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PubMed2001

[Serologic screening for neurosyphilis].

BACKGROUND: Syphilis serology is analysed in all patients admitted as in-patients to the Department of Neurology in Tromsø. In this study we examined the utility of performing routine laboratory testing for syphilis in neurological patients. MATERIAL AND METHODS: We registered all in-patients in the Department of Neurology with a confirmed diagnosis of syphilis during a ten-year period (1990-1999). Additionally, we calculated the cost of performing laboratory tests of all hospitalised patients in this period. RESULTS: From a total of 8,637 patients, we identified five patients with syphilis, one of them with neurosyphilis. This patient had impaired cognitive functions at the time of admittance and a broad spectrum of neurological deficits suggesting a serious neurological disease. A positive syphilis serology confirmed the diagnosis and treatment was initiated. The mean cost for Treponema pallidum serological screening in neurological patients during 10 years was calculated to be about NOK 17,000 per year. INTERPRETATION: Tertiary syphilis is a serious disease with symptoms often mimicking other diseases. Although the laboratory tests for syphilis have been performed in every in-patient admitted to the neurological ward, a speedier diagnosis of neurosyphilis could not be detected in any patient in a ten-year hospital material. Routine serological examination for syphilis in neurological patients is therefore not recommended in this geographical area.

Cost-Benefit Analysis↗
PubMed2002

[Vesicosphincteric disorders and neurosyphilis].

Voiding disorders secondary to neurosyphilis have now become rare. The authors report a case of a patient with arthritis of the knee associated with dysuria and chronic urinary retention. Urethrocystography showed a large bladder with post-voiding residual urine. Urodynamic assessment revealed detrusor areflexia. The aetiological diagnosis was neurosyphilis. Serological tests for sexually transmitted diseases must be systematically performed in patients presenting with idiopathic voiding disorders.

Arthritis, Infectious↗
PubMedDate not supplied

[Interface neurology/psychiatry: a case report of neurosyphilis].

Organic diseases can occur with different psychiatric symptoms. Neurosyphilis was considered to be a landmark in the history of organic mental syndromes. The complexity of its clinical picture decreases the boundaries between Neurology and Psychiatry and requires a multidisciplinary approach. We report a case of neurosyphilis that began with psychiatric symptoms in a twenty five years old male.

Adult↗
PubMed2003

[Neurosyphilis in psychiatry: surprising underlying disorder in 3 patients].

In 3 patients, two men aged 34 and 46 years and a woman aged 24 years, who appeared to have psychiatric disorders, neurosyphilis was diagnosed on the basis of screened blood tests. Treatment with intravenous benzylpenicillin alleviated the symptoms. In recent years the incidence of primary syphilis in the Netherlands has risen. There is a wide range of symptoms and the interpretation of serologic results is difficult, especially if there is co-infection with HIV; this disease also increases the chance of progression from primary syphilis to neurosyphilis. Patients admitted to clinical care are usually severely ill and are frequently uncooperative or present unclear histories. Detection at an early stage is vital, as adequate treatment prevents disease progression. This could be achieved by a general screening of clinical psychiatric patients for syphilis in addition to the screening of selected groups.

Adult↗
PubMed1992

Neuroleptic malignant syndrome in a patient with neurosyphilis.

Neuroleptic malignant syndrome (NMS) is a catatonic-like syndrome of uncertain etiology occurring in patients taking dopamine blocking medications. The paper describes how NMS presents and is treated and reports the case of a patient with undetected neurosyphilis who developed NMS. The case highlights the need for a thorough organic evaluation of all patients with initial-onset psychotic features and suggests the possibility of a CNS cofactor--neurosyphilis--initiating the NMS as proposed by other researchers.

Adult↗
PubMed2004

[When to think about neurosyphilis?].

The clinical spectrum of neurosyphilis is large. Serologic tests for syphilis are commonly indicated in diseases involving the central nervous system. The diagnosis of syphilis relies on epidemiological, clinical and biological grounds (cerebrospinal fluid abnormalities and RPR test). The treatment of neurosyphilis is still penicillin G.

Anti-Bacterial Agents↗
PubMed1990

[Neurosyphilis 1982-1989].

We report the signs, symptoms, serological and CSF findings in 27 patients with syphilis and inflammatory involvement of the central nervous system. In 24 patients the neurosyphilis was symptomatic. Most patients did not report previous signs of early syphilis. A CSF pleocytosis was present in 25 patients (greater than 90%) and the CSF VDRL was reactive with a titer of 1:2 or above in 19 patients (70%). The symptomatology seemed not to be atypical for neurosyphilis although a precise classification was often not possible and the diagnosis was seldom suspected on clinical grounds. In most patients the clinician can monitor the effectiveness of antibiotic therapy by simple laboratory parameters which reflect the activity of the inflammatory process. It is disquieting, however, to note how inconsistently this follow-up was performed.

Adult↗
PubMedDate not supplied

[Results of the treatment of neurosyphilis with high doses of crystalline and procaine penicillins].

The results of the treatment in two groups of patients with neurosyphilis are compared. In 23 cases, i.v. infusions of crystalline penicillin were given for 10 days in daily dose of 20-24 mega U., combined with probenecid. Then it was followed by i.m. procaine penicillin in daily dose of 1.2 mega U., in total dose 12-50 mega U. The mean duration of follow-up was 7,8 months. The second group (34 cases) was treated with procaine penicillin i.m. in daily dose of 1.2 mega U., the total dose was 24-60 mega U. The mean duration of follow-up was 2.5 years. The differences between the results of the treatment in both groups were not significant. In 3 reinfected patients with early asymptomatic neurosyphilis in spite of intensive treatment with penicillin sero- and cerebro-spinal fluid-resistant syphilis developed.

Adult↗
PubMed1989

[Neurosyphilis in patients infected with the human immunodeficiency virus].

Nervous central system involvement is observed in two out of three patients infected with human immunodeficiency virus and probably, the true prevalence is even higher than that clinically detected. The coexistence of neurosyphilis in this group of patients has been poorly studied and the possibility that some alterations in the natural history of syphilis related to its rapid course with respect to time in which neurologic involvement would occur would have reasonable immunologic basis. We report two patients aged 26 and 22 who presented antibodies against human immunodeficiency virus together with meningo-vascular syphilis with spinal involvement and secondary brain infarction, respectively. In both patients, neurosyphilis was the first manifestation of human immunodeficiency virus infection and none of them referred a history of previous primary or secondary syphilis.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Syphilis in HIV infection. 2 cases of neurosyphilis].

In HIV-infected people the course of syphilis is altered and aggressive. Besides seronegativity Neurosyphilis can manifest premature and as a outcome of failed penicillin-therapy in secondary syphilis. Two cases of neurosyphilis are reported and discussed. The usefulness of spinal fluid analysis is pointed out. Recommendations for diagnostics and therapy are given.

AIDS Serodiagnosis↗
PubMed1988

Modern neurosyphilis--a critical analysis.

Neurosyphilis remains a source of perplexity for today's physicians. Controversies exist over the interpretation of serologic tests, cerebrospinal fluid (CSF) abnormalities, diagnostic criteria, and treatment regimens. Its occurrence with human immunodeficiency virus (HIV) infection has raised fears of its recrudescence. A critical analysis of the evidence behind these viewpoints leads to several conclusions: the CSF VDRL is the most appropriate diagnostic test; pleocytosis is the only reliable CSF measure of disease activity; commonly accepted diagnostic criteria do not exclude nonsyphilitic disease; and treatment requires the prolonged use of parenteral penicillin, but no superior regimen has been found. Most data do not currently support the view that concurrent HIV infection produces accelerated or resistant neurosyphilis.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Cerebrospinal fluid IgG and IgM indexes as indicators of active neurosyphilis.

Serological and non-serological tests were performed in matched samples of cerebrospinal fluid and serum from 236 syphilitic patients. An increased IgG or IgM index, or both, was found about 70 times more often in symptomatic neurosyphilis than in latent syphilis without involvement of the central nervous system. An increased Ig index, together with a cell count greater than 5/microL, was only found in symptomatic neurosyphilis. Although the numbers of data are small, we conclude that the IgG and IgM indexes are valuable tests in the diagnosis of syphilitic involvement of the central nervous system.

Adult↗
PubMed1987

Treatment of neurosyphilis. A comparison of penicillin regimens.

Recommendations for treatment of neurosyphilis and reasons for renewed debate are briefly reviewed and discussed. Experience with 11 patients with neurosyphilis who were treated with different preparations of penicillin by different routes of administration is recorded. The concentration of penicillin was measured in the serum and cerebrospinal fluid in each case. Very high levels were attained by the intravenous administration of penicillin G, but in the follow-up period of 1 year this has not been shown to confer any advantage. The administration of procaine penicillin 1.2 million U intramuscularly daily for 20 days is as effective as a dosage schedule which requires admission to hospital for intravenous administration.

Adult↗
PubMedDate not supplied

Ceftriaxone therapy for asymptomatic neurosyphilis. Case report and Western blot analysis of serum and cerebrospinal fluid IgG response to therapy.

A 27-year-old man with documented hypersensitivity to penicillin was treated intramuscularly for asymptomatic neurosyphilis with ceftriaxone (1 g daily for 14 days). After treatment the serum titer in the VDRL (Venereal Disease Research Laboratory) test declined from 32 to four dilutions. Lumbar punctures at months 3, 6, 9, and 28 after treatment revealed normalization of the cell count in cerebrospinal fluid and a decline in the VDRL titer in cerebrospinal fluid from four to one dilution(s). Western blot analysis revealed the presence in serum of IgG antibodies to at least 17 treponemal antigens and in cerebrospinal fluid of antibodies to at least ten treponemal antigens. Following ceftriaxone therapy serum and cerebrospinal fluid IgG reactivity to all antigens steadily decreased in intensity. These results indicate that ceftriaxone may provide a useful alternative therapy for penicillin-allergic patients with neurosyphilis.

Adult↗
PubMed1983

Parkinsonism secondary to neurosyphilis. A case report.

A case of parkinsonism associated with neurosyphilis, which improved markedly after appropriate treatment, is described. Although neurosyphilis is a rare cause of parkinsonism, it should be considered when parkinsonism appears in the 30-50-year age group, particularly if other anomalous neurological findings are present. Adequate therapy may improve the patient's condition and prevent further progression.

Humans↗
PubMedDate not supplied

Must we revise our clinical concepts of tabetic neurosyphilis?

To document the changing clinical patterns of today's tabetic neurosyphilis, 14 tabetics who were seen between 1966 and 1976 are reported. Most patients (85 %) were clinically oligosymptomatic, not only because of the small number but also due to the mildness in degree of objective neurological manifestations. Clinicians are alerted to the existence of the oligosymptomatic, variable and deceptive aspects of today's tabetic neurosyphilis.

Adult↗
PubMed1980

Failure of penicillin G benzathine in the treatment of neurosyphilis.

Although penicillin remains highly effective in syphilis, important questions exist regarding the optimal regimen for syphilitic involvement of the nervous system. Progression of neurosyphilis despite 7.2 million units of penicillin G benzathine occurred in the case reported here, with subsequent resolution following high-dose intravenous aqueous penicillin therapy. This and other recent reports support the conclusion that neurosyphilis should be treated with higher amounts of penicillin than is provided by the benzathine regimens.

Adult↗
PubMed1995

[Neurosyphilis and AIDS].

Syphilis in HIV-infected patients reveals some particular aspects which are clinically relevant and disturbing: it is more frequent and develops more quickly to late stages, namely neurosyphilis; this progression may happen even if classic therapy in the early stages has been undertaken; the diagnosis of neurosyphilis is rather complex, the serological tests being of no definite credit; high doses of intravenous penicillin should be administered for a long period. We report a case that exemplifies the aspects described above.

AIDS-Related Opportunistic Infections↗