Neurosyphilis

Berger, Joseph; Dawson, Dolphus R.

doi:10.1016/b978-0-7020-4088-7.00098-5

Cited by 89 publications

(104 citation statements)

References 65 publications

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“…The authors concluded that a negative CSF result from a treponeme-specific antibody test may not exclude a diagnosis of neurosyphilis when the clinical suspicion for neurosyphilis is high (87). In addition, due to the high sensitivity of the FTA-ABS with respect to detecting very low levels of contaminating serum antibody, it is particularly important to prevent contamination of the CSF specimen with serum or plasma since small amounts of blood contamination of the CSF may give falsepositive test results with the FTA-ABS (88). Despite effective treatment, the CSF FTA-ABS results can continue to be positive for an extended period.…”

Section: Neurosyphilismentioning

confidence: 99%

Recent Trends in the Serologic Diagnosis of Syphilis

Morshed

Singh

2014

Clin. Vaccine Immunol.

164

156

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bComplexities in the diagnosis of syphilis continue to challenge clinicians. While direct tests (e.g., microscopy or PCR) are helpful in early syphilis, the mainstay of diagnosis remains serologic tests. The traditional algorithm using a nontreponemal test (NTT) followed by a treponemal test (TT) remains the standard in many parts of the world. More recently, the ability to automate the TT has led to the increasingly widespread use of reverse algorithms using treponemal enzyme immunoassays (EIAs). Rapid, point-of-care TTs are in widespread use in developing countries because of low cost, ease of use, and reasonable performance. However, none of the current diagnostic algorithms are able to distinguish current from previously treated infections. In addition, the reversal of traditional syphilis algorithms has led to uncertainty in the clinical management of patients. The interpretation of syphilis tests is further complicated by the lack of a reliable gold standard for syphilis diagnostics, and the newer tests can result in false-positive reactions similar to those seen with older tests. Little progress has been made in the area of serologic diagnostics for congenital syphilis, which requires assessment of maternal treatment and serologic response as well as clinical and laboratory investigation of the neonate for appropriate management. The diagnosis of neurosyphilis continues to require the collection of cerebrospinal fluid for a combination of NTT and TT, and, while newer treponemal EIAs look promising, more studies are needed to confirm their utility. This article reviews current tests and discusses current controversies in syphilis diagnosis, with a focus on serologic tests.

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Section: Neurosyphilismentioning

confidence: 99%

Recent Trends in the Serologic Diagnosis of Syphilis

Morshed

Singh

2014

Clin. Vaccine Immunol.

164

156

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“…Instead, most of the neurosyphilis patients studied here showed symptoms associated with syphilitic meningitis. Two patients presented with cranial nerve palsy, a common manifestation of the early form of syphilitic meningitis that is frequently the first clinical symptom of the disease 1,2,3,6 . Two others had a clinical profile and MRI consistent with meningomyelitis but responded very well to treatment with penicillin, supporting the diagnosis; HIV serology was positive in both these patients.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…Late forms usually occur years to decades after the primary infection and can affect the brain, causing dementia paralytica (general paresis of the insane), and the spinal cord, resulting in tabes dorsalis 1,2,3,11,12 . No cases of paralytic dementia or tabes dorsalis were observed in our study, in agreement with reports in the literature that manifestations .…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…Another important risk factor for syphilis (and neurosyphilis) is male sex and the group of men who have sex with men 1,2,3 . However, in our case series we observed a greater frequency of female patients with neurosyphilis (57%).…”

Section: Demographics and Coinfection With Hivmentioning

confidence: 99%

“…Patients were considered to have responded to syphilis treatment when there was resolution, improvement or stabilization of clinical abnormalities and normalization of CSF findings 1,2 .…”

Section: Response To Treatmentmentioning

confidence: 99%

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Neurosyphilis and ocular syphilis clinical and cerebrospinal fluid characteristics: a case series

Borges

Almeida

Sue

et al. 2018

Arq. Neuro-Psiquiatr.

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Background During the first decade of this century, a significant increase in the incidence of syphilis was documented. Objective To study clinical and laboratory characteristics of central nervous system and ocular syphilis. Methods A retrospective case series of 13 patients with a clinical and laboratory diagnosis of neurosyphilis and/or ocular syphilis who had been admitted to the Neurology and Neuro-ophthalmology Service of the Hospital de Clínicas, Federal University of Paraná. Results Nine patients had a diagnosis of neurosyphilis and two of them also had ocular syphilis. Four patients had a diagnosis of ocular syphilis alone. Among the patients with a diagnosis of neurosyphilis, six had symptomatic syphilitic meningitis, of whom one manifested as cranial nerve palsy alone, one as cranial nerve palsy plus ocular syphilis, two as transverse myelitis (syphilitic meningomyelitis), one as meningitis worsening the patient’s myasthenia gravis symptoms and one as meningitis plus ocular syphilis. Additionally, we diagnosed three patients with meningovascular neurosyphilis. In the univariate analysis, patients without ocular syphilis showed greater levels of total protein and white blood cells in the cerebrospinal fluid than patients with ocular syphilis. Conclusion This Brazilian case series of patients with neurosyphilis and ocular syphilis highlights the wide variability of this disease. A high degree of diagnostic suspicion is necessary when facing neurological and ocular symptoms for rapid diagnosis and appropriate management of patients.

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