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At least 19 recordsLinked to original sources
PubMed1981

The profile of neurosyphilis in Denmark A clinical and serological study of all patients in Denmark with neurosyphilis disclosed in the years 1971-1979 incl. by Wassermann reaction (CWRM) in the cerebrospinal fluid.

55 cases of neurosyphilis, probably all that has been disclosed in Denmark in the nine year period 1971 to 1979 are submitted. 55 case histories and 10 tables illustrate the variegated clinical features and the differential diagnoses, the serological data, and CSF findings, the treatment and its results. As the symptomatology of the series fits well into the classification of neurosyphilis of the past our cases are classified accordingly in five clinical groups with seven subgroups. Penicillin treatment was applied to all the patients in current dosages and proved beneficial in most patients with regard to clinical symptoms and to laboratory parameters. The outcome here registered seem, however, to be related more to the character of the disease than to the types or amounts of penicillin. Eleven of the patients had a history of previous positive serology and two of them had been treated with penicillin for early syphilis but their neurosyphilis was evidently due to an untreated reinfection. Ten of the patients had aortitis.

Adolescent↗
PubMed1995

Neurosyphilis in HIV-infected patients.

To determine the prevalence and the clinical and serological findings of neurosyphilis in HIV-infected patients, Treponema pallidum hemagglutination (TPHA) tests, CD4+ lymphocyte counts and determination of rapid plasma reagin (RPR) titers were performed in 972 HIV-infected patients over a period of 3.5 years. Patients were scored according to the Centers for Disease Control's classification for HIV infection. Reactive serum syphilis tests and positive cerebrospinal fluid (CSF)-Venereal Disease Research Laboratory (VDRL) tests, with or without clinical symptoms, were used as the criteria for diagnosis of neurosyphilis. The TPHA test was positive in 31 patients, representing 3.1% of all HIV-infected patients included in the study. Of these, 13 were intravenous drug addicts, 14 were homosexuals and 4 were heterosexuals. Diagnosis of syphilis was concurrent with HIV infection in 19 patients, prior to HIV infection in 6 patients and after HIV infection in 6 patients. CSF examinations were performed in 28 of the 31 (90.3%) patients with serologically evident syphilis. Four patients had positive CSF-VDRL tests with pleocytosis (23.5% of untreated syphilis patients in whom CSF was examined), three of whom reported mild headache, which was considered a doubtful manifestation of neurosyphilis. Patients with syphilis diagnosed and treated prior to diagnosis of HIV infection did not have evidence of neurosyphilis. Seven patients had pleocytosis with a negative CSF-VDRL test, without any clinical manifestations of neurosyphilis. There was no significant difference in the mean CD4+ lymphocyte count between patients with and without neurosyphilis (p = 0.5). RPR titers in neurosyphilis patients were greater than those in patients previously treated for syphilis and in those with pleocytosis only (p = 0.046 and 0.036, respectively). All neurosyphilis patients had an RPR titer > 1:8. After therapy, neurosyphilis patients had negative CSF-VDRL tests with a lower level of pleocytosis. The prevalence of neurosyphilis was 0.4% in HIV-infected patients and 23.5% in HIV-infected patients with untreated syphilis. This high prevalence of neurosyphilis warrants CSF examination in HIV-infected patients with syphilis, regardless of the stage of syphilis.

Adult↗
PubMed1992

Response of latent syphilis or neurosyphilis to ceftriaxone therapy in persons infected with human immunodeficiency virus.

OBJECTIVE: To evaluate the effect of ceftriaxone in treating latent syphilis or asymptomatic neurosyphilis in patients infected with the human immunodeficiency virus (HIV). DESIGN: Follow-up study of patients treated at two HIV-based clinics during 16 months from 1989 to 1991. PATIENTS: Patients were those in whom a clinical diagnosis of latent syphilis or asymptomatic neurosyphilis was made, who received all recommended doses of antimicrobial therapy, and who returned for follow-up visits for 6 or more months. RESULTS: Forty-three patients were treated with ceftriaxone, 1 to 2 g daily for 10 to 14 days. Thirteen underwent lumbar puncture before treatment; 7 (58%) had documented neurosyphilis (pleocytosis in 5, elevated protein levels in 6, VDRL reactive in cerebrospinal fluid [CSF] in 7), and 6 had documented latent syphilis (entirely normal CSF). The remaining 30 were said to have presumed latent syphilis. There was no relation between the diagnosis and the selected dosage of ceftriaxone. Response rates were similar in those who had documented neurosyphilis and documented or presumed latent syphilis. Overall, 28 patients (65%) responded to therapy, 5 (12%) were serofast, 9 (21%) had a serologic relapse, and 1 (2%) who experienced progression to symptomatic neurosyphilis was a therapeutic failure. Thirteen patients received benzathine penicillin for presumed latent syphilis; results were similar to those observed after ceftriaxone therapy, with 8 (62%) responders, 1 (8%) serofast, 2 (15%) relapses, and 2 (15%) failures. CD4 cell counts in responders were not different from those who failed to respond. CONCLUSIONS: Even in the absence of neurologic symptoms, half of the HIV-infected persons who have serologic evidence of syphilis may have neurosyphilis. Although ceftriaxone achieves high serum and CSF levels, 10 to 14 days of treatment with this drug were associated with a 23% failure rate in HIV-infected patients who had latent syphilis or asymptomatic neurosyphilis. Three doses of benzathine penicillin did not have a significantly higher relapse rate and may provide appropriate therapy, at least for documented latent syphilis in persons co-infected with HIV. Studies comparing ceftriaxone with 10 to 14 doses of procaine penicillin are needed to determine the most cost-effective treatment for asymptomatic neurosyphilis or presumed latent syphilis in this group of patients.

Adult↗
PubMed1998

Neurosyphilis during the AIDS epidemic, San Francisco, 1985-1992.

To investigate the epidemiology and clinical spectrum of neurosyphilis in a population with high rates of coexisting syphilis and human immunodeficiency virus (HIV) infection, a retrospective analysis of cases in all San Francisco hospitals from 1985 to 1992 was conducted. Neurosyphilis was defined by a newly reactive cerebrospinal fluid VDRL; 117 patients with neurosyphilis were identified. The median age was 39 years, 91% were male, 74 (63%) were white, and 75 (64%) were HIV-infected. Thirty-eight (33%) presented with an early symptomatic neurosyphilis syndrome. Six (5%) had late neurosyphilis. Thirty-eight (32%) patients were asymptomatic, and 35 (30%) had findings attributable to coexisting neurologic diseases. Patients demonstrated high serum nontreponemal (VDRL) titers (median, 1:128) at neurosyphilis presentation. In contrast to the findings from the preantibiotic era, neurosyphilis was identified in young patients most often with HIV coinfection, and early symptomatic syndromes were identified more frequently than late neurosyphilis syndromes.

AIDS-Related Opportunistic Infections↗
PubMed1994

Evaluation of neurosyphilis in human immunodeficiency virus-infected individuals.

The diagnosis of neurosyphilis in patients infected with the human immunodeficiency virus (HIV) remains problematic. We examined the use of the Treponema pallidum hemagglutination (TPHA) index and quantitative tests of CSF by means of microhemagglutination-T. pallidum for diagnosis of neurosyphilis in 58 HIV-infected persons with latent syphilis who had not recently received therapy for syphilis. Five patients (9%) had reactive CSF VDRL tests and thus had proven neurosyphilis. For 13 patients (22%), CSF findings were normal and revealed no evidence of neurosyphilis. For 40 patients (69%), abnormal CSF findings were characteristic of neurosyphilis, but their CSF VDRL tests were nonreactive. Twenty-five of the 40 patients with possible neurosyphilis had pleocytosis and elevated CSF levels of protein and/or IgG. Five (12.5%) of these 40 patients had positive TPHA indices that indicated intrathecal antitreponemal antibody production, a finding that provided greater support for the diagnosis of active neurosyphilis. With use of the TPHA index, patients with CSF abnormalities can be better classified in regard to their need for therapy for neurosyphilis.

Adult↗
PubMed1993

Neurosyphilis. A comparative study of the effects of infection with human immunodeficiency virus.

BACKGROUND: The course of neurosyphilis has been reported to be altered by human immunodeficiency virus (HIV) infection. Prior reports of neurosyphilis occurring in association with HIV infection have been largely anecdotal and have failed to compare neurosyphilis in patients with HIV infection with an uninfected control group. This study was performed to determine if the clinical presentation encountered is different in the presence of HIV infection. DESIGN: A retrospective, hospital-based, case series study based on chart review encompassing a 64-month period. SETTING: The study was performed in a large, university-affiliated, public health trust hospital in south Florida. PATIENTS: Forty-six hospitalized patients with neurosyphilis were identified; 13 patients fulfilled Centers for Disease Control and Prevention (Atlanta, Ga) criteria for acquired immunodeficiency syndrome (AIDS), 11 were HIV seropositive only, and 22 were HIV uninfected. Neurosyphilis was determined by a reactive cerebrospinal fluid VDRL slide test. RESULTS: The HIV-infected patients (both AIDS and HIV-seropositive groups) were younger and more frequently had features of secondary syphilis, such as rash, fever, adenopathy, headache, or meningismus. Significant differences were observed in cerebrospinal fluid measurements when the HIV-infected group was compared with the HIV-uninfected group, including a higher mean white blood cell count in patients with AIDS and a higher mean protein level and a lower mean glucose level in the HIV-infected group. Syphilitic meningitis was more common in HIV-seropositive patients, although the HIV-uninfected patients presented with a greater variety of types of neurosyphilis. Ophthalmic syphilis was observed more frequently in the HIV-infected group. CONCLUSIONS: Significant differences exist between neurosyphilis occurring in the presence and absence of HIV infection.

Adult↗
PubMed1989

Clinical significance of cerebrospinal fluid tests for neurosyphilis.

From 1978 to 1987, 1,665 cerebrospinal fluid (CSF) fluorescent treponemal antibody absorption (CSF-FTA-ABS) tests were performed as the screening procedure for neurosyphilis. The CSF samples from 48 patients were reactive, and the medical history and results of the CSF-Venereal Disease Research Laboratory test (CSF-VDRL) for syphilis for 38 of these patients were reviewed. Likely active neurosyphilis was diagnosed if the patient had a reactive CSF-FTA-ABS test, recent onset of neurological signs consistent with neurosyphilis, abnormal CSF, and no other recognized cause for the neurological illness. Fifteen patients were so classified. Four had a reactive CSF-VDRL test. The specificity of the CSF-VDRL in diagnosing likely active neurosyphilis was 100%, but the sensitivity was only 27%. The insensitivity of the CSF-VDRL test limits its usefulness as a screening test for neurosyphilis. The CSF-FTA-ABS test appears more sensitive for screening but is less specific than the CSF-VDRL test in distinguishing currently active neurosyphilis from past syphilis. These findings imply that clinical judgment is still essential in establishing the diagnosis of active neurosyphilis.

Adolescent↗
PubMed2000

Posterior segment manifestations of active ocular syphilis, their response to a neurosyphilis regimen of penicillin therapy, and the influence of human immunodeficiency virus status on response.

OBJECTIVE: To determine the relative frequencies of signs in posterior segment ocular syphilis, the response to a neurosyphilis regimen of penicillin, and differences in findings between human immunodeficiency virus (HIV)-coinfected and -noncoinfected patients in a community setting. DESIGN: Retrospective, noncomparative, consecutive case series. PARTICIPANTS: Fourteen consecutive patients with posterior segment ocular syphilis over a 14-year period within or during the acquired immune deficiency syndrome era. INTERVENTION: Neurosyphilis intravenous penicillin regimen. MAIN OUTCOME MEASURES: Initial and final visual acuity; treponemal and nontreponemal serologic analyses; cerebrospinal fluid cell count, protein, and Venereal Disease Research Laboratory analyses; posterior segment signs; and relapses and recurrences. RESULTS: Blacks and males were predominantly affected. Five (36%) of patients were HIV coinfected, and ocular syphilis led to the HIV infection diagnosis in three. Four (29%) patients had received previous antibiotic therapy for primary or secondary syphilis, raising the suspicion of relapse. Two patients had negative nontreponemal serologic results. All patients responded rapidly to neurosyphilis therapy. One patient subsequently relapsed after neurosyphilis therapy, and a second was reinfected with recurrence of ocular involvement. One previously undescribed retinal manifestation was discovered: a sectorial retinochoroiditis with delayed retinal circulation in the involved area. CONCLUSIONS: Ocular syphilis is a form of neurosyphilis and requires neurosyphilis therapy regardless of when it develops after primary infection. Conventional syphilis staging is of little use in understanding ocular syphilis. A high suspicion for this diagnosis is appropriate, especially in poorer black males with posterior segment inflammatory disease. Human immunodeficiency virus coinfection with ocular syphilis is common, but does not affect response to a neurosyphilis regimen of penicillin in the short term. Awareness of the multiple presentations of posterior segment ocular syphilis will aid ophthalmologists in averting misdiagnosis or delayed diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Finding neurosyphilis without the Venereal Disease Research Laboratory test.

BACKGROUND: The cerebrospinal fluid (CSF)-Venereal Disease Research Laboratory (VDRL) test is only 27% sensitive for diagnosing neurosyphilis. Discriminant analysis, used on 124 patients, shows that other commonly used laboratory tests can, in combination, identify 87% of patients with neurosyphilis with 94% specificity. STUDY DESIGN: The insensitivity of the CSF-VDRL (27% in persons with neurosyphilis) and the foreseen greater need to identify and treat neurosyphilis in the era of human immunodeficiency virus caused us to analyze the serum and cerebrospinal fluid results of 73 patients with syphilis and of 51 patients with clinically diagnosed neurosyphilis. Discriminant analysis was applied to different sets of laboratory tests to find the combination of test results best able to predict retrospectively the clinical diagnosis of syphilis or neurosyphilis, without reference to the CSF-VDRL. RESULTS: The predicting function averages 94% specificity and 87% sensitivity. Test result variables considered together are: CSF-FTA-ABS, serum FTA-ABS, CSF-TPHA, serum TPHA, and CSF cells. CONCLUSIONS: The authors conclude that clinicians or laboratories can, independently of the CSF-VDRL, compute a score showing whether the results of a set of commonly used tests suggest neurosyphilis in a patient.

Cardiolipins↗
PubMed1988

Diagnosis of neurosyphilis: a critical assessment of current methods.

Clinical features of 74 patients with neurosyphilis and 38 syphilitic patients with nonsyphilitic neurologic disorders were correlated with results of their serum and cerebrospinal fluid (CSF) VDRL and FTA tests, and with the WBC count and total protein level in the CSF. The most common clinical features in those having neurosyphilis were reflex changes (53.9%), peripheral neuropathy (44.5%), ataxia (38%), and cranial nerve palsies (24.3%). In 27% of the patients with neurosyphilis the CSF was VDRL-reactive, while in 77% the CSF was FTA-reactive. The frequency of elevated WBC counts in various serologic categories ranged from 23% to 46%, and the frequency of elevated protein levels ranged from 23% to 27%; neither the mean WBC count nor the protein level differed significantly among the different serologic categories (P less than .05). Only two of the 74 patients with neurosyphilis had elevation of both the WBC and protein level. None of the syphilitic patients without neurosyphilis had an elevated WBC or protein level, though the CSF was FTA-reactive in all 38. Among the neurosyphilis patients whose CSF was VDRL-nonreactive but FTA-reactive, 21% had an elevated protein level and 26% had an elevated WBC count. These results support the view that patients having neurosyphilis will not necessarily have either VDRL-reactive CSF or the other expected CSF abnormalities.

Humans↗
PubMed1986

Inappropriate use of the cerebrospinal fluid Venereal Disease Research Laboratory (VDRL) test to exclude neurosyphilis.

Only 3 of 2536 cerebrospinal fluid (CSF) VDRL tests ordered at the Johns Hopkins Hospital in 1980 were positive. Of patients on whom the test was ordered, 226 had a positive or borderline serum fluorescent treponemal antibody absorption test. Records from 156 (69%) of these patients, including all 3 with positive CSF-VDRL tests, were reviewed and showed that the diagnosis of neurosyphilis had been considered only in 44 (28%). One third of records lacked notations of historical and physical findings characteristic of neurosyphilis. Forty seropositive patients who had lumbar puncture to rule out asymptomatic neurosyphilis had negative CSF-VDRL tests; none had neurosyphilis diagnosed. Use of the CSF-VDRL test seemed to represent predominantly "box-checking" on the requisition to rule out neurosyphilis. Yet the test performs better when "ruling in" rather than ruling out neurosyphilis. The Centers for Disease Control should reevaluate its recommendation to rule out neurosyphilis in asymptomatic patients with untreated syphilis of greater than 1 year's duration, given the costs, risks, and dubious benefits.

Antibodies, Bacterial↗
PubMed1994

The response of symptomatic neurosyphilis to high-dose intravenous penicillin G in patients with human immunodeficiency virus infection.

BACKGROUND: Infection with the human immunodeficiency virus (HIV) may affect both the natural course of syphilis and the response to treatment. We examined the response to treatment with high-dose penicillin G in HIV-infected patients with symptomatic neurosyphilis. METHODS: Neurosyphilis was defined by reactivity in serum treponemal tests for syphilis, neurologic manifestations consistent with neurosyphilis, and a positive Venereal Disease Research Laboratory (VDRL) test on cerebrospinal fluid. We identified 11 HIV-infected patients with symptomatic neurosyphilis; 5 had been treated previously for early syphilis with penicillin G benzathine. Patients were treated with 18 million to 24 million units of penicillin G per day administered intravenously for 10 days. Cerebrospinal fluid was examined approximately 6 and 24 weeks after treatment, when the polymerase chain reaction and rabbit inoculation were used to detect Treponema pallidum. RESULTS: In four of the seven patients studied 24 weeks after treatment, the serum titers on rapid plasma reagin (RPR) testing decreased by at least two doubling dilutions, and four patients had reductions in the cerebrospinal fluid titers on VDRL testing or reverted to nonreactive results. In two patients there was no normalization or improvement in serum titers on RPR testing or cerebrospinal fluid titers on VDRL testing, cell counts, or protein concentrations. One patient relapsed with meningovascular syphilis six months after therapy. T. pallidum was detected by the polymerase chain reaction in cerebrospinal fluid from 3 of 10 patients before treatment, but in none of the 10 post-treatment specimens. CONCLUSIONS: In patients with early syphilis who are also infected with HIV, therapy with penicillin G benzathine may fail, and neurosyphilis may develop. The regimen of high-dose penicillin recommended for neurosyphilis is not consistently effective in patients infected with HIV.

Adult↗
PubMed1997

Diagnosis of neurosyphilis: appraisal of clinical caseload.

OBJECTIVES: To review the management of a cohort of patients with positive treponemal serology and psychiatric and/or neurological disorders. METHODS: A retrospective case note review of 172 patients with positive treponemal serology attending the Patrick Clement's Clinic, Central Middlesex Hospital between December 1990 and November 1995 was performed. RESULTS: 101 men and 71 women were new attenders diagnosed with positive treponemal serology. A neurological problem was identified in 27 patients (12 women and 15 men) with psychiatric and/or neurological disorders, of whom 20 (six women and 14 men) underwent investigation of the cerebrospinal fluid (CSF). With the medical history and results of CSF-RPR and FTA tests, white cell count (WCC), and total protein level in the CSF, 10 patients (eight men and two women) were diagnosed with likely neurosyphilis and 17 with neurological disorders not thought to be caused by syphilis. The clinical features in those having neurosyphilis were sensorineural hearing loss (n = 5) and tabes dorsalis (n = 5). In the seven patients diagnosed with neurosyphilis who underwent CSF examination one patient had a reactive CSF-FTA, elevated protein, and elevated WCC; one patient had a reactive CSF-FTA and RPR with elevated protein; the total protein only was elevated in three cases and the WCC elevated in one case. Nine of the 10 patients with neurosyphilis received adequate neurosyphilitic treatment; one patient was lost to follow up. CONCLUSIONS: The management of patients with positive treponemal serology and psychiatric and/or neurological disorders was consistent. Patients with suspected neurosyphilis or patients with neurological signs compatible with neurosyphilis (who did not undergo CSF examination) were treated with adequate neurosyphilitic therapy.

Adult↗
PubMed1992

Neurosyphilis in HIV carriers: MR findings in six patients.

Neurosyphilis, a sexually transmitted disease that can cause neurologic damage, has become increasingly prevalent in the AIDS era. HIV carriers can contract neurosyphilis without the presence of other concurrent opportunistic infections. Because MR findings of neurosyphilis are seldom reported, we retrospectively reviewed and evaluated contrast-enhanced MR images of six young (average age, 33 years) HIV-positive men with high serum and CSF VDRL titers indicative of neurosyphilis. All six patients tested negative for concurrent opportunistic infections. Five patients had acute or subacute strokelike symptoms involving the basal ganglia or middle cerebral arteries; one had a parietal convexity mass mimicking meningioma with headache and ataxia. Contrast-enhanced MR images showed patchy enhancement involving the basal ganglia and middle cerebral artery territories in the first five patients and the convexity mass in the sixth patient. On the basis of brain biopsy, a convexity mass was diagnosed in the patient with syphilitic gumma. The imaging findings of the remaining five patients represented ischemic infarct caused by meningovascular syphilis. After penicillin treatment, serum and CSF VDRL titers decreased, and neurologic signs and symptoms improved in all six patients. A follow-up MR study in the patient with the gumma showed that the lesion resolved almost completely. In young HIV patients with stroke symptoms or a convexity mass, neurosyphilis should be considered. Contrast-enhanced MR can reveal the extent of involvement by neurosyphilis and should be used to facilitate diagnosis and proper treatment.

Adult↗