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Sexually Transmitted Diseases Mar 2018After reaching a nadir at the turn of the century, syphilis rates in the United States have increased since 2000. Treponema pallidum may disseminate to the central... (Review)
Review
After reaching a nadir at the turn of the century, syphilis rates in the United States have increased since 2000. Treponema pallidum may disseminate to the central nervous system within hours to days after inoculation. In this review, we focus on knowledge gaps and areas of controversy in neurosyphilis epidemiology, diagnosis, and management. Modern estimates of the prevalence of neurosyphilis are hindered by the lack of consistent reporting data and are based on relatively small retrospective cohort studies. The various diagnostic modalities for neurosyphilis have significant limitations. Although several novel biomarkers for neurosyphilis have been evaluated, none to date have found a place in clinical practice. The role of a cerebrospinal fluid examination in patients without neurological symptoms continues to be an area of controversy, whereas the data for the use of antibiotic regimens other than intravenous aqueous or intramuscular procaine penicillin for the treatment of neurosyphilis are limited. As syphilis incidence continues to increase unabated in many countries around the world, it is critical to address these gaps of knowledge.
Topics: Health Knowledge, Attitudes, Practice; Humans; Incidence; Neurosyphilis
PubMed: 29420441
DOI: 10.1097/OLQ.0000000000000723 -
Journal of Clinical Microbiology Sep 2021Syphilis is a multisystem infection caused by the spirochete Treponema pallidum. Currently, cases of possible syphilis are commonly investigated using the treponemal... (Review)
Review
Syphilis is a multisystem infection caused by the spirochete Treponema pallidum. Currently, cases of possible syphilis are commonly investigated using the treponemal serological tests T. pallidum IgG chemiluminescence immunoassay (CLIA) and the T. pallidum particle agglutination (TPPA). The nontreponemal rapid plasma reagin (RPR) flocculation test is used to assess disease activity. There has been a resurgence of syphilis diagnoses in Australia. Large foci of infection have been identified in isolated communities. The remoteness of these locations, in conjunction with the particular sociocultural characteristics of the population, pose unique challenges to the traditional diagnostic and treatment paradigms for syphilis. As a consequence of this increased incidence of syphilis, there has been interest in the utility of point-of-care tests (POCTs), nucleic acid amplification tests (NAATs), the role of IgM testing in suspected congenital syphilis, and the laboratory investigation of possible neurosyphilis. This review looks at the current status of traditional serological assays and provides an update on more recent methods. It assesses the published literature in this area and makes recommendations for the rational use of pathology testing to aid in the diagnosis of the many facets of syphilis.
Topics: Antibodies, Bacterial; Humans; Neurosyphilis; Syphilis; Syphilis Serodiagnosis; Treponema pallidum
PubMed: 33980644
DOI: 10.1128/JCM.00100-21 -
Practical Neurology Jun 2018Syphilis is a resurgent sexually transmitted infection in the UK that is disproportionately diagnosed in patients living with HIV, particularly in men who have sex with... (Review)
Review
Syphilis is a resurgent sexually transmitted infection in the UK that is disproportionately diagnosed in patients living with HIV, particularly in men who have sex with men. Syphilis appears to present differently in patients with HIV, particularly in those with severe immunosuppression. Progression to neurosyphilis is more common in HIV coinfection and can be asymptomatic, often for several years. The presentations of neurosyphilis vary but can include meningitis, meningovascular disease, general paresis and tabes dorsalis. There is debate about the circumstances in which to perform a lumbar puncture, and the current gold standard diagnostics have inadequate sensitivity. We recommend a pragmatic approach to lumbar punctures, interpreting investigations and deciding when to consider treatment with a neuropenetrative antibiotic regimen.
Topics: Adult; Diagnosis, Differential; HIV Infections; Humans; Male; Middle Aged; Neuroimaging; Neurosyphilis
PubMed: 29478035
DOI: 10.1136/practneurol-2017-001754 -
Clinical Infectious Diseases : An... Jun 2020We reviewed the relevant syphilis diagnostic literature to address the following question: what are the performance characteristics, stratified by the stage of syphilis,... (Review)
Review
We reviewed the relevant syphilis diagnostic literature to address the following question: what are the performance characteristics, stratified by the stage of syphilis, for nontreponemal serologic tests? The database search included key terms related to syphilis and nontreponemal tests from 1960-2017, and for data related to the venereal disease research laboratory test from 1940-1960. Based on this review, we report the sensitivity and specificity for each stage of syphilis (primary, secondary, early latent, late latent, or unknown duration; tertiary as well as neurosyphilis, ocular syphilis, and otic syphilis). We also report on reactive nontreponemal tests in conditions other than syphilis, false negatives, and automated nontreponemal tests. Overall, many studies were limited by their sample size, lack of clearly documented clinical staging, and lack of well-defined gold standards. There is a need to better define the performance characteristics of nontreponemal tests, particularly in the late stages of syphilis, with clinically well-characterized samples. Published data are needed on automated nontreponemal tests. Evidence-based guidelines are needed for optimal prozone titrations. Finally, improved criteria and diagnostics for neurosyphilis (as well as ocular and otic syphilis) are needed.
Topics: Humans; Laboratories; Neurosyphilis; Syphilis; Syphilis Serodiagnosis; Treponema pallidum
PubMed: 32578862
DOI: 10.1093/cid/ciaa306 -
Ugeskrift For Laeger Mar 2022This review focuses on typical and atypical manifestations of neurosyphilis. The manifestations of neurosyphilis are manyfold and may involve many specialties. Today,... (Review)
Review
This review focuses on typical and atypical manifestations of neurosyphilis. The manifestations of neurosyphilis are manyfold and may involve many specialties. Today, clinicians have limited experience with the well-described manifestations of neurosyphilis. Many screening opportunities for men who have sex with men might catch the majority of cases of syphilis in this group. However, a concern could be if disclosure about heterosexuality or, in general, monosymptomatic neurosyphilis constitute a risk for delayed diagnosis.
Topics: Homosexuality, Male; Humans; Male; Neurosyphilis; Sexual and Gender Minorities; Syphilis
PubMed: 35499222
DOI: No ID Found -
CMAJ : Canadian Medical Association... Jul 2020
Topics: Adult; Anti-Bacterial Agents; Canada; Disease Management; Female; Humans; Male; Neurosyphilis; Penicillins
PubMed: 32690559
DOI: 10.1503/cmaj.200189 -
PLoS Neglected Tropical Diseases Aug 2017Neurological involvement is one of the most important clinical manifestations of syphilis and neurological disease occurs in both early and late syphilis. The impact of... (Review)
Review
INTRODUCTION
Neurological involvement is one of the most important clinical manifestations of syphilis and neurological disease occurs in both early and late syphilis. The impact of HIV co-infection on clinical neurosyphilis remains unclear. The highest prevalence of both syphilis and HIV is in Africa. Therefore it might be expected that neurosyphilis would be an important and not uncommon manifestation of syphilis in Africa and frequently occur in association with HIV co-infection; yet few data are available on neurosyphilis in Africa. The aim of this study is to review data on neurosyphilis in Africa since the onset of the HIV epidemic.
METHODS
We searched the literature for references on neurosyphilis in Africa for studies published between the 1st of January 1990 and 15th February 2017. We included case reports, case series, and retrospective and prospective cohort and case-control studies. We did not limit inclusion based on the diagnostic criteria used for neurosyphilis. For retrospective and prospective cohorts, we calculated the proportion of study participants who were diagnosed with neurosyphilis according to the individual study criteria. Depending on the study, we assessed the proportion of patients with syphilis found to have neurosyphilis, and the proportion of patients with neurological syndromes who had neurosyphilis. Due to heterogeneity of data no formal pooling of the data or meta-analysis was undertaken.
RESULTS
Amongst patients presenting with a neurological syndrome, three studies of patients with meningitis were identified; neurosyphilis was consistently reported to cause approximately 3% of all cases. Three studies on stroke reported mixed findings but were limited due to the small number of patients undergoing CSF examination, whilst neurosyphilis continued to be reported as a common cause of dementia in studies from North Africa. Ten studies reported on cases of neurosyphilis amongst patients known to have syphilis. Studies from both North and Southern Africa continue to report cases of late stage syphilis, including tabes dorsalis and neurosyphilis, in association with ocular disease.
DISCUSSION
This is the first systematic review of the literature on neurosyphilis in Africa since the beginning of the HIV epidemic. Neurosyphilis continues to be reported as a manifestation of both early and late syphilis, but the methodological quality of the majority of the included studies was poor. Future well-designed prospective studies are needed to better delineate the incidence and clinical spectrum of neurosyphilis in Africa and to better define interactions with HIV in this setting.
Topics: Africa; Coinfection; HIV Infections; Humans; Neurosyphilis
PubMed: 28859081
DOI: 10.1371/journal.pntd.0005880 -
CMAJ : Canadian Medical Association... Dec 2023
Topics: Male; Humans; Adult; Neurosyphilis; Stroke; HIV Infections
PubMed: 38049166
DOI: 10.1503/cmaj.221339-f -
Frontiers in Public Health 2022Neurosyphilis is a chronic infectious disease caused by the invasion of into the central nervous system. In recent years, with the increase in the latent syphilis... (Review)
Review
Neurosyphilis is a chronic infectious disease caused by the invasion of into the central nervous system. In recent years, with the increase in the latent syphilis infection rate, the incidence of neurosyphilis has gradually increased, the typical symptoms of neurosyphilis have decreased, atypical manifestations have increased, and the clinical manifestations have become increasingly diverse. Cerebrospinal fluid testing plays an important role in the diagnosis of neurosyphilis. In recent years, there have been many advances in cerebrospinal fluid testing. This review focuses on the current and potential laboratory indicators of neurosyphilis in cerebrospinal fluid, aiming to provide a reference for clinical application and ideas for future experimental research of neurosyphilis.
Topics: Humans; Neurosyphilis; Persistent Infection
PubMed: 36452956
DOI: 10.3389/fpubh.2022.1030480 -
Medicine Aug 2022Neurosyphilis presenting as limbic encephalitis (LE) is an important differential diagnosis of autoimmune LE (ALE) defined by Graus in 2016. However, data on the... (Review)
Review
RATIONALE
Neurosyphilis presenting as limbic encephalitis (LE) is an important differential diagnosis of autoimmune LE (ALE) defined by Graus in 2016. However, data on the clinical differences and similarities between neurosyphilis presenting as LE and ALE are limited. Herein, we report neurosyphilis presenting as ALE that fulfilled the main items of the Graus ALE criteria. Moreover, a literature review of neurosyphilis presenting as LE was performed.
PATIENT CONCERNS
A 66-year-old Japanese man developed nonconvulsive status epilepticus. He presented with progressive personality change and working memory deficits within 3 months prior to admission. A hyperintense lesion localized in the bilateral medial temporal area was observed on T2-weighted fluid-attenuated inversion recovery brain magnetic resonance imaging. Cerebrospinal fluid analysis showed mild pleocytosis and the presence of oligoclonal band. However, in-house assays did not detect antineuronal antibodies. Electroencephalogram showed lateralized rhythmic delta activity in the right temporal area. The serum and cerebrospinal fluid serological and antigen tests for syphilis had positive results.
DIAGNOSIS
ALE was initially suspected based on the patient's symptoms and ancillary test findings that fulfilled the Graus ALE criteria. However, based on the positive confirmatory test results for syphilis, a diagnosis of neurosyphilis was eventually made.
INTERVENTION
The patient received intravenous midazolam, oral levetiracetam, and lacosamide to control nonconvulsive status epilepticus. In addition, he was treated with intravenous benzylpenicillin at a dose of 24 million units/day for 14 days.
OUTCOMES
The patient's cognitive function relatively improved after antibiotic treatment. However, he presented with persistent mild working memory deficit, which was evaluated with the Wechsler Adult Intelligence Scale, 3rd edition. Therefore, on day 103 of hospitalization, he was transferred to another hospital for rehabilitation and long-term care due to limitations in performing activities of daily living.
LESSONS
The present case was diagnosed with neurosyphilis presenting as ALE, but meanwhile, in most case, neurosyphilis presenting as LE developed at a slower progressive rate, and it had a broader or restricted involvement on brain MRI than ALE based on the literature review. Therefore, an appropriate differential diagnosis of LE can be obtained by identifying clinical differences between the 2 conditions.
Topics: Activities of Daily Living; Adult; Aged; Autoimmune Diseases; Humans; Limbic Encephalitis; Magnetic Resonance Imaging; Male; Neurosyphilis; Status Epilepticus; Syphilis
PubMed: 35984192
DOI: 10.1097/MD.0000000000030062