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NeurosyphilisNeurosyphilis General InformationNeurosyphilis appears in the persons who are infected with syphilis and did not treat it adequately, about 8 to 15 years after they got infected. This ignorance leads to the infection of central nervous system, especially of the spinal cord and brain so that may occur in any stage of the syphilis (in 30- 40% of the cases). This infection is very common among people HIV-positive, but the cases are similar to those before an HIV pandemic. Although not everyone with syphilis develops this infection; it usually depends on the state of the immune system of the organism and on what effects has the infections over that body. In the situation of HIV patients it is highly recommended, by some specialists, to have a lumbar puncture that it is very useful to look after an asymptomatic Neurosyphilis (present in 25-35% of the cases with secondary syphilis). This is demonstrated on an examination of the cerebrospinal fluid (CSF). It may be a result of an unusual glucose level or of a number of proteins and leukocytes cells. Antibody tests demonstrate reactivity to VDRL (Venereal Disease Research Laboratory). In HIV-positive patients’ has been reflected significance and an extent of neurological involvement. These results came from clinical or laboratory criteria. But this situation has been complicated in the past years by the antiretroviral therapy of the host immunosuppression. After many tests and studies it has been discovered that there are four different types of Neurosyphilis: general paresis, tabes dorsalis, meningovascular and asymptomatic.Neurosyphilis SymptomsThis infection may present or may not present symptoms or signs. Asymptomatic is when the VDRL test (serology test) has a reactive nontreponemal CSF serology result. Normally, the CSF shows unusual levels of glucose, proteins and lymphocytes in the blood. This case is common among 25% of patients presenting secondary syphilis. Neurosyphilis may be divided in two big categories (early involvement of the CNS limited to the meninges and parenchymal involvement) and it is delineated in six other little categories: asymptomatic, acute syphilitic meningitis, arteritic (meningovascular) syphilis, tabes dorsalis (parenchimal), general paresis and optic atrophy. The early type of the infection attacks vessels and meninges (mesodermal structures), while the late type affects the spinal and brain parenchyma. The symptoms have mainly a central origin. The most frequent disorders caused by Neurosyphilis are: headaches, seizures, changes of the personality (in 35% of the cases), strokes, hearing loss, ataxia, lighting pain in the abdomen or larynx, ophthalmic signs (such as blurred vision, photophobia, visual diming, and reduced color perception), bladder incontinence (and other urinary problems) and dizziness. Other more rare and uncommon symptoms may be: changes of the pupils, hyporeflexia, mania, cranial neuropathy, hypotonia, dementia, loss of vibratory sense, decreased proprioception, paranoia, and Romberg sign. Many people are very easily irritable, with poor concentration and mental confusion. These lead to a severe depression that can be very hard to control. A stiff neck, an abnormal walk and reflexes, atrophied muscles, a loss of muscles normal function may be met in some patients. Neurosyphilis TreatmentAbnormally high protein concentration or a high number of leukocytes in the CSF are ways to diagnose Neurosyphilis. Blood tests are often used to find any kind of substances produced by the bacteria responsible with producing syphilis. A very known and popular test is VDRL test. Other tests include studying the spinal fluid for signs of the syphilis that cause problems in the nervous system. If you have had syphilis some time ago and the disease returned with symptoms of neurological problems you should make an appointment with your personal doctor and then decide what to do. It is very important to start a new treatment as soon as possible so that the signs do not develop any adverse effects because the primary sings of the disease can very easily and slowly aggravate. Your health care provider will recommend you what it is to be done and will send you to consult a specialist in the problem. Before proceeding with any treatment, the doctor must observe how the patient’s organism reacts to the severity of Neurosyphilis. Neurosyphilis is very often treated with penicillin that may be administrated in numerous ways. It is very useful to know that penicillin is first injected into the vain for about 7-8 days, and only after this is injected into the muscle, four about 20 days. The treatment for this type of syphilis is the same for those cases that do not have a positive CSF result or include auditory or ocular syphilis. The drug used as a primary medication is aqueous crystalline penicillin G. This treatment must be done only intravenous for 10 to 15 days without stopping it or at every four hours a day. But this method cannot be used all the time because the intravenous administration may not be possible. So, an alternative treatment is the one with procaine penicillin that must be administrated every day, for three weeks, in combination with probenecid. These injections may not be so well received by the patients because procaine causes pain if it is injected and it may be hard to ensure that the patient is complied. After the 15 days of treatment with aqueous crystalline or aqueous procaine penicillin G are completed, some experts recommend 3 doses of benzathine penicillin G once a week in order to address concerns about slowly dividing treponemes and to approximate the 20 day of therapy for those presenting a late latent disease. In all the treatments for Neurosyphilis oral antibiotics are not given as alternative therapies. An effective alternative that has been long studied and tested before being applied to any patient is intramuscular ceftriaxone daily for 15 days. Being on a treatment is not enough! You must make sure that the infection is gone or in process to be gone following up your blood tests at 4, 8, 16 and 30 months. Neurosyphilis can be easily prevented if a prompt diagnosis and the right treatments for the original syphilis infection are given to the patient. |
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