Changes in the Cerebrospinal Fluid in Neurosyphilis After Malaria Therapy

Abstract

(4). All positive cerebrospinal fluid reactions at the end of a year are indicative that further treatment is necessary.(5) The number of serological relapses was low: 2 in the malaria group and 3 in the malaria-plus-tryparsamide series.(6) In no case tested after 2 consecutive negative results did the cerebrospinal fluid reactions revert to positive.(7) In latent and asymptomatic neurosyphilis it is not necessary to supplement malaria therapy with chemotherapy. The results of malaria therapy in the treatment of neurosyphilis are assessable from two aspects, clinical and serological. From the point of view of the patient, of his relatives and of the community, the former is obviously the more useful and for a long time it was, and sometimes it still is, the only thing considered. This outlook was inevitable until some sort of working hypothesis could be produced to explain the action of malaria.It is now more or less generally accepted that malaria is a spirochaeticidal agent and that its success in neurosyphilis is due to its action in bringing about the death of the spirochaetes. In order to assess the success or failure of the treatment we need some indicator of the presence of the living organism. This has been found in the cerebrospinal fluid. A positive reaction of the cerebrospinal fluid indicates the presence of living spirochaetes, a negative one of dead organisms. We have here a simple and straightforward means of telling how successful the treatment has been.

PROBLEMS of NEUROSYPHILIS

“…Whelen (1946) carried out a detailed analysis of the serological follow‐up of over 500 cases treated in the Horton Mott Clinic, the period of follow‐up varying from one to fifteen years. Generally speaking, at the end of the first year the condition of the fluid was a fairly reliable indicator as to whether further treatment was necessary or not.…”

Neurosyphilis

“…From the same Centre, Whelen (1946) reported a detailed analysis of the serological follow up of over 500 cases. The work was based largely on Dattner's premises, so well advocated in his book 'The Management of Neurosyphilis ' (944).…”