Congenital Syphillis, Reccurent Apthae, Behcets and Reiter's Syndrome

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Congenital Syphilis

• Congenital syphilis is syphilis present in utero and at birth, and occurs when a child is born to a mother with secondary syphilis

• If a pregnant mother is identified as being infected with syphilis, treatment can effectively prevent congenital syphilis from developing in the unborn child, especially if she is treated before the sixteenth week of pregnancy

• Result in Still birth / congenital syphilis / normal child

• Frontal bossing and short maxilla

• High arch palate and mulberry/moon molar

• Saddle nose Higoumenaki’s Sign

• Rhagades Shaber shin

Treatment

• A woman in the secondary stage of syphilis decreases her child's risk of developing congenital syphilis by 98% if she receives treatment before the last month of pregnancy.

• An affected child can be treated using antibiotics much like an adult; however, any developmental symptoms are likely to be permanent

Recurrent Aphthous stomatitis

• also termed canker sores, recurrent aphthous stomatitis, RAS, recurring oral aphthae and recurrent aphthous ulceration

• repeated formation of ulcers in the mouth

Etiology

• The cause is not entirely clear, but is thought to be multifactorial

• Multiple research studies have attempted to identify a causative organism

• Genetic History• Immunology• Iron, Vitamin B, Folic Acid deficiency

Precipitating Factors

• Trauma• Endocrine Factors• Psychic Factors• Allergic Factors• Systemic Disease

Classification

• Recurrent Aphthous minor• Recurrent Aphthous major• Recurrent Herpetiform ulceration• Associated with Behcet’s syndrome

Clinical Features , Mikulicz ulcers• They occur mainly in persons 10-40 years of age.• They often cause pain and inability to eat .• They are small round or ovoid ulcers 2-4 mm in diameter• Ulcer floor that is yellowish but assumes a gray hue.• Surrounded by an erythematous halo and some edema.• They are found mainly on the nonkeratinized mobile mucosa. • They occur in groups of only a few ulcers (ie, 1-6) at a time.• They heal in 7-10 days.• They leave little or no evidence of scarring.

Sutton ulcers• They are larger, of longer duration, of more frequent

recurrence, and often more painful.• They are round or ovoid like MiAUs but are larger• They reach a large size, usually about 1 cm or more• They are found on any area of the oral mucosa• They occur in groups of only a few ulcers (ie, 1-6) • They heal slowly over 10-40 days.• They recur extremely frequently.• They may heal with scarring.

Herpetiform ulceration (HU)

• They are found in a slightly older age group, in females• They begins with vesiculation that passes rapidly into

multiple, minute, pinhead-sized, discrete ulcers.• They involve any oral site, including the keratinized

mucosa, increase in size, and coalesce to leave large round ragged ulcers.

• They heal in 10 days or longer.• They are often extremely painful.• They recur so frequently that ulceration may be

virtually continuous.

Histologic Features...

• Ulceration• Fibrinopurulent membrane• Micro organism• Granulation tissue• Inflammation• Endothelial cells• Fibrosis

• Anitshow cell

Treatment Modalities

• Antibiotics• Antiseptics• Diet Suppliment• Symptomatic Treatment

Behçet's syndrome

• Turkish dermatologist Hulusi Behçet, 1937 • a syndrome of recurrent aphthous ulcers, genital ulcerations,

and uveitis leading to blindness.• Etiology is proposed to be an infectious trigger, with

inflammatory mediators and immune deregulation• HLA B 51• Environmental Factors• Infections

• In 1990, the International Study Group (ISG) for Behçet's Disease clarified criteria for the diagnosis of Behçet disease

• Recurrent painful genital ulcers that heal with scarring• Ophthalmic lesions, including anterior or posterior uveitis,

hypopyon, or retinal vasculitis• Skin lesions, including erythema nodosum–like lesions,

pseudofolliculitis, or papulopustular or acneiform lesions

Oral Lesions

• Painful oral lesions • (aphthous or herpetiform)• high recurrence rate• multiple lesions or crops• commonly found in • keratinized areas

Skin lesions

• lesions often occur in the genital region of both sexes

• In males, scrotal, penile shaft.• In females, the labial area, vagina and on the

perineum• Acneiform papulopustular lesions

Ocular Lesions• anterior or posterior uveitis, hypopyon• Symptoms commonly include blurred vision,

periorbital pain, photophobia, and excessive lacrimation.

• Highly recurrent posterior uveitis can lead to blindness.

Lab Findings

• Hypergammaglobulinemia• Leukocytosis with eosinophilia• CRP, C9, C3 and C4 may be elevated

Treatment

• No specific treatment• May spontaneously resolve or lead to death

Reiter’s Syndrome

• characterized by a triad of balanitis, urethritis, and conjunctivitis, and by lesions of the skin and mucosal surfaces.

• Infectious origin ??• Mimics Gonorrhea• Considered to be an immunodysregulated

condition• HLA B27

• Urethritis is a common condition of Reiter's. This involves inflammation of the urethra

• Arthritis - experience swelling and tenderness• conjunctivitis may develop.• Skin lesions appear as small, painless sores

on the head of the penis, roof of the mouth or tongue.

Oral Manifestations

Treatment

• May undergo spontaneous remission• Can be treated by antibiotics and

corticosteroids...

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