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1.
PLoS One ; 15(10): e0238617, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027255

RESUMO

BACKGROUND: Neurosyphilis (NS) presents with a variety of clinical syndromes that can be attributed to other aetiologies due to difficulties in its diagnosis. We reviewed all cases of NS from the "Top End" of the Australian Northern Territory over a ten-year period to assess incidence, clinical and laboratory manifestations. METHODS: Patient data (2007-2016) were extracted from hospital records, centralised laboratory data and Northern Territory Centre for Disease Control records. Clinical records of patients with clinically suspected NS were reviewed. A diagnosis of NS was made based on the 2014 US CDC criteria. Results were also recategorized based on the 2018 US CDC criteria. RESULTS: The population of the "Top End" is 185,570, of whom 26.2% are Indigenous. A positive TPPA was recorded in 3126 individuals. A total of 75 (2.4%) of TPPA positive patients had a lumbar puncture (LP), of whom 25 (35%) were diagnosed with NS (9 definite, 16 probable). Dementia was the most common manifestation (58.3%), followed by epilepsy (16.7%), psychosis (12.5%), tabes dorsalis (12.5%) and meningovascular syphilis (8.3%). 63% of probable NS cases were not treated appropriately due to a negative CSF VDRL. Despite increased specificity of the 2018 US CDC criteria, 70% of patient in the probable NS group were not treated appropriately. The overall annual incidence [95%CI] of NS was 2.47[1.28-4.31] per 100 000py in the Indigenous population and 0.95[0.50-1.62] in the non-Indigenous population (rate ratio = 2.60 [1.19-5.70];p = 0.017). CONCLUSION: Neurosyphilis is frequently reported in the NT, particularly in Indigenous populations. Disturbingly, 60% of probable neurosyphilis patients based on the 2014 criteria, and 70% based on the 2018 criteria with were not treated appropriately. It is critical that clinicians should be aware of the diagnosis of NS and treat patients appropriately.


Assuntos
Neurossífilis/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neurossífilis/diagnóstico , Neurossífilis/tratamento farmacológico , Northern Territory/epidemiologia , Penicilina G Benzatina/uso terapêutico , Prevalência , Estudos Prospectivos , Estudos Retrospectivos
3.
Cerebrovasc Dis ; 49(3): 301-306, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32570248

RESUMO

BACKGROUND AND AIMS: Syphilis and stroke are high prevalent diseases in south Brazil and estimates of concomitance and possible role of syphilis in acute stroke are lacking. Our aims are to estimate the prevalence of syphilis and neurosyphilis (NS) in a cohort of tertiary stroke center. METHODS: We reviewed all hospital records of stroke/transitory ischemic attack (TIA) using International Classification of Diseases, 10th revision, at discharge, frequency of syphilis screen, serology positivity, cerebrospinal fluid (CSF) analysis, and prevalence of NS in this stroke population applying CDC criteria. RESULTS: Between 2015 and 2016, there were 1,436 discharges for cerebrovascular events and in 78% (1,119) of these cases, some syphilis screening was performed. We have found a frequency of positive serology for syphilis of 13% (143/1,119), and higher stroke severity was the main determinant for non-screening. Applying standard NS criteria, 4.7% (53/1,119) cases with CSF analysis had NS diagnosis: 8 based on CSF-Venereal Disease Research Laboratory (VDRL) positive and 45 based on abnormal CSF white cells or protein, but CSF VDRL negative. NS VDRL positive cases were younger, had higher serum VDRL title, had more frequent HIV infection, and received NS treatment more often. Demographic and clinical characteristics were not different between NS VDRL negative and non-NS cases. CONCLUSION: Positive syphilis serology is frequent in patients with acute stroke/TIA in our region. Acute post-stroke CSF abnormalities make the diagnosis of NS difficult in the context of CSF VDRL negative.


Assuntos
Ataque Isquêmico Transitório/epidemiologia , Programas de Rastreamento , Neurossífilis/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Brasil/epidemiologia , Feminino , Humanos , Ataque Isquêmico Transitório/líquido cefalorraquidiano , Ataque Isquêmico Transitório/diagnóstico , Masculino , Pessoa de Meia-Idade , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/diagnóstico , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/líquido cefalorraquidiano , Acidente Vascular Cerebral/diagnóstico , Sorodiagnóstico da Sífilis
5.
Artigo em Russo | MEDLINE | ID: mdl-32307418

RESUMO

A clinical case of late neurosyphilis with prominent cognitive function failure developed in a young male patient is presented. Atypical disease development and negative laboratory tests required to perform the differential diagnosis with inflammatory and degenerative brain diseases, extended blood and CSF tests for syphilis. During the diagnostic procedures the patient received complex therapy with neurotropic, antioxidant, and anti-dementia drugs. The treatment improved cognitive function and increased the efficacy of further treatment.


Assuntos
Neurossífilis/diagnóstico , Antioxidantes , Cognição , Diagnóstico Diferencial , Humanos , Masculino , Sensibilidade e Especificidade
10.
J Infect Chemother ; 26(2): 296-299, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31859039

RESUMO

Syphilitic myelitis is an extremely rare manifestation of neurosyphilis and often misdiagnosed. However, a small amount of literature describe its clinical manifestations and neuroimaging features, and there is no relevant data on the prognosis, especially the long follow-up prognosis. In this paper, four syphilitic myelitis patients admitted to our hospital between July 2012 and July 2017 were retrospectively reviewed. Of the four patients, two females and two males. Treatment included intravenous penicillin G, with 24 million units of penicillin G per day administered intravenously for 14 days. Three patients were also treated with corticosteroids. The prognosis were well in three cases who received early anti-syphilis treatment, but one case who received delayed treatment due to misdiagnosis had no improvement. Neurosyphilis should be considered when there is long-segment myelopathy. Anti-treponemal antibiotics and corticosteroid therapy may improve neurological prognosis.


Assuntos
Mielite/diagnóstico , Mielite/etiologia , Neurossífilis/complicações , Neurossífilis/diagnóstico , Adulto , Idoso , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Mielite/tratamento farmacológico , Neurossífilis/tratamento farmacológico , Penicilina G/uso terapêutico , Prednisolona/uso terapêutico , Estudos Retrospectivos , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Resultado do Tratamento
11.
Kathmandu Univ Med J (KUMJ) ; 18(70): 207-209, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33594034

RESUMO

General paralysis of insane is a form of neurosyphilis which brings parenchymatous changes in the central nervous system. Its manifestations include a variety of neuropsychiatric symptoms ranging from cognitive impairment to overt psychosis. Clinicians face difficulties in proper diagnosis as variety of symptoms changes from one form to other within a short period of time. Rarity of the disease at this modern era of penicillin is also another factor in timely diagnosis and management of such cases. Here we present a case of general paralysis of insane who presented with variety of neuropsychiatric symptoms and have had great difficulties to reach into the diagnosis.


Assuntos
Transtornos Mentais , Neurossífilis , Face , Humanos , Neurossífilis/complicações , Neurossífilis/diagnóstico , Neurossífilis/tratamento farmacológico
12.
BMJ Case Rep ; 12(12)2019 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-31871011

RESUMO

A 39-year-old Caucasian man presented with headaches and retro-orbital pain but normal vision. Bilateral optic nerve swelling was found on funduscopy though optic nerve function and computed perimetry were normal and there was no relative afferent pupillary defect. CT venogram and MRI were unremarkable. Cerebrospinal fluid (CSF) opening pressure was normal on lumbar puncture and Treponema pallidum antibodies and T. pallidum particle agglutination test were positive on CSF analysis. He tested negative for HIV. Symptoms rapidly resolved with 2 weeks of intravenous benzylpenicillin. At 1 month follow-up, the right optic nerve swelling had reduced while the left optic nerve swelling had increased; his vision remained unaffected and he was symptom free and continued to have no objective evidence of optic nerve dysfunction.


Assuntos
Neurite (Inflamação)/diagnóstico , Neurossífilis/diagnóstico , Nervo Óptico , Treponema pallidum/isolamento & purificação , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Neurite (Inflamação)/líquido cefalorraquidiano , Neurite (Inflamação)/complicações , Neurite (Inflamação)/microbiologia , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/complicações , Neurossífilis/microbiologia , Oftalmoscopia , Dor/etiologia , Córtex Pré-Frontal
13.
Tidsskr Nor Laegeforen ; 139(18)2019 Dec 10.
Artigo em No | MEDLINE | ID: mdl-31823567

RESUMO

BACKGROUND: Stroke has several causes and the diagnostic investigation can be challenging. Neurosyphilis occurs when Treponema pallidum infects the central nervous system, and is a rare cause of stroke. CASE PRESENTATION: A man in in his late forties with diabetes mellitus and overweight presented with headache, speech impairment and right-sided stroke symptoms. He also had cognitive impairment and psychiatric symptoms. He underwent intravenous thrombolysis, and standardised stroke investigation was without clear findings. Cerebral MRI demonstrated non-specific subtle changes in the primary motor cortex in the left frontal lobe. However, lumbar puncture revealed elevated white blood cell count, and syphilis tests were positive. INTERPRETATION: Diagnosis of syphilis is often difficult and requires specific suspicion. Due to increasing incidence of the disease and its therapeutic consequences, alertness around the condition is important. Neurosyphilis should be suspected in young patients with stroke symptoms in the absence of risk factors and/or with cryptogenic strokes, especially in the presence of risk factors for syphilis infection and in patients from endemic areas.


Assuntos
Neurossífilis , Distúrbios da Fala , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/complicações , Neurossífilis/diagnóstico , Paresia/etiologia , Distúrbios da Fala/etiologia , Sorodiagnóstico da Sífilis , Treponema pallidum
14.
BMC Infect Dis ; 19(1): 1017, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791265

RESUMO

BACKGROUND: Early diagnosis and treatment of neurosyphilis is of great significance for regression. There is no gold standard for the diagnosis of neurosyphilis. We did this study to explore the factors associated with the clinical diagnosis of neurosyphilis and assess their accuracy for the diagnosis of neurosyphilis. METHODS: We retrospectively reviewed 100 cases of syphilis patients who underwent lumbar puncture at a major dermatology hospital in Guangzhou, China between April 2013 and November 2016. Fifty patients who were clinically diagnosed with neurosyphilis were selected as case group. Control group consisted of 50 general syphilis patients who were matched with age and gender. The records of patients were reviewed to collect data of socio-demographic information, clinical symptom, and laboratory indicators. Multivariable logistic regression was used to explore diagnostic indictors, and ROC analysis was used to assess diagnostic accuracy. RESULTS: Neurological symptoms (odds ratio (OR) = 59.281, 95% CI:5.215-662.910, P = 0.001), cerebrospinal fluid (CSF) Treponema pallidum particle agglutination (TPPA) titer (OR = 1.004, 95% CI:1.002-1.006, P < 0.001), CSF protein (OR = 1.005, 95% CI:1.000-1.009, P = 0.041), and CSF white blood cell (WBC) (OR = 1.120, 95% CI:1.017-1.233, P = 0.021) were found to be statistically associated with neurosyphilis. In ROC analysis, CSF TPPA titer had a sensitivity of 90%, a specificity of 84%, and an area under curve (AUC) of 0.941. CONCLUSION: CSF TPPA can potentially be considered as an alternative test for diagnosis of neurosyphilis. Combining with neurological symptoms, CSF protein, CSF WBC, the diagnosis would have a higher sensitivity.


Assuntos
Soronegatividade para HIV , Neurossífilis/diagnóstico , Adulto , Estudos de Casos e Controles , China/epidemiologia , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Feminino , Infecções por HIV/líquido cefalorraquidiano , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/complicações , Neurossífilis/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Sífilis/líquido cefalorraquidiano , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/epidemiologia , Treponema pallidum
15.
Klin Lab Diagn ; 64(11): 659-662, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31747493

RESUMO

To develop predictive model of damage of nervous system on the basis of definition of concentration of interleukins-23, 12p40 and also a glial fibrillar acid protein (GFAP) in liquor of patients with various forms of syphilis. Comprehensive laboratory examination of patients with neurosyphilis and syphilis without specific damage of nervous system who were observed in venereologic office of BOUZAS of OO «Clinical Dermatovenerologic Clinic¼ of Omsk is conducted. To all patients were carried out: a serological blood analysis, serological and clinical trial of liquor, and also immunological research of liquor (interleukins - 23, 12p40, and also GFAP). On the basis of the research IL-23, SILT-12p40, GFAP, the level of protein and a pleocytosis in liquor the predictive model of development of neurosyphilis in patients with syphilis without specific damage of nervous system is offered. The analysis of immunological changes in liquor of patients showed that the research of a number of cytokines and markers of damage of nervous tissue to liquor as the most specific and reliable, especially in the absence of clinical symptomatology from central nervous system can be an integral part of diagnostics of neurosyphilis also.


Assuntos
Proteína Glial Fibrilar Ácida/sangue , Subunidade p40 da Interleucina-12/sangue , Interleucina-23/sangue , Tecido Nervoso/patologia , Neurossífilis/diagnóstico , Humanos , Neurossífilis/imunologia
17.
Medicine (Baltimore) ; 98(36): e16887, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490372

RESUMO

RATIONALE: Multiple syphilitic gummas involving both the brain and spinal cord are quite rare. Central nervous system (CNS) syphilitic gummas are commonly misdiagnosed as CNS tumors, and clinical suspicion and diagnosis of a syphilitic gumma by physicians are vital to avoiding unnecessary surgeries. Our case emphasizes the importance of routine serologic syphilis tests and standard therapy with penicillin in patients with a CNS mass. PATIENT CONCERNS: A 22-year-old previously healthy man presented with a 9-day history of progressive right lower limb weakness. DIAGNOSIS: The diagnosis of gummatous neurosyphilis was based on positive serological, cerebrospinal fluid tests for syphilis and magnetic resonance imaging (MRI) findings, which revealed the presence of multiple dural-based enhancing masses with marked edema. INTERVENTIONS: Therapy consisting of intravenous penicillin G at 24 million units daily divided into 6 doses were given for a total of 21 days, along with 3 weekly intramuscular injections of benzathine penicillin G (2.4 million units) to ensure that the syphilitic lesions in the CNS were adequately treated. OUTCOMES: Complete resolution of the lesions was observed on MRI over a 3-month period. LESSONS: The importance of routine serologic syphilis tests and standard therapy with penicillin in patients with central CNS mass lesions is noted to avoiding unnecessary surgeries.


Assuntos
Neurossífilis/diagnóstico , Antibacterianos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Diagnóstico Diferencial , Soronegatividade para HIV , Humanos , Imagem por Ressonância Magnética , Masculino , Neurossífilis/diagnóstico por imagem , Neurossífilis/tratamento farmacológico , Penicilina G/uso terapêutico , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Adulto Jovem
19.
J Clin Neurosci ; 69: 67-73, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31427238

RESUMO

The term of neurosyphilis (NS) refers to infection of central nervous system by Treponema pallidum. Classically, it has been divided into early (meningitis, meningovascular) and late forms (general paresis and tabes dorsalis). The availability of penicillin and high sensitivity of Treponema pallidum to this antibiotic has led to a widely held perception about rarity of syphilitic forms with central nervous system involvement. However, patient can exhibit atypical clinical presentation. Recently different clinical cases with autoimmune encephalitis-mimicking presentation or atypical movement disorders were described. In this article we presented clinical case series with different clinical and MRI presentation and discuss diagnostic and treatment challenges. During our screening period at neurological department we revealed 6 NS cases. Three of them have an atypical presentation. The first patient was misdiagnosed as acute disseminated encephalomyelitis, the second patient had hippocampal sclerosis and epileptic seizures. Another patient had cognitive decline and autoimmune encephalitis-like MRI lesions. We put an emphasis on widening of indication for lumbar puncture and NS tests in patients with syphilitic anamnesis and neurological manifestations.


Assuntos
Neurossífilis/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/complicações , Neurossífilis/tratamento farmacológico , Treponema pallidum
20.
Am J Forensic Med Pathol ; 40(4): 371-375, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31306170

RESUMO

Creutzfeldt-Jakob disease (CJD) is a complex and rapidly fatal prion infection of the central nervous system with characteristic clinical and pathological findings. Herein, we present the case of an 80-year-old man with a 2-month history of rapid cognitive decline and ataxic gait. He was found to have a positive rapid plasma reagin and fluorescent treponemal antibody absorption (FTA-ABS) upon clinical testing and was presumed to have neurosyphilis. His neurological status precipitously declined during his hospitalization and he died. A complete autopsy was performed, which revealed diffuse spongiform change throughout the cerebrum. Brain tissue was sent to the National Prion Disease Surveillance Center, where immunostaining for prion protein (3F4) showed granular deposits, confirming the diagnosis of CJD. There have been rare cases reported in which CJD was clinically suspected but neurosyphilis was confirmed at autopsy. To our knowledge, this is the first case to be published in which the clinical findings strongly favored neurosyphilis, but spongiform encephalopathy was identified at autopsy. We review the clinical, radiographic, electrophysiological, laboratory, and histopathological features of both diseases and discuss the overlapping findings and inherent diagnostic difficulties. We also review the recommended protocols for safely handling suspected prion-infected autopsy tissue. A heightened awareness of the features of CJD and other prion diseases is needed among forensic pathologists, neuropathologists, and general autopsy pathologists to understand how to safely handle the tissue to get definite diagnoses for the decedent's family members and clinical care team.


Assuntos
Encéfalo/metabolismo , Encéfalo/patologia , Síndrome de Creutzfeldt-Jakob/diagnóstico , Proteínas Priônicas/metabolismo , Idoso de 80 Anos ou mais , Anticorpos , Diagnóstico Diferencial , Humanos , Masculino , Neurossífilis/diagnóstico , Proteínas Priônicas/imunologia
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