Neurosyphilis

Neurosyphilis – damage to the nervous system by a syphilitic infection – can occur at any stage of the development of this infection and depends on the ingress of the causative agent of syphilis (treponema pallidum) into the brain tissue.

The reasons

Previously, the main cause of syphilis of the nervous system was considered to be the absence or insufficient previous treatment. Modern syphilis is characterized by an increase in the number of erased, atypical, low-symptomatic, seroresistant and early latent forms. These features are a consequence of the altered reactivity of the organism and the evolution of the pathogenic properties of the pale spirochete, which has largely lost its neurotropism.

Symptoms

Brain syphilis has no specific clinical manifestations that would distinguish it from other organic lesions of vascular, inflammatory or other origin.

The clinical picture is formed along the lines of not inflammatory, but inflammatory-degenerative forms. There were more patients with diffuse symptoms (loss and decrease of Achilles, knee reflexes, sluggish pupillary reaction to light, impaired muscular-articular feeling, etc.), the symptoms of progressive paralysis changed. Expressed forms of dorsal tabes and cerebrospinal syphilis, which once constituted almost the main core of the organic pathology of the nervous system, are now almost never found. Gumma of the brain and spinal cord, syphilitic cervical pachymeningitis became clinical casuistry. The evolution of the clinical picture can only partially be associated with the widespread use of antibiotics that have a pronounced anti-inflammatory effect.

Diagnosis

The leading diagnostic method is serological, based on the use of non-treponemal tests (for example, the Wasserman reaction or a complex of serological reactions), and more reliable treponemal tests (for example, immunofluorescence reactions). Non-treponemal tests become positive 5-6 weeks after infection. They can be false positive (for example, in viral infections, tuberculosis, leptospirosis, bacterial endocarditis, diffuse connective tissue diseases, chronic liver disease) and false negative. The Wasserman reaction and its analogues become negative with successful treatment. The immunofluorescence reaction (IF) becomes positive 3-4 weeks after infection and remains positive throughout the rest of life, even with successful antibiotic therapy.

Diagnosis of neurosyphilis requires the presence of 3 criteria: 1) positive non-treponemal and/or treponemal serum reactions, 2) neurological syndromes characteristic of neurosyphilis, 3) cerebrospinal fluid changes (positive Wasserman reaction and/or inflammatory changes plus positive RIF). Treatment involves the / in the introduction of large doses of penicillin (up to 24 million IU / day) for 14 days. The / m administration of bicillin does not allow to achieve therapeutic concentration in the cerebrospinal fluid. In the first 24 hours after the start of treatment, a Jarisch-Herzheimer reaction may occur, manifested by acute fever, chills, tachycardia, nausea, headache, myalgia. These symptoms can be reduced with corticosteroids. If you are allergic to penicillin, tetracyclines or cephalosporins are used.

Treatment

Complex therapy is carried out in a hospital (pyrotherapy in combination with one of the main antisyphilitic products – bicillin-5) according to generally accepted schemes; also use vitamin therapy.

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