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Zhu Z, Gong H, Liu M, Zhang H, Yang L, Zhang X, Zheng H, Li Y, Li M, Li J. Diagnosing Tabes Dorsalis in HIV-Negative Patients: Clinical Features, Neuroimaging, and Laboratory Insights in the Modern Antibiotic Era. Infect Drug Resist 2024; 17:2567-2577. [PMID: 38919834 PMCID: PMC11197998 DOI: 10.2147/idr.s464581] [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: 02/18/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
Background Tabes dorsalis is a late manifestation of neurosyphilis, characterized by progressive ataxia, lightning pains, loss of proprioception, and urinary incontinence. The absence of a definitive diagnostic standard and the non-specific clinical manifestations have led to a significant rate of misdiagnoses. Methods Hospitalized patients with tabes dorsalis at Peking Union Medical College Hospital between January 2010 and December 2023 were reviewed. Results A total of 13 patients were included, with 10 males and 3 females. The median age was 50 years (range, 34-64). The most frequent initial symptoms were limb numbness (30.8%) and lightning pains (30.8%). Eleven patients (84.6%) received misdiagnoses prior to the final diagnosis. The most frequently observed physical sign was positive Romberg's sign (84.6%). Notably, Argyll Robertson pupil was presented in 7 subjects (53.8%). Serological tests revealed positive rapid plasma regain (RPR) and Treponema pallidum particle agglutination (TPPA) for all patients. All CSF samples were TPPA-reactive. Intramedullary hyperintensity on T2-weighted imaging of spinal MRI was found in 5 patients (38.5%). All patients received anti-syphilitic treatment, with effective treatment recorded in five cases. Conclusion This study underscores the importance of neurological symptoms and signs in diagnosing tabes dorsalis. Individuals with progressive ataxia and positive Romberg's sign should be closely monitored for potential neurosyphilis. Integrating clinical features, laboratory tests, and neuroimaging could reduce misdiagnosis and expedite the initiation of anti-syphilitic therapy.
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Affiliation(s)
- Zhou Zhu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Huizi Gong
- Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Mingjuan Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Leyan Yang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Xinyi Zhang
- Departments of Internal Medicine and Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Heyi Zheng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Yanfeng Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Mingli Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
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Yang Y, Gu X, Zhu L, Cheng Y, Lu H, Guan Z, Shi M, Ni L, Peng RR, Zhao W, Wu J, Qi T, Long F, Chai Z, Gong W, Ye M, Zhou P. Clinical spectrum of late symptomatic neurosyphilis in China: an 11-year retrospective study. Sex Transm Infect 2024:sextrans-2024-056117. [PMID: 38902025 DOI: 10.1136/sextrans-2024-056117] [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: 01/23/2024] [Accepted: 05/26/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES This study aimed to describe the clinical features of neurosyphilis in Chinese patients in an attempt to find clinical features that are helpful for the early identification of neurosyphilis. METHODS This retrospective study included people with syphilis who visited Shanghai Skin Disease Hospital between January 2010 and December 2020. Lumbar puncture was performed on those who met the inclusion and exclusion criteria. The diagnosis of neurosyphilis was based on clinical and laboratory findings. The parameters were analysed statistically. RESULTS Of the 3524 patients with neurosyphilis, 2111 (59.9%) and 1413 (40.1%) were asymptomatic and symptomatic neurosyphilis, respectively. General paresis was the most common type of symptomatic neurosyphilis (46.8%). The clinical manifestations of symptomatic neurosyphilis include psychiatric and neurotic symptoms, among which general paresis predominantly presented as psychiatric symptoms such as affective (66.7%) and memory disorder (72.9%). Tabes dorsalis is often presented as neurotic symptoms. One hundred fifty patients (10.6%) with symptomatic neurosyphilis presented candy signs, a rare and specific neurosyphilis symptom that is common in general paresis. Girdle sensation was presented in 13 patients, mainly with tabes dorsalis, which had not been reported in previous studies. CONCLUSIONS Notably, the candy sign is identified as a specific symptom of general paresis, while girdle sensations are highlighted as a particular symptom of tabes dorsalis. This is the largest study describing the clinical spectrum of neurosyphilis since the onset of the penicillin era and could help doctors learn more about the disease. A comprehensive description of the possible clinical manifestations of late symptomatic neurosyphilis, particularly highlighting rare symptoms, can identify suspicious patients and prevent diagnostic delays.
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Affiliation(s)
- Yilan Yang
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Xin Gu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Lin Zhu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Yuanyuan Cheng
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Haikong Lu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Zhifang Guan
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Mei Shi
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Liyan Ni
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Rui-Rui Peng
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Wei Zhao
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Juan Wu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Tengfei Qi
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Fuquan Long
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Zhe Chai
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Weiming Gong
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Meiping Ye
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Pingyu Zhou
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
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Papp JR, Park IU, Fakile Y, Pereira L, Pillay A, Bolan GA. CDC Laboratory Recommendations for Syphilis Testing, United States, 2024. MMWR Recomm Rep 2024; 73:1-32. [PMID: 38319847 PMCID: PMC10849099 DOI: 10.15585/mmwr.rr7301a1] [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: 02/08/2024] Open
Abstract
This report provides new CDC recommendations for tests that can support a diagnosis of syphilis, including serologic testing and methods for the identification of the causative agent Treponema pallidum. These comprehensive recommendations are the first published by CDC on laboratory testing for syphilis, which has traditionally been based on serologic algorithms to detect a humoral immune response to T. pallidum. These tests can be divided into nontreponemal and treponemal tests depending on whether they detect antibodies that are broadly reactive to lipoidal antigens shared by both host and T. pallidum or antibodies specific to T. pallidum, respectively. Both types of tests must be used in conjunction to help distinguish between an untreated infection or a past infection that has been successfully treated. Newer serologic tests allow for laboratory automation but must be used in an algorithm, which also can involve older manual serologic tests. Direct detection of T. pallidum continues to evolve from microscopic examination of material from lesions for visualization of T. pallidum to molecular detection of the organism. Limited point-of-care tests for syphilis are available in the United States; increased availability of point-of-care tests that are sensitive and specific could facilitate expansion of screening programs and reduce the time from test result to treatment. These recommendations are intended for use by clinical laboratory directors, laboratory staff, clinicians, and disease control personnel who must choose among the multiple available testing methods, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients. Future revisions to these recommendations will be based on new research or technologic advancements for syphilis clinical laboratory science.
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Liu M, Tong M, Zhou J, Lan Y, Wu M, Zhang H, Leng L, Zheng H, Li Y, Li M, Li J. Clinical and Laboratory Characteristics, Neuroimaging Alternations and Treatment Response of 25 HIV-Negative General Paresis Patients. Infect Drug Resist 2023; 16:6931-6939. [PMID: 37928605 PMCID: PMC10624117 DOI: 10.2147/idr.s421672] [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: 06/01/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose General paresis is a common type of neurosyphilis featuring progressive cognitive deterioration. The lack of a golden standard of diagnosis and its nonspecific clinical manifestations resulted in a high rate of misdiagnoses. This study aims to investigate the clinical, laboratory and radiological presentations of general paresis and enrich its knowledge for timely diagnoses. Patients and methods The study collected hospitalized patients admitted for general paresis from September 2002 to November 2022. Their socio-demographical and medical status, clinical presentations, cognitive assessments, laboratory and radiographical manifestations and treatment information were collected retrospectively. Results A total of 20 males and 5 females were included. Patients' ages ranged from 30 to 66 years (average 50.3 years). The average and median time for diagnosing general paresis was 14.1 months and 10.0 months respectively. The most frequent initial symptom is memory deterioration (68.0%). Impaired calculative ability and memory deterioration were the most frequent cognitive anomalies, as found in 50% and 45.4% of subjects during examination. The mean and median scores of MoCA was 16.7 and 17 respectively. Serological tests revealed positive TPPA for all patients and a median RPR titer at 1:64 positive. All CSF samples with TPPA and FTA-ABS results reported positivity. The MRI manifestations of general paresis include patchy or speckled hyperintensities (70.8%) and cerebral atrophy (45.8%). The most common lesioned sites in MRI were the ventricular and paraventricular area (50.0%) and temporal lobes (45.8%). For treatment, penicillin-based anti-syphilitic plans were adopted in 17 patients (68.0%). Conclusion The clinical features and radiological alternations of general paresis patients often exhibited diverse and nonspecific alternations. However, some specific clinical manifestations and auxiliary examinations can provide meaningful clues for the identification and differential diagnosis of this disease.
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Affiliation(s)
- Mingjuan Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
- 4+4 M.D. Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, People’s Republic of China
| | - Meiyi Tong
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Jia Zhou
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Yining Lan
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Mengyin Wu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Ling Leng
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Heyi Zheng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Yanfeng Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Mingli Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
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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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Chen R, Lin LR, Xiao Y, Ke WJ, Yang TC. Evaluation of cerebrospinal fluid ubiquitin C-terminal hydrolase-L1, glial fibrillary acidic protein, and neurofilament light protein as novel markers for the diagnosis of neurosyphilis among HIV-negative patients. Int J Infect Dis 2023; 127:36-44. [PMID: 36400375 DOI: 10.1016/j.ijid.2022.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the possibility of using cerebrospinal fluid (CSF) ubiquitin C-terminal hydrolase L1 (UCH-L1), glial fibrillary acidic protein (GFAP), and neurofilament light protein (NF-L) for the diagnosis of neurosyphilis (NS). METHODS A cross-sectional study of 576 subjects was conducted at Zhongshan Hospital from January 2021 to August 2022 to evaluate the diagnostic accuracy of CSF UCH-L1, GFAP, and NF-L for NS and analyze their correlations with CSF rapid plasma reagin (RPR), white blood cells (WBCs), and protein. RESULTS Patients with NS had higher CSF UCH-L1, GFAP, and NF-L levels than patients with syphilis/non-NS and nonsyphilis. Using a cut-off point of 652.25 pg/ml, 548.89 pg/ml, and 48.38 pg/ml, CSF UCH-L1, GFAP, and NF-L had a sensitivity of 85.11%, 76.60%, and 82.98%, with a specificity of 92.22%, 85.56%, and 91.11%, respectively, for NS diagnosis. Moreover, parallel and serial testing algorithms improved their sensitivity and specificity to 93.62% and 98.89%, respectively. Interestingly, levels between patients with NS who are CSF RPR-positive and -negative did not differ and showed a weak or moderate correlation with WBC and CSF protein in patients with syphilis. CONCLUSION CSF UCH-L1, GFAP, and NF-L can be used as novel markers for the diagnosis of NS, independent of CSF RPR, WBC, and proteins.
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Affiliation(s)
- Rui Chen
- Center of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Li-Rong Lin
- Center of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Yao Xiao
- Department of Hospital Infection Management, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wu-Jian Ke
- Dermatology Hospital, Southern Medical University, Guangzhou, China.
| | - Tian-Ci Yang
- Center of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China; Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China; Xiamen Clinical Laboratory Quality Control Center, Xiamen, China.
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Fournier A, Fines M, Verdon R. Neurosifilide. Neurologia 2022. [DOI: 10.1016/s1634-7072(22)47092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Du FZ, Wu MZ, Zhang X, Zhang RL, Wang QQ. Ceftriaxone compared with penicillin G for the treatment of neurosyphilis: study protocol for a multicenter randomized controlled trial. Trials 2022; 23:835. [PMID: 36183101 PMCID: PMC9526986 DOI: 10.1186/s13063-022-06769-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 09/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neurosyphilis may cause irreversible neurological sequelae. First-line treatment consists of penicillin G, with ceftriaxone being an alternative treatment in patients allergic to penicillin. The lack of clinical data comparing the efficacy of these two drugs indicated the need for comparative clinical trials to improve national treatment guidelines in China. METHODS/DESIGN In this multicenter randomized controlled clinical trial, 290 patients newly diagnosed with neurosyphilis will be randomized 1:1 to treatment with aqueous crystalline penicillin G (ACPG) or ceftriaxone. Patients will be treated with standard regimens of ACPG or ceftriaxone according to Chinese National Guidelines and will be followed up for 12 months. All clinical parameters will be assessed at baseline and at follow-up 3, 6, 9, and 12 months later. The primary outcomes will include cerebrospinal fluid (CSF) white blood cell (WBC) count, serological efficacy, and clinical efficacy. The secondary outcomes will include CSF protein concentrations, Mini-Mental State Examination (MMSE) scores, imaging results, recurrence, and time to recovery from neurosyphilis. Adverse events will be monitored and recorded during the trial. DISCUSSION This trial will provide clinical data to determine whether ceftriaxone is non inferior to ACPG in treating neurosyphilis and will provide evidence for the improvement of treatment guidelines. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100047164. Registered on 9 June 2021 and updated on 23 November 2021.
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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, No. 12 Jiangwangmiao Street, Xuanwu District, Nanjing, 210042, China
| | - Min-Zhi Wu
- Department of Dermatology, The Fifth People's Hospital of Suzhou, No. 10 Guangqian Road, Xiangcheng District, Suzhou, 215505, 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, No. 12 Jiangwangmiao Street, Xuanwu District, Nanjing, 210042, China
| | - Rui-Li Zhang
- Department of Dermatology, The Second Affiliated Hospital of Nanjing Medical University, No. 121 Jiangjiayuan Road, Gulou District, Nanjing, 210011, 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, No. 12 Jiangwangmiao Street, Xuanwu District, Nanjing, 210042, China.
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9
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Du FZ, Zhang HN, Li JJ, Zheng ZJ, Zhang X, Zhang RL, Wang QQ. Neurosyphilis in China: A Systematic Review of Cases From 2009-2021. Front Med (Lausanne) 2022; 9:894841. [PMID: 35646949 PMCID: PMC9136070 DOI: 10.3389/fmed.2022.894841] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Considered the increased threaten of neurosyphilis in China, a review on cases reported in the literature to describe the clinical epidemiological characteristics of neurosyphilis cases, may be beneficial to the early detection and management strategies of neurosyphilis for clinicians. We searched the literature on Chinese neurosyphilis cases published from January 1, 2009 to December 31, 2021, described their clinical epidemiological characteristics and calculated the prevalence of neurosyphilis amongst other associated diseases, according to the individual study criteria. A total of 284 studies including 7,486 neurosyphilis cases were included. No meta-analysis was performed due to the heterogeneity of the data. Among 149 case reports and 93 retrospective case series studies, the main clinical manifestation of 3,507 neurosyphilis cases was cerebral parenchymal syphilis (57.3%), followed by asymptomatic neurosyphilis (16.7%), meningovascular syphilis (13.6%), meningitis syphilis (7.7%) and ocular syphilis (2.8%), etc. In addition, the initial diagnosis was incorrect in 53.2% patients, and the most frequent misdiagnoses were mental disorders (31.0%), stroke (15.9%), cognitive impairment (9.0%), etc. The positive or abnormal rates of cerebrospinal fluid non-treponemal and treponemal tests, white blood cell counts and protein concentrations were 74.2%, 96.2%, 61.5%, and 60.9%, respectively. Aqueous penicillin was the first choice for treatment in 88.3% cases, and 81.7% and 50.0% patients had response in the improvement of symptoms and serological effective in CSF, respectively. Among 26 studies on neurosyphilis patients amongst other associated diseases, the prevalence of neurosyphilis amongst central nervous system infectious diseases, syphilis-associated neurological symptoms, serofast status, coinfected with human immunodeficiency virus were 10.6%-30.1%, 23.2%-35.5%, 9.8%-56.1%, and 8.9%, respectively. In summary, the lack of early detection of neurosyphilis cases remains a clinical challenge. The high rate of misdiagnosis and high prevalence of neurosyphilis amongst associated diseases strongly remind clinicians to focus on the early detection among suspected cases. Besides, the standard treatment regimen and long-term follow-up, which complied with guideline should be provided. Further prospective studies are urgent to better delineate the clinical epidemiological characteristics of neurosyphilis in China.
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Affiliation(s)
- Fang-Zhi Du
- Department of Clinical Prevention and Control of STD, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Hai-Ni Zhang
- Department of Clinical Prevention and Control of STD, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Jing-Jing Li
- Department of Dermatology, The Fifth People's Hospital of Suzhou, Suzhou, China
| | - Zhi-Ju Zheng
- Department of Clinical Prevention and Control of STD, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Xu Zhang
- Department of Clinical Prevention and Control of STD, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Rui-Li Zhang
- Department of Dermatology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian-Qiu Wang
- Department of Clinical Prevention and Control of STD, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
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10
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Mehta N, Bhari N, Gupta S. Asian guidelines for syphilis. J Infect Chemother 2022; 28:1084-1091. [PMID: 35527175 DOI: 10.1016/j.jiac.2022.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Nikhil Mehta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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11
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Niimura M, Imai H. Multiple Spinal Syphilitic Gummas Diagnosed by Postoperative Histopathology and Antibiotic Responsiveness: A Case Report. NMC Case Rep J 2022; 8:637-643. [PMID: 35079528 PMCID: PMC8769426 DOI: 10.2176/nmccrj.cr.2021-0098] [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: 04/06/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022] Open
Abstract
Neurosyphilis is an infection of the central nervous system by Treponema pallidum. Gummatous neurosyphilis, especially spinal syphilitic gumma, is an exceedingly rare manifestation and may be misdiagnosed as other tumors due to its rarity. A 42-year-old man with a medical history of treatment for syphilis presented with rapidly progressive leg paralysis, leg sensory disturbance, and bladder and rectal disturbance. Spinal MRI demonstrated an intradural extramedullary lesion strongly compressing the spinal cord at the T6/7 level, which was accompanied with dural tail sign and perilesional meningeal thickening at the T6–T8 levels. Small intradural extramedullary lesions were also detected at the T1 and T8 levels. Serological and cerebrospinal fluid examinations for syphilis were both positive. In the treatment of spinal syphilitic gumma, the decompression of the spinal cord by lesionectomy followed by postoperative antibiotic treatment is considered to be an optimal procedure in patients with rapid progression of neurological deterioration. In the present case, the symptomatic main lesion that was compressing the thoracic cord was excised by surgery and analyzed by histopathological examination, and another small asymptomatic lesion was resolved by postoperative antibiotic treatment. Spinal syphilitic gumma was diagnosed using both histopathological findings of the surgically resected lesion and another residual lesion that was resolved by postoperative antibiotic treatment.
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Affiliation(s)
- Manabu Niimura
- Department of Neurosurgery, Shinagawa Shisyokai Hospital, Tokyo, Japan.,Department of Neurosurgery, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Hideaki Imai
- Department of Neurosurgery, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
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12
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Ge W, Zhang Y, Peng C, Li D, Gao L, Bao J, Li C, Chen N, Zhou D, He L. Development and external validation of a nomogram for neurosyphilis diagnosis among non-HIV patients: a cross-sectional study. BMC Neurol 2021; 21:451. [PMID: 34789198 PMCID: PMC8600785 DOI: 10.1186/s12883-021-02454-8] [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: 08/03/2021] [Accepted: 10/21/2021] [Indexed: 02/08/2023] Open
Abstract
Background The diagnosis of neurosyphilis is challenging due to the requirement of a lumbar puncture and cerebrospinal fluid (CSF) laboratory tests. Therefore, a convenient diagnostic nomogram for neurosyphilis is warranted. This study aimed to construct diagnostic models for diagnosing neurosyphilis. Methods This cross-sectional study included data of two patient cohorts from Western China Hospital of Sichuan University between September 2015 and April 2021 and Shangjin Hospital between September 2019 and April 2021 as the development cohort and the external validation cohort, respectively. A diagnostic model using logistic regression analysis was constructed to readily provide the probability of diagnosis at point of care and presented as a nomogram. The clinical usefulness of the diagnostic models was assessed using a receiver operating characteristic (ROC) and Harrell concordance (Harrell C) index for discrimination and calibration plots for accuracy, which adopted bootstrap resampling 500 times. Results One hundred forty-eight and 67 patients were included in the development and validation cohorts, respectively. Of those, 131 were diagnosed as having reactive neurosyphilis under the criteria of positive results in both CSF treponemal and non-treponemal tests. In the development cohort, male, psychiatric behaviour disorders, and serum toluidine red unheated serum test were selected as diagnostic indicators applying a stepwise procedure in multivariable logistic model. The model reached 80% specificity, 79% sensitivity, and 0·85 area under the curves (AUC) (95% confidence interval, 0·76–0·91). In the validation cohorts, the Harrell C index for the diagnostic possibility of reactive neurosyphilis was 0·71. Conclusions A convenient model using gender, presence of psychiatric behaviour disorders, and serum TRUST titre was developed and validated to indicate diagnostic results in patients suspected of neurosyphilis. Checking the model value of factors on nomogram is a feasible way to assist clinicians and primary health servers in updating patients’ medical charts and making a quantitatively informed decision on neurosyphilis diagnosis. Trial registration This research was retrospectively registered in the Ethics committee on biomedical research, West China Hospital of Sichuan University. The research registration and committee’s reference number was 1163 in 2020 approval. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02454-8.
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Affiliation(s)
- Wenjing Ge
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yang Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chao Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Dongdong Li
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Lijie Gao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jiajia Bao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Changling Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ning Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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13
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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.
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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,
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14
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Abstract
PURPOSE OF REVIEW This article focuses on the epidemiology, clinical presentation, diagnosis, and management of neurosyphilis, with an emphasis on clinically relevant issues faced by the practicing neurologist. RECENT FINDINGS The incidence of primary and secondary syphilis, the sexually transmissible stages of infection, has been on the rise for the past 2 decades. A concerning recent trend is the surge in cases of syphilis in women and of congenital syphilis. Neurosyphilis remains a relatively common complication that can occur at any stage of syphilis. Along with meningitis, meningovascular syphilis, which has been historically described as a late presentation of neurosyphilis, now frequently occurs as a manifestation of early infection. Late forms of neurosyphilis, including tabes dorsalis and general paresis, are less prevalent in the era of widespread penicillin use. As more laboratories adopt the reverse-sequence algorithm for syphilis testing, patients with serodiscordant results (ie, a reactive serum treponemal test with a nonreactive nontreponemal test) may present an increasingly encountered diagnostic challenge for neurologists. Although the CSF Venereal Disease Research Laboratory (VDRL) remains a mainstay of diagnostic testing for neurosyphilis, using a higher titer cutoff (greater than 1:320) for the Treponema pallidum particle agglutination assay (TPPA) from the CSF may improve the utility of the TPPA as a supporting criterion for the diagnosis of neurosyphilis. Penicillin G is the treatment of choice for neurosyphilis, although ceftriaxone may be a reasonable alternative therapy. SUMMARY A high index of suspicion and awareness of the variable clinical presentations of neurosyphilis are essential to the approach to this treatable infection. Neurologists should be mindful of the limitations of serologic testing in the diagnosis of neurosyphilis and exercise clinical judgment to determine the likelihood of the diagnosis.
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15
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Park IU, Tran A, Pereira L, Fakile Y. Sensitivity and Specificity of Treponemal-specific Tests for the Diagnosis of Syphilis. Clin Infect Dis 2021; 71:S13-S20. [PMID: 32578866 PMCID: PMC7312216 DOI: 10.1093/cid/ciaa349] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We conducted a systematic review of relevant syphilis diagnostic literature to address the question, “What is the sensitivity and specificity of the treponemal tests currently approved by the Food and Drug Administration (FDA) for the diagnosis of syphilis (by stage)?” There were 16 treponemal assays evaluated: 13 immunoassays and 3 manual assays (fluorescent treponemal antibody absorbed test [FTA-ABS], microhemagglutination assay for Treponema pallidum antibodies [MHA-TP], Treponema pallidum particle agglutination assay [TP-PA]). MHA-TP and FTA-ABS were less sensitive in primary and secondary syphilis than TP-PA; TP-PA is the most specific manual treponemal assay. There is insufficient evidence to recommend one particular treponemal immunoassay (eg, enzyme immunoassays, chemiluminescence immunoassays, microbead immunoassays) over another based on published performance data. For diagnosis of neurosyphilis, cerebrospinal fluid (CSF) TP-PA has similar performance to CSF FTA-ABS in studies with patients with definitive or presumptive neurosyphilis. However, CSF treponemal testing has limitations in its sensitivity and specificity and should be interpreted within the context of the clinical scenario, additional CSF test results and syphilis prevalence.
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Affiliation(s)
- Ina U Park
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Correspondence: I. U. Park, Department of Family and Community Medicine, University of California San Francisco School of Medicine, Medical Consultant, Division of STD Prevention, Centers for Disease Control and Prevention, STD Control Branch, 850 Marina Bay Parkway, Building P, 2nd Floor, Richmond, CA 94804 ()
| | - Anthony Tran
- Public Health Laboratory, Department of Forensic Sciences, Washington, DC, USA
| | - Lara Pereira
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yetunde Fakile
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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16
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Gao JH, Li WR, Xu DM, Zheng BW, Huang YM, Wu WQ, Zhang W. Clinical Manifestations, Fluid Changes and Neuroimaging Alterations in Patients with General Paresis of the Insane. Neuropsychiatr Dis Treat 2021; 17:69-78. [PMID: 33469294 PMCID: PMC7812051 DOI: 10.2147/ndt.s279265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/08/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE We aim to study the clinical manifestations, fluid changes and neuroimaging alterations in patients with general paresis of the insane (GPI). METHODS A total of 119 patients suffering from GPI recruited in Beijing Ditan Hospital, Capital Medical University from 2010 to 2020 were retrospectively analyzed. RESULTS In 119 GPI patients, 103 cases (86.6%) were male. Misdiagnosed rate was up to 83.2%, schizophrenia and mood disorders were the most common misdiagnosed diseases. Duration from symptom onset to the final confirmed diagnosis was 10.4±12.9 months. The main clinical manifestations included cognitive impairment (114 cases, 95.8%) and neuropsychiatric symptoms (107 cases, 90.0%). The cognitive domains including the delayed recall, visuospatial/executive function and language ability indicated by MoCA score were damaged severely. Rapid plasma regain (RPR) of all GPI patients was 100% positive in serum and 89.9% positive in cerebral spinal fluid (CSF). The white blood cell (WBC) number in CSF was between 6 and 50/μL in 73 GPI patients (61.3%). The protein level was between 45.1 and 70mg/dL in 47 cases (39.5%). In the 110 cases, 96 cases (87.3%) were abnormal indicated by cerebral atrophy mostly located in the anterior brain and abnormal signals distributed in various regions of the brain mostly in the frontal lobe and temporal lobe. CONCLUSION The symptoms of GPI were complex and easy to misdiagnose. The clinicians were still short of vigilance for neurosyphilis. We should expand serologic testing for syphilis especially in patients with cognitive impairment and neuropsychiatric symptoms. We suggest syphilis curricula in the training program of the clinicians especially for neurologist and psychiatrist.
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Affiliation(s)
- Jun-Hua Gao
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wu-Rong Li
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dong-Mei Xu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bo-Wen Zheng
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yu-Ming Huang
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wen-Qing Wu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei Zhang
- Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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17
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Weng W, Hou J, Song B, Zhang M, Zhang T, Gao Y. Identification of the factors associated with post-treatment asymptomatic neurosyphilis in HIV-negative patients with serological non-response syphilis: a retrospective study. Int J STD AIDS 2020; 32:331-335. [PMID: 33345747 DOI: 10.1177/0956462420965850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Some syphilis patients do not exhibit an appropriate serological response after treatment despite the absence of any clinical evidence of treatment failure or reinfection. This condition is called "serofast syphilis" or "serological non-response syphilis." This study explored the incidence of asymptomatic neurosyphilis (ANS) and related factors in 324 asymptomatic patients with serological non-response syphilis. We analyzed descriptive statistics stratified by the presence of asymptomatic neurosyphilis for the basic characteristics of samples. Bivariate analysis was conducted to assess correlations between outcomes and potential predictors. Variables significant in the bivariate analysis (p<0.1) were entered into multivariable logistic regression models. All p-values were two-sided with a significance threshold of p<0.05. The results indicated that 89 of 324 patients had ANS (incidence of 27.5%), and the greatest risk factors were a < fourfold decrease in serum rapid plasma reagin (RPR) titers after treatment and current serum RPR titers >1:32. Our findings suggest that ANS is common among syphilis patients, and patients with a fourfold decrease in serum RPR titers after treatment and current serum RPR titers >1:32 are more likely to develop ANS.
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Affiliation(s)
- Wenjia Weng
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jiahua Hou
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Bingbing Song
- Department of Dermatology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Ming Zhang
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Yanqing Gao
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
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18
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Shang XJ, He CF, Tang B, Chang XL, Ci C, Sang H. Neuroimaging Features, Follow-Up Analyses, and Comparisons Between Asymptomatic and Symptomatic Neurosyphilis. Dermatol Ther (Heidelb) 2020; 10:273-283. [PMID: 32124253 PMCID: PMC7090109 DOI: 10.1007/s13555-020-00361-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Many studies have explored the imaging characteristics of patients with neurosyphilis, but no systematic study has been made on the neuroimaging changes after anti-syphilitic treatment. The purpose of this study was to examine neuroimaging differences before and after treatment, comparing patients with asymptomatic and symptomatic neurosyphilis. Methods A total of 102 patients with neurosyphilis, including 60 cases of symptomatic neurosyphilis and 42 cases of asymptomatic neurosyphilis, were identified between December 2012 and June 2019. Their demographics, medical histories, serological tests of peripheral blood and cerebrospinal fluid, and especially neuroimaging features before and after anti-syphilitic treatment were collected and analyzed. Results The patients presented with variable clinical and neuroimaging features, including cerebral infarction or hemorrhage, atrophy, demyelination, arteritis, encephalitis, and hippocampal sclerosis. A total of 29 neuroradiological re-examinations were performed in 19 patients treated with anti-syphilitic medicine. The results indicated that some patients still presented neuroradiological progression after treatment, including 42.1% showing infarction lesions, 47.4% mild to severe brain atrophy, and 15.8% white matter demyelination. Conclusion The clinical and neuroimaging features of neurosyphilis patients are diverse, and their follow-up neuroimaging continued to show progression even with standardized treatment. Electronic supplementary material The online version of this article (10.1007/s13555-020-00361-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xian-Jin Shang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Cai-Feng He
- Jinling Hospital Department of Dermatology, Nanjing Medical University, Nanjing, 210002, People's Republic of China.,Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Biao Tang
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Xiao-Li Chang
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Chao Ci
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, People's Republic of China
| | - Hong Sang
- Jinling Hospital Department of Dermatology, Nanjing Medical University, Nanjing, 210002, People's Republic of China.
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Versiani I, Cabral-Castro MJ, Puccioni-Sohler M. A comparison of nontreponemal tests in cerebrospinal fluid for neurosyphilis diagnosis: equivalent detection of specific antibodies. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 77:91-95. [PMID: 30810592 DOI: 10.1590/0004-282x20180155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Syphilis is a re-emerging sexually-transmitted infection, caused by the spirochete Treponema pallidum, that may penetrate early into the central nervous system. The venereal disease research laboratory test (VDRL) on the cerebrospinal fluid (CSF) is the most widely used for neurosyphilis diagnosis. We evaluated the performance of two other nontreponemal tests (rapid plasma reagin [RPR] and unheated serum reagin [USR] tests) in comparison with the VDRL in CSF. METHODS We analyzed CSF samples from 120 individuals based on VDRL reactivity in the CSF and the clinical picture of neurosyphilis. RESULTS High inter-rater reliability was found among all three tests, with equivalent sensitivity and specificity. Intraclass correlation coefficient for absolute agreement was 1 for VDRL versus USR, 0.99 for VDRL versus RPR, and 0.99 for RPR versus USR. CONCLUSIONS Rapid plasma reagin and unheated serum reagin tests were identified as excellent alternatives for neurosyphilis diagnosis.
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Affiliation(s)
- Isadora Versiani
- Universidade Federal do Estado do Rio de Janeiro, Escola de Medicina e Cirurgia, Rio de Janeiro RJ, Brasil
| | - Mauro Jorge Cabral-Castro
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Pós-Graduação em Doenças Infecciosas e Parasitárias, Rio de Janeiro RJ, Brasil
| | - Marzia Puccioni-Sohler
- Universidade Federal do Estado do Rio de Janeiro, Escola de Medicina e Cirurgia, Rio de Janeiro RJ, Brasil.,Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Pós-Graduação em Doenças Infecciosas e Parasitárias, Rio de Janeiro RJ, Brasil
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20
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Affiliation(s)
- Chris Kenyon
- Institute of Tropical Medicine, Antwerp, Belgium
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21
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22
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Shen S, Yang R, Wang L, Tang L, Liu B. Multiple intracranial and spinal cord syphilitic gummas in a human immunodeficiency virus-negative man with untreated syphilis: A case report. Medicine (Baltimore) 2019; 98:e16887. [PMID: 31490372 PMCID: PMC6739007 DOI: 10.1097/md.0000000000016887] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Multiple syphilitic gummas involving both the brain and spinal cord are quite rare. Central nervous system (CNS) syphilitic gummas are commonly misdiagnosed as CNS tumors, and clinical suspicion and diagnosis of a syphilitic gumma by physicians are vital to avoiding unnecessary surgeries. Our case emphasizes the importance of routine serologic syphilis tests and standard therapy with penicillin in patients with a CNS mass. PATIENT CONCERNS A 22-year-old previously healthy man presented with a 9-day history of progressive right lower limb weakness. DIAGNOSIS The diagnosis of gummatous neurosyphilis was based on positive serological, cerebrospinal fluid tests for syphilis and magnetic resonance imaging (MRI) findings, which revealed the presence of multiple dural-based enhancing masses with marked edema. INTERVENTIONS Therapy consisting of intravenous penicillin G at 24 million units daily divided into 6 doses were given for a total of 21 days, along with 3 weekly intramuscular injections of benzathine penicillin G (2.4 million units) to ensure that the syphilitic lesions in the CNS were adequately treated. OUTCOMES Complete resolution of the lesions was observed on MRI over a 3-month period. LESSONS The importance of routine serologic syphilis tests and standard therapy with penicillin in patients with central CNS mass lesions is noted to avoiding unnecessary surgeries.
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Affiliation(s)
- Sisi Shen
- Department of Neurology, the Third Hospital of Mianyang
- Sichuan Mental Health Center
| | - Ruiyi Yang
- Sichuan Mental Health Center
- Department of the Medical Imaging Unit, The Third Hospital of Mianyang, Mianyang, Sichuan, China
| | - Libo Wang
- Department of Neurology, the Third Hospital of Mianyang
- Sichuan Mental Health Center
| | - Liwei Tang
- Department of Neurology, the Third Hospital of Mianyang
- Sichuan Mental Health Center
| | - Bo Liu
- Department of Neurology, the Third Hospital of Mianyang
- Sichuan Mental Health Center
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Ozturk-Engin D, Erdem H, Hasbun R, Wang SH, Tireli H, Tattevin P, Argemi X, Ouamara-Digue E, Gombos A, Lakatos B, Sırmatel F, Cag Y, Pekok AU, Senbayrak S, Balkan II, Gheno M, Uzun N, Kaya S, Cicek-Senturk G, Şengöz G, Tekin R, Çelen MK, Nayman-Alpat S, Ergen P, Şener A, Agalar C, Köse S, Inkaya AÇ, Kaptan F, Al-Majid F, Savasci U, Vahaboglu H. Predictors of unfavorable outcome in neurosyphilis: Multicenter ID-IRI Study. Eur J Clin Microbiol Infect Dis 2018; 38:125-134. [PMID: 30368740 DOI: 10.1007/s10096-018-3403-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/12/2018] [Indexed: 11/28/2022]
Abstract
Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphilis. We aimed to identify the factors affecting poor outcome in NS patients. Patients with positive cerebrospinal fluid Venereal Disease Research Laboratory test, and positive serological serum treponemal or nontreponemal tests were classified as definite NS. The data of 141 patients with definite NS were submitted from 22 referral centers. Asymptomatic NS, syphilitic meningitis, meningovascular syphilis, tabes dorsalis, general paresis, and taboparesis were detected in 22 (15.6%), 67 (47.5%), 13 (9.2%), 10 (7%), 13 (9.2%), and 16 patients (11.3%), respectively. The number of HIV-positive patients was 43 (30.4%). The most common symptoms were headache (n = 55, 39%), fatigue (n = 52, 36.8%), and altered consciousness (50, 35.4%). Tabetic symptoms were detected in 28 (19.8%), paretic symptoms in 32 (22.6%), and vascular symptoms in 39 patients (27.6%). Eye involvement was detected in 19 of 80 patients (23.7%) who underwent eye examination and ear involvement was detected in eight of 25 patients (32%) who underwent ear examination. Crystallized penicillin was used in 109 (77.3%), procaine penicillin in seven (4.9%), ceftriaxone in 31 (21.9%), and doxycycline in five patients (3.5%). According to multivariate regression analysis, while headache was a protective factor in NS patients, double vision was significantly associated to poor outcome. We concluded that double vision indicated unfavorable outcome among NS patients. A high clinical suspicion is needed for the diagnosis NS. As determined in our study, the presence of headache in syphilitic patients can help in early diagnosis of central nervous system disease.
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Affiliation(s)
- Derya Ozturk-Engin
- Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Hakan Erdem
- Principal Coordinator of ID-IRI, Ankara, Turkey
| | - Rodrigo Hasbun
- Department of Infectious Diseases, UT Health McGovern Medical School, Houston, TX, USA
| | - Shu-Hua Wang
- Division of Infectious Diseases, Deparment of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Hulya Tireli
- Department of Neurology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Xavier Argemi
- Department of Infectious Diseases and Clinical Microbiology, Nouvel Hôpital Civil, Strasbourg, France
| | - Enora Ouamara-Digue
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Andrea Gombos
- Department of Infectious Disease and Clinical Microbiology, Saint Laszlo Hospital Budapest, Budapest, Hungary
| | - Botond Lakatos
- Department of Infectious Disease and Clinical Microbiology, Saint Laszlo Hospital Budapest, Budapest, Hungary
| | - Fatma Sırmatel
- Department of Infectious Disease and Clinical Microbiology, Izzet Baysal University School of Medicine, Bolu, Turkey
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Umut Pekok
- Department of Infectious Diseases and Clinical Microbiology, Private Erzurum Sifa Hospital, Erzurum, Turkey
| | - Seniha Senbayrak
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ilker Inanç Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Marie Gheno
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Nuray Uzun
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selçuk Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Gönül Cicek-Senturk
- Department of Infectious Disease and Clinical Microbiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Gönül Şengöz
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Recep Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Mustafa Kemal Çelen
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Saygın Nayman-Alpat
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Pınar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Alper Şener
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Canan Agalar
- Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Sükran Köse
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Education Hospital, İzmir, Turkey
| | - Ahmet Çagkan Inkaya
- Department of Infectious Disease and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Figen Kaptan
- Department of Infectious Diseases and Clinical Microbiology, Atatürk Training and Research Hospital, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Fahad Al-Majid
- Department of Medicine, Infectious Diseases Division, King Saud University Hospital, Riyadh, Saudi Arabia
| | - Umit Savasci
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - Haluk Vahaboglu
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
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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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Mao C, Gao J, Jin L, Peng B, Guo Y. Postmortem Histopathologic Analysis of Neurosyphilis: A Report of 3 Cases With Clinicopathologic Correlations. J Neuropathol Exp Neurol 2018; 77:4931113. [PMID: 29546365 DOI: 10.1093/jnen/nly004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Indexed: 01/22/2023] Open
Abstract
Neurosyphilis occurs in the late stage of systemic syphilis infection; early diagnosis and treatment are crucial to the prognosis. We review 3 autopsy cases with different subtypes of neurosyphilis, that is cases with meningovascular, general paresis, and a combination of the 2, respectively. We investigated the gross morphology and leptomeninges, vessels, cerebral cortex, white matter, brainstem, cerebellum, olfactory bulb and spinal cord microscopically. We found that meningovascular inflammation exists in both early and late phases of neurosyphilis, not only in the meningovascular subtype. Vertebrobasilar artery involvement is common and infarcts of the areas perfused by these arteries in young patient highly suggests neurosyphilis. Damage to the cortical architecture and neuropil is the main mechanism of dementia in general paresis and temporal lobe may not firstly be involved as many other diseases with dementia. Early involvement of olfactory bulbs may help in the early diagnosis of the disease. Our findings indicate that many specific features may help in clinical practice and that further research is needed to clarify the mechanisms.
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Affiliation(s)
- Chenhui Mao
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Jing Gao
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Liri Jin
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yupu Guo
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
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Tong ML, Zhang HL, Zhu XZ, Fan JY, Gao K, Lin LR, Liu LL, Li SL, Lin HL, Lin ZF, Niu JJ, Zheng WH, Yang TC. Re-evaluating the sensitivity of the rabbit infectivity test for Treponema pallidum in modern era. Clin Chim Acta 2016; 464:136-141. [PMID: 27876463 DOI: 10.1016/j.cca.2016.11.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/31/2016] [Accepted: 11/18/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The rabbit infectivity test (RIT) was previously described as a highly-sensitive method for clinically detecting Treponema pallidum. But our primary study indicated this result may have changed in current antibiotics era. METHODS By inoculating rabbits testis with cerebrospinal fluid (CSF) (n=63) and exudate from hard chancre lesions (n=13), we re-evaluated the sensitivity of RIT in modern era. All isolated T. pallidum strains from the RIT were performed for the strain type based on "CDC subtype/tp0548" method. Chi-square and Fisher's exact tests were used to determine the statistical significance of differences across data sets. RESULTS Result indicated that 2 of 63 CSF (2/63, 3.17%) and 5 of 13 lesion exudate samples (5/13, 38.47%) were positive in the RIT, with a much longer time to detection for CSF samples. Only 1 of 28 samples from patients who admitted treatment with antibiotics prior to clinical exam was positive in the RIT; while 6 of 48 patients, who admitted no recent exposure to antibiotics or was unclear about the medical history, were positive in RIT. DNA sequence analysis revealed 6 strains of 14d/f subtype and one strain of 14a/f subtype. CONCLUSIONS In conclusions, RIT is no longer a highly sensitive method for detecting T. pallidum in clinical samples as before, and is not inadequately considered to be a reference method for measuring the sensitivity of other new methods, such as the PCR. These data represent the first reexamination of the sensitivity of RIT in the post-antibiotic era with a large clinical sample.
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Affiliation(s)
- Man-Li Tong
- Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China
| | - Hui-Lin Zhang
- Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China
| | - Xiao-Zhen Zhu
- Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China
| | - Jin-Yi Fan
- Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China
| | - Kun Gao
- Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China
| | - Li-Rong Lin
- Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China
| | - Li-Li Liu
- Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China
| | - Shu-Lian Li
- Department of Gynaecology and Obstetrics, Xiamen Huli District Maternity and Child Care Hospital, Xiamen 361000, China
| | - Hui-Ling Lin
- Department of Gynaecology and Obstetrics, Xiamen Huli District Maternity and Child Care Hospital, Xiamen 361000, China
| | - Zhi-Feng Lin
- Department of Gynaecology and Obstetrics, Xiamen Huli District Maternity and Child Care Hospital, Xiamen 361000, China
| | - Jian-Jun Niu
- Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China; Department of Hospital Infection and Medical Healthy Care, Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen 361004, China
| | - Wei-Hong Zheng
- Department of Neurology, Medical College of Xiamen University, Xiamen 361004, China.
| | - Tian-Ci Yang
- Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China.
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Lin LR, Lin DH, Tong ML, Liu LL, Fan JY, Zhu XZ, Gao K, Chen MJ, Zheng WH, Zhang HL, Li SL, Lin HL, Lin ZF, Niu JJ, Yang TC. Macrophage migration inhibitory factor as a novel cerebrospinal fluid marker for neurosyphilis among HIV-negative patients. Clin Chim Acta 2016; 463:103-108. [PMID: 27751728 DOI: 10.1016/j.cca.2016.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/08/2016] [Accepted: 10/13/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neurosyphilis (NS) is difficult to diagnose, especially in syphilis patients with negative cerebrospinal fluid (CSF) rapid plasma reagin (RPR) or Venereal Disease Research Laboratory (VDRL) tests. METHODS We conducted a cross-sectional study and an analysis of macrophage migration inhibitory factor (MIF) in syphilitic patients to identify a novel marker for the diagnosis of NS, with a focus on probable NS (NS with negative VDRL/RPR tests). For this purpose, CSF and serum MIF concentrations were determined in 43 NS and 43 syphilis/non-NS (N-NS) patients at the Zhongshan Hospital of the Medical College of Xiamen University from July 2014 to June 2015. Sixty-three blood donors were used as healthy controls. RESULTS NS patients had higher CSF (median [IQR]: 8.77ng/ml [4.76-19.13]) and serum (52.58ng/ml [28.31-95.94]) MIF concentrations than N-NS patients did (4.08 [2.21-9.68] and 34.30 [19.77-59.75], respectively). Using a cut-off point of 6.63ng/ml, CSF MIF had a sensitivity of 74.42% and a specificity of 67.74% for the diagnosis of NS. The sensitivity was higher than that of CSF RPR (39.53%) and increased protein (48.84%) tests and similar to that of CSF pleocytosis (67.44%). Additionally, the sensitivity of CSF MIF, which was 92.31% for the diagnosis of probable NS, was higher than that of CSF pleocytosis (65.38%) and increased protein (53.85%) tests. By integrating all CSF parameters (pleocytosis, increased protein and MIF), the sensitivity would be improved to 100% by parallel testing, which would avoid missed diagnoses. Moreover, the specificity would be improved to 100% by the serial testing algorithm, which would again avoid misdiagnosis. CONCLUSIONS CSF MIF concentrations can be used as a novel CSF marker to establish or exclude a diagnosis of NS.
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Affiliation(s)
- Li-Rong Lin
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China; Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen, China
| | - Dan-Hong Lin
- Medical Technology Department of Fujian Health College, Fuzhou, China
| | - Man-Li Tong
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
| | - Li-Li Liu
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
| | - Jin-Yi Fan
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
| | - Xiao-Zhen Zhu
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
| | - Kun Gao
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
| | - Mei-Jun Chen
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
| | - Wei-Hong Zheng
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
| | - Hui-Lin Zhang
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
| | - Shu-Lian Li
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, China
| | - Hui-Ling Lin
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, China
| | - Zhi-Feng Lin
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, China
| | - Jian-Jun Niu
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China; Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen, China.
| | - Tian-Ci Yang
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China; Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen, China.
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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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Abstract
Syphilis has reemerged as an important cause of neurological disease, affecting any part of the neuraxis at any stage of infection. What was once a dwindling diagnosis is now redoubling, particularly in the HIV-positive and in men who have sex with men populations. In the era of antibiotics and HIV coinfection, neurosyphilis presentations are protean, making diagnosis notoriously challenging. Advanced disease may be irreversible, and so early detection and treatment are ideal. Herein, we review recent advances in understanding neurosyphilis.
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Casolla B, Ristori G, Romano A, Bozzao A, Orzi F. Subacute multicranial neuropathy revealing an early case of meningeal syphilis. Neurol Sci 2015; 36:1033-4. [PMID: 25739944 DOI: 10.1007/s10072-015-2125-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/22/2015] [Indexed: 12/11/2022]
Abstract
We report a case of neurosyphilis presenting with meningitis and subacute multicranial neuropathy in a young immune-competent man. Signs of primary and secondary stages of syphilitic infection occurred almost contemporarily in our patient. MRI revealed the involvement of several cranial nerves. CSF examination proved to be diagnostic. Syphilitic meningitis should be considered among the differential diagnoses of subacute, multicranial neuropathy, or skull base meningitis. The clinical course of this patient shows that early diagnosis and treatment warrant a good neurological outcome.
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Affiliation(s)
- Barbara Casolla
- NeSMOS Department (Neurosciences, Mental Health and Sensory Organs), School of Medicine and Psychology, University of Rome "La Sapienza", UOC Neurology, Sant'Andrea Hospital, Rome, Italy,
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31
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Bag AK, Davenport JJ, Hackney JR, Roy R, Fathallah-Shaykh HM. Case 212: chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. Radiology 2015; 273:940-7. [PMID: 25420171 DOI: 10.1148/radiol.14131355] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
History A previously healthy 23-year-old white man presented to the emergency department of our hospital with a 2-month history of dysarthria, progressively worsening vertigo, and difficulty walking. A diagnosis of retinitis pigementosa was made in this patient's childhood. He did not have any history of congenital syphilis. He did not have a history of nausea or vomiting, fever, weight loss, headache, photophobia, seizure, extremity weakness, or sensory disturbance. Physical examination revealed dysarthria, dysmetria, and ataxia. Kernig and Brudzinski signs were absent, and pathergy test results were negative. Laboratory evaluation revealed normal complete and differential blood counts and normal serum chemistry, including a normal serum angiotensin-converting enzyme level. Analysis of his serum was negative for antinuclear antibody (or ANA), cytoplasmic antineutrophil cvtoplasmic antibody (or cANCA), Sjögren syndrome antigens A and B (SS-A and SS-B, respectively), antitissue transglutaminase and antiendomysial antibodies, and paraneoplastic profile. Serum analysis was also negative for human immunodeficiency virus type 1 and type 2 RNA, Venereal Disease Research Laboratory (VDRL) test, rapid plasma regain (RPR), and fluorescent treponemal antibody absorption. Cerebrospinal fluid (CSF) analysis revealed clear fluid, a normal glucose level (64 mg/dL [3.6 mmol/L]; normal range, 40-70 mg/dL [2.2-3.9 mmol/L]), an elevated protein level (97 mg/dL; normal range, 12-60 mg/dL), and an elevated white blood cell count (7/mm(3) [0.007 ×10(9)/L] in tube 1 and 17/mm(3) [0.017 × 10(9)/L] in tube 2) with 84% lymphocytes. CSF immunoglobulin G level was elevated (30.1 mg/dL; normal, <5.9 mg/dL); however, there were no oligoclonal bands. Gram staining, acid-fast staining, and lactic acid, cryptococcal antigen, histoplasma antigen, herpes simplex virus polymerase chain reaction, VDRL, and RPR test results for CSF were negative. CSF did not grow any bacteria, fungus, or acid-fast bacillus at culture. CSF flow cytometry did not reveal a monoclonal lymphoid population. Initial imaging included brain magnetic resonance (MR) imaging. Computed tomography (CT) images of the chest, abdomen, and pelvis were normal (not shown). The patient's clinical symptoms and imaging findings responded to treatment with a high dose of oral steroids. However, the patient's symptoms exhibited clinical and radiologic progression after several attempts to taper the steroid dose.
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Affiliation(s)
- Asim K Bag
- From the Departments of Radiology (A.K.B., J.J.D., R.R.), Pathology (J.R.H.), and Neurology (H.M.F.) University of Alabama at Birmingham, JT-N432, 619 19th St S, Birmingham, AL-35249-6830
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Day GS, Tang-Wai DF. When dementia progresses quickly: a practical approach to the diagnosis and management of rapidly progressive dementia. Neurodegener Dis Manag 2014; 4:41-56. [PMID: 24640978 DOI: 10.2217/nmt.13.75] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Making a diagnosis of rapidly progressive dementia requires practical adaptation of the skills used to assess patients with chronic causes of cognitive impairment. An expedited assessment, commensurate with the accelerated pace of the disease, is required to identify the cause of symptoms amidst a myriad of possibilities. Features upon history, physical examination and cognitive assessment that support specific diagnoses are reviewed, and a stratified approach to testing is presented. The use of readily-accessible investigations is prioritized, acknowledging the implications and applications of novel diagnostic tests. The coordinated use of clinical and laboratory measures are promoted as a means of facilitating rapid evaluation, with the ultimate goal of identifying patients with potentially reversible causes of rapidly progressive dementia.
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Affiliation(s)
- Gregory S Day
- University of Toronto, Division of Neurology, University Health Network Memory Clinic, Toronto Western Hospital, Toronto, ON, Canada
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