Neurosyphilis: A current review

O’Donnell, Judith A.; Emery, Christopher L.

doi:10.1007/s11908-005-0060-7

Cited by 37 publications

(26 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There are no gold standard tests for the diagnosis of neurosyphilis, but definitive diagnosis usually requires serologic confirmation of syphilis infection (any stage) together with a reactive cerebrospinal fluid VDRL test (74). In addition, the criteria for asymptomatic neurosyphilis have not been standardized and have been applied inconsistently in research studies, further complicating the interpretation of tests used to diagnose neurosyphilis (75,76).…”

Section: Neurosyphilismentioning

confidence: 99%

“…It should be noted, however, that the results of a CSF examination are frequently normal in patients with auditory involvement (78). Whenever the eye or ear or both are involved, the patient case is managed as a neurosyphilis infection regardless of CSF findings (76). The value of identifying asymptomatic neurosyphilis, particularly in HIV-coinfected patients, remains controversial (74,77).…”

Section: Neurosyphilismentioning

confidence: 99%

See 1 more Smart Citation

Recent Trends in the Serologic Diagnosis of Syphilis

Morshed

Singh

2014

Clin. Vaccine Immunol.

167

156

View full text Add to dashboard Cite

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.

show abstract

Section: Neurosyphilismentioning

confidence: 99%

Section: Neurosyphilismentioning

confidence: 99%

Recent Trends in the Serologic Diagnosis of Syphilis

Morshed

Singh

2014

Clin. Vaccine Immunol.

167

156

View full text Add to dashboard Cite

show abstract

“…However, it should be noted that the results of a CSF examination are often normal in patients with hearing impairment [9]. Whenever the eye or the ear or both are involved, the patient's case is managed as a neurosyphilis regardless of CSF results [7]. The available tests for the detection of syphilis in the CSF can be divided into direct detection and antibody analysis methods.…”

Section: Vdrl (Venereal Disease Researchmentioning

confidence: 99%

Biological Diagnosis and Monitoring of Neurosyphilis: Study of Cerebrospinal Fluid in 30 Cases

Zineb¹

2017

MOJCR

View full text Add to dashboard Cite

Aim: identify the most informative cerebrospinal fluid (CSF) markers in the diagnosis of active neurosyphilis and in surveillance during antibiotic treatment.Type of study: retrospective, analytical, epidemiological study over a period of 10 years, from 1 January 2006 to 31 December 2016 conducted in the laboratory of microbiology of CHU HASSAN II of Fez. Patients and methods:We have identified 30 cases of neurosyphilis over a 10-year period. All patients were HIV negative. We realised on the CSF, a cytochemical examination, white and red blood cell count, a total protein and glucose levels on CSF and serum, VDRL and TPHA tests for the detection of specific antibodies. Results:The CSF study showed 6 cases (20%) of meningitis with cytology varying between 20 and 890 cells / ml predominantly lymphocytic. 40% of cases had hyper-proteinuria with extremes 0.2 and 4.3 g / l, glycorachia was normal in all cases. The initial titration of VDRL and TPHA was positive in 18 (60%) and 22 (74%) in the CSF, respectively, and 20 (67%) and 26 (87%) in the serum. Conclusion:An accurate and simple approach to the diagnosis of neurosyphilis remains elusive and the diagnosis continues to require a thorough assessment of the patient, including exposure to the risk, presence of compatible clinical signs and symptoms, and laboratory. While direct tests (such as microscopy or PCR) are useful in early infection, serological testing remains the mainstay of the diagnosis of neurosyphilis.

show abstract

“…Early neurosyphilis occurs in the first weeks to years after infection and principally involves the meninges, sometimes with involvement of structures that traverse the subarachnoid space, such as cranial nerves and cerebral arteries. Syphilitic meningitis, which occasionally complicates secondary syphilis, presents as headache and meningismus, sometimes associated with cranial neuropathies (most commonly II, III, VI, VII) and less commonly seizures, hydrocephalus, or spinal cord dysfunction (meningomyelitis) [14,15,Class III]. Meningovascular syphilis presents as meningitis with ischemic stroke, often in a young person.…”

Section: Clinical Featuresmentioning

confidence: 99%

Treatment of neurosyphilis

Jay

2006

Curr Treat Options Neurol

View full text Add to dashboard Cite

In 2001, the incidence of primary and secondary syphilis increased in the United States for the first time in a decade. Increasing rates of early syphilis among men who have sex with men have been reported in many American cities, with similar outbreaks noted in Canada and Europe. In San Francisco, the increase has been particularly sharp and accompanied by an increase in the incidence of neurosyphilis. Early neurosyphilis develops within weeks to years of primary infection and primarily involves the meninges. Syndromes include syphilitic meningitis (often accompanied by cranial neuropathies), meningovascular syphilis (with associated ischemic stroke), or asymptomatic neurosyphilis. Late neurosyphilis occurs years to decades after exposure as cerebral or spinal gummatous disease or the classic parenchymal forms affecting the brain (general paresis or syphilitic encephalitis) or spinal cord and nerve roots (tabes dorsalis). Treponema pallidum, the causative agent, cannot be cultured in vitro, and microscopic techniques are laborious. Thus, diagnosis depends on serologic tests and cerebrospinal fluid (CSF) examination. The suboptimal sensitivity and specificity of these tests complicate diagnosis, particularly among patients coinfected with HIV. CSF examination should be performed to evaluate for neurosyphilis in all patients with positive serum syphilis serology and neurologic, ophthalmic, or tertiary disease, or in those who have failed therapy, and in HIV-infected patients with late latent syphilis or syphilis of unknown duration. Intravenous penicillin G is the recommended treatment for all forms of neurosyphilis and for syphilitic eye disease. An outpatient alternative, if adherence can be assured, is intramuscular benzathine penicillin with oral probenecid. Newer drugs that penetrate CSF, such as ceftriaxone or azithromycin, have not yet been adequately tested for neurosyphilis. Syphilis facilitates transmission of HIV (and vice versa), and thus all patients diagnosed with syphilis should be offered HIV testing.

show abstract

Neurosyphilis: A current review

Cited by 37 publications

References 38 publications

Recent Trends in the Serologic Diagnosis of Syphilis

Recent Trends in the Serologic Diagnosis of Syphilis

Biological Diagnosis and Monitoring of Neurosyphilis: Study of Cerebrospinal Fluid in 30 Cases

Treatment of neurosyphilis

Contact Info

Product

Resources

About