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Kotani R, Hatano K, Ishibashi K, Iwata A. 18F-THK5351 PET Is Superior to Conventional MRI in Identifying Inflammatory Lesions by Imaging Astrogliosis in 2 Cases of Neurosyphilis. Clin Nucl Med 2024:00003072-990000000-01324. [PMID: 39390647 DOI: 10.1097/rlu.0000000000005494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
ABSTRACT 18F-labeled THK5351 PET can visualize ongoing astrogliosis by estimating monoamine oxidase B levels and can be used as a neuroinflammation marker for identifying inflammatory lesions by imaging astrogliosis. Assessment of its performance is of interest, especially when compared with conventional MRI. Here, we present 2 cases of neurosyphilis, in which 18F-THK5351 PET identified inflammatory lesions by imaging astrogliosis, whereas MRI had difficulty detecting the lesions. Hence, this study suggests that 18F-THK5351 PET is superior to conventional MRI in identifying inflammatory lesions and that this feature of 18F-THK5351 can provide insights into the pathophysiology of neurosyphilis in living patients.
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Zhou Y, Xie Y, Xu M. Potential mechanisms of Treponema pallidum breaching the blood-brain barrier. Biomed Pharmacother 2024; 180:117478. [PMID: 39321510 DOI: 10.1016/j.biopha.2024.117478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 09/14/2024] [Accepted: 09/20/2024] [Indexed: 09/27/2024] Open
Abstract
Syphilis, a sexually transmitted disease caused by Treponema pallidum subsp. pallidum (T. pallidum), can lead to a complication known as neurosyphilis. Neurosyphilis affects multiple components of the nervous system, including the meninges, blood vessels, brain parenchyma, and others, significantly impacting the central nervous system (CNS). Despite the effective control of syphilis spread by antibiotics, recent years have seen a resurgence in incidence among high-risk populations. The blood-brain barrier (BBB) is a critical defense for the CNS, preventing toxins and pathogens, including viruses, from entering and ensuring CNS function. The exact mechanisms of how T. pallidum penetrates the BBB are still not fully understood. Extensive research suggests that T. pallidum can disrupt endothelial cells and intercellular junctions, as well as induce abnormal activation of immune cells and aberrant cytokine expression, potentially facilitating its breach of BBB. Based on current research, we focus on the detrimental effects of cytokines on BBB integrity. We have also summarized the pathways T. pallidum uses to penetrate cellular barriers. Understanding the interaction between T. pallidum and the BBB is essential for revealing neurosyphilis pathogenesis and developing new therapies. DATA AVAILABILITY: Data used to support the findings of this study are included in the article.
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Affiliation(s)
- Yiming Zhou
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, China; Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, University of South China, China; Institution of Pathogenic Biology, Hengyang Medical School, University of South China, Hengyang, China
| | - Yafeng Xie
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, China; Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, University of South China, China; Institution of Pathogenic Biology, Hengyang Medical School, University of South China, Hengyang, China; Department of Clinical Laboratory, The Second Affiliated Hospital of the University of South China, Hengyang, China.
| | - Man Xu
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, China; Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, University of South China, China; Institution of Pathogenic Biology, Hengyang Medical School, University of South China, Hengyang, China.
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Duffus E, Chinta S, Patel P, Finkel DG. Coinfection of cerebral toxoplasmosis and neurosyphilis as the first manifestation of AIDS. BMJ Case Rep 2024; 17:e261502. [PMID: 39299714 DOI: 10.1136/bcr-2024-261502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024] Open
Abstract
A male in his 30s with a medical history of newly diagnosed HIV with a CD4 count of 292 cells/mm3 presented with a bilateral frontal headache and left upper and lower extremity weakness and paraesthesias. A few months prior, the patient experienced a desquamating rash on his scalp and a pruritic, papular genital rash, which both self-resolved. CT head without contrast revealed extensive vasogenic oedema involving the right basal ganglia, thalamus, temporal and occipital lobes. MRI of the brain with and without contrast revealed two enhancing masses in the right lentiform nucleus and right temporal-occipital junction with associated vasogenic oedema. Cerebrospinal fluid (CSF) studies confirmed cerebral toxoplasmosis with positive CSF Toxoplasma gondii PCR and neurosyphilis with positive serum rapid plasma reagin and CSF venereal disease research laboratory test. He was treated with trimethoprim/sulfamethoxazole and intravenous penicillin G with the resolution of his symptoms.
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Affiliation(s)
- Emily Duffus
- Internal Medicine/Pediatrics, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sree Chinta
- Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Pooja Patel
- Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Diana G Finkel
- Department of Medicine, Division of Infectious Disease, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Li HY, Wang HY, Duan YF, Gou Y, Liu XQ, Gao ZX. Neurosyphilis Presenting as Psychiatric Symptoms at Younger Age: A Case Report. Int Med Case Rep J 2024; 17:647-650. [PMID: 38974881 PMCID: PMC11227323 DOI: 10.2147/imcrj.s477459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/23/2024] [Indexed: 07/09/2024] Open
Abstract
Neurosyphilis is a central nervous system infection caused by Treponema pallidum that imitates various neurological and mental disorders. Therefore, patients with this disease are prone to misdiagnoses. Here, we report a case of neurosyphilis with a psychotic disorder as the main manifestation. A young girl exhibited mental and behavioural abnormalities after a heartbreak, which manifested as alternating low mood, emotional irritability, and a lack of interest in social relations, followed by memory loss. The cerebrospinal fluid protein - Treponema pallidum particle agglutination test was positive, the toluidine red unheated serum test titre was 1:4, the white blood cell count was 5 × 10^6/L, the cerebrospinal fluid protein level was 0.97 g/L, and the brain CT was abnormal. After admission, the possibility of neurosyphilis was considered and the patient received intravenous penicillin G treatment. The patient's clinical symptom ms improved. This case emphasises that doctors should maintain clinical suspicion of Treponema pallidum infection in adolescent patients with mental abnormalities.
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Affiliation(s)
- Hong-Yan Li
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
| | - Hao-Yu Wang
- Department of Radiology, The First People’s Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan, People’s Republic of China
| | - Yi-Fei Duan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yu Gou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xiao-Qin Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zheng-Xiang Gao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Majid H, Ali S, Raza FA, Jabeen S, Majid H, Sheikh A, Ahmed M. Neurosyphilis with sequential respiratory complications: A case report highlighting diagnostic and treatment challenges. SAGE Open Med Case Rep 2024; 12:2050313X241256825. [PMID: 38817409 PMCID: PMC11138193 DOI: 10.1177/2050313x241256825] [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: 01/06/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
In this case report, we describe the presentation and clinical course of a 25-year-old male with a complex medical history and a fatal outcome due to neurosyphilis. The diagnosis of neurosyphilis-related complications. Neurosyphilis, a variant of tertiary syphilis, is a rare condition but can present with a wide range of neurological symptoms. This makes its diagnosis challenging. The study aims to report and discuss neurosyphilis in a young male, resulting in respiratory complications, and explore the clinical presentation, diagnostic and process, treatment challenges it poses to a tertiary care setup of a third-world country regimen, and the profound significance of this particular case.
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Affiliation(s)
- Hanifa Majid
- Dow University of Health Sciences, Karachi, Pakistan
| | - Sajjad Ali
- Ziauddin Medical College, Ziauddin University, Karachi, Pakistan
| | - Fatima A Raza
- Karachi Medical and Dental College, Karachi, Pakistan
| | | | - Habiba Majid
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Areeba Sheikh
- Dow University of Health Sciences, Karachi, Pakistan
| | - Muzamil Ahmed
- Dow University of Health Sciences, Karachi, Pakistan
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Chen X, Di L, Qian M, Shen D, Feng X, Zhang X. Neurological features of Hansen disease: a retrospective, multicenter cohort study. Sci Rep 2024; 14:10374. [PMID: 38710787 PMCID: PMC11074337 DOI: 10.1038/s41598-024-60457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/23/2024] [Indexed: 05/08/2024] Open
Abstract
To elucidate the neurological features of Hansen disease. The medical records of patients with confirmed Hansen disease transferred from the neurology department were reviewed, and all medical and neurological manifestations of Hansen disease were assessed. Eleven patients with confirmed Hansen disease, 10 with newly detected Hansen disease and 1 with relapsed Hansen disease, who visited neurology departments were enrolled. The newly detected patients with Hansen disease were classified as having lepromatous leprosy (LL, n = 1), borderline lepromatous leprosy (BL, n = 2), borderline leprosy (BB, n = 2), borderline tuberculoid leprosy (BT, n = 1), tuberculoid leprosy (TT, n = 2), or pure neural leprosy (PNL, n = 2). All of the patients with confirmed Hansen were diagnosed with peripheral neuropathy (100.00%, 11/11). The symptoms and signs presented were mainly limb numbness (100.00%, 11/11), sensory and motor dysfunction (100.00%, 11/11), decreased muscle strength (90.90%, 10/11), and skin lesions (81.81%, 9/11). Nerve morphological features in nerve ultrasonography (US) included peripheral nerve asymmetry and segmental thickening (100.00%, 9/9). For neuro-electrophysiology feature, the frequency of no response of sensory nerves was significantly higher than those of motor nerves [(51.21% 42/82) vs (24.70%, 21/85)(P = 0.0183*)] by electrodiagnostic (EDX) studies. Nerve histological features in nerve biopsy analysis included demyelination (100.00%, 5/5) and axonal damage (60.00%, 3/5). In addition to confirmed diagnoses by acid-fast bacteria (AFB) staining (54.54%, 6/11) and skin pathology analysis (100.00%, 8/8), serology and molecular technology were positive in 36.36% (4/11) and 100.00% (11/11) of confirmed patients of Hansen disease, respectively. It is not uncommon for patients of Hansen disease to visit neurology departments due to peripheral neuropathy. The main pathological features of affected nerves are demyelination and axonal damage. The combination of nerve US, EDX studies, nerve biopsy, and serological and molecular tests can improve the diagnosis of Hansen disease.
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Affiliation(s)
- Xiaohua Chen
- Leprosy Department, Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
- Beijing Key Laboratory for Research On Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China.
| | - Li Di
- Department of Neurology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Min Qian
- Department of Neurology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Xinhong Feng
- Department of Neurology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Xiqing Zhang
- Department of Neurology, Beijing Junyi Traditional Chinese Medicine Hospital, Beijing, China
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Fletcher AM, Bhattacharyya S. Infectious Myelopathies. Continuum (Minneap Minn) 2024; 30:133-159. [PMID: 38330476 DOI: 10.1212/con.0000000000001393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Infectious myelopathy of any stage and etiology carries the potential for significant morbidity and mortality. This article details the clinical presentation, risk factors, and key diagnostic components of infectious myelopathies with the goal of improving the recognition of these disorders and guiding subsequent management. LATEST DEVELOPMENTS Despite our era of advanced multimodal imaging and laboratory diagnostic technology, a causative organism often remains unidentified in suspected infectious and parainfectious myelopathy cases. To improve diagnostic capability, newer technologies such as metagenomics are being harnessed to develop diagnostic assays with a greater breadth of data from each specimen and improvements in infection identification. Conventional assays have been optimized for improved sensitivity and specificity. ESSENTIAL POINTS Prompt recognition and treatment of infectious myelopathy decreases morbidity and mortality. The key diagnostic tools include serologies, CSF analysis, and imaging; however clinical presentation, epidemiologic risk factors, and history of recent illness are all vital to making the proper diagnosis because current laboratory and imaging modalities are often inconclusive. The cornerstone of recommended treatment is targeted antimicrobials with appropriate immune modulation, surgical intervention, supportive care, and interdisciplinary involvement, all of which further improve outcomes for patients with infectious myelopathy.
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8
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Wu S, Ye F, Wang Y, Li D. Neurosyphilis: insights into its pathogenesis, susceptibility, diagnosis, treatment, and prevention. Front Neurol 2024; 14:1340321. [PMID: 38274871 PMCID: PMC10808744 DOI: 10.3389/fneur.2023.1340321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Background and aim Invasion of the central nervous system by Treponema pallidum can occur at any stage of syphilis. In the event that T. pallidum is not cleared promptly, certain individuals may experience progression to neurosyphilis, which manifests as cognitive and behavioral abnormalities, limb paralysis, and potentially fatal outcomes. Early identification or prevention of neurosyphilis is therefore crucial. The aim of this paper is to conduct a critical and narrative review of the latest information focusing exclusively to the pathogenesis and clinical management of neurosyphilis. Methodology To compile this review, we have conducted electronic literature searches from the PubMed database relating to neurosyphilis. Priority was given to studies published from the past 10 years (from 2013 to 2023) and other studies if they were of significant importance (from 1985 to 2012), including whole genome sequencing results, cell structure of T. pallidum, history of genotyping, and other related topics. These studies are classic or reflect a developmental process. Results Neurosyphilis has garnered global attention, yet susceptibility to and the pathogenesis of this condition remain under investigation. Cerebrospinal fluid examination plays an important role in the diagnosis of neurosyphilis, but lacks the gold standard. Intravenous aqueous crystalline penicillin G continues to be the recommended therapeutic approach for neurosyphilis. Considering its sustained prominence, it is imperative to develop novel public health tactics in order to manage the resurgence of neurosyphilis. Conclusion This review gives an updated narrative description of neurosyphilis with special emphasis on its pathogenesis, susceptibility, diagnosis, treatment, and prevention.
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Affiliation(s)
| | | | | | - Dongdong Li
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
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Peel J, Blazos M, Manuchehri H, Fish C, Griffin DWJ. Frontal Lobe Lesion Masquerades as Meningioma. Clin Infect Dis 2023; 77:1733-1735. [PMID: 38102806 DOI: 10.1093/cid/ciad521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Affiliation(s)
- Joanne Peel
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia
| | - Mitsi Blazos
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia
| | - Hossein Manuchehri
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Australia
| | - Charles Fish
- Department of Neurosurgery, Alfred Hospital, Melbourne, Australia
| | - David W J Griffin
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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Funayama M, Kuramochi S, Kudo S. Neurosyphilis Initially Misdiagnosed as Behavioral Variant Frontotemporal Dementia: Life-Changing Differential Diagnosis. J Alzheimers Dis Rep 2023; 7:1077-1083. [PMID: 37849632 PMCID: PMC10578330 DOI: 10.3233/adr-230107] [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: 08/10/2023] [Accepted: 09/02/2023] [Indexed: 10/19/2023] Open
Abstract
Diagnosing neurosyphilis can be challenging and it may be misdiagnosed as behavior variant frontotemporal dementia, given its affinity for the frontal and temporal lobes. Here we present a model case, who, in his 40 s, was initially misdiagnosed with behavioral variant frontotemporal dementia based on extreme self-neglect and disinhibition over six months and frontal lobe atrophy. He was later diagnosed as neurosyphilis with positive syphilis tests in his cerebrospinal fluid. He underwent penicillin treatment and fully recovered. Relatively rapid cognitive decline, particularly if young, should prompt physicians to consider neurosyphilis as a treatable dementia, which could completely change a patient's life.
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Affiliation(s)
- Michitaka Funayama
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Shin Kuramochi
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan
- Department of Neuropsychiatry, Kawasaki Municipal Hospital, Kawaski, Kanagawa, Japan
| | - Shun Kudo
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Pastuszak M, Kwaśny A, Czarnowska-Cubała M, Kwaśna J. Comment on: "Imaging features of neurosyphilis". J Neuroradiol 2023; 50:502. [PMID: 37182615 DOI: 10.1016/j.neurad.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/10/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Michał Pastuszak
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80- 214 Gdańsk, Poland.
| | - Aleskander Kwaśny
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80- 214 Gdańsk, Poland
| | - Monika Czarnowska-Cubała
- Department of Radiology, Faculty of Medicine, Medical University of Gdańsk, 80- 214, Gdańsk, Poland
| | - Julia Kwaśna
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80- 214 Gdańsk, Poland
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Corrêa DG, de Souza SR, Freddi TDAL, Fonseca APA, Dos Santos RQ, da Cruz LCH. Reply to "Comment on: Imaging features of neurosyphilis". J Neuroradiol 2023; 50:503-504. [PMID: 37182616 DOI: 10.1016/j.neurad.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ, Brazil, 2640-102; Department of Radiology, Federal Fluminense University, Rua Marquês de Paraná, 303, Centro, Niterói, RJ, Brazil, 24070-035.
| | - Simone Rachid de Souza
- Department of Pathology, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil, 21941-617
| | | | - Ana Paula Alves Fonseca
- Department of Radiology, UnitedHealth Group, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | - Roberto Queiroz Dos Santos
- Department of Radiology, Hospital dos Servidores do Estado. Rua Sacadura Cabral, 178, Saúde, Rio de Janeiro, RJ, Brazil, 20221-903; Department of Radiology, Hospital das Américas, United Health Group, Avenida Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, RJ, Brazil, 22775-001
| | - Luiz Celso Hygino da Cruz
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ, Brazil, 2640-102
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Costa RDS, Hygino da Cruz Jr LC, de Souza SR, Ventura N, Corrêa DG. Insights into Magnetic Resonance Imaging Findings in Central Nervous System Paracoccidioidomycosis: A Comprehensive Review. Res Rep Trop Med 2023; 14:87-98. [PMID: 37554584 PMCID: PMC10406117 DOI: 10.2147/rrtm.s391633] [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: 04/19/2023] [Accepted: 07/29/2023] [Indexed: 08/10/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is a infection caused by the thermodimorphic fungus Paracoccidioides spp. (P. lutzii and, mainly, P. brasiliensis). This infection predominantly affects rural male workers aged between 30 and 50 years old who deal with soil on daily activities. Clinically, the disease is classified as acute/subacute phase, which evolves rapidly, secondary to dissemination of the fungus through to the phagocytic-mononuclear system, leading to fever, weight loss, and anorexia, associated with hepatosplenomegaly and lymphadenopathy, which can be complicated with suppuration and fistulization; and chronic phase, which corresponds to 74% to 95% of symptomatic cases, with a common pulmonary involvement. Central nervous system involvement is almost always a characteristic of the chronic form. Inhalation is the most common route of primary infection, usually affecting the lungs, forming the primary complex. From the primary complex, hematogenic dissemination can occur to any organ, including the brain and spinal cord. Although PCM of the central nervous system diagnosis is usually based on histopathological analysis and the imaging features are not specific for PCM, computed tomography and magnetic resonance imaging can demonstrate evidences of granuloma, abscess, meningitis, or a combination of these lesions, contributing to a preoperative diagnosis, especially when considered in conjunction with epidemiology. In this article, we review the pathophysiology, clinical manifestations and imaging aspects of neuro-PCM.
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Affiliation(s)
- Rangel de Sousa Costa
- Department of Radiology, Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil
| | | | - Simone Rachid de Souza
- Department of Pathology, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Nina Ventura
- Department of Radiology, Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil
| | - Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil
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