<i>Editorial Commentary:</i>Neurosyphilis: Diagnosis and Response to Treatment

Musher, Daniel M.

doi:10.1086/591535

Cited by 12 publications

(6 citation statements)

References 11 publications

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“…This observation was consistent with a previous finding that serum antibody tests for cardiolipin, like the RPR titer (Musher, 2008) or the Venereal Disease Research Laboratory (VDRL) test (Roberts & Emsley, 1995), could indicate treponema pallidum activity. The slow wave activity identified by EEG before treatment was consistent with previous findings in active neurosyphilis (Luo et al, 2008).…”

Section: Discussionsupporting

confidence: 93%

Psychological/Cognitive Aspects in Untreated Neurosyphilis and Treatment with Penicillin G (A Case Study)

Muneoka

Kon²,

Kawabe³

et al. 2012

IJPS

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Active neurosyphilis is uncommon after the introduction of penicillin. We evaluated the pathology of a case of untreated neurosyphilis that was diagnosed as a manic episode. Examinations were performed before and after high-dose penicillin G treatment. Evaluations included the Mini-Mental State Examination (MMSE), the Neurobehavioral Cognitive Status Examination (Cognistat), the Bender Gestalt Test, an electroencephalogram, and brain magnetic resonance imaging/angiography. The most obvious improvements after treatment with penicillin G were the constructive ability and the ability to draw two-and three-dimensional designs. A paradoxical deterioration in several items on the Cognistat after treatment suggested an impairment in working memory. The clinical and psychological abnormalities observed in this case were speculated to be due to disturbed visual cognition related to encephalitis and impaired working memory related to temporofrontal lobe pathology. Current diagnostic tools were useful for precisely diagnosing and assessing the prognosis of older patients with late-onset mania

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Section: Discussionsupporting

confidence: 93%

Psychological/Cognitive Aspects in Untreated Neurosyphilis and Treatment with Penicillin G (A Case Study)

Muneoka

Kon²,

Kawabe³

et al. 2012

IJPS

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“…There is a growing consensus that NS patients can benefit from regular benzylpenicillin therapy, and high-dose benzylpenicillin is of proven efficacy at the early stage of NS [27]. Here, we outlined benzylpenicillin-induced neutropenia as a complication of NS treatment.…”

Section: Discussionmentioning

confidence: 99%

Neutropenia induced by high-dose intravenous benzylpenicillin in treating neurosyphilis: Does it really matter?

Peng

Zhao

et al. 2017

PLoS Negl Trop Dis

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BackgroundPrompt therapy with high-dose intravenous benzylpenicillin for a prolonged period is critical for neurosyphilis patients to avoid irreversible sequelae. However, life-threatening neutropenia has been reported as a complication of prolonged therapy with high doses of benzylpenicillin when treating other diseases. This study aimed to investigate the incidence, presentation, management and prognosis of benzylpenicillin-induced neutropenia in treating neurosyphilis based on a large sample of syphilis patients in Shanghai.Methodology/Principal findingsBetween 1st January 2013 and 31st December 2015, 1367 patients with neurosyphilis were treated with benzylpenicillin, 578 of whom were eligible for recruitment to this study. Among patients without medical co-morbidities, the total incidence of benzylpenicillin-induced neutropenia and severe neutropenia was 2.42% (95% CI: 1.38–4.13%) and 0.35% (95% CI: 0.06–1.39%), respectively. The treatment duration before onset of neutropenia ranged from 10 to 14 days, with a total cumulative dose of between 240 and 324 megaunits of benzylpenicillin. Neutropenia was accompanied by symptoms of chills and fever (5 patients), fatigue (2 patients), cough (1 patient), sore throat (1 patient), diarrhea (1 patient) and erythematous rash (1 patient). The severity of neutropenia was not associated with age, gender or type of neurosyphilis (p>0.05). Neutropenia, even when severe, was often tolerated and normalized within one week. A more serious neutropenia did not occur when reinstituting benzylpenicillin in patients with mild or moderate neutropenia nor when ceftriaxone was used three months after patients had previously experienced severe neutropenia.Conclusions/SignificanceBenzylpenicillin-induced neutropenia was uncommon in our cohort of patients. Continuation of therapy was possible with intensive surveillance for those with mild or moderate neutropenia. For severe neutropenia, it is not essential to aggressively use hematopoietic growth factors or broad-spectrum antibiotics for patients in good physical condition after withdrawing anti-neurosyphilis regimen. We did not see an exacerbation of neutropenia in patients with the readministration of benzylpenicillin.

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“…374–379], the Hooshmand data suggested that almost twice as many patients had a negative CSF VDRL. The reason for the discrepancy was never elucidated; some argued that the case selection was unreliable [80] while others suggested that this was the result of exposure to antibiotics that have antitreponemal activity [46,81]. In summary, a positive VDRL establishes a diagnosis of neurosyphilis, but a negative VDRL does not exclude it.…”

Section: Diagnosismentioning

confidence: 99%

REVIEW: Neurosyphilis: A Historical Perspective and Review

Ghanem

2010

CNS Neuroscience & Therapeutics

276

227

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Treponema pallidum subspecies pallidum, the causative agent of syphilis, disseminates to the central nervous system within days after exposure. Clinical manifestations can occur during any stage of the infection, and include asymptomatic neurosyphilis, acute meningeal syphilis, meningovascular syphilis, paretic neurosyphilis, and tabetic neurosyphilis. The majority of cases are reported in HIV-infected patients but the epidemiology of modern neurosyphilis is not well defined because of the paucity of population-based data. Decreasing reports of late neurosyphilis have been countered with increasing reports of early neurologic involvement. This review summarizes the clinical manifestations, diagnosis, and therapy of neurosyphilis, focusing on areas of continued controversy, and highlighting several important questions that remain unanswered. Since 2000, the rates of syphilis continue to increase. Given the effectiveness of penicillin therapy, these trends suggest a failure of prevention. Regrettably, rather than become an infection of historical significance, syphilis in the era of HIV continues to challenge researchers and clinicians.

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Editorial Commentary:Neurosyphilis: Diagnosis and Response to Treatment

Cited by 12 publications

References 11 publications

Psychological/Cognitive Aspects in Untreated Neurosyphilis and Treatment with Penicillin G (A Case Study)

Psychological/Cognitive Aspects in Untreated Neurosyphilis and Treatment with Penicillin G (A Case Study)

Neutropenia induced by high-dose intravenous benzylpenicillin in treating neurosyphilis: Does it really matter?

REVIEW: Neurosyphilis: A Historical Perspective and Review

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