Neurosyphilis and Penicillin Levels in Cerebrospinal Fluid

Mohr, John A.; Griffiths, William C.; Jackson, Roger P.; Saadah, Hannah; Bird, Philip; Riddle, Joseph

doi:10.1001/jama.1976.03270200046031

Cited by 149 publications

(37 citation statements)

References 9 publications

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“…In case 2 of our present study, however, it is possible that the three-times-a-day regime might have been insufficient, causing a nonresponse to therapy. Importantly, penicillin concentrations of more than 0.018 mg/l in CSF must be reached to effectively treat T. pallidum in the CNS [3], and some reports suggest that intramuscular administration of procaine penicillin (up to 14.4 million units) in combination with oral probenecid does not lead to effective CSF penicillin levels [1,[43][44][45]. In the UK, the treatment of neurosyphilis with intramuscular procaine penicillin combined with oral probenecid is still the gold standard and treatment failures have rarely been documented [3].…”

Section: Discussionmentioning

confidence: 99%

Late-stage neurosyphilis presenting with severe neuropsychiatric deficits: diagnosis, therapy, and course of three patients

et al. 2011

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Neurosyphilis is an infectious disease that has reappeared over the past two decades. It is caused by Treponema pallidum subspecies pallidum that can affect the central nervous system (CNS) during any stage of the disease. Besides early CNS involvement predominantly presenting with symptoms of meningitis, a parenchymal affection of the brain leading to severe neuropsychiatric symptoms particularly emerges at later stages, but is rarely seen nowadays due to early antibiotic treatment. Together with the clinical findings, a characteristic combination of serological and cerebrospinal fluid (CSF) abnormalities leads to the diagnosis of neurosyphilis and is required to assess its activity. However, particularly at later stages of disease and after antibiotic treatment, serological and CSF abnormalities may become ambiguous and, therefore, difficult to interpret. This can be accompanied by persisting or fluctuating neuropsychological deficits. To this day, no well-controlled clinical data exists concerning the treatment of late-stage neurosyphilis, neither on type, optimal dosage, duration, and long-term efficacy of antibiotic therapy. Therefore, treatment and follow-up of late-stage neurosyphilis are challenging tasks. Here, we present three cases of neurosyphilis with severe neuropsychiatric symptoms in non-immunocompromised patients and a review of the recent literature.

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Section: Discussionmentioning

confidence: 99%

Late-stage neurosyphilis presenting with severe neuropsychiatric deficits: diagnosis, therapy, and course of three patients

et al. 2011

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“…In the late 1970s and throughout the 1980s, great attention was given to studies that revealed that, during therapy with benzathine penicillin, drug levels were generally undetectable in the CSF [14,15]. This finding was expected, because serum levels do not exceed 0.1 mg/mL and CSF levels are only a small percentage of serum levels.…”

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confidence: 99%

Editorial Commentary:Neurosyphilis: Diagnosis and Response to Treatment

Musher¹

2008

CLIN INFECT DIS

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“…While studies have shown that treatment with intramuscular penicillin fails to obtain treponemicidal concentrations in cerebrospinal fluid,5 there are reports in the literature of successful outcomes using intramuscular penicillin and even oral amoxicillin and oral steroids 6. Intravenous penicillin has been shown to achieve treponemicidal concentrations in the cerebrospinal fluid in patients with neurosyphilis, and is generally accepted as the optimal current treatment regimen 5 , 7. This is a long, costly and inconvenient course.…”

Section: Discussionmentioning

confidence: 99%

Otosyphilis and HIV: therapeutic dilemma and outcome of treatment

Mckenzie¹,

Loock

2009

Case Reports

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We present a case report and review the world literature concerning otosyphilis, particularly with reference to the HIV positive patient. Our patient received two separate courses of treatment for otosyphilis. A course of intramuscular penicillin and oral prednisone resulted in no improvement in his hearing thresholds. A subsequent course of intravenous penicillin and oral prednisone resulted in an improvement of 79 db in his three frequency pure tone average. Otosyphilis is one of the rare causes of treatable sensorineural hearing loss. HIV has been shown to increase the severity and the progression of luetic ear disease. This case reveals that the optimal treatment remains a 10 day course of intravenous penicillin and oral prednisone.

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Neurosyphilis and Penicillin Levels in Cerebrospinal Fluid

Cited by 149 publications

References 9 publications

Late-stage neurosyphilis presenting with severe neuropsychiatric deficits: diagnosis, therapy, and course of three patients

Late-stage neurosyphilis presenting with severe neuropsychiatric deficits: diagnosis, therapy, and course of three patients

Editorial Commentary:Neurosyphilis: Diagnosis and Response to Treatment

Otosyphilis and HIV: therapeutic dilemma and outcome of treatment

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