Neurosyphilis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
The symptoms of tabes dorsalis usually develop secondary to long-term untreated syphilis, and start with symptoms such as lightning pains, impaired sensation and proprioception, and hypesthesias. Common complications of tabes dorsalis include Dementia, stroke, eye disease, Paralysis, and Charcot arthropathy (Charcot joint).
Natural History, Complications, and Prognosis
Natural History
Neurosyphilis is one of the various manifestations of syphilis disease.
patients with syphilis has this important findings in natural history:
- Painless chancre appears 3-4 weeks after exposure.
- Chancre typically resolves, after which the patient may develop constitutional symptoms and generalized symmetric rash in 4 to 8 weeks.
- This stage is typically self limited to 4 to 8 weeks without treatment and patient enters into asymptomatic latent phase.
- Approximately 25% of patients develop recurrent symptoms in one year.
- Approximately 35% of patients develop tertiary syphilis, which includes the following complications:
- Cardiovascular involvement after 15-30 years (80-85% of patients) including aortic aneurysm, aortic regurgitation, angina, and heart failure
- Gummatous lesions involving skin, bone and joints, associated with significant morbidity and mortality[1][2][3][4]
- Neurologic infection in 10-15 years (5-10% of patients) including cranial nerve dysfunction, meningitis, stroke, acute or chronic altered mental status, loss of vibration sense, and auditory or ophthalmic abnormalities
The symptoms of neurosyphilis usually develop secondary to long-term untreated syphilis, and include:
- Cranial nerve dysfunction symptoms:
- Diplopia[5]
- Impaired vision[6]
- Hearing loss[7]
- Voice changes[8]
- Meningitis symptoms (neurosyphilis can cause both symptomatic and asymptomatic meningitis):[9]
- Symptoms of spinal cord involvement (tabes dorsalis):
- Lightning pains[10]
- Impaired sensation and proprioception[11]
- Hypesthesias[12]
- Symptoms of cerebral syphilitic gumma:[13][14][15]
The symptoms of tabes dorsalis typically occurs 10 to 30 years after primary infection by treponema pallidum.[16]
If left untreated, most patients with neurosyphilis may progress to develop paralysis, dementia, Charcot arthropathy, stroke and blindness.
Complications
Common complications of neurosyphilis include:
- Meningitis[17]
- Meningiovascular syphilis[18][19]
- Argyll-Robertson pupil[20]
- Stroke[21]
- Cranial nerve neuropathies [22]
- Charcot arthropathy (Charcot joint) of the foot may be seen[24]
- Broad base gate and sensory ataxic gait is usually seen in patients with tabes dorsalis
Prognosis
Prognosis varies by site of involvement and duration of disease:[1][2][3]
- Among patients with neurosyphilis, 90% respond to treatment.
- Gummatous lesions reverse with treatment.
- Mortality rate of patients with neurosyphilis is around 20% which is mainly due to related complications.
References
- ↑ 1.0 1.1 Thomas SB, Quinn SC (1991). "The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community". Am J Public Health. 81 (11): 1498–505. PMC 1405662. PMID 1951814.
- ↑ 2.0 2.1 GJESTLAND T (1955). "The Oslo study of untreated syphilis; an epidemiologic investigation of the natural course of the syphilitic infection based upon a re-study of the Boeck-Bruusgaard material". Acta Derm Venereol Suppl (Stockh). 35 (Suppl 34): 3–368, Annex I-LVI. PMID 13301322.
- ↑ 3.0 3.1 Singh AE, Romanowski B (1999). "Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features". Clin Microbiol Rev. 12 (2): 187–209. PMC 88914. PMID 10194456.
- ↑ French P (2007). "Syphilis". BMJ. 334 (7585): 143–7. doi:10.1136/bmj.39085.518148.BE. PMC 1779891. PMID 17235095.
- ↑ Jordan K, Marino J, Damast M (1978). "Bilateral oculomotor paralysis due to neurosyphilis". Ann Neurol. 3 (1): 90–3. doi:10.1002/ana.410030114. PMID 655658.
- ↑ Smith GT, Goldmeier D, Migdal C (2006). "Neurosyphilis with optic neuritis: an update". Postgrad Med J. 82 (963): 36–9. doi:10.1136/pgmj.2004.020875. PMC 2563717. PMID 16397078.
- ↑ Nadol JB (1975). "Hearing loss of acquired syphilis: diagnosis confirmed by incudectomy". Laryngoscope. 85 (11 pt 1): 1888–97. doi:10.1288/00005537-197511000-00012. PMID 1195972.
- ↑ Klein TA, Ridley MB (2014). "An old flame reignites: vagal neuropathy secondary to neurosyphilis". J Voice. 28 (2): 255–7. doi:10.1016/j.jvoice.2013.08.018. PMID 24315656.
- ↑ Ahsan S, Burrascano J (2015). "Neurosyphilis: An Unresolved Case of Meningitis". Case Rep Infect Dis. 2015: 634259. doi:10.1155/2015/634259. PMC 4446468. PMID 26075118.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Li JC, Mahta A, Kim RY, Saria M, Kesari S (2012). "Cerebral syphilitic gumma: a case report and review of the literature". Neurol Sci. 33 (5): 1179–81. doi:10.1007/s10072-011-0878-8. PMID 22167653.
- ↑ Yoon YK, Kim MJ, Chae YS, Kang SH (2013). "Cerebral syphilitic gumma mimicking a brain tumor in the relapse of secondary syphilis in a human immunodeficiency virus-negative patient". J Korean Neurosurg Soc. 53 (3): 197–200. doi:10.3340/jkns.2013.53.3.197. PMC 3638277. PMID 23634274.
- ↑ Lee CW, Lim MJ, Son D, Lee JS, Cheong MH, Park IS; et al. (2009). "A case of cerebral gumma presenting as brain tumor in a human immunodeficiency virus (HIV)-negative patient". Yonsei Med J. 50 (2): 284–8. doi:10.3349/ymj.2009.50.2.284. PMC 2678706. PMID 19430565.
- ↑ Schöfer H (2004). "[Syphilis. Clinical aspects of Treponema pallidum infection]". Hautarzt. 55 (1): 112–9. doi:10.1007/s00105-003-0608-0. PMID 14749871.
- ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
- ↑ Simon RP (1985). "Neurosyphilis". Arch Neurol. 42 (6): 606–13. PMID 3890813.
- ↑ Lukehart SA, Hook EW, Baker-Zander SA, Collier AC, Critchlow CW, Handsfield HH (1988). "Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment". Ann Intern Med. 109 (11): 855–62. PMID 3056164.
- ↑ Loewenfeld IE (1969). "The Argyll Robertson pupil 1869-1969. A critical survey of the literature". Surv Ophthalmol. 14 (3): 199–299. PMID 19093312.
- ↑ Hotson JR (1981). "Modern neurosyphilis: a partially treated chronic meningitis". West J Med. 135 (3): 191–200. PMC 1273113. PMID 7340118.
- ↑ Musher, Daniel M., Richard J. Hamill, and Robert E. Baughn. "Effect of human immunodeficiency virus (HIV) infection on the course of syphilis and on the response to treatment." Annals of Internal Medicine 113.11 (1990): 872-881.
- ↑ 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.
- ↑ 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.