Neurosyphilis

Alzheimer s disease Cerebral infarction Cerebral tumors Closed head injury Cushing s syndrome Hemodialysis Hepatic encephalopathy Huntington s disease Hyperthyroidism Ictal or post-ictal mania Multiple sclerosis Neurosyphilis... 

With regard to neurosyphilis, a reduction in neurologic manifestations is desired, which may include seizures, paresis, hyperreflexia, visual disturbances, hearing loss, neuropathy, or... 

Signs, symptoms, or CSF findings consistent with neurosyphilis... 

As an effective treatment for neurosyphilis, the Centers for Disease Control and Prevention (CDC) endorses two regimens of penicillin. Alternatively, ceftriaxone may also be prescribed.13... 

In patients who are both negative for HIV and the lumbar puncture, administer benzathine penicillin G 2.4 million units intramuscularly once weekly for 3 additional weeks. Perform a patient follow-up in 6 months including a clinical examination and another non-treponemal titer. In HIVnegative patients with lumbar puncture findings compatible with neurosyphilis, treat the patient accordingly for neurosyphilis. 

Strongly consider neurosyphilis in individuals who show a four-fold increase in titers, patients who have an initially high titer (1 32 or greater) that fails to decline at least fourfold, HIV-positive patients, and those who develop symptoms consistent with neurosyphilis. 

Doxycycline6 or fluoroquinolone 0 Spirochetes Treponema pallidum Neurosyphilis Penicillin G Ceftriaxone0 Primary or secondary Benzathine penicillin G Doxycyclinee or ceftriaxone0... 

Tertiary Cardiovascular syphilis (aortitis or aortic insufficiency), neurosyphilis (meningitis, general paresis, dementia, tabes dorsalis, eighth cranial nerve deafness, blindness), gummatous lesions involving any organ or tissue... 

Most untreated patients with latent syphilis have no further sequelae however, approximately 25% to 30% progress to either neurosyphilis or late syphilis with clinical manifestations other than neurosyphilis. 

Patients with abnormal cerebrospinal fluid findings should be treated as having neurosyphilis. 

Primary, secondary, or latent syphilis of less than I-year s duration (early latent syphilis) Latent syphilis of more than 1-yearns duration (late latent syphilis) or syphilis of unknown duration Neurosyphilis... 

Some experts administer benzathine penicillin G 2.4 million units IM once per week for up to 3 weeks after completion of the neurosyphilis regimens to provide a total duration of therapy comparable to that used for late syphilis in the absence of neurosyphilis. For nonpregnant patients pregnant patients should be treated with penicillin after desensitization. 

Infections (encephalitis, neurosyphilis, sepsis, human immunodeficiency virus)... 

Neurosyphilis - Aqueous procaine penicillin G, 2 to 4 million units/day IM plus... 

Late (tertiary, neurosyphilis, and latent syphilis with positive spinal fluid examination or no spinal fluid examination)... 

Neurosyphilis- (as an alternative to the recommended regimen of penicillin G aqueous)... 

As a second difference in neuroimmunological processes, we find a slow, long-lasting decay of intrathecal antibody synthesis, sometimes detectable 10-15 years after sufficient treatment (neurosyphilis, neuroborelliosis, or HSV encephalitis). 

IgA < 20%, IgM < 50% Herpes simplex encephalitis Neurosyphilis Chronic HIV encephalitis... 

Infection in the Distant Past with a Persisting Anamnestic Immune Response. There are, for example, TPHA antibodies in neurosyphilis (K6, LI, L3). 

Oligoclonal IgM bands are observed in multiple sclerosis (in 40% of cases), neurosyphilis (22%), meningitis (44%), and encephalitis (22%). Oligoclonal IgM disappears again rapidly, in contrast to oligoclonal IgG (LI). 

K6. Kelbich, R, Jflek, D., Krai, V., etal., Eindings in cerebrospinal fluid in patients with neurosyphilis. Clin. Biochem. Metab. 8(29), 229-239 (2000). 

Penicillin G Prevents bacterial cell wall synthesis by binding to and inhibiting cell wall transpeptidases Rapid bactericidal activity against susceptible bacteria Streptococcal infections, meningococcal infections, neurosyphilis IV administration rapid renal clearance (half-life 30 min, so requires frequent dosing (every 4 h) Toxicity Immediate hypersensitivity, rash, seizures... 

Bismuth arsphenamine sulphonate (Bismarsen , Fig. 9) a yellow powder readily soluble in water, was first prepared by Raiziss in 1924 [70]. Stokes and Chambers [71] were the first to use the drug clinically, giving two injections a week for 14 weeks. Four such courses separated by intervals of a fortnight were administered in all. Nevertheless the effects were slow compared with the arsphenamines, although the tonic effect was greater and the side effects less numerous. Relapses, particularly in the central nervous system (CNS) were more frequent. Consequently, Rayburn and Boyd emphasized the fact that some individuals with neurosyphilis who were intolerant to arsenic in any other form could nevertheless tolerate it in the form of Bismarsen [72]. The low toxicity, the tonic effect, and the ease of administration were the chief advantages in favor of Bismarsen . The other compounds of bismuth with arsenic were not extensively tested in humans. 

Rayburn CR, Boyd TM (1931) The treatment of neurosyphilis - Observations on 393 patients over a period of five years. Am J Syph 15 168-184... 

Spirochetes Treponema pallidum Neurosyphilis Penicillin G Ceftriaxone ... 

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