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PubMed2002

Antibacterial therapy of neurosyphilis: lack of impact of new therapies.

Neurosyphilis is caused by the spirochete Treponema pallidum. These organisms divide slowly, requiring long exposure to antibacterials for treatment success. In order for an antibacterial to be effective in the therapy of neurosyphilis, it must achieve treponemicidal concentrations in the CSF, have a long half-life and be given in a treatment regimen that favours compliance. Penicillin was first introduced for the treatment of syphilis in 1943, and despite interest in the use of amoxicillin, erythromycin, tetracycline, doxycycline, ceftriaxone and azithromycin, penicillin remains the only recommended antibacterial agent for neurosyphilis.

Antitreponemal Agents↗

PubMed1998

The elderly psychiatric patient with positive syphilis serology: the problem of neurosyphilis.

OBJECTIVE: Older patients have a high prevalence of neurological and psychiatric disorders. They also have a baseline prevalence of late latent syphilis or positive syphilis serology. Thus the clinical question arises as to whether a neuropsychiatric disorder in a geriatric patient is neurosyphilis or if the positive serology is incidental. METHOD: An illustrative case example is used to illustrate this dilemma. The relevant literature is reviewed. RESULTS: The cerebrospinal fluid (CSF) protein is an important indicator of inflammatory activity in the central nervous system and is used as a clinical guide in the diagnosis. Elderly patients have higher values of normal CSF protein than younger patients. CONCLUSIONS: Given the importance of CSF protein in the diagnosis of neurosyphilis, physicians must include this knowledge, that elderly patients have higher CSF protein values, in their clinical decision making in the differentiation between neurosyphilis and late latent syphilis in the elderly patient.

Aged↗

PubMed1999

Recrudescence of treated neurosyphilis in a patient with human immunodeficiency virus.

The natural history of syphilis has been altered by the human immunodeficiency virus (HIV) epidemic. Treatment of patients coinfected with syphilis and HIV is currently controversial; progression and relapse of neurosyphilis have been reported. This case report documents failure of primary treatment and neurosyphilitic recrudescence. In a 32-year-old HIV-positive woman with syphilis who had no additional sexual contacts, the disease progressed to neurosyphilis despite three intramuscular doses of penicillin. After extended intravenous penicillin treatment, neurosyphilis later recurred and re-treatment was necessary. Because many urban centers are affected by high rates of sexually transmitted diseases, including common coinfections of syphilis and HIV, further efforts should be made to identify subsets of patients who may be at high risk of syphilitic recrudescence.

Adult↗

PubMed2006

[Neurosyphilis and bladder dysfunction].

OBJECTIVES: Syphilis is a systemic disease the course of which follows successive clinical stages. Central nervous system and spinal cord involvement on late phases may lead to bladder dysfunction. We report one case of neurosyphilis with associated bladder hyperreflexia. METHODS/RESULTS: 51-year-old male with the diagnosis of neurosyphilis consulting for voiding disorders with evidence of detrusor hyperactivity of neurogenic etiology on the urodynamic study. CONCLUSIONS: The differential diagnosis of neurogenic bladder in patients with psychiatric or neurological symptoms should include neurosyphilis. Etiologic diagnosis is obtained by cerebrospinal fluid examination, and the diagnosis of bladder dysfunction by urodynamic study.

Humans↗

PubMed2000

Neurosyphilis as a cause of facial and vestibulocochlear nerve dysfunction: MR imaging features.

The prevalence of syphilis increased for several decades before the mid-1990s in the United States, particularly in the southern states. We report a case of neurosyphilis causing bilateral facial and vestibulocochlear nerve dysfunction in which the diagnosis was not initially suspected based on the patient's demographics and history. The MR imaging features helped to make the diagnosis in this case and to exclude other possible causes of multiple cranial nerve dysfunction in this patient. Hearing loss associated with neurosyphilis is one of the few treatable forms of progressive hearing loss, and it is essential that a diagnosis of neurosyphilis be made expeditiously.

Facial Nerve↗

PubMedDate not supplied

[Headaches, otalgia and peripheral facial palsy as a form of presentation of neurosyphilis].

INTRODUCTION: Decrease in incidence of neurosyphilis over the last few decades implies that clinicians consider less frequently this diagnosis. On the other hand, some reports suggest an increase in atypical forms of this disease that represent an additional reason for missing this diagnosis. CLINICAL CASE: We report on a 16 year-old immunocompetent black female from Guinea-Bissau presented with headaches, ear pain, hearing loss and peripheral facial paralysis. A cranial CT scan showed a hypodense area in the left cortico-subcortical zone and a contrast enhancement on the left pontocerebellar angle and internal auditory meatus. On the third day of admission a diagnosis of meningitis was made, with high titles of VDRL and TPHA in CSF and serum, leading to a diagnosis of neurosyphilis. The epidemiological aspects of this case suggest either a late congenital syphilis or an infection as a result of a blood transfusion administered seven years earlier in Guinea-Bissau. CONCLUSION: This rare form of presentation of neurosyphilis emphasizes the importance of considering systematically this diagnosis, even in the context of atypical presentations.

Adolescent↗

PubMed2002

Neurosyphilis.

We describe the case of a young woman with a rapid deterioration in her cognitive status and physical functioning. An extensive laboratory and radiologic evaluation confirmed the diagnosis of neurosyphilis. Despite the reemergence of syphilis with the acquired immunodeficiency syndrome (AIDS) epidemic, neurosyphilis is often neglected in the differential diagnosis of patients with aseptic meningitis and mental status changes who are negative for the human immunodeficiency virus (HIV). The high mortality rateassociated with delay in recognition, diagnosis, and treatment of neurosyphilis obligates its inclusion in the differential of young patients with cognitive decline.

Cognition Disorders↗

PubMed1992

Psychiatric manifestations of neurosyphilis.

To investigate referral patterns, initial diagnoses and clinical features of patients with neurosyphilis who present with psychiatric manifestations, records were kept of 21 such patients admitted to an acute psychiatric ward. In none of the 12 cases referred from primary care workers was the possibility of neurosyphilis considered. In only 3 cases was this diagnosis considered on admission to the psychiatric ward before serum serological test results were known. Commonest presenting symptoms were personality change (16 patients) and memory impairment (13 patients). Neurological signs or symptoms were also common, particularly absent pupillary reaction to light (5 patients) and buccolingual masticatory movements (5 patients). A positive serological test remains the single most important factor in identifying patients with neurosyphilis.

Adult↗

PubMed2005

[Epidemiological and clinical aspects of neurosyphilis in Morocco].

Neurosyphilis accounts for 56%-70% of all visceral syphilis and is a complication in 5%-10% of cases of untreated syphilis. The aim of this study was to evaluate the epidemiological aspects and clinical presentations of neurosyphilis in Morocco through a series of 201 patients attending the Centre for Neurological Services at the university hospital in Rabat between 1986 and 1997. The mean age of the patients was 41.26 (SD 9.23) years (range: 17-70 years); the majority (91%) were male. The incidence of neurosyphilis in Morocco is high. From 31 cases per year in 1985, it has fallen since 1990 to reach 10 cases in 1997. Among the different clinical presentations recorded, chronic meningoencepahalitis was the commonest, followed by meningovasculitis, tabes dorsalis and optic atrophy.

Adolescent↗

PubMed1985

[Immunology of neurosyphilis: intrathecal synthesis of Treponema pallidum-specific IgG and IgM antibodies].

Due to uncharacteristic symptoms of central nervous system (CNS) alterations during Treponema pallidum (TP) infection, the exact diagnosis of neurosyphilis has become more and more difficult. Particularly, there is a lack of sufficiently specific and sensitive assays for the demonstration of intrathecal synthesis of TP-specific immunoglobulins. TP-specific IgG or IgM class antibodies were estimated quantitatively in serum and cerebrospinal fluid (CSF) of 302 syphilitic patients by a modified enzyme immunoassay (ELISA), and antibody concentrations were quantitated as ELISA units per mg total IgG or IgM. In 197 of 237 patients with neurosyphilis an intrathecal synthesis of TP-specific IgG or IgM could be demonstrated by a 3- to 450-fold higher antibody concentration in the CSF than in the corresponding serum. In contrast, 65 patients without CNS involvement on the infection did not show any difference in the antibody concentration of CSF and serum. Thus, the diagnosis of neurosyphilis respectively the exclusion of CNS participation on the TP infection on an immunological base has become possible.

Adult↗

PubMed1983

[Hearing and equilibrium disorders in patients with neurosyphilis].

83 patients with neurosyphilis and 12 patients with latent syphilis underwent a cochleovestibular examination. Pathological changes were present in 54% of the patients with neurosyphilis. In the group of patients with latent syphilis functional changes could only be found in 25% of the patients. The greatest number of hearing disturbances occurred in persons suffering from general paresis, 65% were affected. Usually damage occurred in both ears. Specific topical diagnosis was often not possible although the results of the stapedial reflex indicated that peripheral cochlear lesions were present. In particular damage in the level of the high frequencies seemed to be prevalent. Disturbances of the vestibular system occurred in 25% of neurosyphilis patients. Most frequently lesions occurred in patients with cerebrospinal syphilis (40%). The comparison of subjective and objective symptoms of the vestibular system were very similar in most groups. As for the results presented it is suggested that a serological treponemal test should be undertaken in patients with non-specific disturbances of the vestibulo-cochlear system.

Adult↗

PubMed1994

The usefulness of cerebrospinal fluid tests for neurosyphilis.

To determine the usefulness of cerebrospinal fluid (CSF) tests for syphilis at a large academic hospital, clinical and laboratory data on 644 patients in whom such testing was requested over a 12-month period were analysed. In 198 cases (31%) the Treponema pallidum haemagglutination (TPHA) screening test could not be performed because of insufficient fluid. Thirty-eight of the remaining patients were diagnosed as having active neurosyphilis. Examination of 22 files of patients who had a positive TPHA and fluorescent treponemal antibody absorption (FTA-Abs) test together with a negative CSF Venereal Disease Research Laboratory (VDRL) test revealed that other CSF measures indicating disease activity (CSF protein, cells or IgG index) were not utilised optimally. In 10 (45%) of these patients neurosyphilis was not diagnosed despite either abnormal or incomplete CSF biochemical analysis, indicating that if the CSF VDRL is used as the sole marker for disease activity, some cases of neurosyphilis are likely to be missed.

Adult↗

PubMed1977

Neurosyphilis.

In the future it seems probable that cases of neurosyphilis will be seen sporadically by physicians and neurologists. As a result of the almost universal ingestion of antibiotics for trivial conditions, many cases of syphilis will be modified or arrested and some patients will be cured of the disease without ever knowing that they have acquired it. In others, developing neurosyphilis may be attenuated by inadequate chance treatment and the clinical and laboratory manifestations may become more subtle and difficult to recognize, leading to errors in diagnosis. Clinical experience of the varied manifestations of neurosyphilis has become less widespread among physicians and consequently greater care should be taken to ensure that the diagnosis is not missed.

Adolescent↗

PubMed1997

[Neurosyphilis with multiple gummas and AIDS. Report of a case].

The incidence of neurosyphilis has been increasing since AIDS has appeared but acute gummatous necrotizing progression is so far exceptional. We report a second case of "quaternary neurosyphilis" in a 29-year-old patient without serologic nor CT scan evidence of treponema. Diagnosing neurosyphilis is particularly difficult in HIV-1 infected patients, specially in spirochetes-poor injuries.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Neurosyphilis manifesting as spinal transverse myelitis.

Spinal myelitis caused by neurosyphilis is an extremely rare disease, and there are only few visual examples of magnetic resonance imaging scans. We present a clinical case of neurosyphilis, which is of great importance concerning diagnostic, differential diagnosis, and tactics of management. A patient complaining of progressive legs weakness, numbness, and shooting-like pain in the legs as well as pelvic dysfunction was admitted to the hospital. Neurological examination revealed spinal cord lesion symptoms: legs weakness, impairment of superficial and deep sensation together with pathological symptoms in the legs. Hernia of intervertebral disc or tumor was suspected, and myelography with computed tomography of the spine was performed. No pathological findings were observed. More precise examination of the patient (a small scar in the genitals and condylomata lata in anal region were noticed) pointed to possible syphilis-induced spinal cord lesion. Serologic syphilis diagnostic tests (Treponema pallidum hemagglutination assay, reagin plasma response, serum enzyme-linked immunosorbent assay) and cerebrospinal fluid tests (general cerebrospinal fluid test and Venereal Disease Research Laboratory test) confirmed the diagnosis of neurosyphilis. Spinal cord lesion determined by magnetic resonance imaging was evaluated as spinal syphilis or syphilis-induced myelitis. Conventional treatment showed a partial effect.

Adult↗

PubMed1985

Neurosyphilis.

Syphilis and its consequent central nervous system sequelae remain clinical problems, especially when presenting in the unfamiliar acute meningeal forms of syphilitic meningitis and meningovascular syphilis. The diagnosis of neurosyphilis of all types depends on evaluation of spinal fluid reactivity as evidenced by pleocytosis and increased protein content with reactive serology. The cerebrospinal fluid is always abnormal in active disease, and only active disease responds to treatment. Penicillin remains the drug of choice for all forms of neurosyphilis, but disease progression has been frequently reported following the use of penicillin G benzathine. Documentation of cerebrospinal fluid resolution over the months following penicillin therapy is required to confirm curative treatment.

Adult↗

PubMed1982

Neurosyphilis: intrathecal synthesis of oligoclonal antibodies to Treponema pallidum.

Oligoclonal IgG was present in the cerebrospinal fluid (CSF) of each of three patients with neurosyphilis studied. Conventional serological tests disclosed reduced serum/CSF ratios of antibodies to Treponema pallidum (TP) in each patient, consistent with intrathecal production of treponemal antibodies. Antibody analyses of electrofocused specimens by an immunofixation technique disclosed intrathecal production of oligoclonal TP antibodies in all patients. Treponemal antibody light chains showed a close correlation with the light chains of the oligoclonal CSF IgG. Absorption of the CSF with TP caused removal of the oligoclonal IgG. The results provide strong evidence that the oligoclonal CSF IgG in neurosyphilis represents TP antibodies, reflecting a specific immune response in the central nervous system to the infectious agent.

Aged↗

PubMed2004

Neurosyphilis masquerading as corticobasal degeneration.

We report on a patient with a syndrome resembling corticobasal ganglionic degeneration (CBD), including slight cognitive impairment, asymmetric akinesia, rigidity with myoclonus, and arm levitation, which can be one of the features of alien limb phenomenon; however, further diagnostic testing was consistent with neurosyphilis. Syphilis, "the great imitator," may also masquerade as CBD. Because neurosyphilis is treatable, it should be considered in the workup of patients with cognitive impairment and motor signs of CBD.

Atrophy↗