Neurosyphilis is more common in malignant syphilis: A case series and review of the literature

Zhu, Lin; Shi, Mei; Peng, Rui-Rui; Gu, Xia; Zhang, Guan; Xu, Huanbin; Zhou, Pingyu

doi:10.1177/0956462419826710

Cited by 8 publications

(18 citation statements)

References 36 publications

(41 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Malignant syphilis may also lead to more rapid CNS involvement and be first evident together with neurosyphilis with or without HIV 9,48–50 . One group found that neurosyphilis occurred concomitantly in 30% of malignant syphilis patients and only 13.1% of patients with regular secondary syphilis 51 . Possible ocular involvement includes scleral nodules, keratitis, anterior chamber inflammation, and impaired vision 44,52,53 .…”

Section: Clinical Featuresmentioning

confidence: 99%

“…9,[48][49][50] One group found that neurosyphilis occurred concomitantly in 30% of malignant syphilis patients and only 13.1% of patients with regular secondary syphilis. 51 Possible ocular involvement includes scleral nodules, keratitis, anterior chamber inflammation, and impaired vision. 44,52,53 Spread to the ears can lead to hearing abnormalities.…”

Section: Systemic Manifestationsmentioning

confidence: 99%

See 1 more Smart Citation

Malignant syphilis: a new and revised definition

Karanfilian

Almohssen²,

Kapila

et al. 2022

Int J Dermatology

View full text Add to dashboard Cite

Malignant syphilis is a rare, severe variant of secondary syphilis that primarily affects immunocompromised patients. Historically, the clinical presentation included a prodrome of constitutional symptoms followed by the development of characteristic skin lesions. The definition of malignant syphilis has not been updated since it was first described as only a cutaneous manifestation. In recent years, syphilis has reemerged as a major public health issue, particularly in men who have sex with men (MSM) and patients with HIV. With increasing rates of syphilis in the HIV‐positive population, the systemic manifestations of malignant syphilis have become more apparent. We propose a revised definition and elucidate why the term malignant syphilis should be expanded to include systemic manifestations, stressing musculoskeletal, central nervous system, ocular, ear, cardiovascular, rectal, liver, lung, and renal involvement. This updated definition is dramatically expanded to reflect its systemic manifestations. Recognition of these manifestations may prevent devastating long‐term effects.

show abstract

Section: Clinical Featuresmentioning

confidence: 99%

Section: Systemic Manifestationsmentioning

confidence: 99%

Malignant syphilis: a new and revised definition

Karanfilian

Almohssen²,

Kapila

et al. 2022

Int J Dermatology

View full text Add to dashboard Cite

show abstract

“…A retrospective study reported 26 malignant syphilis patients with typical, serious skin lesions and high non-treponemal tests titers (38). Seven (26.9%) patients were diagnosed with neurosyphilis according to the reactive CSF-VDRL test among these patients.…”

Section: Malignant Syphilismentioning

confidence: 99%

Neurosyphilis in China: A Systematic Review of Cases From 2009–2021

Du¹,

Zhang²,

et al. 2022

Front. Med.

View full text Add to dashboard Cite

Considered the increased threaten of neurosyphilis in China, a review on cases reported in the literature to describe the clinical epidemiological characteristics of neurosyphilis cases, may be beneficial to the early detection and management strategies of neurosyphilis for clinicians. We searched the literature on Chinese neurosyphilis cases published from January 1, 2009 to December 31, 2021, described their clinical epidemiological characteristics and calculated the prevalence of neurosyphilis amongst other associated diseases, according to the individual study criteria. A total of 284 studies including 7,486 neurosyphilis cases were included. No meta-analysis was performed due to the heterogeneity of the data. Among 149 case reports and 93 retrospective case series studies, the main clinical manifestation of 3,507 neurosyphilis cases was cerebral parenchymal syphilis (57.3%), followed by asymptomatic neurosyphilis (16.7%), meningovascular syphilis (13.6%), meningitis syphilis (7.7%) and ocular syphilis (2.8%), etc. In addition, the initial diagnosis was incorrect in 53.2% patients, and the most frequent misdiagnoses were mental disorders (31.0%), stroke (15.9%), cognitive impairment (9.0%), etc. The positive or abnormal rates of cerebrospinal fluid non-treponemal and treponemal tests, white blood cell counts and protein concentrations were 74.2%, 96.2%, 61.5%, and 60.9%, respectively. Aqueous penicillin was the first choice for treatment in 88.3% cases, and 81.7% and 50.0% patients had response in the improvement of symptoms and serological effective in CSF, respectively. Among 26 studies on neurosyphilis patients amongst other associated diseases, the prevalence of neurosyphilis amongst central nervous system infectious diseases, syphilis-associated neurological symptoms, serofast status, coinfected with human immunodeficiency virus were 10.6%–30.1%, 23.2%–35.5%, 9.8%–56.1%, and 8.9%, respectively. In summary, the lack of early detection of neurosyphilis cases remains a clinical challenge. The high rate of misdiagnosis and high prevalence of neurosyphilis amongst associated diseases strongly remind clinicians to focus on the early detection among suspected cases. Besides, the standard treatment regimen and long-term follow-up, which complied with guideline should be provided. Further prospective studies are urgent to better delineate the clinical epidemiological characteristics of neurosyphilis in China.

show abstract

“…One should also be aware of asymptomatic neurosyphilis, which is difficult to diagnose in people living with HIV and often overlooked 9,10 . In addition, a recent study found a much higher proportion (30%) of those with malignant syphilis developed concurrent neurosyphilis as compared to those with the common type of secondary syphilis (13%) 11 . Patients with syphilitic uveitis often have CSF abnormalities facilitating the diagnosis of neurosyphilis.…”

mentioning

confidence: 99%

“…9,10 In addition, a recent study found a much higher proportion (30%) of those with malignant syphilis developed concurrent neurosyphilis as compared to those with the common type of secondary syphilis (13%). 11 Patients with syphilitic uveitis often have CSF abnormalities facilitating the diagnosis of neurosyphilis. Optic syphilis may flare with the JHR with deterioration of visual acuity.…”

mentioning

confidence: 99%