Chorea as the presentating feature of neurosyphilis

Özben, Serkan; Erol, Canan; Özer, Feriha; Tiras, Raziye

doi:10.4103/0028-3886.53277

Cited by 21 publications

(6 citation statements)

References 18 publications

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“…The clinical manifestations of neurosyphilis are diverse, thus the diagnosis of neurosyphilis should be based on clinical manifestations, TP serological test, and CSF examination, and a single examination is not enough to confirm its diagnosis. [ 10 , 11 ] In this study, serum TRUST test and TPPA test showed positive, CSF leukocyte count and protein concentration increased to different extents, and TPPA and VDRL tests of the CSF showed positive in these patients, which met the diagnostic criteria for neurosyphilis. Moreover, 55% of patients were symptomatic.…”

Section: Discussionsupporting

confidence: 50%

CXCL13 and TH1/Th2 cytokines in the serum and cerebrospinal fluid of neurosyphilis patients

Yan

Wang²,

et al. 2017

Medicine

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Neurosyphilis is a chronic infectious disease with involvement of central nervous system infection by Treponema pallidum. This study was to investigate the contents of B lymphocyte chemokine 1 (BLC-1/chemokine [C-X-C motif] ligand 13), Th1 cytokines (Interleukin [IL]-2, IL-12, and Interferon [IFN]-γ), and Th2 cytokines (IL-6 and IL-10) in serum and cerebrospinal fluid (CSF) of HIV-negative patients with neurosyphilis before and after treatment, aiming to elucidate roles of CXCL13 and Th1/Th2 cytokines in immune response to and pathogenesis of neurosyphilis.Enzyme-linked immunosorbent assay was employed to detect the contents of CXCL13, IL-2, IL-12, IFN-γ, IL-6, and IL-10 in serum and CSF of 47 HIV-negative patients with neurosyphilis, 36 syphilis patients without neurological involvement and 23 controls (noninfectious intracranial disease) before, 3 and 12 months after treatment with high dose penicillin.Results showed that there was no significant difference in blood CXCL13 content among 3 groups (P > .05); CSF CXCL13 content in neurosyphilis patients was significantly higher than in other 2 groups (P < .001), and positively related to leucocyte count, protein concentration, and IgG index. IL-6 and IL-10 contents of the serum and CSF in neurosyphilis patients were markedly higher than in other 2 groups (P < .05 or .01), but IL-2, IL-12, and IFN-γ of the serum and CSF were significantly lower than in other 2 groups (P < .05 or .01). The IL-6, IL-10, IL-2, IL-12, and IFN-γ contents of the serum and CSF were comparable between control group and syphilis group (P > .05). CSF CXCL13 content was positively related with IL-6 and IL-10 content, while negatively related to IL-12 content in neurosyphilis patients. CSF IL-6 content was negatively related with IL-12 content. In neurosyphilis patients, the CSF CXCL13 content reduced significantly at 3 and 12 months (P < .001), the CSF IL-2 and IL-12 contents increased significantly at 12 months, and CSF IL-6 contents reduced significantly at 12 months after treatment (P < .05 or .01).It is concluded that neurosyphilis patients did not have normal immune function. CXCL13 and Th1/Th2 cytokines are involved in the immune response of neurosyphilis patients. CSF CXCL13 and Th1/Th2 cytokines contents may be used for the diagnosis and evaluation of therapeutic efficacy of neurosyphilis.

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Section: Discussionsupporting

confidence: 50%

CXCL13 and TH1/Th2 cytokines in the serum and cerebrospinal fluid of neurosyphilis patients

Yan

Wang²,

et al. 2017

Medicine

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“…Chorea-ballism may be associated with a variety of factors such as cerebrovascular and inflammatory disease, drugs, metabolic derangement, neurodegenerative disorders, and tumors 1–5. Hyperglycemia is an unusual cause of chorea-ballism.…”

mentioning

confidence: 99%

Hemichorea-Hemiballism with a Diabetic Patient

Kim

Seok

et al. 2010

JMD

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“…Cases of influenza A, parvovirus B19 encephalitis, and West Nile virus encephalitis presenting with chorea that slowly improved with supportive care over several weeks [ 15 16 17 ]. When syphilis was the cause, symptoms responded to standard treatment with benzathine penicillin 2.4 million units IM followed by penicillin G 2.4 million units IM for 14 days [ 18 19 ]. In a number of cases, patients were co-infected with syphilis and HIV requiring both antibiotic and antiviral treatments [ 19 20 ].…”

Section: Resultsmentioning

confidence: 99%

Treatment of Secondary Chorea: A Review of the Current Literature

Feinstein

Walker

2020

Tremor and Other Hyperkinetic Movements

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Background: Chorea consists of involuntary movements affecting the limbs, trunk, neck or face, that can move from one body part to another. Chorea is conceptualized as being "primary" when it is attributed to Huntington's disease (HD) or other genetic etiologies, or "secondary" when it is related to infectious, pharmacologic, metabolic, autoimmune disorders, or paraneoplastic syndromes. The mainstay of the secondary chorea management is treating the underlying causative disorder; here we review the literature regarding secondary chorea. We also discuss the management of several non-HD genetic diseases in which chorea can be a feature, where metabolic targets may be amenable to intervention and chorea reduction. Methods: A PubMed literature search was performed for articles relating to chorea and its medical and surgical management. We reviewed the articles and cross-references of pertinent articles to assess the current clinical practice, expert opinion, and evidence-based medicine to synthesize recommendations for the management of secondary chorea. Results: There are very few double-blind randomized controlled trials assessing chorea treatments regardless of etiology. Most recommendations are based on small open-label studies, case reports, and expert opinion. Discussion: Treatment of secondary chorea is currently based on expert opinion, clinical experience, and small case studies, with limited evidence-based medical data. When chorea is secondary to an underlying infection, medication, metabolic abnormality, autoimmune process, or paraneoplastic illness, the movements typically resolve following treatment of the underlying disease. Tardive dyskinesia is most rigorously studied secondary chorea with the best evidence-based medicine treatment guidelines recommending the use of pre-synaptic dopamine-depleting agents. Even though there is an insufficient pool of EBM, small clinical trials, case reports, and expert opinion are valuable for guiding treatment and improving the quality of life for patients with chorea. Highlights: There is a dearth of well-controlled studies regarding the treatment of chorea. Expert opinion and clinical experiences are fundamental in guiding chorea management and determining successful treatment. In general, secondary chorea improves with treating the underlying medical abnormality; treatments include antibiotics, antivirals, immunosuppression, dopamine depleting agents, chelation, and supportive care.

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Chorea as the presentating feature of neurosyphilis

Abstract: Syphilis is still a significant public health problem in developing countries. Although chorea is a very rare manifestation of neurosyphilis, it might be on occasions the initial symptom. This report presents a patients with neurosyphilis who had chorea as the initial presenting symptom.

Cited by 21 publications

References 18 publications

CXCL13 and TH1/Th2 cytokines in the serum and cerebrospinal fluid of neurosyphilis patients

CXCL13 and TH1/Th2 cytokines in the serum and cerebrospinal fluid of neurosyphilis patients

Hemichorea-Hemiballism with a Diabetic Patient

Treatment of Secondary Chorea: A Review of the Current Literature

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