1
|
Abstract
Dermatologists are familiar with the classic aspects of syphilis. Our objective in this update is to display novel features of sexually acquired syphilis, its pathophysiology, natural history, atypical clinical variants, skin of color, clinical pearls, and prospects. Textbook knowledge, congenital syphilis, epidemiology, and historical data are excluded.
Collapse
Affiliation(s)
- Jorge Navarrete
- Department of Dermatology, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; Department of Dermatology and Sexually Transmitted Infections Clinic, Hospital Padre Hurtado, Santiago, Chile.
| | - Stephanie Saavedra-Portales
- Department of Dermatology and Sexually Transmitted Infections Clinic, Hospital San Juan de Dios, Santiago, Chile
| |
Collapse
|
2
|
Zhou X, Peng S, Song T, Tie D, Tao X, Jiang L, Zhang J. Neurosyphilis with ocular involvement and normal magnetic resonance imaging results affirmed by metagenomic next-generation sequencing. Front Cell Infect Microbiol 2022; 12:985373. [PMID: 36530424 PMCID: PMC9756949 DOI: 10.3389/fcimb.2022.985373] [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: 07/03/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022] Open
Abstract
The rapid and accurate identification of pathogenic agents is the key to guide clinicians on diagnosis and medication, especially for intractable diseases, such as neurosyphilis. It is extremely challenging for clinicians to diagnose neurosyphilis with no highly sensitive and specific test available. It is well known that the early transmission and immune evasion ability of Treponema pallidum have earned it the title of "stealth pathogen." Neurosyphilis has complex clinical manifestations, including ocular involvement, which is infrequent and often overlooked, but its neuroimaging results may be normal. Therefore, it is important to find a new test that can detect the presence or absence of Treponema pallidum immediately for the diagnosis of neurosyphilis. We reviewed all the patients admitted to the Sichuan Provincial People's Hospital between 2021 and 2022 who had ocular involvement and whose clinical samples were examined via metagenomic next-generation sequencing (mNGS), and we found 10 candidates for further analysis. The results of magnetic resonance imaging (MRI) were normal for four patients, and three of them met the diagnostic criteria for neurosyphilis confirmed by mNGS. In addition, the results of mNGS from the three patients were further validated using polymerase chain reaction (PCR). Five of the 10 patients had diplopia manifestations; two (20%) experienced abducens nerve palsies, two (20%) had eyelid drooping, and one (10%) had decreased vision. One of the 10 patients (10%) who was HIV positive and five patients had abnormal MRI results. To our knowledge, Treponema pallidum was detected by mNGS in patients with ocular involvement and normal MRI results for the first time. Given this situation, we recommend mNGS as a potential and supplementary tool for the diagnosis and differential diagnosis of neurosyphilis.
Collapse
Affiliation(s)
- Xiaoli Zhou
- Department of Laboratory Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China,Sichuan Translational Medicine Research Hospital, Chinese Academy of Sciences, Chengdu, China
| | - Shengkun Peng
- Sichuan Translational Medicine Research Hospital, Chinese Academy of Sciences, Chengdu, China,Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Tiange Song
- Department of Laboratory Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China,Sichuan Translational Medicine Research Hospital, Chinese Academy of Sciences, Chengdu, China
| | - Dandan Tie
- Department of Laboratory Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China,Sichuan Translational Medicine Research Hospital, Chinese Academy of Sciences, Chengdu, China
| | - Xiaoyan Tao
- Department of Laboratory Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China,Sichuan Translational Medicine Research Hospital, Chinese Academy of Sciences, Chengdu, China
| | - Li Jiang
- Department of Laboratory Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China,Sichuan Translational Medicine Research Hospital, Chinese Academy of Sciences, Chengdu, China,*Correspondence: Li Jiang, ; Jie Zhang,
| | - Jie Zhang
- Department of Laboratory Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China,Sichuan Translational Medicine Research Hospital, Chinese Academy of Sciences, Chengdu, China,*Correspondence: Li Jiang, ; Jie Zhang,
| |
Collapse
|
3
|
Clavijo Prado CA, Aroca Torres J, Abadía Rincon AL, Vargas Ramírez AM, Chauvez Gallego A. Aproximación diagnóstica de la neurosífilis. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
La neurosífilis es la enfermedad del sistema nervioso central (SNC) causada por Treponema pallidum, perteneciente al grupo de las espiroquetas; se puede presentar en pacientes inmunocompetentes pero existe una asociación mayor con el virus de inmunodeficiencia humana (VIH). Estos casos son más severos y con manifestaciones neurológicas variables. Si bien la forma típica es la más frecuente, existen expresiones atípicas que pueden llegar a presentarse en 30% de los casos según los estudios radiológicos, por lo cual es importante reconocerlas a fin de garantizar un diagnóstico temprano y una intervención oportuna. No solo es un problema de salud pública por su prevalencia sino también por el amplio espectro clínico que le ha valido el nombre de gran simuladora, siendo desconocidas en muchas ocasiones por los médicos de atención primaria. El siguiente trabajo ha sido planteado con base en tres casos clínicos (2 de vasculitis en SNC, una panuveítis) con el objetivo de desmitificar los tiempos de presentación y aclarar las manifestaciones clínicas que comprometen el SNC, tratando de precisar el diagnóstico para la realización de un tratamiento pertinente y oportuno que reduzca las secuelas.
Collapse
|
4
|
Kuznetsov DV, Kudryavtseva LE, Korsunskaya IM. Progression of neurosyphilis in a patient with HIV-infection. Case report. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.2.201521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In recent years, the incidence of syphilis, including neurosyphilis, has been increasing worldwide. In our practice, we have noticed an increase in the number of patients who were not examined for the specific pathologies associated with syphilis in timely manner. Given the variety of clinical manifestations of syphilis and the change in the course of the disease associated with HIV-infection, we described the observation of a patient with rapidly progressing (up to the development of a gummous form) neurosyphilis. The clinical case is intended to drag the attention of specialists to necessity to inform patients about the possible consequences of their disease and importance of thorough diagnosis by related specialists.
Collapse
|
5
|
Birrell JM, Lowe M, Gunathilake M, Krause V. 'Neurosyphilis in the Northern Territory of Australia: a clinical guideline'. Intern Med J 2022; 53:738-744. [PMID: 35000259 DOI: 10.1111/imj.15691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Northern Territory (NT) of Australia is currently experiencing a syphilis epidemic. Neurosyphilis is commonly considered in the differential diagnosis for patients presenting with neurologic conditions such as dementia and stroke in the NT. AIMS To explore the local epidemiologic, diagnostic and treatment complexities of neurosyphilis in the NT and produce a guideline for clinical practice. METHODS A database search was undertaken and local and global neurosyphilis guidelines were analysed. A guideline was created based on findings of the critical review and consultation with local multi-disciplinary experts. RESULTS Neurosyphilis is frequently encountered in the NT but studies suggest it is often under-treated. Dementia is the most common clinical presentation locally. Establishing a diagnosis of neurosyphilis is complex and requires stepwise evaluation of clinical, laboratory and radiological findings. CONCLUSIONS A clinical guideline and algorithm have been developed for the diagnosis and management of patients with neurosyphilis. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Johanna M Birrell
- Northern Territory Centre for Disease Control, Public Health Unit, PO Box 40596, Casuarina, NT, 0811, AUS
| | - Michael Lowe
- Royal Darwin Hospital, Department of Medicine, Casuarina, AUS
| | - Manoji Gunathilake
- Northern Territory Centre for Disease Control, Public Health Unit, Casuarina, AUS
| | - Vicki Krause
- Northern Territory Centre for Disease Control, Public Health Unit, Casuarina, AUS
| |
Collapse
|
6
|
Du FZ, Wang QQ, Zheng ZJ, Zhang X, Liang GJ, Chen XS, Zhang RL. The challenge of diagnosis and treatment of neurosyphilis in China: results from a nationwide survey. Sex Health 2021; 18:333-339. [PMID: 34470696 DOI: 10.1071/sh21023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/05/2021] [Indexed: 11/23/2022]
Abstract
Background The uncertainty of how neurosyphilis is diagnosed and treated in clinical settings led us to investigate whether this serious manifestation of syphilis infection is properly managed in China. METHODS This national cross-sectional study of the diagnosis and treatment of neurosyphilis included 1392 clinicians at 398 hospitals located in 116 cities in China. RESULTS Of 398 hospitals, 244 (61.3%) failed to perform diagnostic laboratory tests and 181 (45.5%) failed to provide recommended treatment for neurosyphilis. Of 1392 clinicians, 536 (38.5%) had previously diagnosed patients with neurosyphilis, but 419 (78.2%) of the latter provided diagnoses that did not meet the criteria set by national guidelines. Of the 485 clinicians who had previously treated patients with neurosyphilis, 280 (57.7%) failed to follow national guidelines for treatment. Analysis indicated that clinicians working in North China (adjusted odds ratio (aOR), 4.24; 95% confidence interval (CI), 1.65-10.88), tertiary hospitals (aOR, 3.23; 95% CI, 1.63-6.41), and hospitals specialising in sexually transmitted infections (aOR, 2.49; 95% CI, 1.24-4.99) were more likely to follow national guidelines for neurosyphilis treatment. CONCLUSION Lack of knowledge in disease management poses a great obstacle to prevent the serious consequences of neurosyphilis in Chinese patients. More effective measures are urgently needed to improve this suboptimal situation.
Collapse
Affiliation(s)
- Fang-Zhi Du
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College; National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing 210042, China
| | - Qian-Qiu Wang
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College; National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing 210042, China; and Corresponding authors. Q.-Q. Wang, ; R.-L. Zhang,
| | - Zhi-Ju Zheng
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College; National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing 210042, China
| | - Xu Zhang
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College; National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing 210042, China
| | - Guo-Jun Liang
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College; National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing 210042, China
| | - Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College; National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing 210042, China
| | - Rui-Li Zhang
- Department of Dermatology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China; and Corresponding authors. Q.-Q. Wang, ; R.-L. Zhang,
| |
Collapse
|
7
|
Abstract
Syphilis is a multisystem infection caused by the spirochaete Treponema pallidum Currently, cases of possible syphilis are commonly investigated using the treponemal serological tests T. pallidum IgG chemiluminescence immunoassay (CLIA) and the T. pallidum particle agglutination (TPPA). The non-treponemal rapid plasma reagin (RPR) flocculation test is used to assess disease activity. There has been a resurgence of syphilis diagnoses in Australia. Large foci of infection have been identified in isolated communities. The remoteness of these locations, in conjunction with the particular socio-cultural characteristics of the population, pose unique challenges to the traditional diagnostic and treatment paradigms for syphilis. As a consequence of this increased incidence of syphilis, there has been interest in the utility of point of care tests (POCT), nucleic acid amplification tests (NAAT), the role of IgM testing in suspected congenital syphilis, and the laboratory investigation of possible neurosyphilis. This review looks at the current status of traditional serological assays and provides an update on more recent methods. It assesses the published literature in this area and makes recommendations for the rational use of pathology testing to aid in the diagnosis of the many facets of syphilis.
Collapse
|
8
|
Skalnaya A, Fominykh V, Ivashchenko R, Averchenkov D, Grazhdantseva L, Frigo N, Negasheva E, Dolya O, Brylev L, Guekht A. Neurosyphilis in the modern era: Literature review and case series. J Clin Neurosci 2019; 69:67-73. [PMID: 31427238 DOI: 10.1016/j.jocn.2019.08.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/05/2019] [Indexed: 11/27/2022]
Abstract
The term of neurosyphilis (NS) refers to infection of central nervous system by Treponema pallidum. Classically, it has been divided into early (meningitis, meningovascular) and late forms (general paresis and tabes dorsalis). The availability of penicillin and high sensitivity of Treponema pallidum to this antibiotic has led to a widely held perception about rarity of syphilitic forms with central nervous system involvement. However, patient can exhibit atypical clinical presentation. Recently different clinical cases with autoimmune encephalitis-mimicking presentation or atypical movement disorders were described. In this article we presented clinical case series with different clinical and MRI presentation and discuss diagnostic and treatment challenges. During our screening period at neurological department we revealed 6 NS cases. Three of them have an atypical presentation. The first patient was misdiagnosed as acute disseminated encephalomyelitis, the second patient had hippocampal sclerosis and epileptic seizures. Another patient had cognitive decline and autoimmune encephalitis-like MRI lesions. We put an emphasis on widening of indication for lumbar puncture and NS tests in patients with syphilitic anamnesis and neurological manifestations.
Collapse
Affiliation(s)
- A Skalnaya
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, Moscow, Russia; Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - V Fominykh
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia; Bujanov Moscow City Clinical Hospital, Moscow, Russia.
| | - R Ivashchenko
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - D Averchenkov
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | | | - N Frigo
- Moscow Scientific and Practical Center for Dermatology, Venerology and Cosmetology, Moscow Healthcare Department, Russia
| | - E Negasheva
- Moscow Scientific and Practical Center for Dermatology, Venerology and Cosmetology, Moscow Healthcare Department, Russia
| | - O Dolya
- Moscow Scientific and Practical Center for Dermatology, Venerology and Cosmetology, Moscow Healthcare Department, Russia
| | - L Brylev
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia; Bujanov Moscow City Clinical Hospital, Moscow, Russia; Moscow Research and Clinical Center for Neuropsychiatry, Moscow Healthcare Department, Russia
| | - A Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow Healthcare Department, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| |
Collapse
|
9
|
Smibert OC, Abbinga S, Spelman DW, Jenney AWJ. Neurosyphilis: Concordance between cerebrospinal fluid analysis and subsequent antibiotic strategy for patients undergoing evaluation of a diagnosis of neurosyphilis. Int J Infect Dis 2019; 82:73-76. [PMID: 30853444 DOI: 10.1016/j.ijid.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The confirmation or analysis and exclusion of a diagnosis of neurosyphilis has long presented a challenge for infectious diseases clinicians. The authors reviewed the concordance between cerebrospinal fluid (CSF) analysis and the subsequent antibiotic strategy for patients undergoing evaluation of a diagnosis of neurosyphilis. METHODS All patients with positive serum syphilis serology referred for CSF analysis between January 2009 and May 2016 were included. Indications for CSF analysis were determined by review of the hospital electronic medical records. CSF parameters were determined from the hospital pathology database. Cases were defined as either 'confirmed', 'supportive' of, or 'not supportive' of a diagnosis of neurosyphilis based on existing definitions. Subsequent therapy was defined as for neurosyphilis, late latent primary syphilis or no therapy based on existing guidelines. RESULTS Of 131 patients reviewed, 95.4% were male and HIV co-infected (74%). A confirmed diagnosis of neurosyphilis was met by fourteen patients (10.7%). All but two of these were treated with a neurosyphilis-directed regimen. Of the 58 patients treated with neurosyphilis antibiotics, 17.2% had no CSF findings suggestive of the diagnosis. Seventy-three patients were not treated for neurosyphilis; however 35 of these met the CSF criteria for a diagnosis supportive of neurosyphilis. CONCLUSIONS The results of routine CSF analysis in patients with a possible diagnosis of neurosyphilis are inconsistently applied in the clinical setting, calling into question the value of routine CSF. Empirical neurosyphilis treatment should be considered up front in patients with high pre-test probability of the diagnosis.
Collapse
Affiliation(s)
- O C Smibert
- Microbiology Unit, The Alfred Hospital and Monash University, Melbourne, Victoria 3004, Australia; Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria 3004, Australia.
| | - S Abbinga
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria 3004, Australia
| | - D W Spelman
- Microbiology Unit, The Alfred Hospital and Monash University, Melbourne, Victoria 3004, Australia; Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria 3004, Australia
| | - A W J Jenney
- Microbiology Unit, The Alfred Hospital and Monash University, Melbourne, Victoria 3004, Australia; Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria 3004, Australia
| |
Collapse
|