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Syphilis, caused by the spirochaete Treponema pallidum is one of the most important venereal disease.
The chancre begins as a solitary, slowly growing, hard, pale brownish – red, usually painless nodule, that varies in size up to several centimeters in diameter. The contagious induration characteristically creates a button like mass directly subjacent to the eroded skin or mucosa, providing the basis of the designation hard chancre. The ulcer persists for 3-12 weeks, during which the inguinal lymph nodes, usually on both sides, become somewhat enlarged and hard, with nonspecific acute or chronic lymphadenitis (inguinal lymphadenopathy). Histologically, the chancre is characterized by a intense mononuclear leukocytic infiltration, chiefly of plasma cells with scattered, macrophages and lymphocytes, which are mainly responsible for the hardness and swelling. Papular lesions in the region of the penis or vulva may become large, elevated, broad plaques.
Histologically, in the secondary lesions in the skin and mucous membranes, the main changes are vascular enlargement and infiltration, mainly of plasma cells, but also lymphocytes, and macrophages. Tertiary lesions appear irregularly, especially in the internal organs, skin and mucous membranes; they are few but usually much larger than the primary and secondary lesions, and lead to serious and permanent damage.
Gumma is a characteristic lesions of tertiary syphilis, which may form in any organ or tissue. A thick hydrogel lens may be used to provide mechanical support — this case illustrates a descemetocoele secondary to herpes zoster keratitis. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics. Various dematomycosis, such as tinea corporis, tinea cruris, tinea manus, tinea pedis and tinea versicolor.
Local pruritis, neurodermitis, contact dermatitis, seborrheic dermatitis and chronic eczema. Eczema, contact dermatitis, seborrheic dermatitis, neurodermitis, tinea corporis, tinea cruris and tinea manus and pedis.
Acne vulgaris, in particular blackhead acne lesions, senile, sunlight or drug-induced skin atrophy, hyperkeratosis ichthyosis and a variety of unusual calm and excessive skin pigment and psoriasis. Acne vulgaris, in particular blackhead acne lesions, senile, sunlight or drug-induced skin atrophy, hyperkeratosis ichthyosis and a variety of unusual calm and excessive skin pigment and psoriasis. Eczema, contact dermatitis, seborrheic dermatitis, neurodermitis, tinea corporis, tinea cruris and tinea manus and pedis.
Local pruritis, neurodermitis, contact dermatitis, seborrheic dermatitis and chronic eczema.
Various dematomycosis, such as tinea corporis, tinea cruris, tinea manus, tinea pedis and tinea versicolor. It is a worldwide disease, which is transmitted almost exclusively by sexual contact (acquired syphilis).
The classic lesion of primary syphilis is the chancre, a characteristic ulcer located at the site of Treponema pallidum inoculation. Then it superficially erodes to create a clean-based, shallow ulceration on the surface of the slightly elevated papule. When the lesion is on a mucous surface and the part is not kept clean, there may be more extensive ulceration and suppurative exudation.
The most common presentation of secondary syphilis is a rash, which appears 2 weeks to 6 months after the chancre heals, with multiple symmetrical lesions of the skin and squamous mucous membranes.


These flat red-brown elevations (up to 2-3 cm in diameter) are designated conylomata lata (wart like lesions on the genitals). Characteristic changes include a thickened capsule, follicular hyperplasia, increased numbers of plasma cells and macrophages, luetic vasculitis.
After some months all these features disappear spontaneously and the disease becomes latent. When the rash is distinctly papular it is usually accompanied by thickening of the epithelium.
After the lesions of secondary syphilis have subsided, an asymptomatic period lasts for years or decades.
Cardiovascular syphilis principally involving the aorta, may become manifest after several years from the initial infection.
The slowly progressive infection damages the meninges, cerebral cortex, spinal cord, cranial nerves, or eyes. Although varicella is most often a relatively benign and self-limited childhood illness, the disease can be associated with a variety of serious and potentially lethal complications in both immunocompromized and immunocompetent persons.
Group A streptococcal necrotizing fasciitis complicating primary varicella: A series of fourteen patients. Invasive group A streptococcal infections in children with varicella in Southern California. Population-based surveillance for group A streptococcal necrotizing fasciitis: Clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases.
Skin, finger (toe) infection caused by dermatophyte, yeast and other fungal, such as: tinea corporis, tinea of feet and hands, tinea versicolor, tinea capitis, tinea barbae , tinea unguium , Candidiasis of skin and nail , angular stomatitis , otitis externa. By the yeast (such as Candida) and gram-positive bacterial vaginal infections and secondary infection.
Skin, finger (toe) infection caused by dermatophyte, yeast and other fungal, such as: tinea corporis, tinea of feet and hands, tinea versicolor, tinea capitis, tinea barbae , tinea unguium , candidiasis of skin and nail , angular stomatitis , otitis externa. By the yeast (such as Candida) and gram-positive bacterial vaginal infections and secondary infection. The chancre appears usually on the external genitals (gland penis, vulva), one week to 3 months after exposure, with an average incubation period of 3 weeks.
The rash is erythematous (discrete red-brown lesions) and maculopapular, involving the trunk and extremities and often including the palms and soles. However, during this latent period, spirochetes continue to multiply, and the deep-seated lesions of tertiary syphilis gradually develop and expand.
Gummas are most commonly found in the skin, bone and joints, although the lesion may occur in any body site. Tertiary syphilis involving the central nervous system is sub-classified according to predominant tissue affected.
Though necrotizing fasciitis following chicken pox has been reported, literature search has revealed that it has not been reported in infants in India so far. Because this product has the antibacterial function to the Gram-positive bacteria, can be used for such a secondary bacterial infection. Because this product has the antibacterial function to the Gram-positive bacteria, can be used for such a secondary bacterial infection. Blood transfusions, direct inoculation and nonsexual contact are only rare causes of syphilis.


In approximately 10% of cases the chancre may be extra-genital: lips, fingers, oropharynx, anus, rectum, or some other site. They cause extensive destruction like in the nasal bones with loss of the bridge of the nose and perforation of the palate, ulceration and destruction of the larynx, creeping ulcers in the skin.
Thus, there are references to meningovascular syphilis (meninges), tabes dorsalis (spinal cord), and general paresis (cerebral cortex).
Five cases of necrotizing fasciitis as a complication of varicella have been reported in India, but all of them are above one year, hence this case is being reported. The course of acquired syphilis is classically divided into 3 stages: primary, secondary, and tertiary syphilis. In about 50% of females and 30% of males, primary lesions either never develop, or are not detected. There was a history of papulo-vesicular rash in the elder sibling 3 weeks back, which was diagnosed as varicella.
The patient's past history was of no significance and there was no history of repeated chest infections. The physical examination revealed that the child was febrile with healed scabs over the extremities [Figure 1]. There was puffiness around eyes with swelling and induration over the nape of the neck extending from sub-occipital region to the nape of the neck [Figure 2].
The local examination revealed indurated lesions with discoloration suggestive of necrotizing fasciitis. The child was treated with intravenous ceftriaxone, metronidazole, and surgical debridement was undertaken [Figure 3].
The child responded to treatment by clinical improvement and reduction of the induration with localization of the lesion. Type I Necrotizing fasciitis refers to mixed infections involving anaerobes and one or more facultative anaerobes, such as streptococci and members of the Enterobacteriaceae family.
The most common type of Necrotizing fasciitis is type II.Necrotizing fasciitis as a complication of varicella zoster infection is rare, but it is a serious condition with potential devastating sequelae and requires prompt diagnosis and surgical management. The condition is difficult to recognize in early phase, when it is often confused with cellulitis, but symptoms like rapid progression, poor therapeutic response, blistering necrosis, cyanosis, extreme local tenderness, high temperature, tachycardia, hypotension, and altered level of consciousness may suggest necrotizing fasciitis. In our case the complication developed on the fifth day of the rash.Given the rapid progression of infection, patients suspected of having necrotizing fasciitis must be admitted to hospital and monitored very closely. Although imaging with ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI) have been noted to be of value in diagnosing Necrotizing fasciitis, surgical management should not be delayed in favor of these assessments. Initially the patient should be started on a combination of clindamycin and a third-generation cephalosporin that covers Pseudomonas aeruginosa.
Once culture findings and bacterial sensitivity are obtained, antibiotics are administered accordingly. Antibiotics alone, because of their inability to reach the poorly vascularized and necrotic fascia, have little effect if surgery is not performed.
Varicella vaccine is recommended for routine administration as a two dose regimen to healthy children at ages 12-15 months and 4-6 years.



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