Congenital and Acquired Syphilis in Infants and Children

Abstract

The favorable implications of massive dose arsenotherapy of early syphilis in adults by the intravenous drip method focused our attention on the possibility of employing such a method in the treatment of congenital and acquired syphilis in infants and children.The following report is presented to record the results of treatment of 36 infants and children, 32 of whom had congenital syphilis and 4 acquired syphilis, the study extending from August 1940 to the present date. We have attempted to evaluate the efficacy, optimal dosage, technic and toxicologic effects of five day intravenous drip mapharsen therapy. The spirochetosis of congenital syphilis with its widespread changes presents a far more complex problem than the early syphilis of adults. The nutritional and developmental status of the infant has been profoundly altered; growth and metabolism are retarded. Neonatal syphilis calls for, first, exacting pediatric care to save life and, second, antisyphilitic treatment. PLAN OF STUDYThe status of the serologic reaction of the blood and of the liver, kidneys, bones and hemopoietic sys¬ tem was studied immediately before, during and after treatment.Preliminary laboratory studies included roentgenograms of the long bones, the standard and quantitative Kahn tests, the Kolmer complement fixa¬ tion test, complete blood counts including a platelet count, urinalyses including a determination of urobilinogen excretion, and blood chemistry determinations including those of the nonprotein nitrogen, total serum protein, serum albumin and globulin, icteric index, calcium, phosphorus and ascorbic acid. During treat¬ ment blood counts and urinalyses were done.On the day after the completion of the mapharsen venoclysis all laboratory determinations performed before treatment were repeated. During the remainder of the child's stay in the hospital quantitative Kahn tests were performed weekly and urinalyses, blood counts and blood chemistry determinations as indicated. Following discharge from the hospital all patients returned monthly to our outpatient clinic for further sérologie study, clinical observation and infant and child welfare guidance. Roentgen studies were repeated every three months. TREATMENTPreparatory.-Before we proceeded with the insti¬ tution of intravenous arsenotherapy the physical and nutritional status of the infant or child was carefully studied. Extremely debilitated infants observed in the neonatal period and those seen in the first half year of life with evident syphilis of the skin, viscera or bones were never placed on specific therapy until their ability to take food and maintain themselves was proved. During this period they were given a pre¬ liminary course of mercurial inunctions (1 Gm. of 10 per cent ointment) three times a week for a period of two or more weeks, until they gave satisfactory evidence of a favorable response as shown by a gain in weight and improved clinical appearance. Infants with severe anemia were given citrated blood trans¬ fusions from our blood bank in the amount of 10 cc...