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__NOTOC__
{{Tabes dorsalis (patient information)}}
{{Tabes dorsalis (patient information)}}
'''For the WikiDoc page for this topic, click [[Tabes dorsalis|here]]'''
{{CMG}}; {{AE}}{{MMJ}} [[Varun Kumar]], M.B.B.S.
 
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Varun Kumar]], M.B.B.S.


==Overview==
==Overview==
Tabes dorsalis includes [[Syphilis|syphilitic]] myelopathy and other symptoms of nerve damage. Syphilitic myelopathy is a complication of untreated [[syphilis]] that involves muscle weakness and abnormal sensations.
Tabes dorsalis is a form of [[neurosyphilis]], which is a complication of late or tertiary [[syphilis]] infection. [[Syphilis]] is a [[Sexually transmitted disease|sexually transmitted infectious disease]]. The infection damages the [[spinal cord]] and peripheral nervous tissue. Most [[Symptom|symptoms]] of tabes dorsalis include, lightning pains, impaired [[sensation]] and [[proprioception]], h[[Hypesthesia|ypesthesias]], progressive [[sensory ataxia]](inability to feel the [[lower limbs]]), [[Hyporeflexia|diminished reflexes]] or [[Areflexia|loss of reflexes]], [[Poor coordination]] or loss of coordinatio, [[Unsteady gait]]([[locomotor ataxia]]) and [[Sexual function]] problems. patients with tabes dorsalis has abnormal [[Venereal disease research laboratory (VDRL) test|VDRL]] and [[Rapid plasma reagent|RPR]] test result and the diagnosis should be confirmed by some other special tests. [[Penicillin]] is the treatment of choice for tabes dorsalis that kills all [[Treponema pallidum|treponema pallidum bacteria]] but sever spinal damage may be permanent. Common complications of tabes dorsalis include; [[Dementia]], [[stroke]], [[eye disease]], [[Paralysis]] and [[Charcot joint|charcot arthropathy]]([[Charcot joint]]).


==What are the symptoms of Tabes dorsalis?==
==What are the symptoms of Tabes dorsalis?==
Line 16: Line 15:
*[[Unsteady gait]]([[locomotor ataxia]])<ref name="pmid8334567">{{cite journal| author=Gue JW, Wang SJ, Lin YY, Liao KK, Wong WW| title=Neurosyphilis presenting as tabes dorsalis in a HIV carrier. | journal=Zhonghua Yi Xue Za Zhi (Taipei) | year= 1993 | volume= 51 | issue= 5 | pages= 389-91 | pmid=8334567 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8334567  }} </ref>
*[[Unsteady gait]]([[locomotor ataxia]])<ref name="pmid8334567">{{cite journal| author=Gue JW, Wang SJ, Lin YY, Liao KK, Wong WW| title=Neurosyphilis presenting as tabes dorsalis in a HIV carrier. | journal=Zhonghua Yi Xue Za Zhi (Taipei) | year= 1993 | volume= 51 | issue= 5 | pages= 389-91 | pmid=8334567 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8334567  }} </ref>
*[[Sexual function]] problems<ref name="pmid22334859">{{cite journal| author=Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M| title=Case of neurosyphilis presented as recurrent stroke. | journal=Oman Med J | year= 2009 | volume= 24 | issue= 2 | pages= 134-6 | pmid=22334859 | doi=10.5001/omj.2009.29 | pmc=3273935 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22334859  }} </ref>
*[[Sexual function]] problems<ref name="pmid22334859">{{cite journal| author=Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M| title=Case of neurosyphilis presented as recurrent stroke. | journal=Oman Med J | year= 2009 | volume= 24 | issue= 2 | pages= 134-6 | pmid=22334859 | doi=10.5001/omj.2009.29 | pmc=3273935 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22334859  }} </ref>
In Tabes dorsalis, there are also symptoms of nervous system damage, including:
*Mental illness
*[[Stroke (patient information)|Stroke]]
*Vision changes


==What causes Tabes dorsalis?==
==What causes Tabes dorsalis?==
Tabes dorsalis is a form of [[neurosyphilis]], which is a complication of late or tertiary [[syphilis]] infection. Syphilis is a sexually transmitted, infectious disease.
Tabes dorsalis is a form of [[neurosyphilis]], which is a complication of late or tertiary [[syphilis]] infection. [[Syphilis]] is a [[Sexually transmitted disease|sexually transmitted infectious disease]]. The infection damages the [[spinal cord]] and peripheral nervous tissue.<ref name="pmid17235095">{{cite journal| author=French P| title=Syphilis. | journal=BMJ | year= 2007 | volume= 334 | issue= 7585 | pages= 143-7 | pmid=17235095 | doi=10.1136/bmj.39085.518148.BE | pmc=1779891 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17235095  }} </ref>


The infection damages the spinal cord and peripheral nervous tissue.
==Diagnosis==
Physical examination may show:


Tabes dorsalis is now very rare because syphilis is usually treated early in the disease. Blood tests can identify the disease in its silent (latent) form. People who donate blood and pregnant women are given these tests.
*Positive [[Romberg's test|romberg test]] is one of the most important findings in [[physical examination]] of patients with tabes dorsalis<ref name="pmid17235095">{{cite journal| author=French P| title=Syphilis. | journal=BMJ | year= 2007 | volume= 334 | issue= 7585 | pages= 143-7 | pmid=17235095 | doi=10.1136/bmj.39085.518148.BE | pmc=1779891 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17235095  }} </ref>
*Patient is usually oriented to persons, place, and time
* [[Hyporeflexia]] or [[areflexia]] may be seen<ref name="pmid22330117">{{cite journal| author=Pandey S| title=Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis. | journal=J Spinal Cord Med | year= 2011 | volume= 34 | issue= 6 | pages= 609-11 | pmid=22330117 | doi=10.1179/2045772311Y.0000000041 | pmc=3237288 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22330117  }} </ref>
* Impaired balance bilateral [[Babinski's Reflex]] may be present<ref name="pmid22334859">{{cite journal| author=Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M| title=Case of neurosyphilis presented as recurrent stroke. | journal=Oman Med J | year= 2009 | volume= 24 | issue= 2 | pages= 134-6 | pmid=22334859 | doi=10.5001/omj.2009.29 | pmc=3273935 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22334859  }} </ref>
* Bilateral [[muscle weakness]] mostly in [[lower limbs]] may be seen<ref name="pmid16778468">{{cite journal| author=Matijosaitis V, Vaitkus A, Pauza V, Valiukeviciene S, Gleizniene R| title=Neurosyphilis manifesting as spinal transverse myelitis. | journal=Medicina (Kaunas) | year= 2006 | volume= 42 | issue= 5 | pages= 401-5 | pmid=16778468 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16778468  }} </ref>
* [[Argyll Robertson pupil|Argyll Robertson pupils]] may be present<ref name="pmid16845316">{{cite journal| author=Thompson HS, Kardon RH| title=The Argyll Robertson pupil. | journal=J Neuroophthalmol | year= 2006 | volume= 26 | issue= 2 | pages= 134-8 | pmid=16845316 | doi=10.1097/01.wno.0000222971.09745.91 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16845316  }} </ref>
*Bilateral [[sensory loss]] in the extremity mostly in [[lower limbs]] may be seen<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
*Broad base gate and [[Sensory ataxia|Sensory ataxic gait]] is usually seen in patients with tabes dorsalis<ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
*[[Cranial nerve palsy]] caused by [[gummatous]] [[neurosyphilis]] may be seen<ref name="pmid8279327">{{cite journal| author=Vogl T, Dresel S, Lochmüller H, Bergman C, Reimers C, Lissner J| title=Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings. | journal=AJNR Am J Neuroradiol | year= 1993 | volume= 14 | issue= 6 | pages= 1329-31 | pmid=8279327 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8279327  }} </ref>
*Finger-to-nose test is usually abnormal<ref name="pmid19918420">{{cite journal| author=Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD| title=Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report. | journal=Cases J | year= 2009 | volume= 2 | issue=  | pages= 8334 | pmid=19918420 | doi=10.4076/1757-1626-2-8334 | pmc=2769430 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19918420  }} </ref>


==When to seek urgent medical care?==
Tests may include the following::<ref name="CDC2016">http://www.cdc.gov/std/tg2015/syphilis.htm Accessed on September 28th, 2016</ref><ref name="pmid18159528">{{cite journal| author=Ratnam S| title=The laboratory diagnosis of syphilis. | journal=Can J Infect Dis Med Microbiol | year= 2005 | volume= 16 | issue= 1 | pages= 45-51 | pmid=18159528 | doi= | pmc=2095002 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159528  }} </ref><ref name="pmid25428245">{{cite journal| author=Morshed MG, Singh AE| title=Recent trends in the serologic diagnosis of syphilis. | journal=Clin Vaccine Immunol | year= 2015 | volume= 22 | issue= 2 | pages= 137-47 | pmid=25428245 | doi=10.1128/CVI.00681-14 | pmc=4308867 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25428245  }} </ref><ref name="pmid22942884">{{cite journal| author=Tsang RS, Radons SM, Morshed M| title=Laboratory diagnosis of syphilis: A survey to examine the range of tests used in Canada. | journal=Can J Infect Dis Med Microbiol | year= 2011 | volume= 22 | issue= 3 | pages= 83-7 | pmid=22942884 | doi= | pmc=3200370 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22942884  }} </ref><ref name="pmid25428245">{{cite journal| author=Morshed MG, Singh AE| title=Recent trends in the serologic diagnosis of syphilis. | journal=Clin Vaccine Immunol | year= 2015 | volume= 22 | issue= 2 | pages= 137-47 | pmid=25428245 | doi=10.1128/CVI.00681-14 | pmc=4308867 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25428245  }} </ref><ref name="pmid24278076">{{cite journal| author=Pastuszczak M, Wojas-Pelc A| title=Current standards for diagnosis and treatment of syphilis: selection of some practical issues, based on the European (IUSTI) and U.S. (CDC) guidelines. | journal=Postepy Dermatol Alergol | year= 2013 | volume= 30 | issue= 4 | pages= 203-10 | pmid=24278076 | doi=10.5114/pdia.2013.37029 | pmc=3834708 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24278076  }} </ref>
Call your health care provider if you have:
*[[Dark field microscopy|Darkfield]] examinations and tests to detect ''[[T. pallidum]]'' in lesion [[exudate]] or tissue are the definitive methods for diagnosing early [[syphilis]].


*Loss of coordination
*Although no ''[[T. pallidum]]'' detection tests are commercially available, some laboratories provide locally developed [[PCR]] tests for the detection of [[T. pallidum|''T. pallidum''.]]
*Loss of muscle strength
*Loss of sensation


==Diagnosis==
*A presumptive diagnosis of [[syphilis]] is possible with the use of two types of serologic tests:
Physical examination may show:
:*Nontreponemal tests (e.g., [[VDRL|venereal disease research laboratory (VDRL)]] and [[RPR|rapid plasma reagent test]]) and
:*Treponemal tests (e.g., [[FTA-ABS|fluorescent treponemal antibody absorbed (FTA-ABS) tests]], the ''[[T. pallidum]]'' passive particle agglutination (TP-PA) assay, various [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]).


*Damage to the spinal cord (myelopathy)
*The use of only one type of [[serologic]] test is insufficient for diagnosis because each type of test has limitations, including the possibility of false-positive test results in persons without [[syphilis]].
*Pupils that react abnormally to light
*Reduced or absent reflexes due to nerve damage


Tests may include the following:
*False-positive nontreponemal test results can be associated with various medical conditions unrelated to [[syphilis]], including [[Autoimmune|autoimmune conditions]], older age, and injection-drug use.<ref name="pmid7548285">{{cite journal |author=Nandwani R, Evans DT |title=Are you sure it's syphilis? A review of false positive serology |journal=[[International Journal of STD & AIDS]] |volume=6 |issue=4 |pages=241–8 |year=1995 |pmid=7548285 |doi= |url= |accessdate=2012-02-16}}</ref><ref name="urlwww.aphl.org">{{cite web |url=http://www.aphl.org/aphlprograms/infectious/std/Documents/LaboratoryGuidelinesTreponemapallidumMeetingReport.pdf |title=www.aphl.org |format= |work= |accessdate=2012-12-19}}</ref> Therefore, persons with a reactive nontreponemal test should receive a treponemal test to confirm the diagnosis of [[syphilis]].


*CSF (cerebrospinal fluid) examination
===Nontreponemal test===
*Head CT, spine CT, or MRI scans of the brain and spinal cord to rule out other diseases
*Includes [[Venereal disease research laboratory (VDRL) test|VDRL]] and [[Rapid plasma reagent|RPR]] tests
*Serum VDRL or serum RPR (used as a screening test for syphilis infection -- if it is positive, one of the following tests will be needed to confirm the diagnosis):
*[[Antibody]] titers may correlate with disease activity
**FTA-ABS
*May reverse following treatment
**MHA-TP
*Used to follow treatment response
*A fourfold change in titer is necessary to demonstrate significant difference between two nontreponemal tests
*Results from two tests cannot be compared directly with each other


==Treatment options==
===Trepenomal tests ===
The goals of treatment are to cure the infection and slow the progression of the disorder. Treating the infection helps prevent new nerve damage and may reduce symptoms, but it does not reverse existing nerve damage.
*Include [[FTA-ABS|fluorescent treponemal antibody absorbed (FTA-ABS) tests]], ''[[T. pallidum]]'' passive particle agglutination (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]
*[[Antibody titer]]<nowiki/>s, once positive, remain positive for the rest of the patient's life, regardless of treatment or disease activity
*Cannot be used for monitoring treatment response
*Screening using trepenomal tests may help identify individuals previously treated for [[syphilis]], those with untreated or incompletely treated [[syphilis]], and persons with false-positive results


For neurosyphilis, aqueous penicillin G (by injection) is the drug of choice. Some patients with penicillin allergies may have to be desensitized to penicillin so that they can be safely treated with it.
=== Special laboratory findings in neurosyphilis ===
[[Neurosyphilis]] is often initially suspected based on clinical findings with positive serologic tests and finally confirmed through [[Lumbar puncture|lumbar puncture(LP)]].


Symptoms of existing neurologic damage need to be treated. People who are unable to eat, dress themselves, or take care of themselves may need help. Rehabilitation, physical therapy, and occupational therapy may help people who have muscle weakness.
Abnormalities in the [[CSF]] consistent with disease include:<ref name="pmid27606153">{{cite journal| author=Henao-Martínez AF, Johnson SC| title=Diagnostic tests for syphilis: New tests and new algorithms. | journal=Neurol Clin Pract | year= 2014 | volume= 4 | issue= 2 | pages= 114-122 | pmid=27606153 | doi=10.1212/01.CPJ.0000435752.17621.48 | pmc=4999316 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27606153  }} </ref>
* [[Pleocytosis]], often lymphocytic predominant
* Mild protein elevation
* Positive CSF [[Venereal disease research laboratory (VDRL) test|VDRL]].
* CSF [[Fluorescent treponemal antibody absorbtion (FTA-ABS) test|FTA-ABS]] can be used but is not specific
CSF abnormalities alone can not make or rule out the diagnosis of [[neurosyphilis]]. Every result should be placed in context with the clinical scenario and special finding in imaging and laboratory tests of each patient.


You may needanalgesics to control pain. These may include over-the-counter medications such as aspirin or acetaminophen for mild pain, or narcotics for more severe pain. Anti-epilepsy drugs such as carbamazepine may help treat lightning pains.
==Treatment options==
[[Penicillin]], administered [[intravenous]]ly, is the treatment of choice of tabes dorsalis.. Preventive treatment for those who come into [[sexual contact]] with an individual with tabes dorsalis is important. CNS involvement can occur during any stage of syphilis. However, [[Syphilis laboratory findings#CSF analysis|CSF laboratory abnormalities]] are common in persons with [[Syphilis pathophysiology#Primary syphilis|early syphilis]], even in the absence of clinical neurological findings. No evidence exists to support variation from recommended treatment for early [[syphilis]] for patients found to have such abnormalities. If clinical evidence of neurologic involvement is observed (e.g., [[Cognition|cognitive]] dysfunction, motor or sensory deficits, [[ophthalmic]] or [[auditory]] symptoms, [[cranial nerve palsies]], and symptoms or signs of [[meningitis]]), a [[Syphilis laboratory findings#CSF analysis|CSF examination]] should be performed. [[uveitis|Syphilitic uveitis]] or other [[ocular]] manifestations frequently are associated with neurosyphilis and should be managed according to the treatment recommendations for [[neurosyphilis]]. Patients who have [[neurosyphilis]] or syphilitic eye disease (e.g., [[uveitis]], [[neuroretinitis]], and [[optic neuritis]]) should be treated with the recommended regimen for [[neurosyphilis]]; those with eye disease should be managed in collaboration with an [[ophthalmologist]]. A [[CSF]] examination should be performed for all patients with syphilitic eye disease to identify those with abnormalities; patients found to have abnormal [[CSF]] test results should be provided follow-up [[CSF]] examinations to assess treatment response.  Associated pain can be treated with [[opiate]]s, [[valproate]], or [[carbamazepine]]. Patients may also require physical or rehabilitative therapy to deal with [[muscle wasting]] and [[weakness]]


==Where to find medical care for Tabes dorsalis?==
==Where to find medical care for Tabes dorsalis?==
Line 68: Line 81:


==Possible complications==
==Possible complications==
*Complications of late-stage syphilis infection, which may include:
Common complications of tabes dorsalis include:<ref name="pmid23919113">{{cite journal| author=Kaynak G, Birsel O, Güven MF, Oğüt T| title=An overview of the Charcot foot pathophysiology. | journal=Diabet Foot Ankle | year= 2013 | volume= 4 | issue=  | pages=  | pmid=23919113 | doi=10.3402/dfa.v4i0.21117 | pmc=3733015 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23919113  }} </ref><ref name="pmid19148316">{{cite journal| author=Tso MK, Koo K, Tso GY| title=Neurosyphilis in a non-HIV patient: more than a psychiatric concern. | journal=Mcgill J Med | year= 2008 | volume= 11 | issue= 2 | pages= 160-3 | pmid=19148316 | doi= | pmc=2582679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19148316  }} </ref>
**Inflammation of the aorta (aortitis) with aortic aneurysm
* [[Dementia]], [[stroke]], [[eye disease]]
**Disease of the heart valves
* [[Paralysis]]
**Damage to bones, skin, and other organs
 
*Complications of neurosyphilis, including dementia, stroke, eye disease
*[[Charcot joint|Charcot arthropathy]]([[Charcot joint]]) of the foot may be seen.
*Difficulty with walking and balance
*Broad base gate and [[Sensory ataxia|Sensory ataxic gait]] is usually seen in patients with tabes dorsalis.
*[[Paralysis]]


==Sources==
==Sources==
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{{WH}}
{{WH}}
{{WS}}
{{WS}}
<references />

Latest revision as of 14:43, 16 February 2018

Tabes dorsalis

Overview

What are the symptoms?

What are the causes?

When to seek urgent medical care?

Diagnosis

Treatment options

Where to find medical care for Tabes dorsalis?

What to expect (Outlook/Prognosis)?

Possible complications

Tabes dorsalis On the Web

Ongoing Trials at Clinical Trials.gov

Images of Tabes dorsalis

Videos on Tabes dorsalis

FDA on Tabes dorsalis

CDC on Tabes dorsalis

Tabes dorsalis in the news

Blogs on Tabes dorsalis

Directions to Hospitals Treating Tabes dorsalis

Risk calculators and risk factors for Tabes dorsalis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2] Varun Kumar, M.B.B.S.

Overview

Tabes dorsalis is a form of neurosyphilis, which is a complication of late or tertiary syphilis infection. Syphilis is a sexually transmitted infectious disease. The infection damages the spinal cord and peripheral nervous tissue. Most symptoms of tabes dorsalis include, lightning pains, impaired sensation and proprioception, hypesthesias, progressive sensory ataxia(inability to feel the lower limbs), diminished reflexes or loss of reflexes, Poor coordination or loss of coordinatio, Unsteady gait(locomotor ataxia) and Sexual function problems. patients with tabes dorsalis has abnormal VDRL and RPR test result and the diagnosis should be confirmed by some other special tests. Penicillin is the treatment of choice for tabes dorsalis that kills all treponema pallidum bacteria but sever spinal damage may be permanent. Common complications of tabes dorsalis include; Dementia, stroke, eye disease, Paralysis and charcot arthropathy(Charcot joint).

What are the symptoms of Tabes dorsalis?

What causes Tabes dorsalis?

Tabes dorsalis is a form of neurosyphilis, which is a complication of late or tertiary syphilis infection. Syphilis is a sexually transmitted infectious disease. The infection damages the spinal cord and peripheral nervous tissue.[9]

Diagnosis

Physical examination may show:

Tests may include the following::[15][16][17][18][17][19]

  • Although no T. pallidum detection tests are commercially available, some laboratories provide locally developed PCR tests for the detection of T. pallidum.
  • A presumptive diagnosis of syphilis is possible with the use of two types of serologic tests:
  • The use of only one type of serologic test is insufficient for diagnosis because each type of test has limitations, including the possibility of false-positive test results in persons without syphilis.
  • False-positive nontreponemal test results can be associated with various medical conditions unrelated to syphilis, including autoimmune conditions, older age, and injection-drug use.[20][21] Therefore, persons with a reactive nontreponemal test should receive a treponemal test to confirm the diagnosis of syphilis.

Nontreponemal test

  • Includes VDRL and RPR tests
  • Antibody titers may correlate with disease activity
  • May reverse following treatment
  • Used to follow treatment response
  • A fourfold change in titer is necessary to demonstrate significant difference between two nontreponemal tests
  • Results from two tests cannot be compared directly with each other

Trepenomal tests

Special laboratory findings in neurosyphilis

Neurosyphilis is often initially suspected based on clinical findings with positive serologic tests and finally confirmed through lumbar puncture(LP).

Abnormalities in the CSF consistent with disease include:[22]

  • Pleocytosis, often lymphocytic predominant
  • Mild protein elevation
  • Positive CSF VDRL.
  • CSF FTA-ABS can be used but is not specific

CSF abnormalities alone can not make or rule out the diagnosis of neurosyphilis. Every result should be placed in context with the clinical scenario and special finding in imaging and laboratory tests of each patient.

Treatment options

Penicillin, administered intravenously, is the treatment of choice of tabes dorsalis.. Preventive treatment for those who come into sexual contact with an individual with tabes dorsalis is important. CNS involvement can occur during any stage of syphilis. However, CSF laboratory abnormalities are common in persons with early syphilis, even in the absence of clinical neurological findings. No evidence exists to support variation from recommended treatment for early syphilis for patients found to have such abnormalities. If clinical evidence of neurologic involvement is observed (e.g., cognitive dysfunction, motor or sensory deficits, ophthalmic or auditory symptoms, cranial nerve palsies, and symptoms or signs of meningitis), a CSF examination should be performed. Syphilitic uveitis or other ocular manifestations frequently are associated with neurosyphilis and should be managed according to the treatment recommendations for neurosyphilis. Patients who have neurosyphilis or syphilitic eye disease (e.g., uveitis, neuroretinitis, and optic neuritis) should be treated with the recommended regimen for neurosyphilis; those with eye disease should be managed in collaboration with an ophthalmologist. A CSF examination should be performed for all patients with syphilitic eye disease to identify those with abnormalities; patients found to have abnormal CSF test results should be provided follow-up CSF examinations to assess treatment response. Associated pain can be treated with opiates, valproate, or carbamazepine. Patients may also require physical or rehabilitative therapy to deal with muscle wasting and weakness

Where to find medical care for Tabes dorsalis?

Directions to Hospitals Treating Tabes dorsalis

What to expect (Outlook/Prognosis)?

Progressive disability is possible if the disorder is left untreated.

Possible complications

Common complications of tabes dorsalis include:[23][12]

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000729.htm

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  1. ↑ MAO S, LIU Z (2009). "Neurosyphilis manifesting as lightning pain". Eur J Dermatol. 19 (5): 504–6. doi:10.1684/ejd.2009.0712. PMID 19487174.
  2. ↑ Vora SK, Lyons RW (2004). "The medical Kipling--syphilis, tabes dorsalis, and Romberg's test". Emerg Infect Dis. 10 (6): 1160–2. doi:10.3201/eid1006.031117. PMC 3323152. PMID 15224672.
  3. ↑ 3.0 3.1 Pandey S (2011). "Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis". J Spinal Cord Med. 34 (6): 609–11. doi:10.1179/2045772311Y.0000000041. PMC 3237288. PMID 22330117.
  4. ↑ Sabre L, Braschinsky M, Taba P (2016). "Neurosyphilis as a great imitator: a case report". BMC Res Notes. 9: 372. doi:10.1186/s13104-016-2176-2. PMC 4964046. PMID 27465246.
  5. ↑ Smikle MF, James OB, Prabhakar P (1988). "Diagnosis of neurosyphilis: a critical assessment of current methods". South Med J. 81 (4): 452–4. PMID 3358168.
  6. ↑ Mehrabian S, Raycheva M, Traykova M, Stankova T, Penev L, Grigorova O; et al. (2012). "Neurosyphilis with dementia and bilateral hippocampal atrophy on brain magnetic resonance imaging". BMC Neurol. 12: 96. doi:10.1186/1471-2377-12-96. PMC 3517431. PMID 22994551.
  7. ↑ Gue JW, Wang SJ, Lin YY, Liao KK, Wong WW (1993). "Neurosyphilis presenting as tabes dorsalis in a HIV carrier". Zhonghua Yi Xue Za Zhi (Taipei). 51 (5): 389–91. PMID 8334567.
  8. ↑ 8.0 8.1 Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M (2009). "Case of neurosyphilis presented as recurrent stroke". Oman Med J. 24 (2): 134–6. doi:10.5001/omj.2009.29. PMC 3273935. PMID 22334859.
  9. ↑ 9.0 9.1 French P (2007). "Syphilis". BMJ. 334 (7585): 143–7. doi:10.1136/bmj.39085.518148.BE. PMC 1779891. PMID 17235095.
  10. ↑ Matijosaitis V, Vaitkus A, Pauza V, Valiukeviciene S, Gleizniene R (2006). "Neurosyphilis manifesting as spinal transverse myelitis". Medicina (Kaunas). 42 (5): 401–5. PMID 16778468.
  11. ↑ Thompson HS, Kardon RH (2006). "The Argyll Robertson pupil". J Neuroophthalmol. 26 (2): 134–8. doi:10.1097/01.wno.0000222971.09745.91. PMID 16845316.
  12. ↑ 12.0 12.1 12.2 Tso MK, Koo K, Tso GY (2008). "Neurosyphilis in a non-HIV patient: more than a psychiatric concern". Mcgill J Med. 11 (2): 160–3. PMC 2582679. PMID 19148316.
  13. ↑ Vogl T, Dresel S, Lochmüller H, Bergman C, Reimers C, Lissner J (1993). "Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings". AJNR Am J Neuroradiol. 14 (6): 1329–31. PMID 8279327.
  14. ↑ Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD (2009). "Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report". Cases J. 2: 8334. doi:10.4076/1757-1626-2-8334. PMC 2769430. PMID 19918420.
  15. ↑ http://www.cdc.gov/std/tg2015/syphilis.htm Accessed on September 28th, 2016
  16. ↑ Ratnam S (2005). "The laboratory diagnosis of syphilis". Can J Infect Dis Med Microbiol. 16 (1): 45–51. PMC 2095002. PMID 18159528.
  17. ↑ 17.0 17.1 Morshed MG, Singh AE (2015). "Recent trends in the serologic diagnosis of syphilis". Clin Vaccine Immunol. 22 (2): 137–47. doi:10.1128/CVI.00681-14. PMC 4308867. PMID 25428245.
  18. ↑ Tsang RS, Radons SM, Morshed M (2011). "Laboratory diagnosis of syphilis: A survey to examine the range of tests used in Canada". Can J Infect Dis Med Microbiol. 22 (3): 83–7. PMC 3200370. PMID 22942884.
  19. ↑ Pastuszczak M, Wojas-Pelc A (2013). "Current standards for diagnosis and treatment of syphilis: selection of some practical issues, based on the European (IUSTI) and U.S. (CDC) guidelines". Postepy Dermatol Alergol. 30 (4): 203–10. doi:10.5114/pdia.2013.37029. PMC 3834708. PMID 24278076.
  20. ↑ Nandwani R, Evans DT (1995). "Are you sure it's syphilis? A review of false positive serology". International Journal of STD & AIDS. 6 (4): 241–8. PMID 7548285. |access-date= requires |url= (help)
  21. ↑ "www.aphl.org" (PDF). Retrieved 2012-12-19.
  22. ↑ Henao-Martínez AF, Johnson SC (2014). "Diagnostic tests for syphilis: New tests and new algorithms". Neurol Clin Pract. 4 (2): 114–122. doi:10.1212/01.CPJ.0000435752.17621.48. PMC 4999316. PMID 27606153.
  23. ↑ Kaynak G, Birsel O, Güven MF, Oğüt T (2013). "An overview of the Charcot foot pathophysiology". Diabet Foot Ankle. 4. doi:10.3402/dfa.v4i0.21117. PMC 3733015. PMID 23919113.
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