Conclusions:
In clinical practice, particularly during emergencies, any ischemic stroke patient should be screened for neurosyphilis.
Eur J Med Res. 2012 Feb 14;17(1):3.
An immunocompetent migrant presenting with neurosyphilis with an unusual unilateral papillitis: a case report.
Turchetti P, Pacella F, Pacella E, Mirisola C, Uccella I.
Source
National Institute for Health, Migration and Poverty (INMP/NIHMP), Rome, Italy. uccella@inmp.it.
Abstract
ABSTRACT: Unilateral papillitis caused by Treponema pallidum was found in an immunocompetent homosexual patient with severe vision loss who had received previous antibiotics treatment. Syphilis-related ocular manifestation is more common in the early stages of the disease and it can be associated with a central nervous system localization. In this patient, neurosyphilis was diagnosed on the basis of clinical and laboratory findings. Optical examination revealed unilateral papillitis in the left eye and no relative afferent pupillary defects. The patient underwent visual field examinations with conventional perimetry using the 30-2 program of the Humphrey Visual Field Analyzer, which indicated a blind spot enlargement in the left eye. Optical coherence tomography, visual evoked potentials (VEP), and fluorescein angiograms revealed inflammation of the optic nerve head with edematous and blurred margins. A reactive T. pallidum hemagglutination assay with low rapid plasma reagin (RPR) serum titer was performed; an HIV antibody test and MRI of the orbits and head with contrast gave negative results. Resolution of the ocular inflammation after intravenous penicillin treatment was obtained. The reported case illustrates the importance of early recognition of this treatable disease. The rise of syphilis, especially in urban areas, necessitates a high level of suspicion when dealing with patients with intraocular inflammation of unknown origin. Lues serology should be incorporated into routine laboratory diagnostics to aid in the detection of such cases. Considering the re-emergence of syphilis, screening of migrants from countries with high syphilis seroprevalences should be recommended.
Indian J Dermatol. 2012 Jan;57(1):3-8.
Vdrl test and its interpretation.
Nayak S, Acharjya B.
Source
Department of Skin and VD, MKCG Medical College and Hospital, Berhampur, Orissa, India. surajitnyk@yahoo.co.in
Abstract
Venereal disease research laboratory (VDRL) test is a nontreponemal test, used for screening of syphilis due to its simplicity, sensitivity and low cost. Prozone phenomenon and biological false positive (BFP) reaction are two shortcomings of this test. Quantitative estimation of VDRL is essential in treatment evaluation. CSF VDRL test is very specific for neurosyphilis though its sensitivity is low. Interpretation of VDRL in HIV infection is incompletely understood.
Sex Transm Dis. 2012 Apr;39(4):291-7.
The performance of cerebrospinal fluid treponemal-specific antibody tests in neurosyphilis: a systematic review.
Harding AS, Ghanem KG.
Source
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Abstract
BACKGROUND:
No single laboratory test is both sensitive and specific to diagnose neurosyphilis. Several major clinical guidelines suggest that negative cerebrospinal fluid (CSF) treponemal-specific antibody tests rule out the diagnosis of neurosyphilis. Our aim was to systematically review the literature and describe the performance of treponemal-specific CSF antibody tests when diagnosing neurosyphilis.
METHODS:
Two reviewers independently assessed studies published in electronic databases, trial registries, and bibliographies for content and quality. Entry criteria included the assessment of treponemal-specific CSF tests currently used in clinical practice, and the use of standard criteria for both diagnosis and exclusion of neurosyphilis. The primary outcomes were sensitivity, specificity, and negative predictive values of treponemal-specific CSF antibody tests.