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Vomer RP, Narducci D, York E, Milon R, Udoh I. An Unexpected Finding in a Concussed Circus Acrobat. Cureus 2023; 15:e37960. [PMID: 37223133 PMCID: PMC10200774 DOI: 10.7759/cureus.37960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Persistent post-concussive syndrome (PPCS) outlines a complex array of neurocognitive and psychological symptoms that persist in patients after a concussion. A 58-year-old female presented reporting recurrent loss of consciousness, and retrograde and anterograde amnesia following multiple concussions. She also endorsed persistent nausea, balance insufficiencies, hearing loss, and cognitive impairment. In addition, this patient had high-risk sexual behavior without prior testing for sexually transmitted infections. Given her clinical history, the differential included PPCS, complex post-traumatic stress disorder, Korsakoff syndrome, hypothyroidism, and sexually transmitted infection (STI)-related neurocognitive disorder. On exam, this patient had a positive Romberg sign, prominent resting tremoring of upper extremities, and pinpoint pupils unresponsive to light, with bilateral nystagmus. Syphilis testing was positive. The patient was treated with intramuscular benzathine penicillin with significant improvement in gait, balance, headaches, vision, and cognition three months after treatment. Although rare, neurocognitive disorders, including late-stage syphilis, should be considered in the differential diagnosis for PPCS.
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Affiliation(s)
- Rock P Vomer
- Family Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
- Department of Family and Community Health, Department of Orthopaedic Surgery, Division of Sports Medicine, Duke University, Durham, USA
| | - Dusty Narducci
- Family Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Emma York
- Family Medicine, Eastern Virginia Medical School, Norfolk, USA
| | - Ryan Milon
- Family and Community Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
| | - Imoh Udoh
- Department of Orthopaedic Surgery, Division of Sports Medicine, Duke University, Durham, USA
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Witt LS, Wendy Fujita A, Ho J, Shin YM, Kobaidze K, Workowski K. Otosyphilis. Open Forum Infect Dis 2022; 10:ofac685. [PMID: 36776779 PMCID: PMC9907508 DOI: 10.1093/ofid/ofac685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Otosyphilis can be challenging to diagnose, but, if left unrecognized, it may cause irreversible damage. An immunologic interplay between syphilis and human immunodeficiency virus (HIV) makes coinfection likely and may predispose people with HIV to neurosyphilis. In this study, we present a case of a man in his 50s with hearing loss and vertigo diagnosed with otosyphilis as well as a new diagnosis of HIV. This case and corresponding discussion serve to inform the noninfectious disease-trained clinician of the symptoms, diagnostics, and treatment options for otosyphilis as well as to discuss the relationship between HIV and syphilis and demonstrate the importance of disease recognition.
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Affiliation(s)
- Lucy S Witt
- Correspondence: Lucy S. Witt, MD, MPH, 550 Peachtree St. NE, Medical Office Tower, FLR. 7, Atlanta, GA 30308. E-mail: . Wendy Fujita, MD, Department of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30308. E-mail:
| | - A Wendy Fujita
- Correspondence: Lucy S. Witt, MD, MPH, 550 Peachtree St. NE, Medical Office Tower, FLR. 7, Atlanta, GA 30308. E-mail: . Wendy Fujita, MD, Department of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30308. E-mail:
| | - Jeanne Ho
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yoo Mee Shin
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ketino Kobaidze
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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3
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Henriques BL, Cortez AL, Nunes NN, Vidal JE, Avelino-Silva VI. Clinical outcomes of HIV-syphilis coinfection among patients with no neurological symptoms: a retrospective cohort study. HIV Med 2022; 23:1041-1050. [PMID: 35340123 DOI: 10.1111/hiv.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Our objective was to describe and compare the occurrence of neurological outcomes and neurosyphilis in people living with HIV with incident syphilis and no neurological symptoms who underwent early screening for asymptomatic neurosyphilis (ANS) or regular clinical management without a lumbar puncture. METHODS This was a retrospective cohort study in a single referral centre of Sao Paulo, Brazil. Patients with incident syphilis diagnosed between January 2000 and August 2016 and meeting the adapted criteria for ANS investigation suggested by Marra et al. (CD4+ T-cell counts ≤350 cells/mm³ and/or venereal disease research laboratory test results ≥1:16) were identified. Those with no neurological symptoms and immediately referred for lumbar puncture were categorized as group 1, and those not referred for cerebrospinal fluid collection were categorized as group 2. We compared the occurrence of neurological symptoms and neurosyphilis diagnoses between the groups using incidence rates and Kaplan-Meier curves. RESULTS We included 425 participants with a median follow-up of 6 years. The incidence rate of neurological symptoms was 36.5/1000 person-years in group 1 and 40.6/1000 person-years in group 2 (incidence rate ratio [IRR] 0.90; 95% confidence interval [CI] 0.57-1.39; p = 0.62). The incidence rate of neurosyphilis was 15.0 cases/1000 person-years in group 1 and 6.7 cases/1000 person-years in group 2 (IRR 2.26; 95% CI 0.93-5.68; p = 0.05). CONCLUSIONS We found no statistically significant differences between groups in the incidence rates of neurological symptoms and neurosyphilis. Our findings support the current guidelines, which suggest a less invasive approach regarding ANS investigation among people living with HIV with incident syphilis.
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Affiliation(s)
- Barbara L Henriques
- Department of Infectious Diseases, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - André L Cortez
- Department of Infectious Diseases, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - Nathália N Nunes
- Department of Infectious Diseases, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - José E Vidal
- Department of Infectious Diseases, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil.,Departament of Neurology, Instituto de Infectologia Emilio Ribas, Sao Paulo, Brazil
| | - Vivian I Avelino-Silva
- Department of Infectious Diseases, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
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Neß T, Winterhalter S, Stübiger N. Infectious Posterior Uveitis - Toxoplasmosis, Treponema, Tuberculosis (TTT). Klin Monbl Augenheilkd 2022; 239:666-675. [PMID: 35320874 DOI: 10.1055/a-1727-1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Toxoplasma gondii, Treponema pallidum and Mycobacterium tuberculosis are the most important infectious causes of posterior uveitis. The epidemiology, clinical picture, diagnostic and treatment strategies of these diseases are presented.
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Affiliation(s)
- Thomas Neß
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Deutschland.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | | | - Nicole Stübiger
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Mejdoubi A, Khoulali M, Raouzi N, Nasri S, Mebrouk Y, Oulali N, Moufid F. Neurosyphilis revealed by compressive cervical spine syphilitic gumma: a case report. Spinal Cord Ser Cases 2020; 6:56. [PMID: 32606288 PMCID: PMC7324907 DOI: 10.1038/s41394-020-0303-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Neurosyphilis is a sexually transmitted disease secondary to the invasion of the central nervous system by the Treponema pallidum. The spinal syphilitic gumma is rare. CASE PRESENTATION We report a case of extradural cervical spinal syphilitic gumma revealed by spinal cord compression in a 58-year-old male. The epidural lesion was removed via a posterior approach. Histological examination revealed syphilis. Syphilis serologies were positive. Brain MRI showed an associated cerebro-meningeal syphilitic gumma. Antibiotic regime based on aqueous penicillin G was introduced for 14 days. DISCUSSION Currently, there is an increase in the frequency of syphilis and changes in its clinical manifestations. Neurosyphilis can take atypical forms. Spinal syphilitic gumma is a rare manifestation and its association with cerebral involvement is exceptional. Diagnosis is based on serologies in the blood and cerebrospinal fluid. The place of imagery, especially magnetic resonance imaging, is essential. Neurosyphilis should be discussed as a possible differential diagnosis in evaluation of spinal and cerebral lesions.
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Affiliation(s)
- Anasse Mejdoubi
- Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco.
| | - Mohamed Khoulali
- Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco
| | - Nabil Raouzi
- Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco
| | - Siham Nasri
- Department of Radiology, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco
| | - Yassine Mebrouk
- Department of Neurology, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco
| | - Noureddine Oulali
- Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco
| | - Fayçal Moufid
- Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco
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Sensitive detection of Treponema pallidum DNA from the whole blood of patients with syphilis by the nested PCR assay. Emerg Microbes Infect 2018; 7:83. [PMID: 29739928 PMCID: PMC5940865 DOI: 10.1038/s41426-018-0085-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/28/2018] [Accepted: 04/03/2018] [Indexed: 11/17/2022]
Abstract
The aim of this work was to investigate the application of the nested PCR assay for the detection of Treponema pallidum (TP) DNA from the blood of patients with different stages of syphilis. In this study, a nested PCR method targeting the Tpp47 and polA genes (Tpp47-Tp-PCR and polA-Tp-PCR) was developed to detect TP-DNA in whole blood samples collected from 262 patients with different stages of syphilis (84 primary syphilis, 97 secondary syphilis, and 81 latent syphilis patients). The PCR assay detected T. pallidum DNA in 53.6% and 62.9% of the patients with primary and secondary syphilis, respectively, which was much higher than the detection levels in patients with latent syphilis (7.4%) (both p < 0.001). For primary syphilis, a low RPR (0–16) was correlated with a higher detection rate of TP-DNA, whereas for secondary syphilis, the higher detection rate of blood TP-DNA was correlated with higher blood RPR titers (at or beyond 32). For latent syphilis, TP-DNA was only detectable by PCR in the early phase of the latent infection. Thus, blood RPR titers were correlated with the blood T. pallidum burden, but the correlations varied with primary and secondary syphilis. The results indicate that nested PCR is a sensitive method for detecting blood TP-DNA and is especially useful for detecting early syphilis including primary syphilis and secondary syphilis. The findings also suggest that the PCR assay may be used to complement other methods to enhance the diagnosis of syphilis.
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Jo Yaphockun KK, Wai S. Neurosyphilis as a Cause of Transverse Myelitis in a Teenage Girl. J Emerg Med 2018; 54:651-655. [PMID: 29602529 DOI: 10.1016/j.jemermed.2018.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/24/2017] [Accepted: 01/25/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syphilis is a sexually transmitted infection that was nearly eradicated in 2001 but is now making a resurgence. It has a wide range of clinical manifestations depending on disease stage. Neurosyphilis is an infrequently seen infectious disease with central nervous system involvement that can occur in either early- or late-stage syphilis. The diagnosis of neurosyphilis is challenging, primarily because Treponema pallidum, the infecting organism, cannot be cultured in vitro. This article describes a patient with neurosyphilis and reviews the epidemiology and clinical manifestations, diagnostics, and treatment of neurosyphilis. CASE REPORT In compliance with the request of the Privacy Board of our institution, the numerical age of this patient has been omitted. A sexually active teenage girl who was treated for primary syphilis 2 years earlier presented to a tertiary children's hospital with paresthesia and weakness of her right leg, left arm, and neck. Magnetic resonance imaging revealed cervical intramedullary cord edema consistent with transverse myelitis. Serum studies showed positive syphilis enzyme immunoassay, T. pallidum particle agglutination assay, and fluorescent treponemal antibody absorption. A serum rapid plasma reagin test was negative. A lumbar puncture was performed with normal cell count and protein. A cerebrospinal fluid Venereal Disease Research Laboratory test was negative. She was diagnosed with neurosyphilis and treated with intravenous steroids and penicillin G, with near complete resolution of symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The Centers for Disease Control and prevention has noted a steady rise of the incidence of syphilis since 2002. Emergency physicians should be familiar with the spectrum of the clinical manifestations of syphilis, challenges in diagnostics, and appropriate treatment course.
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Affiliation(s)
- Karen Kim Jo Yaphockun
- Department of Emergency Medicine, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California
| | - Shannon Wai
- Department of Emergency Medicine, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California
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9
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Byard RW. Syphilis-Cardiovascular Manifestations of the Great Imitator. J Forensic Sci 2017; 63:1312-1315. [DOI: 10.1111/1556-4029.13709] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Roger W. Byard
- School of Medicine; The University of Adelaide; Frome Road Adelaide SA 5005 Australia
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10
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Abstract
Ocular syphilis is not a new issue but due to increasing rates of new cases is now a contemporary issue. The clinical features are unspecific and can be manifested as all forms of ocular inflammation. Unspecific anterior uveitis is the most frequent ocular involvement; however, typical distinctive patterns are superficial white preretinal precipitates within a panuveitis and acute syphilitic posterior placoid chorioretinitis. The diagnosis should be confirmed by serological tests. Treatment is based on parenteral administration of penicillin.
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11
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Kararizou E, Mitsonis C, Dimopoulos N, Gkiatas K, Markou I, Kalfakis N. Psychosis or Simply a New Manifestation of Neurosyphilis? J Int Med Res 2016; 34:335-7. [PMID: 16866029 DOI: 10.1177/147323000603400314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The widespread use of antibiotics in recent years has caused a significant reduction in the incidence of neurosyphilis and changes in its clinical features. We present a case that initially presented as persistent headache and untreatable psychosis. Neurosyphilis was diagnosed during the clinical evaluation. Blood serum analyses for syphilis were positive for rapid plasma reagin titres, the Venereal Disease Research Laboratories test and fluorescent treponemal antibody absorption. A lumbar puncture was performed and cerebrospinal fluid analysis resulted in the diagnosis of neurosyphilis. The patient completed a 2-week course of treatment with aqueous crystalline penicillin G and his symptoms subsequently improved. We suggest that neurosyphilis should always be included in the differential diagnosis of untreatable psychosis.
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Affiliation(s)
- E Kararizou
- Department of Neurology, Eginition Hospital, Athens National University, Athens, Greece.
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Shi M, Peng RR, Gao Z, Zhang S, Lu H, Guan Z, Gao Y, Wang C, Zhou P. Risk profiles of neurosyphilis in HIV-negative patients with primary, secondary and latent syphilis: implications for clinical intervention. J Eur Acad Dermatol Venereol 2015; 30:659-66. [PMID: 26660338 DOI: 10.1111/jdv.13514] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 10/01/2015] [Indexed: 11/26/2022]
Affiliation(s)
- M. Shi
- Department of Sexually Transmitted Disease Institute; Shanghai Skin Disease Hospital; Shanghai China
| | - R.-R. Peng
- Department of Sexually Transmitted Disease Institute; Shanghai Skin Disease Hospital; Shanghai China
| | - Z. Gao
- Department of Sexually Transmitted Disease Institute; Shanghai Skin Disease Hospital; Shanghai China
- Clinical School of Anhui Medical University; Anhui Medical University; Hefei Anhui China
| | - S. Zhang
- Department of Sexually Transmitted Disease Institute; Shanghai Skin Disease Hospital; Shanghai China
- Clinical School of Anhui Medical University; Anhui Medical University; Hefei Anhui China
| | - H. Lu
- Department of Sexually Transmitted Disease Institute; Shanghai Skin Disease Hospital; Shanghai China
| | - Z. Guan
- Department of Sexually Transmitted Disease Institute; Shanghai Skin Disease Hospital; Shanghai China
| | - Y. Gao
- Department of Sexually Transmitted Disease Institute; Shanghai Skin Disease Hospital; Shanghai China
| | - C. Wang
- Department of Sexually Transmitted Disease Institute; Shanghai Skin Disease Hospital; Shanghai China
| | - P. Zhou
- Department of Sexually Transmitted Disease Institute; Shanghai Skin Disease Hospital; Shanghai China
- Clinical School of Anhui Medical University; Anhui Medical University; Hefei Anhui China
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[Management of uveomeningitis in internal medicine: Proposal for a diagnostic work-up]. Rev Med Interne 2015; 37:25-34. [PMID: 26541836 DOI: 10.1016/j.revmed.2015.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/03/2015] [Accepted: 09/26/2015] [Indexed: 01/14/2023]
Abstract
Uveomeningitis relates to an inflammatory state extending from iris and ciliary bodies to the choroid behind the eye. Because of a close contact between eye and brain, and barrier disruption, the inflammation can spread into the central nervous system (CNS). We review the clinical manifestations of uveitis, which are known to provide helpful clues to the diagnosis and describe the infectious, inflammatory, and neoplastic conditions classically associated with the uveomeningitis. Inflammatory or auto-immune diseases are probably the most common clinically recognized causes of uveomeningitis associated with a significant pleiocytosis. These entities often cause inflammation of various tissues in the body, including ocular structures and the meninges (i.e., sarcoidosis, Behçet's disease, and Vogt-Koyanagi-Harada syndrome). The association of an infectious uveitis with an acute or a chronic meningo-encephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a specific organism responsible for an uveomeningitis. One should consider the diagnosis of primary ocular-CNS lymphoma in patients of 40 years of age or older with bilateral uveitis, especially with prominent vitritis, showing poor response to corticosteroid therapy. Finally, an algorithm for the diagnostic approach of uveomeningitis is proposed.
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Merins V, Hahn K. Syphilis and neurosyphilis: HIV-coinfection and value of diagnostic parameters in cerebrospinal fluid. Eur J Med Res 2015; 20:81. [PMID: 26445822 PMCID: PMC4596308 DOI: 10.1186/s40001-015-0175-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/17/2015] [Indexed: 11/20/2022] Open
Abstract
Background Neurosyphilis might be difficult to diagnose particularly in asymptomatic patients and patients with HIV-coinfection. The objective of this study was to evaluate current diagnostic standards for neurosyphilis in HIV-positive and -negative patients. Methods We studied retrospectively patients with an active syphilis infection who had additionally undergone lumbar puncture. Patients where the criteria for the diagnosis of a definite or probable neurosyphilis were applicable were further analyzed for clinical symptoms, CSF, HIV-status as well as Treponema pallidum testing in serum and CSF. Correlation analysis of categorical variables was done by using the Chi-square test or in cases of small sample sizes the exact test of Fisher. p values ≤0.05 were considered significant. Results Eighty-nine patients were diagnosed with syphilis. All necessary criteria for the diagnosis of a neurosyphilis were available in 67 of them including 35 HIV-positive and 32 HIV-negative patients. A definite neurosyphilis could be retrospectively diagnosed in 13 and a probable in another 25 cases. Normal CSF results were more likely in HIV-negatives (p = 0.016). A neurosyphilis was correlated to a CSF pleocytosis > 5 cells/µl and to an albumin quotient >7.8 mg/dl regardless of a parallel HIV infection. HIV-positives had more frequently a CSF-RPR titre >1:4 than HIV-negatives (p = 0.031). However, the RPR test in CSF in definite or probable neurosyphilis had a sensitivity of only 21 %. Discussion Our data show that a pleocytosis and an elevated albumin quotient correlate with neurosyphilis. However, the CSF-RPR test as gold standard in neurosyphilis diagnostics has a very low sensitivity.
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Affiliation(s)
- V Merins
- Group Practice Family Physicians, Alt-Buckow 9-11, 12349, Berlin, Germany.
| | - K Hahn
- Department of Neurology, Universitätsmedizin Charité, Charitéplatz 1, 10117, Berlin, Germany.
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Chiquet C, Khayi H, Puech C, Tonini M, Pavese P, Aptel F, Romanet JP. Atteinte oculaire de la syphilis. J Fr Ophtalmol 2014; 37:329-36. [DOI: 10.1016/j.jfo.2013.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/03/2013] [Indexed: 11/16/2022]
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Abstract
HIV and syphilis affect similar patient groups and coinfection is common. All patients presenting with syphilis should be offered HIV testing and vice versa. Syphilis can enhance the transmission of HIV. Detection and treatment of syphilis can probably help to reduce HIV transmission. Syphilis may present with atypical features in the HIV-positive patient, for example, there is a higher rate of asymptomatic primary syphilis, and proportionately more HIV-positive patients present with secondary disease. Secondary infection may be more aggressive and there is an increased rate of early neurologic and ophthalmic involvement. Diagnosis is generally made with serology, but the clinician should be aware of the potential for false-negative serology in both primary and, less commonly, in secondary syphilis. All HIV-positive patients should be treated with a penicillin-based regimen, and alternative therapies should be used with caution. All HIV-positive patients should be considered for the evaluation of neurosyphilis. Relapse is a real concern and careful follow up is required. This review will explore the differences in clinical manifestations in HIV-coinfected individuals, and will discuss data to warrant different management in HIV-coinfected individuals.
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Affiliation(s)
- Usha Rani Karumudi
- Department of Infectious Diseases, SUNY-Downstate Health Science Center, Brooklyn, NY 11203, USA.
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Dumaresq J, Langevin S, Gagnon S, Serhir B, Deligne B, Tremblay C, Tsang RSW, Fortin C, Coutlée F, Roger M. Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early Syphilis. J Clin Microbiol 2013; 51:4060-6. [PMID: 24088852 PMCID: PMC3838065 DOI: 10.1128/jcm.01989-13] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 09/24/2013] [Indexed: 11/20/2022] Open
Abstract
The diagnosis of neurosyphilis (NS) is a challenge, especially in HIV-infected patients, and the criteria for deciding when to perform a lumbar puncture (LP) in HIV-infected patients with syphilis are controversial. We retrospectively reviewed demographic, clinical, and laboratory data from 122 cases of HIV-infected patients with documented early syphilis who underwent an LP to rule out NS, and we evaluated 3 laboratory-developed validated real-time PCR assays, the Treponema pallidum particle agglutination (TPPA) assay, the fluorescent treponemal antibody absorption (FTA-ABS) assay, and the line immunoassay INNO-LIA Syphilis, for the diagnosis of NS from cerebrospinal fluid (CSF) samples of these patients. NS was defined by a reactive CSF-VDRL test result and/or a CSF white blood cell (WBC) count of >20 cells/μl. Thirty of the 122 patients (24.6%) had early NS. Headache, visual symptoms, a CD4 cell count of <500 cells/μl, and viremia, as defined by an HIV-1 RNA count of ≥50 copies/ml, were associated with NS in multivariate analysis (P = <0.001 for each factor). Blood serum rapid plasma reagin (RPR) titers were not associated with early NS (P = 0.575). For the diagnosis of NS, the PCR, FTA-ABS, TPPA, and INNO-LIA assays had sensitivities of 58%, 100%, 68%, and 100%, specificities of 67%, 12%, 49%, and 13%, and negative predictive values of 85%, 100%, 84%, and 100%, respectively. Visual disturbances, headache, uncontrolled HIV-1 viremia, and a CD4 cell count of <500 cells/μl were predictors of NS in HIV-infected patients with early syphilis, while blood serum RPR titers were not; therefore, RPR titers should not be used as the sole criterion for deciding whether to perform an LP in early syphilis. When applied to CSF samples, the INNO-LIA Syphilis assay easily helped rule out NS.
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Affiliation(s)
- Jeannot Dumaresq
- Département de Microbiologie et d'Infectiologie, Centre Hospitalier Affilié Universitaire Hôtel-Dieu de Lévis, Lévis, Québec, Canada
| | - Stéphanie Langevin
- Département de Microbiologie et d'Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Simon Gagnon
- Département de Microbiologie et d'Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Bouchra Serhir
- Laboratoire de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
| | - Benoît Deligne
- Département de Médecine Interne et Vasculaire, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Cécile Tremblay
- Département de Microbiologie et d'Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Laboratoire de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
| | - Raymond S. W. Tsang
- Division of Syphilis Diagnostics and Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Claude Fortin
- Département de Microbiologie et d'Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Département de Microbiologie et d'Immunologie de l'Université de Montréal, Montréal, Québec, Canada
| | - François Coutlée
- Département de Microbiologie et d'Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Département de Microbiologie et d'Immunologie de l'Université de Montréal, Montréal, Québec, Canada
| | - Michel Roger
- Département de Microbiologie et d'Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Département de Microbiologie et d'Immunologie de l'Université de Montréal, Montréal, Québec, Canada
- Laboratoire d'Immunogénétique, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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Pastuszczak M, Zeman J, Jaworek AK, Wojas-Pelc A. Cerebrospinal Fluid Abnormalities in HIV-Negative Patients with Secondary and Early Latent Syphilis and Serum VDRL ≥ 1:32. Indian J Dermatol 2013; 58:325. [PMID: 23919017 PMCID: PMC3726894 DOI: 10.4103/0019-5154.113941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Syphilis is caused by a spirochete Treponema pallidum. Invasion of the central nervous system (CNS) by T. pallidum may appear early during the course of disease. The diagnosis of confirmed neurosyphilis is based on the reactive Venereal Disease Research Laboratory (VDRL) in cerebrospinal fluid (CSF). Recent studies indicated that serum RPR ≥ 1:32 are associated with higher risk of reactivity of CSF VDRL. Aims: The main aim of the current study was to assess cerebrospinal fluid serological and biochemical abnormalities in HIV negative subjects with secondary and early latent syphilis and serum VDRL ≥ 1:32. Materials and Methods: Clinical and laboratory data of 33 HIV-negative patients with secondary and early latent syphilis, with the serum VDRL titer ≥ 1:32, who underwent a lumbar puncture and were treated in Department of Dermatology at Jagiellonian University School of Medicine in Cracow, were collected. Results: Clinical examination revealed no symptoms of CNS involvement in all patients. 18% (n = 6) of patients met the criteria of confirmed neurosyphilis (reactive CSF-VDRL). In 14 (42%) patients CSF WBC count ≥ 5/ul was found, and in 13 (39%) subjects there was elevated CSF protein concentration (≥ 45 mg/dL). 10 patients had CSF WBC count ≥ 5/ul and/or elevated CSF protein concentration (≥ 45 mg/dL) but CSF-VDRL was not reactive. Conclusions: Indications for CSF examination in HIV-negative patients with early syphilis are the subject of discussion. It seems that all patients with syphilis and with CSF abnormalities (reactive serological tests, elevated CSF WBC count, elevated protein concentration) should be treated according to protocols for neurosyphilis. But there is a need for identification of biomarkes in order to identify a group of patients with syphilis, in whom risk of such abnormalities is high.
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Affiliation(s)
- Maciej Pastuszczak
- Department of Dermatology, Jagiellonian University School of Medicine, Cracow, Poland
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19
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The eye in sexually transmitted infections: a review of the ocular complications of venereal diseases. Int Ophthalmol 2012; 31:539-50. [DOI: 10.1007/s10792-011-9501-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 12/20/2011] [Indexed: 11/27/2022]
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Vale TC, Moraes TEC, Lara A, Cota GF, Christo PP. Hypertrophic cervical spinal cord pachymeningitis due to Treponema pallidum infection. Neurol Sci 2011; 33:359-62. [PMID: 21863268 DOI: 10.1007/s10072-011-0738-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 07/22/2011] [Indexed: 11/24/2022]
Abstract
Neurosyphilis is recognized as a potential cause of hypertrophic pachymeningitis, but modern reports are few. A middle-aged man presented to hospital with a 1 month history of lower limb pain and weakness. Cerebrospinal fluid analysis showed pleocytosis with high protein levels and a positive venereal disease research laboratory result. Cervical spinal cord resonance imaging disclosed a dural contrast enhancement suggestive of pachymeningitis. Biopsy of the dura mater revealed a thick inflammatory process. Despite being treated accordingly, the patient rapidly deteriorated and died. The patient was diagnosed as having subacute hypertrophic cervical pachymeningitis which caused spinal cord compression. Serological evidence of neurosyphilis was present. Physicians should still be aware of this cause of hypertrophic pachymeningitis.
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Affiliation(s)
- Thiago Cardoso Vale
- Neurology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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21
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The usefulness of toluidine red unheated serum test in the diagnosis of HIV-negative neurosyphilis. Sex Transm Dis 2011; 38:244-5. [PMID: 20871491 DOI: 10.1097/olq.0b013e3181f42093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We retrospectively analyzed the Venereal Disease Research Laboratory test, Treponema pallidum particle agglutination test, and toluidine red unheated serum test (TRUST) in 41 cases of HIV-negative neurosyphilis and 34 non-neurologic syphilitic patient and found that serum-TRUST titers could be the indication of lumbar puncture in syphilitic patients and a reactive cerebrospinal fluid-TRUST is considered diagnostic to neurosyphilis.
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22
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Kolokolov OV, Bakulev AL, Sholomov II, Kravchenya SS, Popovicheva OA, Kolokolov OV, Bakulev AL, Sholomov II, Kravchenya SS, Popovicheva OA. Clinical features of neurosyphilis in sex partners. VESTNIK DERMATOLOGII I VENEROLOGII 2011. [DOI: 10.25208/vdv1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
There was a study involving 726 patients with different syphilis forms with the aim of revealing a neurological deficiency
in them. Nervous system affection symptoms were founding 298 of them. Neurosyphilis was diagnosed in 165 patients
based on the conducted examination. There were five neurosyphilis cases in sex partners among them. The article
provides a detailed description of the clinical picture of the disease and discloses the laboratory examination results.
The polymorphism of clinical and laboratory manifestations of the syphilitic infection in sex partners can be explained by
different terms of infestation, particulars of the immunity and presence of concomitant neurologic and somatic diseases.
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23
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Kararizou E, Naoumis D, Gkiatas K, Kapaki E, Vassilopoulos D. An unusual presentation of neurosyphilis as a probable migraine. J Headache Pain 2010; 11:543-5. [PMID: 20811763 PMCID: PMC3476221 DOI: 10.1007/s10194-010-0254-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 08/16/2010] [Indexed: 11/28/2022] Open
Abstract
We describe a case which initially presented as persistent and untreatable probable migraine, which was subsequently diagnosed as neurosyphilis during the clinical evaluation. All symptoms regressed after appropriate treatment. We suggest that the possibility of neurosyphilis should be taken into account in the differential diagnosis of a persistent headache which does not respond to medication.
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Affiliation(s)
- Evangelia Kararizou
- Neurologic Clinic, Neurological Department, Aeginitio Hospital, University of Athens, 72-74 Vass. Sofias Avenue, 115 28, Athens, Greece.
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Agmon-Levin N, Elbirt D, Asher I, Gradestein S, Werner B, Sthoeger Z. Syphilis and HIV co-infection in an Israeli HIV clinic: incidence and outcome. Int J STD AIDS 2010; 21:249-52. [PMID: 20378895 DOI: 10.1258/ijsa.2009.009011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The re-emergence of syphilis among HIV-infected patients has been reported in recent years. We evaluated co-infection among heterosexual immigrants in an Israeli AIDS center. The records of 1060 HIV-infected patients were evaluated for positive syphilis serology between the years 2000 and 2005, and all seropositive patients were further evaluated. We found 150 HIV/syphilis co-infected patients (57% men, 93% of African origin), of who 135 were found to have late latent syphilis. Lumbar puncture (LP) was performed in 51 patients, 16 (31%) had abnormal cerebrospinal fluid (CSF) compatible with neurosyphilis. Abnormal CSF correlated with the absence of previous anti-syphilis treatment, but not with CD4 count, viral load or Venereal Disease Research Laboratory titres. Penicillin was recommended to all patients according to their disease stages and 81 patients completed 12 months post-treatment follow-up. Twenty-one of 81 (26%) treatments were successful, 33 (41%) showed 'serofast reaction' and 27 (33%) failed therapy. In conclusion, a high incidence of syphilis with CSF reactivity suggestive of neurosyphilis was observed in heterosexual Ethiopian HIV-infected patients. Thus, repeated serological screening and CSF evaluation seems to be indicated in these patients. Penicillin therapy resulted in 'serofast reaction' or treatment failure for most patients. More, intensive treatment might be needed for HIV/syphilis in co-infected patients, especially those with severe immune-deficiency and prolonged syphilis infection.
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Affiliation(s)
- N Agmon-Levin
- Neve-Or AIDS Center, Kaplan Medical Center, Rehovot, Israel
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26
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RODIKOV MV, PROKHORENKOV VI. Neurosyphilis: from the diagnosis to treatment Part i. The epidemiology, pathology and clinic. VESTNIK DERMATOLOGII I VENEROLOGII 2010. [DOI: 10.25208/vdv808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The modern views a lesion of a nervous system at a syphilis are discussed. Data on epidemiology, pathology and clinical signs of neurosyphilis are cited.
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27
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Akute syphilitische posteriore plakoide Chorioretinopathie und Panuveitis als Erstmanifestationen einer Lues. SPEKTRUM DER AUGENHEILKUNDE 2009. [DOI: 10.1007/s00717-009-0357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Mitsonis CH, Kararizou E, Dimopoulos N, Triantafyllou N, Kapaki E, Mitropoulos P, Sfagos K, Vassilopoulos D. Incidence and clinical presentation of neurosyphilis: a retrospective study of 81 cases. Int J Neurosci 2009; 118:1251-7. [PMID: 18698508 DOI: 10.1080/00207450701239426] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aim of the report was the study of the clinical features of neurosyphilis in the last 40 years (1965-2005). The investigation was based on the retrospective review of patients with neurosyphilis hospitalized in our hospital from 1965 to 2005 (period A: 1965-1984 and B: 1985-2005). Eighty one patients with neurosyphilis were studied. Typical forms represent 68.6% of cases of neurosyphilis in period A. In period B, 85.7% of the cases are presented with atypical clinical patterns. Typical forms of the disease were no longer common, while atypical and masked clinical patterns prevailed. Neuropsychiatric symptoms were the most common manifestations of the disease.
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Poliseli R, Vidal JE, Penalva De Oliveira AC, Hernandez AV. Neurosyphilis in HIV-infected patients: clinical manifestations, serum venereal disease research laboratory titers, and associated factors to symptomatic neurosyphilis. Sex Transm Dis 2008; 35:425-9. [PMID: 18446082 DOI: 10.1097/olq.0b013e3181623853] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
GOAL To describe clinical and laboratory features of human immunodeficiency infection (HIV)-infected patients with neurosyphilis. STUDY DESIGN Retrospective study of 27 consecutive cases of HIV-infected patients with a positive Venereal Disease Research Laboratory (VDRL) in cerebrospinal fluid (CSF). RESULTS Median of age was 36 years and 89% were men. Ten (37%) patients had previous nonneurologic syphilis treatment. At the time of neurosyphilis diagnosis, 10 (37%) patients had early syphilis, and 6 of them were neurologically asymptomatic. Nine (33%) patients had symptomatic neurosyphilis. Twenty-six (96%) patients were classified with early neurosyphilis. The medians of serum VDRL and CD4 T cell counts were 1:128 and 182 cell/muL, respectively. Twenty five (93%) patients presented serum VDRL titers > or =1:16. Five of 6 patients with early syphilis and asymptomatic neurosyphilis, presented serum VDRL > or =1:16. Symptomatic patients showed lower CD4 T cell counts (59 cell/muL vs. 208 cell/muL, P = 0.03) and higher protein concentration on CSF (118 mg/dL vs. 39 mg/dL, P <0.001) than asymptomatic patients. CONCLUSIONS Most patients had early and asymptomatic neurosyphilis, and more than one third had early syphilis. Patients with symptomatic neurosyphilis showed lower CD4 T cell counts and higher protein concentration on CSF than those asymptomatic. Most patients had serum VDRL titers > or =1:16, regardless of syphilis stage.
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Affiliation(s)
- Rodolfo Poliseli
- Department of Infectious Diseases, Emílio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil
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31
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Nitrini R. Clinical and therapeutic aspects of dementia in syphilis and Lyme disease. HANDBOOK OF CLINICAL NEUROLOGY 2008; 89:819-823. [PMID: 18631797 DOI: 10.1016/s0072-9752(07)01271-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Ricardo Nitrini
- University of São Paulo School of Medicine, São Paulo, Brazil.
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32
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Fraimow HS, Reboli AC. Specific Infections with Critical Care Implications. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50057-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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33
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Castro R, Prieto ES, da Luz Martins Pereira F. Nontreponemal tests in the diagnosis of neurosyphilis: an evaluation of the Venereal Disease Research Laboratory (VDRL) and the Rapid Plasma Reagin (RPR) tests. J Clin Lab Anal 2008; 22:257-61. [PMID: 18623120 PMCID: PMC6648961 DOI: 10.1002/jcla.20254] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2007] [Accepted: 03/25/2008] [Indexed: 11/11/2022] Open
Abstract
The Venereal Disease Research Laboratory (VDRL) test has long been considered the best serological test for the diagnosis of neurosyphilis. The goal of this study was to find out if the Rapid Plasma Reagin (RPR) could be an alternative to the VDRL. Cerebrospinal fluid (CSF) and sera samples from patients in the following stages of syphilis were tested: 8 had symptomatic and 16 asymptomatic neurosyphilis, 4 were in the primary stage, 6 had secondary syphilis, and 92 were in the latent stage. We have also studied 61 samples from individuals with treated syphilis and 126 with other neurological diseases than neurosyphilis. All the CSF samples were studied with both RPR and VDRL tests. RPR and VDRL test results were mostly concordant. The specificity of these tests for current neurosyphilis was 99% for the VDRL and 99.3% for the RPR, whereas the sensitivity was 70.8 and 75%, respectively, for the VDRL and RPR. In view of these results it seems to us that the RPR could be an alternative to the VDRL in the diagnosis of neurosyphilis.
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Affiliation(s)
- Rita Castro
- Instituto de Higiene e Medicina Tropical, Unidade de Doenças Sexualmente Transmitidas, Lisboa, Portugal.
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34
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Sanchez FM, Zisselman MH. Treatment of psychiatric symptoms associated with neurosyphilis. PSYCHOSOMATICS 2007; 48:440-5. [PMID: 17878505 DOI: 10.1176/appi.psy.48.5.440] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is currently no consensus on how to manage the psychiatric manifestations of neurosyphilis, despite the resurgence of this condition. The authors present five cases of neurosyphilis in inpatient psychiatric settings that manifested with predominantly psychiatric symptoms and were appropriately diagnosed and successfully treated with psychotropic medication concurrent with antibiotic therapy. A review of available data reveals that presently there are no specific guidelines to address psychiatric symptomatology in neurosyphilis. The authors see merit in the prudent use of psychotropic medication to achieve symptom stabilization.
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Affiliation(s)
- Francis M Sanchez
- Werber Bryan Psychiatric Hospital, South Carolina Department of Mental Health, Staff Center C-D, 220 Faison Dr., Columbia, SC 29203, USA.
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35
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Molepo J, Pillay A, Weber B, Morse SA, Hoosen AA. Molecular typing of Treponema pallidum strains from patients with neurosyphilis in Pretoria, South Africa. Sex Transm Infect 2007; 83:189-92. [PMID: 17244664 PMCID: PMC2659089 DOI: 10.1136/sti.2006.023895] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the molecular typing system for Treponema pallidum using cerebrospinal fluid (CSF) specimens obtained from patients with neurosyphilis in Pretoria, South Africa. METHODS CSF specimens were collected from 32 men and 18 women with suspected late neurosyphilis. Typing of T pallidum involved PCR amplification and restriction analysis of the tprE, G and J genes and determination of the number of 60 base pair tandem repeats within the arp gene by PCR amplification. RESULTS Of 13 typeable specimens, 4 strain types were identified: 2i, 3e, 14a and 17e. Subtype 14a was identified in 7 specimens (53.8%), subtype 3e in 4 specimens (30.7%) and subtypes 17e and 2i in 1 specimen (7.6%) each. CONCLUSIONS This study shows that the typing system can be applied to specimens which may contain low numbers of spirochaetes such as CSF.
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Affiliation(s)
- J Molepo
- Department of Microbiological Pathology, Medunsa Campus, University of Limpopo, Pretoria, South Africa
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36
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Abstract
Although once on decline in the United States and Europe, the incidence of syphilis has been on the rise since 2000. This increase is noteworthy because there is a high coinfection rate with HIV, especially among men who have sex with men. In light of high coinfection rates, all HIV-infected patients should be tested for syphilis and vice versa. HIV can alter the clinical manifestations of syphilis and, in turn, syphilis has the potential to change the course and transmission of HIV. This article addresses variations in clinical presentation, diagnosis, and management of individuals coinfected with HIV and syphilis.
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Affiliation(s)
- Jill Stevenson
- University of Washington School of Medicine, A-300 Health Sciences Building, Box 356340, Seattle, WA 98195, USA.
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37
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Manzardo C, Del Mar Ortega M, Sued O, García F, Moreno A, Miró JM. Central nervous system opportunistic infections in developed countries in the highly active antiretroviral therapy era. J Neurovirol 2006; 11 Suppl 3:72-82. [PMID: 16540459 DOI: 10.1080/13550280500513846] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A marked decrease in incidence has been observed for most central nervous system (CNS) opportunistic infections (OIs) after the use of highly active antiretroviral therapy (HAART) in developed countries. However, the spectrum of these OIs in acquired immunodeficiency syndrome (AIDS) patients has remained almost unchanged. CNS toxoplasmosis, cryptococcosis, tuberculosis, and progressive multifocal leukoencephalopathy (PML) remain the most frequent ones. Primary CNS lymphoma should be included in the differential diagnosis of all cases with focal lesions. Final diagnosis is currently made by combining neuroimaging techniques (single-photon emission computed tomography [SPECT], positron emission tomography [PET], magnetic resonance imaging [MRI] and/or computed tomography [CT] scan) and molecular studies of cerebrospinal fluid (CSF) and therapeutical response. Stereotactic biopsy should only be performed in the case of atypical lesions or nonresponse to recommended treatments. After treatment of the acute phase, lifelong maintenance therapy is necessary to prevent OI recurrences. Once HAART is initiated, some patients can develop a clinical worsening of some CNS OIs with or without atypical neuroimaging manifestations. This paradoxical worsening is known as the immune reconstitution inflammatory syndrome (IRIS) and it results from reconstitution of the immune system's ability to recognize pathogens/antigens in patients with prior OIs and low CD4+ T-cell counts. In this context, IRIS can be seen in patients with CNS cryptococcosis, tuberculosis, or PML. On the other hand, HAART-induced immune reconstitution can improve the prognosis of some untreatable diseases such as PML, and can allow maintenance therapy of some CNS OI to be safely discontinued in patients with high and sustained CD4+ T-cell response.
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Affiliation(s)
- Christian Manzardo
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Abstract
In 2001, the incidence of primary and secondary syphilis increased in the United States for the first time in a decade. Increasing rates of early syphilis among men who have sex with men have been reported in many American cities, with similar outbreaks noted in Canada and Europe. In San Francisco, the increase has been particularly sharp and accompanied by an increase in the incidence of neurosyphilis. Early neurosyphilis develops within weeks to years of primary infection and primarily involves the meninges. Syndromes include syphilitic meningitis (often accompanied by cranial neuropathies), meningovascular syphilis (with associated ischemic stroke), or asymptomatic neurosyphilis. Late neurosyphilis occurs years to decades after exposure as cerebral or spinal gummatous disease or the classic parenchymal forms affecting the brain (general paresis or syphilitic encephalitis) or spinal cord and nerve roots (tabes dorsalis). Treponema pallidum, the causative agent, cannot be cultured in vitro, and microscopic techniques are laborious. Thus, diagnosis depends on serologic tests and cerebrospinal fluid (CSF) examination. The suboptimal sensitivity and specificity of these tests complicate diagnosis, particularly among patients coinfected with HIV. CSF examination should be performed to evaluate for neurosyphilis in all patients with positive serum syphilis serology and neurologic, ophthalmic, or tertiary disease, or in those who have failed therapy, and in HIV-infected patients with late latent syphilis or syphilis of unknown duration. Intravenous penicillin G is the recommended treatment for all forms of neurosyphilis and for syphilitic eye disease. An outpatient alternative, if adherence can be assured, is intramuscular benzathine penicillin with oral probenecid. Newer drugs that penetrate CSF, such as ceftriaxone or azithromycin, have not yet been adequately tested for neurosyphilis. Syphilis facilitates transmission of HIV (and vice versa), and thus all patients diagnosed with syphilis should be offered HIV testing.
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Abstract
Syphilis is a sexually transmitted, chronic, systemic infection caused by the spirochete Treponema pallidum. If left untreated, the disease progresses through four stages, with the potential to cause significant morbidity to any major organ of the body. Frequent syphilitic ocular manifestations, which can occur at any stage of the disease, include interstitial keratitis, anterior, intermediate, and posterior uveitis, chorioretinitis, retinitis, retinal vasculitis and cranial nerve and optic neuropathies. Diagnosis is centered around a high level of clinical suspicion and includes treponemal specific and non-treponemal serologic tests. All patients with newly diagnosed syphilis should be tested for co-infection with human immunodeficiency virus, as the risk factors are similar for both diseases. Additionally, all patients with ocular syphilis should be tested for neurosyphilis. The preferred treatment for all stages of syphilis remains parenteral penicillin G. With proper diagnosis and prompt antibiotic treatment, the majority of cases of syphilis can result in a cure.
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Affiliation(s)
- Szilárd Kiss
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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Abstract
Chronic meningitis is a syndrome commonly defined by the presence of continuously persistent meningeal inflammation for at least 4 weeks. Presenting neurologic features are often nonspecific, and the list of differential diagnoses is broad. Despite the development of modern molecular diagnostic methods, establishing a specific cause may challenge the acumen of the treating neurologist with clues to the diagnosis residing outside the nervous system and requiring focused investigation. This review discusses selected etiologies illustrating issues in diagnosis and etiologic categories to be considered in the evaluation of this challenging syndrome.
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Affiliation(s)
- Bruce A Cohen
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, 710 North Lake Shore Drive, Abbott Hall 1121, Chicago, IL 60611, USA.
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41
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da Rocha AJ, Maia ACM, Ferreira NPDF, do Amaral LLF. Granulomatous diseases of the central nervous system. Top Magn Reson Imaging 2005; 16:155-87. [PMID: 16340335 DOI: 10.1097/01.rmr.0000189109.62899.a1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Infectious diseases of the central nervous system (CNS), particularly those accompanied by the formation of granulomas, are a constant diagnostic challenge in some specific regions of the world, above all in developing countries. The pattern of image seen on CT or MR scan is the result of the inter-relations between the individual characteristics of the infectious agent and the capacity of each host to mount an appropriate inflammatory response to that specific type of aggression, inside one particular compartment of the CNS. Taking these parameters into account we will discuss the several patterns of image found in parasitic, bacterial, and fungal granulomatous infections.
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