Disease relevance of Neurosyphilis

• Patients with normal fluid received recommended benzathine penicillin therapy according to the stage of syphilis; patients with CSF abnormalities were offered 10-day therapy for neurosyphilis [1].
• Studies comparing ceftriaxone with 10 to 14 doses of procaine penicillin are needed to determine the most cost-effective treatment for asymptomatic neurosyphilis or presumed latent syphilis in this group of patients [2].
• Response of latent syphilis or neurosyphilis to ceftriaxone therapy in persons infected with human immunodeficiency virus [2].
• Penicillin remains the drug of choice for all forms of neurosyphilis, but disease progression has been frequently reported following the use of penicillin G benzathine [3].
• Significantly more ceftriaxone recipients had a decline in serum RPR titers (8 [80%] of 10 vs. 2 [13%] of 15; P=. 003), even after controlling for baseline RPR titer, skin symptoms and signs, or prior neurosyphilis were controlled for [4].

Psychiatry related information on Neurosyphilis

• Both for general paralysis of the insane and Alzheimer disease, it took time for them to be recognized as frequent causes of dementia [5].

High impact information on Neurosyphilis

• Minocycline for symptomatic neurosyphilis in patients allergic to penicillin [6].
• We examined the response to treatment with high-dose penicillin G in HIV-infected patients with symptomatic neurosyphilis [7].
• The diagnosis of a toxic reaction to isoniazid was delayed by the possibility of concurrent active neurosyphilis and the failure to initially consider isoniazid poisoning in a patient without a history of sudden isoniazid overdose [8].
• Our case suggests that while severe neurosyphilis can occur in HIV-infected persons with normal absolute CD4 counts, the percentage of CD4 cells may be a better indicator of the risk of neurosyphilis [9].
• Two years later, reevaluation revealed active neurosyphilis in the freshly drawn and stored serum and CSF samples [10].

Chemical compound and disease context of Neurosyphilis

• Erythromycin intravenous management in neurosyphilis [11].
• Five patients with laboratory evidence of latent or neurosyphilis were treated orally with doxycycline (200 mg) twice a day for 21 days [12].
• We report a case of successful treatment of symptomatic neurosyphilis with parenteral ceftriaxone [13].
• For the treatment of neurosyphilis, treponemicidal levels of penicillin can be achieved in the CSF using 2.4 million units procaine penicillin daily with concurrent probenecid 500 mg 4 times a day, or an intravenous infusion of benzyl penicillin 12-24 million units daily [14].
• The authors present three cases of neurosyphilis diagnosed at the Center for Psychiatric Medicine of the University of Alabama at Birmingham, where the patients presented with overwhelmingly psychiatric manifestations [15].

Biological context of Neurosyphilis

• CASE SUMMARY: A 45-year-old HIV-positive man (CD4+ count 450 cells/mm(3) and history of AIDS-defining illness) presented with JHR after an initial intravenous dose of penicillin G for presumed neurosyphilis [16].
• On the basis of this case and similar cases reported in the literature, we conclude that most, if not all, human immunodeficiency virus-infected patients with symptomatic neurosyphilis will have an elevated serum and CSF syphilis serology [17].

Anatomical context of Neurosyphilis

• Cerebrospinal fluid IgG changes in neurosyphilis after high-dose penicillin G treatment [18].

Gene context of Neurosyphilis

• Of 261 patients with clinical symptoms of neurosyphilis, 82% had a local production of treponemal IgG antibodies as shown by an elevated ITPA index [19].
• HLA-A, -B, and -C locus antigens were determined in 35 unrelated patients with general paralysis of the insane (GPI), and in 13 neurosyphilis patients without dementia [20].
• We report 2 HIV-seropositive patients with neurosyphilis whose initial CSF VDRL tests were negative [21].
• Intractable epilepsy as the initial manifestation of neurosyphilis [22].
• The presence of free light chains (FLC) was investigated in 32 patients with clinically definite or laboratory supported definite multiple sclerosis (MS), 2 patients with neurosyphilis and 10 normal controls [23].

Analytical, diagnostic and therapeutic context of Neurosyphilis

• Physical examination and serologic examination of blood and CSF confirmed the diagnosis of general paresis [24].
• Two patients developed neurosyphilis after treatment of latent syphilis with intramuscular benzathine penicillin [25].
• A patient with a low-titer VDRL or RPR may have active disease and may require lumbar puncture to rule out neurosyphilis [26].

References