Results:
Of 141 unique citations, 18 studies were included in the systematic review. Due to significant heterogeneity among studies, we were unable to generate pooled summary statistics. Seven different treponemal-specific tests were assessed. Of those, 13 studies evaluated the CSF FTA-ABS (fluorescent treponemal antibody-absorbed) and 9 evaluated the CSF fluorescent treponemal antibody. The performance estimates of these tests were highly variable and depended on the choice of negative and positive controls. No single test had perfect sensitivity, thus the negative predictive value was dependant on the specificity of the test and the prevalence (i.e., pretest probability) of neurosyphilis: the higher the prevalence, the lower the negative predictive value. Few studies included HIV-infected persons.
Conclusions:
A negative CSF-treponemal-specific antibody test may not exclude the diagnosis of neurosyphilis when the clinical suspicion for neurosyphilis is high.
Mov Disord. 2012 Mar 12. doi: 10.1002/mds.24950. [Epub ahead of print]
Acquired neurosyphilis presenting as movement disorders.
Shah BB, Lang AE.
Source
Department of Medicine (Neurology), University of Toronto, and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Ontario, Canada.
Abstract
After a significant decline in the second half of the 20th century, rates of infection with syphilis are again on the rise. Long known as the "great mimicker," syphilitic infection can be difficult to recognize clinically and this particularly holds true for neurologic manifestations of the disease. Gait dysfunction and sensory ataxia have been historically well described in neurosyphilis literature; however, other movement disorders have been reported to a lesser extent. Here we review reports of movement disorders in acquired neurosyphilis. Given its increasing incidence, it is important to be cognizant of its diverse presentation and retain a high index of suspicion for syphilis, particularly as it is completely curable in the early stages. © 2012 Movement Disorder Society.
Sex Transm Infect. 2012 Feb 23. [Epub ahead of print]
Re-evaluation of serological criteria for early syphilis treatment efficacy: progression to neurosyphilis despite therapy.
Zhou P, Gu X, Lu H, Guan Z, Qian Y.
Source
STD Institute, Shanghai Skin Disease Hospital, Shanghai, China.
Abstract
ObjectivesTo study 17 cases of secondary syphilis that progressed to neurosyphilis despite appropriate treatments and whose rapid plasma reagin (RPR) titres showed a fourfold decrease within 6 months but did not revert to negative.MethodsSecondary syphilis patients with the following criteria were analysed: (1) RPR titres declined fourfold within 3 months after therapy, (2) patients denied high-risk sexual behaviours following treatment, (3) RPR titre remained serofast 24 months after treatment, (4) reactive cerebrospinal fluid (CSF)-venereal disease research laboratory (VDRL) and CSF-Treponema pallidum Particle Agglutination Test (TPPA) and (5) HIV antibody negative.Results14 male and three female patients met the criteria. 13 patients were asymptomatic. The CSF leucocyte count was elevated in 10 patients of whom nine also had elevated CSF-proteins. The RPR titres following secondary syphilis treatments were ≥1:32 in five cases, 1:16 in four cases, 1:8 in six cases and 1:4 in two cases. Following treatments for neurosyphilis, four cases with neurological or psychiatric manifestations resolved or improved, nine cases with raised CSF-white blood cells returned to normal and nine of 12 cases with raised CSF-protein declined to normal.ConclusionsNeurosyphilis may be detected in immunocompetent patients despite appropriate therapy for early-stage syphilis and appropriate serological responses. Clinicians should consider a CSF examination in any treated patient with evidence of disease progression irrespective of prior treatment history and serological response.
Del Med J. 2011 Oct;83(10):313-5.
Neurosyphilis and organic psychosis.
Rahman S, Trimzi I, Centers N, Markman L, Mancuso M, Rana A, Gallucci G.
Source
Delaware Psychiatry Residency Program, New Castle, Del. USA.
Abstract
Neurosyphilis is a Central Nervous System infection that can manifest as a psychiatric condition. Although neurosyphilis is not widely considered in the differential when patients present with psychiatric symptoms, routine Rapid Plasma Reagin (RPR) screening is indicated when assessing new-onset psychiatric illness. This case report will illustrate the usefulness of RPR testing for patients admitted to inpatient or outpatient psychiatric treatment.
J Spinal Cord Med. 2011 Nov;34(6):609-11.
Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis.
Pandey S.
Source
Department of Neurology, Institute of Human Behaviour and Allied Sciences, Delhi, India. sanjaysgpgi2002@yahoo.co.in
Abstract
BACKGROUND:
Tabes dorsalis is a late manifestation of untreated syphilis that is characterized by ataxia, lancinating pains, and urinary incontinence. A form of tertiary syphilis or neurosyphilis, it is the result of slow, progressive degeneration of the nerve cells in the spinal cord.
METHOD:
Case report.
FINDINGS:
A 39-year-old man presented with tingling paresthesia in the lower limbs, difficulty in walking, and loss of vision. Magnetic resonance imaging (MRI) of the dorsal spine showed intramedullary hyperintensity and cord atrophy, similar to changes seen in subacute combined degeneration. MRI features of tabes dorsalis have not been described previously to the best of our knowledge.
CONCLUSION:
MRI findings in this patient with tabes dorsalis were similar to those seen in subacute combined degeneration, which is characterized predominantly by cord atrophy and intramedullary hyperintensities.
Neurol Sci. 2011 Dec 24. [Epub ahead of print]
A case report and DSA findings of cerebral hemorrhage caused by syphilitic vasculitis.
Zhang X, Xiao GD, Xu XS, Zhang CY, Liu CF, Cao YJ.
Source
The Department of Neurology, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou City, 215000, Jiangsu Province, People's Republic of China.
Abstract
Syphilis is now rare and easily misdiagnosed because of the wide use of antibiotics in the clinical. We report a case of cerebral hemorrhage in a patient with hypertension who was first diagnosed as hypertensive cerebral hemorrhage. However, treponema pallidum particle agglutination and rapid plasma regain tests of cerebrospinal fluid revealed the existence of neurosyphilis. Interestingly, digital subtraction angiography (DSA) showed severe stenosis in both middle cerebral arteries and right anterior cerebral artery. The case reminded us to pay attention to syphilitic vasculitis in patients with cryptogenic stroke. DSA sometimes may play a critical role in differential diagnosis of neurosyphilis.
Klin Lab Diagn. 2011 Aug;(8):44-5.
[Western blot as a confirming test in the laboratory diagnosis of syphilis].
[Article in Russian]
Novikov AI, Dolgikh TI, Novikov IuA.
Abstract
Two hundred and ninety-five patients who had been found to have Treponema pallidum antibodies detected by enzyme immunoassay were additionally studied by a Western blot test to confirm their presence. Every four cases were ascertained to be false-positive, false seropositivity being more frequent in the presence of IgM antibody against T. palladium. Spinal fluid analysis provided evidence for the course of neurosyphilis in 5 cases. The diagnosis of congenital syphilis was verified in 2 children who had p15, p17, p45, and 47. The findings demonstrate it necessary to extensively use a Western blot in the health care system.
Interact Cardiovasc Thorac Surg. 2012 Feb;14(2):223-5. Epub 2011 Nov 28.
Syphilitic aneurysm of the ascending aorta.
Paulo N, Cascarejo J, Vouga L.
Source
Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal. nspaulo@gmail.com
Abstract
Syphilitic aortic aneurysm is a rare occurrence in the antibiotic era, making the diagnose assumption even more infrequent. Nonetheless, this pathology can appear and should be suspected in patients with aortic aneurysm. We report a case of a 57-year old patient who presents with neurosyphilis and, in the following study, a large ascending aorta aneurysm is identified. The authors discuss the diagnostic challenge, the epidemiologic concerns, surgical indication and treatment and subsequent follow-up.
Clin Infect Dis. 2011 Dec;53 Suppl 3:S110-28.
Management of adult syphilis.
Ghanem KG, Workowski KA.
Source
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA. kghanem@jhmi.edu
Abstract
There are several important unanswered key questions in the management of adult syphilis. A systematic literature review was conducted and tables of evidence were constructed to answer these important questions. A single dose of 2.4 million units of benzathine penicillin G remains the drug of choice for managing early syphilis. Enhanced antibiotic therapy has not been shown to improve treatment outcomes, regardless of human immunodeficiency virus (HIV) status. Although additional data on the efficacy of azithromycin in treating early syphilis have emerged, reported increases in the prevalence of a mutation associated with azithromycin resistance precludes a recommendation for its routine use. Cerebrospinal fluid (CSF) examination should be performed in all persons with serologic evidence of syphilis infection and neurologic symptoms. In those persons with early syphilis who do not achieve a ≥ 4-fold serologic decline in their rapid plasma reagin (RPR) titers 6-12 months after adequate therapy and those with late latent infection who do not achieve a similar decline within 12-24 months, CSF examination should be considered. Among HIV-infected persons, CSF examination among all those with asymptomatic late latent syphilis is not recommended owing to lack of evidence that demonstrates clinical benefit. HIV-infected persons with syphilis of any stages whose RPR titers are ≥ 1:32 and/or whose CD4 cell counts are <350 cells/mm(3) may be at increased risk for asymptomatic neurosyphilis. If CSF pleocytosis is evident at initial CSF examination, these examinations should be repeated every 6 months until the cell count is normal. Several important questions regarding the management of syphilis remain unanswered and should be a priority for future research.
J Neurol Sci. 2012 Mar 15;314(1-2):1-4. Epub 2011 Nov 30.
Treatment and diagnostic accuracy of neurosyphilis at Boston City Hospital's Neurological Unit, 1930-1979.
Patterson D, Vilensky JA, Robertson WM, Berger J.
Source
Department of Anatomy and Cell Biology, Indiana University School of Medicine, Fort Wayne, IN 46805, USA. dpatter4@ohiohealth.com
Abstract
The twentieth century was marked with frequent advances in the treatment and diagnosis of neurosyphilis. Once considered one of the most serious human diseases, neurosyphilis was paramount to a death sentence often preceded by agonizing pain and/or diminishing mental capacities. Since the introduction of penicillin in 1943, however, the prevalence of neurosyphilis has declined dramatically and the prognosis of the few still affected has been greatly improved. We examined patient records from Boston City Hospital's (BCH) Neurologic Unit from 1930 to 1979 to obtain primary data on treatment modalities for neurosyphilis during this period, with particular attention to the use of malarial therapy. We also evaluated these same records to determine whether the "great imitator" moniker that was applied to neurosyphilis may have in part been due to systematic errors in diagnostic criteria and false positive tests. The BCH neurologists used all available treatment compounds, including arsenicals, bismuth, iodides, malaria, and typhoid. The data also suggest that the wide diversity of symptoms attributed to neurosyphilis was probably accurate.
Psychiatr Prax. 2012 Jan;39(1):7-13. Epub 2011 Nov 28.
[The chameleon of psychiatry - psychiatric manifestations of neurosyphilis].
[Article in German]
Friedrich F, Geusau A, Friedrich ME, Vyssoki B, Pfleger T, Aigner M.
Source
Universitätsklinik für Psychiatrie und Psychotherapie, Abteilung für Sozialpsychiatrie, Medizinische Universität Wien, Österreich. fabian.friedrich@meduniwien.ac.at
Abstract
OBJECTIVE:
Recent epidemiological data have shown a significant increase in the prevalence of syphilis. If left untreated, up to 30 % of patients may develop tertiary syphilis, which can manifest as neurosyphilis. The aim of our review is to evaluate psychiatric manifestations of neurosyphilis according to ICD-10.
METHODS:
A systematic electronic search for published studies (1995-2010) was performed using the databases Medline, Embase, Cochrane as well as the search engines Scopus and Google Scholar.
RESULTS:
113 studies were used for detailed analysis. Clinical manifestations of various forms of neurosyphilis are protean, numerous and non-specific and could be on the differential diagnosis for many psychiatric presentations according to ICD-10.
CONCLUSION:
Due to our results, the difficulties in diagnosing syphilis and current epidemiological data, routine screening tests are still mandatory in the psychiatric field. Further, neurosyphilis still has to be considered in the differential diagnosis within the context of psychiatric conditions and diseases.
Med Mal Infect. 2012 Jan;42(1):15-9. doi: 10.1016/j.medmal.2011.10.003. Epub 2011 Nov 25.
Efficacy of ceftriaxone and doxycycline in the treatment of early syphilis.
Psomas KC, Brun M, Causse A, Atoui N, Reynes J, Le Moing V.
Source
Département des maladies infectieuses et tropicales, hôpital Gui-de-Chauliac, Montpellier cedex, France. kcpsomas@igh.cnrs.fr
Abstract
INTRODUCTION:
An increase of syphilis cases has been recorded in the past few decades, especially among HIV-infected patients. These patients often present with concomitant primary and secondary lesions or extensive presentations of syphilis.
OBJECTIVE:
Our goal was to compare alternative regimens to the recommended penicillin treatment.
METHOD:
We retrospectively studied 116 patient files (80% HIV1-infected) treated for a first episode of early syphilis.
RESULTS:
Patients mainly presented with symptoms of secondary syphilis. In 15.5% of the cases patients were asymptomatic and 17.2% of patients with secondary syphilis presented with neurologic or ophthalmic symptoms. Some less usual clinical presentations included diffuse polyadenopathy or isolated fever. The time to serological response was similar among those treated with benzathine-penicillin (n=52), ceftriaxone (n=49), or doxycycline (n=15).
CONCLUSION:
Ceftriaxone and doxycycline could be suitable alternatives to penicillin in the treatment of early syphilis in HIV-infected patients. These two treatments have a concomitant effectiveness even for asymptomatic forms of neurosyphilis.
Zhonghua Yi Xue Za Zhi. 2011 Aug 9;91(29):2055-9.
[Magnetic resonance imaging findings of lesions in limbic system related structures in general paresis of insane].
[Article in Chinese]
Jiang T, Chen SQ, Shan H, Zou Y, Zhang JS, Chen XZ.
Source
Department of Radiology, Sun Yat-Sen University, Guangzhou, China.
Abstract
OBJECTIVE:
To analyze the magnetic resonance imaging (MRI) findings of lesions in the limbic system related structures in general paresis of insane (GPI) patients so as to explore its pathogenesis and provide a new MRI diagnostic method.
METHODS:
The clinical data and MRI findings of lesions in the limbic system related structures were retrospectively analyzed for a total of 31 GPI patients. The parameters were volume and signal abnormality.
RESULTS:
On MRI, structural abnormalities were found in amygdaloid body (n = 29), hippocampus (n = 28), insular lobe (n = 24), parahippocampal gyrus (n = 23), lenticular nucleus (n = 23), corpus callosum (n = 20), caudate nucleus (n = 11), hypothalamus (n = 10), anterior nucleus of thalamus (n = 10), cingulate gyrus (n = 8) and thalamus (n = 2). The frequent manifestations were atrophy, swelling, T2 hyperintensity in various structures and T2 hypointensity in lenticular nucleus.
CONCLUSION:
A frequent involvement of limbic system structures in GPI patients may be related with dementia and other psychiatric symptoms. Swelling and T2 hyperintensity of involved structures may be the characteristic MRI manifestations of GPI.
South Med J. 2011 Dec;104(12):827-30.
Neonates at risk for congenital syphilis: radiographic and cerebrospinal fluid evaluations.
Talati AJ, Koneru P.
Source
Departments of Pediatrics and Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, Tennessee, USA. atalati@uthsc.edu
Abstract
OBJECTIVE:
To review the infants at risk for congenital syphilis (CS) and determine the optimal use of evaluations such as cerebrospinal fluid (CSF), the venereal disease research laboratory (VDRL) test, and long bone radiography studies.
METHODS:
A retrospective chart review of all of the infants at risk for CS from January 1997 to December 2002 at the Regional Medical Center at Memphis was conducted. Subjects were identified from a database of prenatal maternal records. Infant charts showing a diagnosis of presumptive CS were reviewed and data were collected.
RESULTS:
Of the 24,245 deliveries, maternal serology (rapid plasma reagin and microhemagglutination for treponemal antibody) was reactive in 250 women during pregnancy. Of 92 infants with a presumptive diagnosis of syphilis, only 2 (2.1%) were symptomatic. CSF examination for VDRL was feasible in 74 (80%) of the 92 infants. Only 1 (1.35%) of the 74 infants had a positive CSF-VDRL. Three infants had radiographic changes that were consistent with CS.