagalakshmi Chowdhary
Section of Pedodontics and Preventive Dentistry, Sri Siddhartha Dental College and Hospital, BH Route, Agalakote, Tumkur - 572 107, Karnataka
Republic of india
Source of Support: None, Conflict of Involvement: None
DOI: 10.4103/0970-4388.140969
 Abstract |
Late congenital syphilis is a very rare clinical entity, and its early on diagnosis and treatment is essential. Dental findings frequently provide valuable bear witness for the diagnosis of late congenital syphilis. It occurs due to the transmission of the disease from an infected mother to her fetus through placenta. This long forgotten disease continues to issue meaning women resulting in perinatal morbidity and bloodshed. Congenital syphilis is a preventable affliction, and its presence reflects a failure of prenatal care delivery system, also as syphilis control programs. We are reporting a case of late congenital syphilis with only Hutchinson'south teeth.
Keywords: Diagnosis, Hutchinson′south teeth, belatedly congenital syphilis
How to cite this article:
Chowdhary N, Rani BK, Mukunda Chiliad South, Kiran N Grand. Early on detection of built syphilis . J Indian Soc Pedod Prev Dent 2014;32:333-7
Congenital syphilis is an infectious illness transmitted by an infected mother to her fetus. It is the oldest recognized infection, and continues to account for extensive global perinatal morbidity and mortality. [1],[2],[3],[4]
Syphilis among meaning women and the consistent congenital syphilis is now re-emerging in many developing countries. Congenital syphilis is mainly a consequence of the lack of antenatal care (ANC) and control of sexually transmitted infections. [five] The bedrock of the prevention of congenital syphilis is the performance of syphilis serological screening during pregnancy, making appropriate treatment possible, and preventing vertical transmission. [5] Globally, just over 2 meg pregnant women test positive for syphilis each year, comprising i.5% of all pregnancies worldwide. This results in 692,100-1.53 million adverse pregnancy outcomes each year acquired by syphilis. Approximately, 650,000 of these pregnancy complications issue in perinatal expiry. [half dozen],[7],[8],[9],[10],[11]
Near of the clinical signs of congenital syphilis develop after. Manifestations of this disease include mainly the triad of Hutchinson, characterized by Hutchinson's teeth, interstitial keratitis, and eighth nerve deafness. [12] Late congenital syphilis (recognized ii or more years afterward birth) is a very rare clinical entity. [13] Nosotros are reporting here a case of late congenital syphilis who presented at the age of 12 years with only Hutchinson's teeth and mulberry molars.
A 12-year-old male child reported with irregular anterior teeth. On examination, notched upper primal incisors [Figure 1] and mulberry molars [Figure 2] were noticed. Furthermore, retained deciduous maxillary lateral incisors, mandibular primal, and lateral incisors were noticed. On orthopantomograph examination, congenital missing of maxillary and mandibular permanent molar buds were noticed [Figure 3]. Considering the late congenital syphilis farther investigations were carried out under the guidance of a pediatrician. The routine claret investigations revealed normal Hb%, total leukocyte count, differential leukocyte count and platelet count. Crabs Disease Inquiry Laboratory (VDRL) examination (screening test) was reactive at 1:64 dilutions and Treponema pallidum hemagglutination (specific test) was positive. Skeletal survey revealed no radiological prove of periosteal lesions or perichondritis. Ultrasound test of abdomen and pelvis showed no aberration. Leg anteroposterior X-ray was normal. In that location was no lymphadenopathy and no credible bony abnormality. There was no testify of neurological or cardiovascular interest.
His younger brother of historic period 9 years was examined, and aforementioned finding were noticed. VDRL testing was reactive at 1:128 dilutions and T. pallidum hemagglutinations was positive. Consent from a parent was taken, and systemic stage of treatment was carried out by pediatrician. Both children were treated with 3 weekly doses of benzathine penicillin ii.4 1000000 units intramuscularly. Parents were advised for necessary investigations and treatment. On the follow-upwards after 4 weeks, VDRL testing was negative or nonreactive.
After completing systemic phase of handling, dental procedures are carried out in both children. Every bit the mulberry molars are the developmental defects with increased susceptibility to caries, so as a preventive restoration stainless steel crowns are placed. Elder blood brother received stainless steel crown i.r.t 85 [Effigy 4] followed past esthetic restoration i.r.t 11, 21 [Figure v]. Younger brother received stainless steel crowns i.r.t 55, 65, 75, 84, 85 and band and loop space maintainer i.r.t 74 [Figure 6] and [Figure 7]. Permanent first molars were not completely erupted in both the children to place stainless steel crowns.
 | Figure v: Esthetic restoration of notched upper central incisors - 11, 21 Click here to view |
 | Figure 7: Stainless steel crown - 75, 84 and 85, ring and loop infinite maintainer - 74 Click here to view |
This paper presents typical cases of asymptomatic late congenital syphilis with simply Hutchison's teeth. It is very important for a dentist to have a thorough knowledge of dental findings in systemic diseases, which helps in early diagnosis and further referral to concerned specialists. The present cases were diagnosed based only on the dental finding such every bit Hutchison'south teeth and mulberry molars during school dental check-upwardly. By this early diagnosis and systemic phase of treatment helped usa in preventing a child from further complications, which could take been fatal. In 21 st century when it is idea to be eradicated, information technology is re-emerging due to pitfalls in ANC or screening.
The origins of syphilis have been discussed for many centuries. Two primary theories accept been proposed - the New Earth or Columbian theory and the Onetime Earth or pre-Columbian theory. The erstwhile holds that the syphilis was endemic in the office of the earth now known as Haiti and was then acquired and carried to Europe by Columbus in the 1400s. The pre-Columbian theory purports that the syphilis originated in central Africa and was introduced to Europe prior to the voyage past Columbus. A third theory, the Unitarian theory, could exist made to fit the pre-Columbian theory. This theory proposed that syphilis and the nonvenereal treponematoses were all manifestations of the same infection, with the observed clinical differences beingness due mainly to environmental factors, especially temperature. [14],[15] Nevertheless, contempo bacteriological work has demonstrated genetic differences betwixt these organisms. [xvi] Regardless of the origins, however, it remains clear that by 1495, a widespread syphilis epidemic had spread throughout Europe. From there the disease spread to Republic of india in 1498. [15]
In 1905, the association of T. pallidum with syphilis was described past Schaudinn and Hoffman, who demonstrated spirochetes in Giemsa-stained smears of fluid from secondary syphilitic lesions. August von Wassermann devised a serum reaction exam for syphilis in 1906, and serologic tests for syphilis were born. [14] Treatments for syphilis included mercury, organic arsenical compounds, and bismuth until the advent of penicillin. [17] In 1943, Mahoney et al. successfully treated the first four cases of syphilis with penicillin, and more than half a century later penicillin remains the drug of pick. [eighteen] In our nowadays cases, benzithene penicillin of 2.4 million unit was administered by pediatrician for 3 weeks.
Congenital syphilis occurs when T. pallidum crosses the placenta from an infected mother to the fetus during pregnancy or by contact with an infectious lesion during nascency. Manifestations of congenital syphilis are divided into early and tardily signs based on the first 2 years of life. [1]
Tardily built syphilis is actually very rare and occurs in approximately xl% of untreated children. Syphilitic vasculitis effectually the time of nascence tin pb to dental abnormalities that occur in teeth that undergo calcification during the 1 st year of life. [19],[20] Sir Jonathan Hutchinson (1828-1913) from England described a triad in late congenital syphilis consisting of Hutchinson's teeth, interstitial keratitis and eighth nerve deafness. [4] Hutchinson'south teeth are peg-shaped, notched key incisors, while mulberry molars are multicuspid molars. The deciduous teeth have an increased take a chance of dental caries. [21],[22]
The dental defect represents a single disruption to tooth crown formation a few weeks after nascence or during the later evolution of the teeth; [23],[24] however, they simply become apparent with the eruption of the permanent incisors and kickoff molars effectually 6 years of historic period. [24],[25],[26] That is why this particular class of dental defect was non found on deciduous teeth. This procedure of dental defect is explained by inflammatory reaction induced by T. pallidum. The invasion of bacteria to proximity of dental germ in development contact to inhibition of ameloblasts, the cells responsible for the germination of tooth enamel. Permanent upper central incisor teeth ofttimes provide evidence for the diagnosis of late congenital syphilis. [24]
Interstitial keratitis is the typical ocular manifestation, ordinarily diagnosed between 5 and twenty years of age. Information technology tin can lead to secondary glaucoma or corneal clouding. [20] Eighth nerve deafness occurs in 3% of cases and is secondary to luetic involvement of the temporal bone. 8th nerve involvement can be unilateral or bilateral, and it may be responsive to corticosteroids. Although it is usually diagnosed between 30 and twoscore years of historic period, it oft occurs in the outset decades. [27]
A recent data from Globe Health Organization states that only 68% of women in developing countries receive ANC and of these almost one-half do not nourish ANC clinics until afterward the first trimester. [28] Current recommendations for the command of congenital syphilis include the performance of VDRL in the first prenatal appointment, with a repeat exam at the beginning of the 3 rd semester and at birth. [29],[30] Acceptable treatment for significant women is the all-time alternative, since this will prevent fetal infection, or promote cure earlier delivery. If prenatal treatment is not performed, the child must receive treatment as soon every bit possible during the neonatal menses. [30]
This paper high lightens the sensation of the importance of dental findings in systemic disease of tardily congenital syphilis, which is a very rare clinical entity and its importance to make early on diagnosis, and its proper management can preclude further complications. Although an effective treatment is available since the introduction of penicillin in the mid-twenty th century, it notwithstanding remains as an important public wellness trouble. These case reports of late congenital syphilis are a tragic reflection of pitfalls in the screening programs. More emphasis must be placed on principal prevention and appropriate screening programs so that maternal and neonatal syphilis can be identified and treated early on, avoiding significant time to come morbidity.
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[Figure ane], [Effigy two], [Effigy 3], [Effigy iv], [Figure 5], [Figure 6], [Figure 7]
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