Summary about Disease
Wimberger's sign refers to a radiographic finding seen in infants with congenital syphilis. It is characterized by erosive or destructive changes, specifically symmetrical osteolytic lesions, commonly observed in the proximal medial tibial metaphysis. It can also affect other long bones. While indicative of syphilis, it's important to remember that the presence of Wimberger's sign alone doesn't confirm the diagnosis; further testing is crucial.
Symptoms
Wimberger's sign itself isn't a symptom, but a radiographic finding. The underlying disease, congenital syphilis, presents with various symptoms which include:
Skin rashes (often on palms and soles)
Snuffles (a persistent, nasal discharge that is often bloody)
Hepatosplenomegaly (enlarged liver and spleen)
Jaundice (yellowing of the skin and eyes)
Anemia
Bone abnormalities (including pain and limited movement)
Failure to thrive
Pseudoparalysis of Parrot (limb pain causing the infant to avoid movement)
Causes
Wimberger's sign is caused by congenital syphilis. Congenital syphilis occurs when the bacterium Treponema pallidum is transmitted from a pregnant mother to her fetus. The bacteria infects the developing bones, leading to the characteristic lesions.
Medicine Used
The primary treatment for congenital syphilis (and thus to address the cause of Wimberger's sign) is penicillin. Aqueous crystalline penicillin G is typically administered intravenously. Procaine penicillin G can be given intramuscularly. Dosage and duration of treatment are determined by the infant's age and the severity of the infection.
Is Communicable
Congenital syphilis itself is not directly communicable from the infant to others through casual contact. However, syphilis in the pregnant mother is communicable through sexual contact. The transmission to the infant occurs in utero.
Precautions
Prenatal screening: All pregnant women should be screened for syphilis early in pregnancy and again in the third trimester or at delivery if they are at high risk.
Treatment of the mother: If a pregnant woman tests positive for syphilis, she must be treated immediately with penicillin. Adequate treatment before delivery prevents congenital syphilis in most cases.
Safe sex practices: Avoiding risky sexual behaviors, using condoms, and getting tested regularly for sexually transmitted infections reduces the risk of syphilis infection in the first place.
Infant evaluation: Infants born to mothers with syphilis should be thoroughly evaluated and treated, even if they appear asymptomatic.
Follow-up: Infants treated for congenital syphilis need close follow-up, including repeat serologic testing, to ensure the treatment was effective.
How long does an outbreak last?
"Outbreak" isn't the correct term here. Congenital syphilis is an infection present at birth. If left untreated, the effects of the infection (including bone abnormalities and other symptoms) can persist for years and cause significant long-term health problems. However, with appropriate penicillin treatment, the infection can be eradicated, and the progression of the disease halted.
How is it diagnosed?
Diagnosis involves a combination of:
Maternal history: Determining if the mother had syphilis during pregnancy.
Infant's physical exam: Looking for signs and symptoms of congenital syphilis.
Radiographic findings: Identifying Wimberger's sign on X-rays of the long bones.
Serological tests: Blood tests to detect the presence of Treponema pallidum antibodies in the infant's blood. RPR or VDRL tests are usually performed first, and if positive, are confirmed with a more specific test like the FTA-ABS or TP-PA.
Lumbar puncture: In some cases, a spinal tap (lumbar puncture) may be performed to check for neurosyphilis (syphilis affecting the brain and spinal cord).
Timeline of Symptoms
Congenital syphilis symptoms can present at different times:
Early Congenital Syphilis (0-2 years): Symptoms typically appear within the first few weeks to months of life. These include skin rashes, snuffles, hepatosplenomegaly, jaundice, anemia, and bone abnormalities (including Wimberger's sign).
Late Congenital Syphilis (after 2 years): If untreated, late manifestations can develop, including:
Hutchinson's teeth (abnormally shaped teeth)
Saddle nose deformity
Interstitial keratitis (eye inflammation)
Neurosyphilis (neurological problems)
Bone and joint problems
Important Considerations
Early diagnosis and treatment are crucial: The earlier congenital syphilis is diagnosed and treated, the better the outcome for the infant. Untreated congenital syphilis can lead to severe, irreversible complications, including developmental delays, neurological damage, and even death.
Treatment failure: While penicillin is highly effective, treatment failure can occur. Careful monitoring of the infant's serological response is essential to ensure the infection is eradicated.
Jarisch-Herxheimer reaction: Following penicillin treatment, some infants may experience a Jarisch-Herxheimer reaction, characterized by fever, chills, and rash. This is a self-limited reaction due to the release of bacterial products as the bacteria are killed.
Partner notification and treatment: It's crucial to identify and treat the mother's sexual partner(s) to prevent further spread of syphilis.
Public health reporting: Congenital syphilis is a reportable disease, and healthcare providers are required to notify public health authorities.