neurosyphilis

神経梅毒 　

WordNet

1. syphilis of the central nervous system

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/01/31 11:18:59」(JST)

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Section of human skull damaged by late stages of neurosyphilis.

Neurosyphilis is an infection of the brain or spinal cord caused by the spirochete Treponema pallidum. It usually occurs in people who have had chronic, untreated syphilis, usually about 10 to 20 years after first infection and develops in about 25%–40% of persons who are not treated. The United States' Centers for Disease Control and Prevention (CDC) advises that neurosyphilis can occur at any stage of a syphilis infection.

Signs and symptoms

Neurosyphilis has four different forms: asymptomatic, meningovascular, tabes dorsalis, and general paresis. In rare instances, active neurosyphilis can mimic Alzheimer's disease.

Symptoms of neurosyphilis include, but are not limited to the following:

• Abnormal gait
• Blindness
• Confusion, disorientation
• Sudden personality changes
• Changes in mental stability
• Dementia
• Depression
• Headache
• Incontinence
• Irritability
• Memory problems
• Mood disturbances
• Numbness in the toes, feet, or legs
• Poor concentration
• Psychosis
• Seizures
• Neck stiffness
• Tremors
• Visual disturbances. There may be the sign of Argyll Robertson pupils, which are bilateral small pupils that constrict when the patient focuses on a near object, but do not constrict when exposed to bright light.
• Muscle weakness

Upon further diagnostic workup, the following signs may be present:

• Abnormal reflexes
• Muscle atrophy
• Muscle contractions

Diagnosis

In addition to evaluation of any symptoms and signs, various blood tests can be done:

• Venereal Disease Research Laboratory test (VDRL)
• Fluorescent treponemal antibody absorption (FTA-ABS)
• Rapid plasma reagin (RPR)
• Treponema pallidum particle agglutination assay (TPPA)

Also, it is important to test the cerebrospinal fluid for signs of syphilis.

Additional tests to look for problems with the nervous system may include the following:

• Cerebral angiogram
• Head CT scan
• Lumbar puncture ("spinal tap") to acquire a sample for cerebrospinal fluid analysis
• MRI scan of the brain, brainstem, or spinal cord

Treatment

Penicillin is used to treat neurosyphilis, however, early diagnosis and treatment is critical. Two examples of penicillin therapies include:

• Aqueous penicillin G 3–4 million units every four hours for 10 to 14 days.
• One daily intramuscular injection and oral probenecid four times daily, both for 10 to 14 days.

Follow-up blood tests are generally performed at 3, 6, 12, 24, and 36 months to make sure the infection is gone. Lumbar punctures for CSF fluid analysis are generally performed every 6 months.

Neurosyphilis was almost at the point being unheard of in the United States after penicillin therapy was introduced. However, concurrent infection of T. pallidum with human immunodeficiency virus has been found to affect the course of syphilis. Syphilis can lie dormant for 10 to 20 years before progressing to neurosyphilis, but HIV may accelerate the rate of the progress. Also, infection with HIV has been found to cause penicillin therapy to fail more often. Therefore, neurosyphilis has once again been prevalent in societies with high HIV rates and limited access to penicillin.

References

UpToDate Contents

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• 1. 神経梅毒neurosyphilis [show details]
  … parenchyma (general paresis and tabes dorsalis) In the current era, early neurosyphilis is more common than late neurosyphilis, and is most frequently seen in people with HIV. Asymptomatic neurosyphilis lacks …
• 2. 梅毒：治療とモニタリングsyphilis treatment and monitoring [show details]
  …examination prior to initiation of therapy to assess for neurosyphilis. The management of neurosyphilis is described below. If neurosyphilis is not present, we administer penicillin G benzathine (2 …
• 3. 梅毒：HIVに感染していない患者における疫学、病態生理学、臨床症状syphilis epidemiology pathophysiology and clinical manifestations in hiv uninfected patients [show details]
  … present with central nervous system manifestations (neurosyphilis) at any time during the course of infection. A detailed discussion of neurosyphilis is found elsewhere. Patients with signs and symptoms …
• 4. 梅毒：スクリーニングと診断検査syphilis screening and diagnostic testing [show details]
  …individuals with neurosyphilis . Elevations of white blood cells and protein in CSF are often seen in neurosyphilis, but are nonspecific findings. Thus, the laboratory diagnosis of neurosyphilis usually depends …
• 5. 先天梅毒：臨床的特徴および診断congenital syphilis clinical features and diagnosis [show details]
  … subsequently develop signs of neurosyphilis). Examination of the CSF for T. pallidum DNA by polymerase chain reaction may prove more useful for definitive diagnosis of congenital neurosyphilis , but this test is …

English Journal

• Ocular syphilis.

• Davis JL.
• Current opinion in ophthalmology.Curr Opin Ophthalmol.2014 Nov;25(6):513-8. doi: 10.1097/ICU.0000000000000099.
• PURPOSE OF REVIEW: Review current literature relevant to syphilitic uveitis utilizing Medline search and online governmental resources relevant to the diagnosis and management of syphilis presenting with ocular manifestations.RECENT FINDINGS: There is a trend for increasing frequency of primary and
• PMID 25237932

• Imaging of the brain in patients with human immunodeficiency virus infection.

• Gottumukkala RV1, Romero JM, Riascos RF, Rojas R, Glikstein RS.
• Topics in magnetic resonance imaging : TMRI.Top Magn Reson Imaging.2014 Oct;23(5):275-91. doi: 10.1097/RMR.0000000000000031.
• Neurologic disease in acquired immunodeficiency syndrome (AIDS) patients is related either to opportunistic pathogens or to direct central nervous system (CNS) invasion by the human immunodeficiency virus. Despite the increasing availability of antiretroviral therapy, opportunistic infections contin
• PMID 25296273

• Acute cranial neuropathies heralding neurosyphilis in human immunodeficiency virus-infected patient.

• Alqahtani S.
• The American journal of case reports.Am J Case Rep.2014 Sep 25;15:411-5. doi: 10.12659/AJCR.892292.
• Background Symptomatic early neurosyphilis with isolated acute multiple cranial nerves palsy as initial manifestation of HIV infection is very rare. It is caused by direct invasion of the central nervous system by the spirochete Treponema pallidum. Case Report A 31-year-old African-American homosexu
• PMID 25265092

Japanese Journal

• 臨床経験 精神症状が主体で皮膚症状や梅毒に特徴的な神経症状が見られなかった神経梅毒の3症例

• 精神科治療学 32(2), 251-258, 2017-02
• NAID 40021139885

• Cerebral Syphilitic Gumma: Case Report of a Brainstem Mass Lesion and Brief Review of the Literature

• Japanese Journal of Infectious Diseases 70(5), 595-596, 2017
• NAID 130006096736

• Longitudinally Extensive Transverse Myelitis and Optic Neuropathy Associated with Syphilitic Meningomyelitis and Human Immunodeficiency Virus Infection: A Case Report and Review of the Literature

• Internal Medicine 56(15), 2067-2072, 2017
• NAID 130005876357

Related Links

• Neurosyphilis: Causes, Types, and Treatments

There are five different forms of neurosyphilis. Asymptomatic neurosyphilis This is the most common type of neurosyphilis. It usually occurs before the symptoms from syphilis become visible. In this form of neurosyphilis, you won’t ...

• Neurosyphilis: MedlinePlus Medical Encyclopedia

Neurosyphilis is caused by Treponema pallidum. This is the bacteria that causes syphilis. Neurosyphilis usually occurs about 10 to 20 years after a person is first infected with syphilis. Not everyone who has syphilis develops this ...

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★リンクテーブル★

リンク元	「神経梅毒」「CNS syphilis」「general paresis」「general paralysis」
拡張検索	「asymptomatic neurosyphilis」「symptomatic neurosyphilis」

「神経梅毒」

　　[★]

英

neurosyphilis, neurolues

関

梅毒

病型と症状

• 髄膜血管性：髄膜炎症状に基づく：
• 脊髄癆：脊髄の後根・後索障害に基づく：
• 進行麻痺：前頭葉・側頭葉の慢性髄膜炎に基づく：人格変化、知能変化、言語蹉跌。前頭葉・側頭葉の萎縮。

国試

• 102A025、101A003

「CNS syphilis」

　　[★]

中枢神経系梅毒、中枢神経梅毒、CNS梅毒

関

asymptomatic neurosyphilis、general paralysis、general paresis、neurosyphilis、symptomatic neurosyphilis

「general paresis」

　　[★] 進行麻痺、進行性麻痺、進行性マヒ

関

asymptomatic neurosyphilis、CNS syphilis、general paralysis、neurosyphilis、symptomatic neurosyphilis

「general paralysis」

　　[★]

• 全身麻痺

関

asymptomatic neurosyphilis、CNS syphilis、general paresis、neurosyphilis、symptomatic neurosyphilis

「asymptomatic neurosyphilis」

　　[★]

無症候性神経梅毒

関

CNS syphilis、general paralysis、general paresis、neurosyphilis、symptomatic neurosyphilis

「symptomatic neurosyphilis」

　　[★]

症候性神経梅毒

関

asymptomatic neurosyphilis、CNS syphilis、general paralysis、general paresis、neurosyphilis