Diagnostic approach to neurosyphilis

Aproximación diagnóstica de la neurosífilis

Main Article Content

Carlos Andres Clavijo Prado
Juliana Aroca Torres
Alvaro Leonardo abadía Rincon
Ana Maria Vargas Ramírez
Alejandra Chauvez Gallego

Abstract

Neurosyphilis (NS) is a disease affecting the central nervous system (CNS) caused by the spirochete bacteria Treponema pallidum; it may occur in immunocompetent patients but it more generally presents in patients with human immunodeficiency virus (HIV). The latter are more severe cases featuring a wide variety of neurological manifestations. Although the typical form is the most common, there are atypical expressions that may occur in 30% of cases as evidenced by neuroimaging studies, so recognition is important in order to ensure an early diagnosis and timely intervention. It is not only a public health problem due to its prevalence but also because of the broad clinical spectrum for which it has been called the great imitator. However, primary care physicians may not be aware of these manifestations. The following work has been proposed based on three clinical cases (two patients with CNS vasculitis and one with panuveitis) with the aim of demystifying NS forms of presentation and clarifying clinical manifestations involving the CNS, to perform an accurate diagnosis and initiate a proper and timely treatment to reduce sequelae.

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Author Biographies

Carlos Andres Clavijo Prado, Pontificia Universidad Javeriana, Cali

Director Médico Instituto Neurológico del Pacífico. Docente Pontificia Universidad Javeriana Cali, Colombia.

Juliana Aroca Torres, Pontificia Universidad Javeriana, Cali

Estudiante de Medicina

Alejandra Chauvez Gallego, Pontificia Universidad Javeriana, Cali

Residente programa Medicina Familiar.

References

Bhai S, Lyons JL. Neurosyphilis Update: Atypical is the New Typical. Curr Infect Dis Rep. 2015;17(5):481. doi: 10.1007/s11908-015-0481-x DOI: https://doi.org/10.1007/s11908-015-0481-x

Marra CM. Neurosyphilis. Continuum (Minneap Minn). 2015;21(6 Neuroinfectious Disease):1714-28. doi: 10.1212/CON.0000000000000250 DOI: https://doi.org/10.1212/CON.0000000000000250

Gonzalez H, Koralnik IJ, Marra CM. Neurosyphilis. Semin Neurol. 2019;39(4):448–55. doi: 10.1055/s-0039-1688942 DOI: https://doi.org/10.1055/s-0039-1688942

Çakmak SK, Tamer E, Karadağ AS, Waugh M. Syphilis: A great imitator. Clin Dermatol. 2019;37(3):182–91. doi: 10.1016/j.clindermatol.2019.01.007 DOI: https://doi.org/10.1016/j.clindermatol.2019.01.007

Hobbs E, Vera JH, Marks M, Barritt AW, Ridha BH, Lawrence D. Neurosyphilis in patients with HIV. Pract Neurol. 2018;18(3):211–8. doi: 10.1136/practneurol-2017-001754 DOI: https://doi.org/10.1136/practneurol-2017-001754

Tuddenham S, Ghanem KG. Neurosyphilis: Knowledge Gaps and Controversies. Sex Transm Dis. 2018 Mar;45(3):147-151. doi: 10.1097/OLQ.0000000000000723 DOI: https://doi.org/10.1097/OLQ.0000000000000723

Antezana AO, Antezana AN, Teran CG. Neurosífilis. Gac Medica Boliv. 2017;40(1):56–8.

Galindo J, Mier JF, Miranda CA, Rivas JC. Neurosífilis: un problema antiguo que no pierde actualidad. Rev Colomb Psiquiatr. 2017;46(s1):69–76. doi: 10.1016/j.rcp.2017.05.002 DOI: https://doi.org/10.1016/j.rcp.2017.05.002

Skalnaya A, Fominykh V, Ivashchenko R, Averchenkov D, Grazhdantseva L, Frigo N, et al. Neurosyphilis in the modern era: Literature review and case series. J Clin Neurosci. 2019;69:67–73. doi: 10.1016/j.jocn.2019.08.033 DOI: https://doi.org/10.1016/j.jocn.2019.08.033

Ghanem KG, Ram S, Rice PA. The Modern Epidemic of Syphilis. N Engl J Med. 2020;382(9):845–54. doi: 10.1056/NEJMra1901593 DOI: https://doi.org/10.1056/NEJMra1901593

Elmouden H, Louhab N, Kissani N. Medullary involvement in neurosyphilis: a report of 12 cases and a review of the literature. Spinal Cord Ser Cases. 2019;5:38. doi: 10.1038/s41394-019-0185-9 DOI: https://doi.org/10.1038/s41394-019-0185-9

Ha T, Tadi P, Dubensky L. Neurosyphilis [Internet]. StatPearls. 2021 [cited 2021 Mar 30]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/31082023

Ropper AH. Neurosyphilis. N Engl J Med. 2019;381(14):1358–63. doi: 10.1056/NEJMra1906228 DOI: https://doi.org/10.1056/NEJMra1906228

Dutta Majumder P, Chen EJ, Shah J, Ching Wen Ho D, Biswas J, See Yin L, et al. Ocular Syphilis: An Update. Ocul Immunol Inflamm. 2019;27(1):117–25. doi: 10.1080/09273948.2017.1371765 DOI: https://doi.org/10.1080/09273948.2017.1371765

Koundanya V V., Tripathy K. Syphilis Ocular Manifestations [Internet]. StatPearls. 2020 [cited 2021 Mar 30]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32644383

Rolimpandoei SP, Sun X, Shi X, Leman RE, Xie L, Chen L. Diplopia: An Overlooked Feature in Patients with Neurosyphilis. Report of 2 Cases and Literature Review. Sex Transm Dis. 2018;45(2):107-110. doi: 10.1097/OLQ.0000000000000703 DOI: https://doi.org/10.1097/OLQ.0000000000000703

Ramchandani MS, Litvack JR, Marra CM. Otosyphilis: A Review of the Literature. Sex Transm Dis. 2020;47(5):296-300. doi: 10.1097/OLQ.0000000000001155 DOI: https://doi.org/10.1097/OLQ.0000000000001155

Fernandes BFS, Caramelli P. Ischemic stroke and infectious diseases in low-income and middle-income countries. Curr Opin Neurol. 2019;32(1):43-48. doi: 10.1097/WCO.0000000000000641 DOI: https://doi.org/10.1097/WCO.0000000000000641

Munjal S, Ferrando SJ, Freyberg Z. Neuropsychiatric Aspects of Infectious Diseases: An Update. Crit Care Clin. 2017;33(3):681-712. doi: 10.1016/j.ccc.2017.03.007 DOI: https://doi.org/10.1016/j.ccc.2017.03.007

Kato H, Ando T. Neurosyphilis and Dementia. Brain Nerve. 2016;68(4):309-16. doi: 10.11477/mf.1416200399

Eckerman NP. Tabes Dorsalis. In: Encyclopedia of the Neurological Sciences [Internet]. Elsevier Inc.; 2014 [cited 2021 Mar 30]. p. 384–384. Available from: https://pubmed.ncbi.nlm.nih.gov/32491814/ DOI: https://doi.org/10.1016/B978-0-12-385157-4.00365-1

Ramachandran PS, Wilson MR. Diagnostic Testing of Neurologic Infections. Neurol Clin. 2018;36(4):687-703. doi: 10.1016/j.ncl.2018.07.004 DOI: https://doi.org/10.1016/j.ncl.2018.07.004

Chen JH, Zheng X, Liu XQ. Usefulness of positron emission tomography in patients with syphilis: A systematic review of observational studies. Chin Med J (Engl). 2017;130(9):1100-1112. doi: 10.4103/0366-6999.204940 DOI: https://doi.org/10.4103/0366-6999.204940

Smibert OC, Jenney AWJ, Spelman DW. Management of neurosyphilis: time for a new approach?. Intern Med J. 2018;48(2):204–6. doi: 10.1111/imj.13703 DOI: https://doi.org/10.1111/imj.13703

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