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Xie JW, Wang M, Zheng YW, Lin Y, He Y, Lin LR. Performance of the nontreponemal tests and treponemal tests on cerebrospinal fluid for the diagnosis of neurosyphilis: A meta-analysis. Front Public Health 2023; 11:1105847. [PMID: 36817920 PMCID: PMC9932918 DOI: 10.3389/fpubh.2023.1105847] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Nontreponemal and treponemal tests for analyzing cerebrospinal fluid to confirm the existence of neurosyphilis have been widely used, so we aim to evaluate and compare their performance on the cerebrospinal fluid in the diagnosis of neurosyphilis. Methods We conducted a systematic literature search on five databases and utilized a bivariate random-effects model to perform the quantitative synthesis. Results Nontreponemal tests demonstrated a pooled sensitivity of 0.77 (95% CI: 0.68-0.83), a pooled specificity of 0.99 (95% CI: 0.97-1.00), and a summary AUC of 0.97 (95% CI: 0.95-0.98). The pooled sensitivity, pooled specificity, and summary AUC of treponemal tests were 0.95 (95% CI: 0.90-0.98), 0.85 (95% CI: 0.67-0.94), and 0.97 (95% CI: 0.95-0.98), respectively. The pooled specificity of all nontreponemal tests varied minimally (ranging from 0.97 to 0.99), with TRUST (0.83) having a higher pooled sensitivity than VDRL (0.77) and RPR (0.73). Among all treponemal tests, EIA has outstanding diagnostic performance with a pooled sensitivity of 0.99 and a pooled specificity of 0.98. Conclusion Nontreponemal tests exhibited a higher pooled specificity, and treponemal tests exhibited a higher pooled sensitivity in diagnosing neurosyphilis on cerebrospinal fluid. TRUST may be a satisfactory substitute for VDRL. EIA is a prospective diagnostic tool that deserves further study in the future. Our study may be useful to clinical laboratories in selecting appropriate serological tests on the cerebrospinal fluid for the diagnosis of neurosyphilis.
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Affiliation(s)
- Jia-Wen Xie
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Mao Wang
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Ya-Wen Zheng
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Yong Lin
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Yun He
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China
| | - Li-Rong Lin
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China,School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China,*Correspondence: Li-Rong Lin ✉
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2
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Milano C, Hoxhaj D, Del Chicca M, Pascazio A, Paoli D, Tommasini L, Vergallo A, Pizzanelli C, Tognoni G, Nuti A, Ceravolo R, Siciliano G, Hampel H, Baldacci F. Alzheimer's Disease and Neurosyphilis: Meaningful Commonalities and Differences of Clinical Phenotype and Pathophysiological Biomarkers. J Alzheimers Dis 2023; 94:611-625. [PMID: 37334599 DOI: 10.3233/jad-230170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Neurosyphilis-associated cognitive and behavioral impairment- historically coined as "general paralysis of the insane"- share clinical and neuroradiological features with the neurodegenerative disease spectrum, in particular Alzheimer's disease (AD). Anatomopathological similarities have been extensively documented, i.e., neuronal loss, fibrillary alterations, and local amyloid-β deposition. Consequently, accurate classification and timely differential diagnosis may be challenging. OBJECTIVE To describe clinical, bio-humoral, brain MRI, FDG-PET, and amyloid-PET features in cases of neurosyphilis with an AD-like phenotypical presentation, as well as clinical outcome in terms of response to antibiotic therapy. METHODS We selected the studies comparing patients with AD and with neurosyphilis associated cognitive impairment, to investigate candidate biomarkers classifying the two neurological diseases. RESULTS The neuropsychological phenotype of general paralysis, characterized by episodic memory impairment and executive disfunction, substantially mimics clinical AD features. Neuroimaging often shows diffuse or medial temporal cortical atrophy, thus contributing to a high rate of misdiagnosis. Cerebrospinal fluid (CSF)-based analysis may provide supportive diagnostic value, since increased proteins or cells are often found in neurosyphilis, while published data on pathophysiological AD candidate biomarkers are controversial. Finally, psychometric testing using cross-domain cognitive tests, may highlight a wider range of compromised functions in neurosyphilis, involving language, attention, executive function, and spatial ability, which are atypical for AD. CONCLUSION Neurosyphilis should be considered a potential etiological differential diagnosis of cognitive impairment whenever imaging, neuropsychological or CSF features are atypical for AD, in order to promptly start antibiotic therapy and delay or halt cognitive decline and disease progression.
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Affiliation(s)
- Chiara Milano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domeniko Hoxhaj
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Del Chicca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessia Pascazio
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Davide Paoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Tommasini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Vergallo
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Chiara Pizzanelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gloria Tognoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angelo Nuti
- Division of Neurology, Versilia Hospital, Lido di Camaiore, Italy
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Harald Hampel
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Filippo Baldacci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
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3
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Recognizing Atypical Presentations of Alzheimer's Disease: The Importance of CSF Biomarkers in Clinical Practice. Diagnostics (Basel) 2022; 12:diagnostics12123011. [PMID: 36553018 PMCID: PMC9776656 DOI: 10.3390/diagnostics12123011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Besides the typical amnestic presentation, neuropathological studies indicate that Alzheimer's disease (AD) may present with atypical clinical pictures. The relative frequencies of typical and atypical or mixed presentations within the entire spectrum of AD remain unclear, while some mixed or atypical presentations may have not received adequate attention for them to be included in diagnostic criteria. We investigated the spectrum of clinical presentations in patients with the AD CSF biomarker profile (high tau and phospho-tau, low Aβ42 levels), hospitalized in a tertiary academic center. Among 98 patients with the CSF AD profile, 46% of patients had the typical presentation of "hippocampal" amnestic dementia. Additionally, 23.5% and 15.3% fulfilled the criteria of mixed or atypical presentations, respectively, as described in the IWG-2 criteria. The remaining 15.3% had unusual presentations, including non-logopenic (semantic and non-fluent agrammatic) primary progressive aphasia, corticobasal syndrome, and Richardson syndrome, or could be diagnosed with normal pressure hydrocephalus. Despite selection bias (academic center), atypical clinical presentations of AD may be more common than previously thought. CSF biomarkers seem to be a useful tool for antemortem identification of such patients, which is likely to affect therapeutic decisions. Some of the unusual presentations described above should be incorporated in diagnostic criteria.
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4
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Gao ZX, Gou Y, Liu XQ, Peng LW. Advances in laboratory diagnostic methods for cerebrospinal fluid testing for neurosyphilis. Front Public Health 2022; 10:1030480. [PMID: 36452956 PMCID: PMC9703065 DOI: 10.3389/fpubh.2022.1030480] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
Neurosyphilis is a chronic infectious disease caused by the invasion of Treponema pallidum into the central nervous system. In recent years, with the increase in the latent syphilis infection rate, the incidence of neurosyphilis has gradually increased, the typical symptoms of neurosyphilis have decreased, atypical manifestations have increased, and the clinical manifestations have become increasingly diverse. Cerebrospinal fluid testing plays an important role in the diagnosis of neurosyphilis. In recent years, there have been many advances in cerebrospinal fluid testing. This review focuses on the current and potential laboratory indicators of neurosyphilis in cerebrospinal fluid, aiming to provide a reference for clinical application and ideas for future experimental research of neurosyphilis.
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Affiliation(s)
- Zheng-Xiang Gao
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yu Gou
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xiao-Qin Liu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Lei-Wen Peng
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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5
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Zhang M, Zhong X, Shi H, Vanmechelen E, De Vos A, Liu S, Chen B, Mai N, Peng Q, Chen X, Wu Z, Hou L, Zhou H, Ouyang C, Zhang W, Liang W, Dai C, Ning Y. BACE1 and Other Alzheimer's-Related Biomarkers in Cerebrospinal Fluid and Plasma Distinguish Alzheimer's Disease Patients from Cognitively-Impaired Neurosyphilis Patients. J Alzheimers Dis 2021; 77:313-322. [PMID: 32804135 DOI: 10.3233/jad-200362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with spirochetal infection, which causes neurosyphilis (NS) and at a later stage general paresis of the insane (GPI), present with brain pathology features of Alzheimer's disease (AD). However, the relationships among these illnesses regarding biomarker levels are still unclear. OBJECTIVE To explore biomarker levels in NS and GPI compared with those in AD and the relationship between biomarker levels and cognitive function in NS and GPI. METHODS Levels of neurogranin (NGRN) and β-amyloid precursor protein cleaving enzyme (BACE1) in cerebrospinal fluid (CSF)/plasma, together with amyloid-β 1-40 (Aβ40), Aβ42, and total tau in the CSF of 23 AD patients, 55 GPI patients, and 13 NS patients were measured. Patients were classified into none-to-mild, moderate, and severe stages of cognitive impairment. RESULTS Levels of CSF NGRN, BACE1, and tau as well as plasma BACE1 levels were significantly different among groups. In the none-to-mild stage, plasma BACE1 levels correlated with the protein levels in CSF and were significantly increased in AD patients versus GPI patients. The CSF tau levels in AD patients were significantly increased versus GPI patients in the moderate and severe stages. Pooling data from GPI and NS patients, both CSF tau and plasma NGRN levels correlated with cognitive scale scores. CONCLUSION GPI and NS patients might have different biomarker level patterns compared to AD patients. While plasma BACE1 could be a promising early biomarker for distinguishing AD from GPI, CSF tau and plasma NGRN levels might be valuable in indications of cognitive function in pooled NS populations.
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Affiliation(s)
- Min Zhang
- Department of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaomei Zhong
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haishan Shi
- Department of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Sen Liu
- Beijing Seven Dimension Neuroscience Research Center, Beijing, China
| | - Ben Chen
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Naikeng Mai
- Department of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qi Peng
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinru Chen
- Department of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhangying Wu
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Le Hou
- Department of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huarong Zhou
- Department of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cong Ouyang
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiru Zhang
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wanyuan Liang
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunying Dai
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Department of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,The first School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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6
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Li W, Chang H, Wu W, Xu D, Jiang M, Gao J, Huang Y, Xu Y, Yin L, Zhang X. Increased CSF Soluble TREM2 Concentration in Patients With Neurosyphilis. Front Neurol 2020; 11:62. [PMID: 32117023 PMCID: PMC7013092 DOI: 10.3389/fneur.2020.00062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/16/2020] [Indexed: 12/21/2022] Open
Abstract
Objective: To explore cerebrospinal fluid (CSF) levels of soluble triggering receptor expressed on myeloid cells 2 (sTREM2) and neurofilament light proteins (NFL) in patients with neurosyphilis (NS). Methods: We enrolled 71 NS patients (41 early-NS and 30 late-NS patients) and 20 syphilis but non-NS patients whose CSF samples were collected. The CSF levels of the microglial activation biomarker sTREM2 and neuronal injury biomarker NFL were measured using ELISA. Results: CSF sTREM2 levels were significantly higher in NS patients compared to those in syphilis/non-NS patients (p < 0.001). In a subgroup analysis, the CSF sTREM2 levels elevated significantly in late-NS patients than those in early-NS patients (p < 0.001). The CSF sTREM2 levels in early-NS group were also significantly higher than those in syphilis/non-NS group (p = 0.024). Like CSF sTREM2, similar differences between groups were also found in CSF NFL. There was a moderate correlation between CSF sTREM2 and CSF NFL (r = 0.406, p < 0.001) in NS group. Conclusions: CSF sTREM2 levels elevated in NS and peaked at the late stage, suggesting that CSF sTREM2 may be a useful marker to quantify microglia activation in NS and may play a role in the progression of NS. The positive correlation between CSF sTREM2 and CSF NFL indicates a linkage between microglial activation and neuronal injury in NS.
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Affiliation(s)
- Wurong Li
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Haoxiao Chang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wenqing Wu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Dongmei Xu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Meijuan Jiang
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Junhua Gao
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuming Huang
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yun Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Linlin Yin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xinghu Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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7
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Zhong X, Shi H, Hou L, Chen B, Peng Q, Chen X, Wu Z, Wang Y, Mai N, Huang X, Ning Y. Neuropsychiatric Features of Neurosyphilis: Frequency, Relationship with the Severity of Cognitive Impairment and Comparison with Alzheimer Disease. Dement Geriatr Cogn Disord 2018; 43:308-319. [PMID: 28538242 DOI: 10.1159/000476060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The pattern of neuropsychiatric features of patients with neurosyphilis and the impact of the severity of cognitive impairment on neuropsychiatric syndromes are unknown. OBJECTIVE We aim to assess the neuropsychiatric features of patients with neurosyphilis, and compare the impact of the severity of cognitive impairment on the neuropsychiatric syndromes between neurosyphilis and Alzheimer disease (AD). METHODS Neuropsychiatric symptoms and the degree of cognitive impairment were assessed in a case-control study of 91 neurosyphilis, 162 AD, 157 mild cognitive impairment, and 139 normal controls by the Neuropsychiatric Inventory (NPI) scale and Clinical Dementia Rating scale, respectively. Factor analysis was performed on the 12 NPI items. RESULTS Factor analysis showed that patients with neurosyphilis showed more severe neuropsychiatric syndromes at the dementia stage than those neurosyphilis patients at the mild cognitive impairment stage, while neuropsychiatric manifestations were equally common among the different stages of dementia (all p < 0.05). Frontal lobe syndrome was more severe in patients with neurosyphilis than in patients with AD from the early mild cognitive impairment stage to the moderate dementia stage (all p < 0.01). CONCLUSIONS Patients with neurosyphilis show different patterns of neuropsychiatric syndromes at the mild cognitive impairment and dementia stages, and differ from patients with AD.
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Affiliation(s)
- Xiaomei Zhong
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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8
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Luo X, Shi H, Hou L, Zhong X, Chen X, Zhang Y, Zheng D, Tan Y, Hu G, Mu N, Chen J, Fang Y, He H, Ning Y. Different cerebrospinal fluid levels of Alzheimer-type biomarker Aβ42 between general paresis and asymptomatic neurosyphilis. Eur J Neurol 2015; 22:853-8. [PMID: 25707998 DOI: 10.1111/ene.12680] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/22/2014] [Indexed: 12/27/2022]
Affiliation(s)
- X. Luo
- Department of Neurology; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - H. Shi
- Department of Neurology; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - L. Hou
- Department of Neurology; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - X. Zhong
- Department of Neurology; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - X. Chen
- Department of Neurology; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - Y. Zhang
- Department of Neurology; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - D. Zheng
- Department of Neurology; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - Y. Tan
- Department of Neurology; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - G. Hu
- Clinical Laboratory; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - N. Mu
- Department of Geriatrics; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - J. Chen
- Department of Geriatrics; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - Y. Fang
- Department of Neurology; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - H. He
- Neuropsychiatry Research Institute; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - Y. Ning
- Department of Neurology; Guangzhou Brain Hospital; Affiliated Hospital of Guangzhou Medical University; Guangzhou China
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Zhang HL, Lin LR, Liu GL, Zeng YL, Wu JY, Zheng WH, Tong ML, Dong J, Su YH, Liu LL, Yang TC. Clinical spectrum of neurosyphilis among HIV-negative patients in the modern era. Dermatology 2013; 226:148-56. [PMID: 23615173 DOI: 10.1159/000347109] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/30/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical spectrum of neurosyphilis (NS) has changed over time. OBJECTIVE To describe the clinical spectrum and characteristics of NS in HIV-negative patients. METHODS A retrospective chart review was performed for 149 in patients with NS. RESULT All patients were >25 years old, including 16.8% asymptomatic for NS, 15.4% with syphilitic meningitis, 24.2% with meningovascular NS, 38.9% with general paresis, 4.0% with tabes dorsalis and 0.7% with gummatous NS. The original misdiagnosis rate was 84.6%. All 149 patients had positive serum Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR). The overall positive rates of cerebrospinal fluid RPR (CSF-RPR) and CSF-TPPA were 57.0 and 89.9%, respectively. CSF pleocytosis and elevated CSF protein were found in 40.3% of patients. Nonspecific abnormal brain magnetic resonance imaging and electroencephalography findings were present in 60.4 and 54.8% of NS patients, respectively. CONCLUSIONS NS has various clinical manifestations, laboratory findings and magnetic resonance imaging and electroencephalography findings, but all studies lack specificity. Every patient with neurological or psychiatric symptoms that are without unambiguous causes should have blood tests for syphilis. When serology proves positive, patients should undergo CSF examination.
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Affiliation(s)
- Hui-Lin Zhang
- Center of Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
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A late form of neurosyphilis manifesting with psychotic symptoms in old age and good response to ceftriaxone therapy. Int Psychogeriatr 2011; 23:666-9. [PMID: 20843397 DOI: 10.1017/s104161021000181x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neurosyphilis can present with psychiatric symptoms. The late form can occur in old age with psychosis, paranoid delusions, affective disorders or cognitive impairment. Here we present a case of neurosyphilis in an elderly woman who, over six months, progressively manifested personality changes and paranoid delusions which were initially suspected as Alzheimer's disease. Psychotic symptoms showed a good response to antibiotic treatment. We conclude that neurosyphilis is a relevant differential diagnosis in patients developing severe psychiatric symptoms in old age. As a causal antibiotic treatment is possible this infectious disease should be considered seriously in gerontopsychiatric patients.
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